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Therapeutic Pilates-based Exercise Progressions for Hyperkyphosis

Spine Diagram

The arrows emphasize the kyphosis. While the first image reflects a kyphosis of about 20 degrees, which is average, the third image reflects hyperkyphosis – when there’s a thoracic curvature of greater than 40 degrees

This article is a summary of the ‘Posture Perfect’ feature published in Rehab Magazine. Click here to read the full article

Age-related hyperkyphosis affects up to 40% of adults over age 60. Characterized by a Cobb angle of kyphosis greater than 40°, this excessive forward curvature of the thoracic spine limits mobility. As the curvature increases, mechanical restrictions can impair respiratory function and balance, leading to issues such as pneumonia, falls and fractures and even depression caused by low-life satisfaction.

A promising study shows that targeted spine-strengthening exercises and posture training are effective rehabilitation modalities for decreasing hyperkyphosis in older adults. The study cites spinal extensor strengthening, spinal mobility exercises, and other posture-focused exercises as successful in reducing both radiographic and clinical measures of hyperkyphosis by up to 4°.

Merrithew Licensed Training Center owner and STOTT PILATES® Rehab Instructor Trainer Sara Baker, PT, MS, OCS, shared a three-step progression of exercises* demonstrating how Pilates exercises develop a foundation of control, mobility and awareness; then build on that by varying position, load (gravity/body weight or spring resistance) and choreography to increase challenge and progress exercises with Rehab Management.

Sara Baker of Inspire Health in Atlanta, Georgia

Goals of the exercises
  1. Strengthen spinal extensors and integrate into posterior slings/chains of the body
  2. Improve spinal mobility and stability
  3. Enhance postural awareness and control in a variety of positions, with gravity acting on the body in varying planes, with and without load

Phase I

  • Breathing with Resistance Band around lower rib cage to facilitate 3D breath pattern and diaphragmatic breath. Discuss breath mechanics and need for rib cage excursion in posterolateral direction. Beginning facilitation of rib cage and spinal mobility. Relate inhale to spinal extension and exhale to spinal flexion
  • Scapula isolations seated with Foam Roller along spine (pro-retraction, elevation, depression) educate on positioning of scapula in neutral, mobility of scapula for healthy spinal and shoulder mechanics. Relate coupled movements of scapular retraction/spinal extension, scapular protraction/spinal flexion
  • Supine head positioning with pads to achieve neutral cervical spine, positioning of rib cage and pelvic neutral. Use peripheral movement such as arm scissors and circles to challenge holding this neutral spinal alignment. Illustrate the abdominal musculature origin and insertions as the connection which relate the rib cage to the pelvis. Often with a hyperkyphotic posture there will be a thoracolumbar region hypermobility
  • Bilateral closed-chain hip extension prone over Arc Barrel or BOSU® with head down resting on backs of hands. Monitor cervical and thoracolumbar region as client extends hip and lifts knee off mat. Teaching spinal stability with proper hip extension recruitment pattern. Progress to single leg and then to open chain
  • Log roll with Foam Roller, side lying. Cue the relationship and stability of head, rib cage, and pelvis with a 45-degree forward roll and return to side lying—this facilitates the multifidus

Sara Baker using Cardio-Tramp with rehab client

Phase II

  • Breathing sidelying over Arc Barrel or BOSU
  • Arm work on Reformer Long Box-scapula isolations
  • Spine stretch forward with tactile cueing of segmental stacking of spine with spinal extension
  • Cat stretch
  • Spinal rotation
  • Breast stroke prep II over Stability Barrel®, Arc Barrel, or BOSU
  • Standing thigh stretch on Reformer
  • Swimming prep over Arc Barrel or BOSU

Phase III

  • Mermaid on Reformer
  • Arms pulling straps – plow, tricep
  • Chest expansion
  • Front rowing prep – straight forward and offering
  • Back rowing prep – mid-trap strengthener and plow
  • Breast stroke prep I and III
  • Swimming prep quadruped on Rotational Discs
  • Side twist seated on Reformer
  • Knee stretches prep – flat back

Finally, Sara noted there are two key questions to consider. First: “when my client is discharged from therapy, what are the chances they’ll continue with the exercises I’ve given them?” Second: “am I propelling them forward toward a healthier, more active lifestyle?”

*This programming is for clients with hyperkyphosis in the absence of osteopenia or osteoporosis