Pilates

 for  Hip  Joint  Dysfunction

May  Rebecca    Mey-­‐Tal

Comprehensive  Course  June  2017

Israel

1
Abstract

The  purpose  of  this  paper  is  to  explain  and  identify  hip  joint  dysfunction  and  
examine  the  effectiveness  of  Pilates  exercises  during  the  rehabilitation  process.

The  hip  joint  is  one  of  the  most  important  joints  in  the  human  body:  it  bears  our  
body  weight  while  we  sit,  stand,  walk,  or  run.  Fortunately,  it  is  extremely  flexible  and  
allows  for  a  large  range  of  motion  –  second  only  to  the  shoulder  –  while  providing  
great  stability.

Hence,  when  such  a  vital  body  part  sustains  an  injury,  it  has  both  mental  and  
physical  consequences.  The  Pilates  method  is  highly  effective  in  treating  such  an  
injury  as  it  provides  a  comprehensive  and  all-­‐encompassing  treatment  to  both  the  
mental  and  physical  aspects  of  the  injury.  Furthermore,  by  applying  the  method  on  
the  injured  joint,  it  assists  in  improving  the  performance  of  the  joint,  thus  preventing  
the  occurrence  of  such  injuries  in  the  future.

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Table  of  Contents
Title  page………………………………………………………………………………………………………………………………1

Abstract…………………………………………………………………………………………………………………………………2

Table  of  Contents………………………………………………………………………………………………………….……...3

Anatomy…………………………………………………………………………………………………………………………….4-­‐6

Case  Study………………………………………………………………………………………………………………………...7-­‐8

Conditioning  Program  Unilizing  Basi  Block  System………………………………………………….……….9-­‐12

Conclusion…………………………………………………………………………….……………….……………………………13

Bibliography………………………………………………………………………………………………………………………..14

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 Anatomy

The  hip  joint

The  hip  joint  is  one  of  the  most  important  joints  in  the  human  body.  It  allows  us  to  
walk,  run,  and  jump.  It  bears  our  body’s  weight  and  the  force  of  the  strong  muscles  
of  the  hip  and  leg.  Yet,  the  hip  joint  is  also  one  of  our  most  flexible  joints  and  allows  
a  greater  range  of  motion  than  all  other  joints  in  the  body  except  for  the  shoulder.  

The  hip  joint  is  a  ball-­‐and-­‐socket  synovial  joint  formed  between  the  os  coxa  (hip  
bone)  and  the  femur.  A  round,  cup-­‐shaped  structure  on  the  os  coxa,  known  as  the  
acetabulum,  forms  the  socket  for  the  hip  joint.  The  rounded  head  of  the  femur  forms  
the  ball  of  the  joint.

Hyaline  cartilage  lines  both  the  acetabulum  and  the  head  of  the  femur,  providing  a  
smooth  surface  for  the  moving  bones  to  glide  past  each  other.  Hyaline  cartilage  also  
acts  as  a  flexible  shock  absorber  to  prevent  the  collision  of  the  bones  during  
movement.  Between  the  layers  of  hyaline  cartilage,  synovial  membranes  secrete  
watery  synovial  fluid  to  lubricate  the  joint  capsule.  

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Surrounding  the  hip  joint  are  many  tough  ligaments  that  prevent  the  dislocation  of  
the  joint.  The  strong  muscles  of  the  hip  region  also  help  to  hold  the  hip  joint  
together  and  prevent  dislocation.  

Functionally,  the  hip  joint  enjoys  a  very  high  range  of  motion.  The  ball-­‐and-­‐socket  
structure  of  the  joint  allows  the  femur  to  circumduct  freely  through  a  360-­‐degree  
circle.  The  femur  may  also  rotate  around  its  axis  about  90  degrees  at  the  hip  joint.  
Only  the  shoulder  joint  provides  as  high  of  a  level  of  mobility  as  the  hip  joint.

Normal  hip  range  of  motion  (American  Academy  of  Orthopedic  Surgeons)  is  as  
follows:

Flexion:  100  to  120  degrees

Extension:  20  to  30  degrees  (some  use  10  to  20  degrees)

Abduction:  40  to  55  degrees

Adduction:  20  to  45  degrees

ER:  45  to  50  degrees

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IR:  20  to  45  degrees

 In  addition,  to  being  flexible,  each  hip  joint  must  be  capable  of  supporting  half  of  the  
body’s  weight  along  with  any  other  forces  acting  upon  the  body.  During  running  and  
jumping,  for  example,  the  force  of  the  body’s  movements  multiplies  the  force  on  the  
hip  joint  to  many  times  the  force  exerted  by  the  body’s  weight.  The  hip  joint  must  be  
able  to  accommodate  these  extreme  forces  repeatedly  during  intense  physical  
activities.

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Case  study

in  this  case  study,  I  would  like  to  discuss  my  experiences  with  sport  activities.  I  will  
focus  on  the  injuries  I  sustained  throughout  my  experiences  and  the  treatments  I  
used  to  help  me  to  go  back  on  track.

I  am  twenty-­‐six  years  old  and  have  been  exercising  at  the  General  Gymnastic  Team  
of  Haifa  since  I  was  five  years  old.  It  began  as  a  duty  to  compensate  for  the  extra  
flexibility  I  was  born  with,  but  it  turned  quickly  into  a  passion.  I  have  been  a  part  of  
the  team  for  the  next  12  years  until  I  had  to  join  the  army.  The  team  taught  me  
about  my  deep  connection  with  my  body,  which  serves  as  a  window  to  my  soul.

However,  my  passion  came  with  some  casualties  over  the  years.  Recently  I've  been  
diagnosed  with  Bursitis.    There  are  three  bursa  in  the  hip  joint  region  which  often  
become  inflamed,  leading  to  a  condition  known  as  Bursitis.  Bursae  are  small  fluid-­‐
filled  sacs  located  at  points  where  muscles  or  tendons  slide  across  bones.  Symptoms  
of  bursitis  are  local  tenderness  to  pressure  in  the  anterior  hip  (iliopsoas  bursa),  
ischial  tuberosity  (ischiogluteal  bursa),  or  greater  trochanter  (trochanteric  bursa).  
The  client  with  bursitis  will  generally  have  increased  pain  with  stair  climbing,  may  
experience  occasional  snapping,  and  may  be  awakened  at  night  by  pain  when  rolling  
onto  the  affected  side  (trochanteric  bursa).  Weakness  of  the  hip  abductors  is  often  
seen.  Bursitis  may  develop  from  hip  joint  inflammation  caused  by  overuse  or  a  fall,  
or  it  may  be  related  to  activities  such  as  sitting  too  long  or  excessive  hip  joint  
abduction  or  adduction.  Muscle  imbalanced  can  also  contribute  to  bursitis.

Before  it  was  diagnosed,  I  felt  stabbing  and  pain  in  my  left  iliopsoas  and  hip  joint.  At  
first,  I  tried  to  take  care  of  it  by  myself  doing  stretches  and  openings  of  the  painful  
areas,  but  the  pain  just  grew  stronger.  At  this  point,  I  understood  I  had  to  go  and  see  
an  expert  practitioner  to  diagnose  my  condition,  but  it  took  a  while  until  I  found  the  
right  therapist  that  knew  exactly  how  to  deal  with  my  persistent  pain.

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As  time  went  on,  the  tendinitis  also  began  to  affect  my  personal  life  since  I  
experienced  pain  every  time  I  went  for  a  walk.  I  would  often  take  painkillers  to  help  
soothe  the  pain,  but  eventually  they  had  no  effect  on  the  inflammation.  At  this  point  
I  couldn’t  exercise  anymore,  and  the  physical  pain  turned  into  emotional  pain  as  
well.  I  was  broken.

The  truth  was  that  I  betrayed  my  body  long  before  he  forced  me  to  stop.  I  asked  too  
much  of  it,  without  any  logic,  and  it  could  not  bear  the  pressure  anymore.  Pilates,  
running  and  yoga  multiple  times  a  week,  will  charge  a  price  eventually.

After  two  months  of  doing  nothing,  my  dad  told  me  that  I  should  go  back  to  sport.  I  
was  so  afraid  that  as  soon  as  I  will  recommence  my  training,  my  body  will  betray  me,  
and  the  pain  will  quickly  follow.  Thanks  to  Pilates,  this  did  not  happen.  

By  focusing  solely  on  Pilates,  without  running  or  yoga,  I  started  recovering  both  
physically  and  mentally.  Block  after  block,  exercise  after  exercise,  cue  after  cue,  I  
went  back  to  practice,  but  from  a  totally  different  place.

With  small  yet  consistent  steps,  the  block  system  accompanied  and  strengthened  me  
throughout  my  healing  process.  She  sharpened  the  importance  of  balance  between  
flexibility  and  power,  and  gave  me  a  clear  track  of  how  to  implement  it

Thanks  to  Basi's  block  system,  the  despair  and  frustration  were  gone,  and  in  their  
place  came  attentive  and  conscious  work  with  my  body.

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Conditioning  Program  Utilizing  the  Basi  Block  System

Roll  down

We  start  with  the  roll  down  to  examine  and  feel  the  imbalance  in  our  body  so  we  
know  which  areas  we  need  to  focus  on.

Warm  up  (Mat)

Pelvic  Curl  –  focus  on  pelvic  lumbar  stability,  hamstring  control,  spinal  articulation  
and  transverses  abdominals  (TA)  engagement.

Spine  Twist  Supine  –  focus  on  not  flaring  the  ribs,  spinal  rotation,  abdominal  control  
with  oblique  emphasis.

Chest  Lift  –  focus  on  pelvic  lumbar  stability  and  abdominal  strength.

Chest  lift  with  Rotation  –  focus  on  pelvic  lumbar  stability  and  abdominal  strength  
with  oblique  emphasis.

Foot  work  (Wunda  Chair)

Parallel  Heels

Parallel  Toes

V-­‐Position  Heels

V-­‐Position  Toes

Calf  Raises

Single  Leg  Heel

Single  Leg  Toes

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The  wunda  chair  sits  you  up  right  which  forces  the  subject  to  focus  on  their  spine  
alignment  and  core  more  so  than  laying  on  the  back.  In  addition,  foot  work  is  helpful  
for  strengthening  the  hip  extensor  which  can  easily  be  overstretch  and  cause  an  
injury.

Abdominal  Work  (Wunda  Chair)

Pike  Sitting

Standing  Pike  Reverse

These  exercises  help  further  strengthen  and  maintain  control  of  the  abdominal  
muscles.

Hip  Work  (Reformer)

Frog

Circles  Down

Circles  Up

Openings

Focus  is  on  teaching  hip  disassociation,  pelvic  lumbar  stability,  hip  abductor  control  
and  knee  extensor  and  hip  extensor  control.

Spinal  Articulation  (Reformer)

Bottom  Lift  –  focus  on  spinal  articulation,  abdominal  strength  and  hip  extensor  
control.

Bottom  Lift  with  Extension  –  focus  on  spinal  articulation,  abdominal  strength  and  hip  
extensor  control.

Stretches  (Reformer)

Side  split

Important  exercise  that  requires  hip  adductor  stretch  and  strength.

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Full  Body  Integration  (Reformer)

Scooter

I  chose  this  one  specifically  because  it  requires  hip  extensor  control/strength  and  hip  
disassociation.

Arm  Work  (Reformer)

Arm  Sitting  Series:

Chest  Expansion

Biceps

Rhomboids

Hug  a  Tree

Salute

Focus  on  trunk  and  scapula  stabilization.

Leg  Work  (Mat  –  2kg  ankle  weights)

Side  leg  lift  

Forward  and  lift

Forward  with  drops

Focus  is  on  pelvic  lumbar  stability  and  hip  abductor  strength.

Lateral  Flection  and  Rotation  (Wunda  Chair)

Side  kneeling  stretch

Focus  on  stretching  and  strengthening  obliques  whilst  maintain  correct  pelvic/torso  
alignment.

Back  Extension  (Wunda  Chair)

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Swan  on  floor

Focus  on  correct  engagement  of  abdominals  and  articulation  of  spine.

Roll  Down

I  have  created  a  plan  involving  a  full  body  workout  with  a  minor  emphasis  on  
strength  and  flexibility  of  the  hip  joints.  Normally,  the  pain  causes  extreme  freeze  in  
the  affected  area,  while  the  objective  of  my  plan  is  to  gradually  rehabilitate  the  hip  
joint  and  return  it  to  a  fully-­‐functioning  state.

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Conclusion

After  years  of  doing  so  many  kinds  of  sports,  my  body  ached  and  felt  as  though  my  
joints  were  deteriorating  and  I  would  have  to  stop  doing  the  thing  I  loved  the  most.  
Luckily,  by  focusing  on  Pilates  only,  I  was  able  to  start  strengthening  my  muscles  in  a  
way  that  helped  support  my  joints  and  reduce  the  pain,  so  I  could  continue  
exercising  and  keep  my  body  in  peak  physical  condition.  By  focusing  on  muscles  
groups  around  my  hips  and  pelvis,  I  can  maximize  the  amount  of  time  I  can  spend  
exercising  without  feeling  any  discomfort.  While  I  still  experience  pain  if  I  work  
myself  too  hard,  it  is  significantly  less  than  the  pain  I  experienced  before  Pilates.  
Now,  after  studying  the  BASI  block  system  I  found  the  best  viable  way  to  help  not  
only  myself  but  those  who  are  like  me.

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Bibliography

Isacowitz,  Rael.  Study  Guide:  Comprehensive  Course.  San  Diego,  California:  body  Arts  
and  Science  International,  2017.

"Hip  Joint".  Innerbody,  http://www.innerbody.com/image/skel15.html#continued  ,  

Accessed  26  November  2018.

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