Clinical Pilates in Practice: COPD & Lower Limb Biomechanics

Although this is a small study, the paper contributes to our knowledge base around the gait variations that are seen in people with chronic obstructive pulmonary disease.

Wai-Yan Liu, Kenneth Meijer, Jeannet Delbressine, Paul Willems, Emiel Wouters, and Martijn Spruit. "Effects of Pulmonary Rehabilitation on Gait Characteristics in Patients with COPD." Journal of Clinical Medicine 8, no. 4 (2019), 459. doi:10.3390/jcm8040459.

"Subjects with COPD walked with less consistent organization of movement patterns of the lower extremities across walking speeds. These findings suggest the presence of neuromuscular deterioration in the locomotor system, reflecting less healthy movement patterns in subjects with COPD.”1 (p.2).

The authors comment on the role of biomechanical joint limitations, as well as other factors in the discussion, section (and they do a good job of acknowledging the study’s limitations).

Anatomy review

• Patients with COPD often present with static and dynamic lung hyperinflation, a consequence of which is maximally shortened muscle fibres in the diaphragm; as a result, tidal volume expansion is limited.

• Movement of the diaphragm and pelvic floor are linked to control thoracic and abdominopelvic pressures.

• Obturator internus connects to the pelvic floor through fascia of the pelvic bowl; the pelvic floor connects to biceps femoris via the sacrotuberous ligament.

• Piriformis and the other rotator cuff muscles of the hip control femoral head position in the acetabulum

• Femoro-acetabular position effects tibio-femoral position, etc down the chain!

Clinical Pilates in Practice

• Spend time teaching diaphragmatic breathing techniques, including posterior diaphragm expansion.

  → Use props to set up for success!

• Integrate pursed lip breathing/breath control exercises.

  → Hundreds – careful with breath-stacking for hyperinflated lungs!

• Focus on centring the femoral head + work on the rotator cuff muscles of the hip.

  → Integrate the rotator discs.

  → Hip Circles.

  → Leg springs/feet in straps side lying for posterior hip support.

• Integrate breath techniques during footwork.

References

1. Liu, W., Schmid, K., Meijer, K., Spruit, M. and Yentes, J. (2019). Subjects With COPD Walk With Less Consistent Organization of Movement Patterns of the Lower Extremity. Respiratory Care, p.respcare.06743.

2. O'Donnell, D. and Laveneziana, P. (2006). Physiology and consequences of lung hyperinflation in COPD. European Respiratory Review, 15(100), pp.61-67.