How

Can We Improve Female Clients Round Shoulders with

Strengthening Back Muscles through Pilates? (Especially for
Asian Female Clients Who Mostly Have Round Shoulders and
Weak Ab/Back Muscles)








Myunghwa Choi
CTTC 2014
O-Pilates, Seoul, South Korea
April 20, 2015

ABSTRACT
I started to write my paper very carefully using the phrase, Asian female client in the
title. As a military wife, I have been switching my life back and forth either in the U.S. or
in South Korea. This made me think: Can ones nationality or cultural differences
determine or have an impact on peoples poses in different ways? To some degrees, it
may sound like an assumption regarding stereotypes and some people wouldnt agree
with me. However, this idea didnt come to me all of sudden, but slowly flowed into my
mind as I started to teach Pilates.
In my case study, I chose as my client Young-bin, who can be seen as a typical Korean
female client with round shoulders, weak back muscles and not much confidence about
physical exercise. I am going to explain how she transformed with the Pilates program
that I designed for her here. Anatomical explanations will follow as well.

TABLE OF CONTENTS
Page 1

TITLE PAGE

Page 2

ABSTRACT

Page 3

TABLE OF CONTENTS

Page 4

BRIEF ANATOMY OF PECTORALIS MINOR, RHOMBOIDS AND

MULTIFIDUS MUSCLES
Page 7

CASE STUDY

Page 8

BASI BLOCK PROGRAM

Page 10

CONCLUSION

Page 12

BIBLIOGRAPHY

BRIEF ANATOMY OF PECTORALIS MINOR, RHOMBOIDS AND MULTIFIDUS

1) Pectoralis Minor




The pectoralis minor is a thin, triangular
muscle, situated at the upper part of the chest,
beneath the pectoralis major in the human
body. It arises from the upper margins and
outer surfaces of the third, fourth, and fifth ribs, near their cartilages and from the
aponeuroses covering the intercostalis. The pectoralis minor depresses the point of the
shoulder, drawing the scapula inferior, towards the thorax, and throwing its inferior
angle posteriorly. I found out that quiet, introverted women who lacks confidence and
rarely exercise tend to have tight pectoralis minors mostly (again, this is based on my
personal teaching experience). My client and I spent enough time to stretch this muscle
before we started any kind of arm work. When it was too tight, I have her brief massage
on the muscle areas with a tennis ball.

2) Rhomboids

The rhomboid muscles, often simply called the rhomboids. There are two
rhomboid muscles: Rhomboid major and minor. The rhomboid major arises from the
spinous processes of the thoracic vertebrae T2 to T5 as well as the supraspinous
ligament. The rhomboid major helps to hold the scapula (and thus the upper limb) onto
the ribcage. Other muscles that perform this function include the serratus anterior and
pectoralis minor. The rhomboids work collectively with the levator scapulae muscles to
elevate the medial border of the scapula, downwardly rotating the scapula with respect
to the glenohumeral joint. Both rhomboids (major and minor) also act to retract the
scapula, pulling it towards the vertebral column. Most of my female clients who had
round shoulders with weak back muscles also had protruding shoulder blades.

3) Multifidus





The multifidus muscle consists of a
number of fleshy and tendinous fasciculi,
which fill up the groove on either side of the spinous processes of the vertebrae, from
the sacrum to the axis. The multifidus is a very thin muscle. Deep in the spine, it spans
three joint segments, and works to stabilize the joints at each segmental level. The
stiffness and stability makes each vertebra work more effectively, and reduces the
degeneration of the joint structures. As it is already stated in Study Guide, multifidus
should be singled out as an extremely important back extensor muscle with regards to
trunk stabilization. Locating shoulder blades in the right position and strengthening
shoulders cannot be accomplished without healthy multifidus.

CASE STUDY
My client, Young-bin, is a 24-year-old female in good general health, but very weak
muscular condition who came to me because she was stressed out from her CrossFit
personal trainer. Despite working out two to three days a week in the gym for two
months, she seemed very tired and had more shoulder pain than when she only rested
at home. Also, she had a lack of flexibility, barely touching her toes when she bent over
for roll-down. She told me that CrossFit and extreme exercises gave her a lot of
frustration, and this made her look for Pilates. She wanted to improve her posture and
reduce her shoulder and neck pain, also hoping to gain weight in a healthy way. Her
height was 166 cm but her weight was just about 48 kg, which was extremely thin.
When I used arc barrel, I had put a mat around it to prevent her bones from directly
touching the hard surface. We even had to take a rest in the middle of reformer foot
work with medium strength, because of her dizziness. For two weeks, we had to take a
rest with any kinds of foot work series. But instead of urging her to continue, we took a
break and had conversations about her life, diet, jobs, and so on. She didnt even talk
that much at first, but as the sessions continued, she started to smile and concentrate on
the movements and listening to my directions.

Basi Block Program

This is a summary of the rst eight weeks (approximately twenty sessions) of the
Pilates conditioning program I developed for Young-bin, keeping in mind her goals,
which are improving her sway back posture and reducing neck and shoulder pain. I also
considered her to be quiet and introverted. Honestly, it took many sessions to find out
how she feels and to better motivate her.


Week 1 - 2
Mat: Pelvic Curl, *Spine Twist Supine, Chest Lift/with Rotation, Leg Lifts/Changes
Reformer: The whole foot work series (two reds and one blue), Hundred Prep, Hip
Work (Frog, Down Circles, Up Circles, and Opening), Hamstring Stretch Series
Standing lunge, Arms Supine Series, Breaststroke Prep, Roll Down.
* We used a big gym ball to her Spine Twist Supine. Putting the gym ball under her legs
really stabilized her spine on the mat. I didnt force her to follow the Basi Block system
strictly in the very first week not only because of her weak physical condition, but also
not to overwhelm her. I actually spent most of our session hours making sure that she
kept her back on the mat.



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Week 3-5
Mat: Pelvic Curl, Roll-up, Spine Twist Supine, Double Leg Stretch, Single Leg Stretch,
*Criss Cross we had to wait for a better time for Young-bin to accomplish criss-cross
until 5th week. She managed to do Double Leg and Single Leg Stretches but couldnt
stabilize her trunk when she rotated.
Breathing: I taught her the importance of Breath this week. Her breathing patter was
partially wrong from the beginning. Her chest went up a lot when she breathe in. Since
she could not really understand how to breathe in belly first, I made her hold PTB bar
with both hands (without springs) standing beside Cadillac and leaning forward her
upper body. Not bending her knees and keeping her back flat, she breathe in and lot like
frogs belly (imagery). In this way, she slowly understood how to engage her abdominal
muscles for breathing.
Reformer: The whole foot work series (three reds), Hundred, Coordination, Short Box
Series: Round Back, Flat Back, Twist, Hip Work (Extended Frog and Extended Frog
Reverse, Down/Up Circles), Hamstring Stretch Series Kneeling Lunge, Up Stretch
Series: Up Stretch 1, Elephant, Down Stretch, Arms Sitting Series, Mermaid, Side Over
Box, Pulling Straps 1 & 2, Roll Down.

Week 6-8
Mat: Roll-up, Spine Twist Supine, Double Leg Stretch, Single Leg Stretch, Criss Cross
Reformer: The whole foot work series including Prehensile (three reds), Hundred,
Coordination, Short Box series Round Back, Flat Back, Twist, Hip Work (Extended Frog
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and Extended Frog Reverse, Down/Up Circles), Bottom Lift, Bottom Lift with Extension,
*Hamstring Stretch Series Kneeling Lunge, Up Stretch Series ( Elephant, Up 1, Up 2,
Long Stretch), Down Stretch, Arms Sitting Series, Shoulder Push, Arms Kneeling Series,
Hamstring Curl, Jumping Series, Side over Box, Pulling Straps 1 & 2, Breaststroke, Roll
Down
*We tried Full Lunge for Hamstring Stretch but my client felt pain in her left knee
whenever she did Full Lunge. Instead of repeating the same, Kneeling Lunge, I kept
reminding her not to rotate her pelvis when she stretches.

CONCLUSION

When I first met her, she was extremely thin and weak. She couldnt even accomplish
half of the reformer foot work, and kept telling me that she was dizzy. With this in mind,
I designed my program with a narrow variety of equipment. This was when I realized
Basis block system is very applicable while also being unique for everyone. In this way,
having her reviewed what she did from the last session, we tried to focus on
accomplishing the right movement at each time. This also benefitted her by
strengthening her muscles and helping her to feel ready to move on to different
machine with confidence.
Media and society has somehow created this idea that being extremely thin is healthy
and beautiful. Even my client thought that she doesnt need exercises since she was thin
enough. Her introverted personality somehow contributed to her having round
shoulder, since she thought that looking tall and opening her chest might seem arrogant
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in Asian culture sometimes (Again, this is not a fixed idea all the time nowadays, but it
was what she had in her mind). That was why she needed to rebalance both mentally
and physically. Strengthening her abdominals and back extensors really helped her
lengthen vertically. Rhomboid exercises in arm sitting series also helped her,
rebalancing her upper trapezius scapulae lavator and reducing her shoulder pain.
Now it has been about three months since I started to teach her. I can see the slight
physical improvement in her body. However, more than that, it is her inner change that
Im so happy with. Now she can concentrate on herself more than ever and enjoy her
awareness. Even other Pilates instructors who I work with sometimes tell me how much
she has changed when they see her laugh and ask me questions. For her, gaining
confidence back and reducing shoulder pain will be the most remarkable
accomplishments. I am very proud of my client.

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BIBLIOGRAPHY
Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California : Body Arts
and Science International, 2013.
Arnold G. Nelson and Jouko J. Kokkonen. Stretching Anatomy. Prunsol Publishing Co.
through Danny Hong Agency, Seoul, 2011.
Pilates Anatomy. Rael Isacowitz and Karen Clippinger. Human Kinetics. 2011.
BASI Mat Movement Analysis Workbook. Rael Isacowitz. Body Arts and Science
International. 2000-2012.
BASI Reformer Movement Analysis Workbook. Rael Isacowitz. Body Arts and Science
International. 2000-2012.
BASI Study Guide: Comprehensive Course. Rael Isacowitz. Body Arts and Science
International. 2000-2013.
, , 2011
, Bruce Rider, AB, MD, 2008
Rhomboid, Multifidus, Pectoralis Minor pictures
from https://en.wikipedia.org/wiki/Pectoralis_minor_muscle

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