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How To Help Someone With Kyphosis?

Each month I host a Live Q&A Call in which I answer any of your Pilates-related questions. Here is a question from November 2020. 

How Do I Help Someone With Kyphosis in Prone Positions, Supine Curl-Up Positions, and The Mermaid? 

My question is about two of my clients in my basic online mat classes. They both have quite a pronounced kyphosis. It seems to be genetic, as it is father and daughter. Both also have lower back issues, weak shoulders, and a terribly weak core. One is using a cushion about 20cm high for the head in supine. Scarecrow is terribly hard for him. Would you also support his hip bones in prone? Would you do curl-ups at all or rather only do supine work without curl ups? Side bending like Mermaid is also really hard due to the kyphosis. They always twist and it is hard to keep it a lateral bend. Before moving online, I worked with them quite a bit on the foam roller, lengthwise and behind the tips of the scapulae. 

I love this question! First of all, I'm happy to hear that you're using the cushion in supine to make them comfortable.

Scarecrow and other prone exercises are not comfortable for somebody with pronounced kyphosis. The thoracic spine is stiff, locked into its position, and can't flatten out while lying flat on the floor in a prone position. This forces the lumbar spine into hyperextension. That's why I would not choose any prone positions flat on the floor for those students. If the daughter is on the young side, her tissues might have a little more "give" so she might be okay prone. The older you get, the less pliable the tissues are, and the harder it is to make a change. If they lie completely flat, their tissues are already under stress and they're not starting from a relaxed position. They're starting under stress and trying to add more stress on top of it.

In a mat class, you can have them lie on a long box. The box should end at the lower ribs or bra strap level. This allows their upper thoracic to curve down over the front of the box which positions them into their personal neutral. Now their tissues can start in a relaxed position and you can work from there.

In a group class at the studio, it can be a little awkward. Some people don't like to be put on the spot or to be singled out. Some people don't know that Pilates is so much more than fitness. On top of that, most people think that more effort/strain/pain is better. ("More is better." and "No pain no gain." are ubiquitous.) For some reason, when we're going into a fitness class, all of a sudden, we think we have to be all the same even if we're not. Explain to your students before class the benefits of catering the practice to their specific needs, even if it's different than the group. 

If your students are at home and don't have a long box, let them use a foam arc. Almost all of my students have a foam arc at home because it's really affordable. You can even get baby arcs. They are even cheaper. Just having that curve is going to be super helpful for so many different exercises. In terms of kyphosis, they can be prone on the arc/box and the head can drop down, and then they can work up towards neutral.

When you support their thoracic spine in this way, you probably don't need to pad the hip bones. I assume you're trying to pad the hip bones because their lumbar spine is falling into hyperextension. But the hip bones are not the issue. Their thoracic spine is not where it wants to be, so padding the hip bones is sort of the adaptation for the adaptation, which is not what we should be dealing with. We should be dealing with the cause of the problem, not just masking the symptoms. 

When we talk about kyphosis, the most important thing is axial length. This is especially true when we're working on side bending. They need to stretch long. Picture it this way: If you have any kind of power cord, string, or a rubber band and you let it be loose, it will curl up and bend. Once you start stretching it to into opposite directions, all of a sudden, it's straight and it's long. So axial length (pulling really, really tall) will flatten their thoracic curve a little bit.

To hear the rest of my answer and to see me gesturing, giggling, and emoting, check out the Q&A Call Replays. They're all available as part of the membership. You'll also find suggested exercises to help someone with Kyphosis.

Do you have a burning Pilates question? Register for my upcoming live Q&A call and submit your question. Attending live is free and open to anyone.

Do you have any other suggestions for working with someone with Kyphosis? Let me know in the comments.

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