Do your clients describe themselves as having a “bad back?” If so, their complaints are not uncommon. The American Association of Neurological Surgeons reports that more than 65 million Americans suffer from low-back pain every year and that back pain is the second most common reason for visits to doctors’ offices. Furthermore, 50% of all patients who suffer from an episode of low-back pain will have another occurrence within 1 year (American Association of Neurological Surgeons 2000).
Considering these statistics, the likelihood of your encountering clients with back problems is quite high. This article will take you through two lumbar spine diagnoses, common causes, suggested comfortable positions and postures, and recommended Pilates-influenced lumbar stabilization exercises.
With any client who is in postrehabilitation or has a history of a spine ailment, it is important to align yourself with the referring healthcare provider to optimize individual recommendations. The information here is generalized to the majority of individuals in each diagnostic population, but keep in mind that there are always outliers.
Pilates-Based Exercise as a Treatment Option
Clients who are familiar with the techniques of Joseph Pilates may wish to incorporate those techniques into their routines. People with back pain and poor posture can benefit from Pilates exercise, but proper technique is key. You may have to modify exercises to adapt to an individual client’s abilities and needs. Before you begin Pilates-based exercises with your clients, it is a good idea to review your techniques with a certified Pilates instructor-—or perhaps have a certified instructor assist you initially. Although you can incorporate a few Pilates exercises into a client’s routine, individuals who wish to learn a complete Pilates program should be referred to an instructor who is certified in this area.
Lumbar-Disk Herniation & Postrehab Exercises
The disks found between vertebrae have a gel-like center called the “nucleus pulposus” and an outer (tougher) layer known as the “annulus fibrosus.” With age and the loss of water content, a disk’s center may be displaced through a crack in the outer layer, causing a herniation. A physician will make this diagnosis by using imaging studies and the information in the patient’s history.
Most individuals with a herniated disk will improve without surgery. A physician will prescribe nonsurgical treatments, including medications, physical therapy and possibly injections.
Extension-based exercises are generally the most comfortable for clients with a herniated disk, as flexion-based exercises may aggravate symptoms. As always, individual conditions vary, so it is best to communicate with the physician or healthcare professional for individualized recommendations.
Swimming (1-2 sets, 10-20 seconds each)
- Lie on the stomach with arms straight out in front.
- Lift both arms and legs off the mat.
- Flutter the arms and legs in opposition (right arm and left leg, left arm and right leg). Alternate while inhaling for 5 counts and exhaling for 5 counts.
Beginners’ Modification. Beginners can modify this exercise by lifting an opposite arm and leg while keeping the other arm and leg on the floor. They should alternate Opposite-Arm-and-Leg Lifts for 2-3 sets of 10 reps and then progress to the Swimming movement as tolerated.
Double Leg Lift (3 sets, 10 reps)
- Lie on the stomach, exhale and lift both legs slightly off the mat.
- Inhale and lower the legs.
- Arms can be outstretched overhead or supporting the neck by resting under the forehead.
The sciatic nerve runs from the low back/pelvic area through the hip and buttocks region and down each leg. It controls various muscles in the legs and is also responsible for sensation in aspects of the thighs, legs and feet. According to the Mayo Clinic, sciatica refers to “pain that radiates along the path of this nerve–from your back into your buttock and leg. The discomfort can range from mild to incapacitating, and may be accompanied by tingling, numbness or muscle weakness” (Mayo Clinic 2005b).
Sciatica results from pressure placed on the sciatic nerve. The pain is a symptom of another problem-—for example, spinal stenosis, a herniated disk, spondylolisthesis, trauma or piriformis syndrome.
Symptoms may include
- pain from the low back to the knee
- pain from the buttocks region to the outside of the calf and into the top of the foot
- pain from the inside of the calf to the sole of the foot
- numbness along the nerve pathway
- tingling, or “pins and needles,” in the feet
- a loss of bladder or bowel control
A physician will make the diagnosis by using the information given in the client’s history, imaging studies, and manual tests performed in the doctor’s office.
Generally, individuals with sciatica find extension positions (standing, lying prone) most comfortable. Some individuals, however, find comfort in a flexed (knees-to-chest) posture. A physician will typically recommend exercises to help posture, strengthen the muscles of the back and abdomen, and improve flexibility in the muscles of the hip and knee.
Opposite-Arm-and-Leg Lift (3 sets, 10 reps each side),
- Lie on the stomach with arms extended overhead. Exhale while lifting the right arm and left leg.
- Inhale while lowering the arm and leg.
- Exhale and switch to the opposite arm and leg.
Four Points (3 sets, 10 reps each side)
- Begin on hands and knees with the spine in a neutral position. Exhale while extending the right arm and left leg and lifting them off the mat until they are parallel to the floor.
- Inhale and return to the starting position.
- Exhale and switch to the opposite arm and leg.
Piriformis Stretch (3 sets, 15-30 seconds each side)
- Begin on hands and knees and bring the right foot in front of the left thigh until the lower right leg is perpendicular to the torso and resting on the mat.
- Extend the left leg straight back on the mat.
- Sit tall, using the arms for balance. Hold, then switch sides.
Catherine Fiscella, MSPT, is a licensed physical therapist, a personal trainer and a Pilates instructor.
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