Pilates-Based Exercises for Lumbar Spinal Stenosis

Are your clients complaining of back pain, or do they describe themselves as having a “bad back?” If so, their complaints are not uncommon. The Mayo Clinic recently reported that 4 out of 5 adults experience at least one bout of back pain at some point during their lifetime. Considering these statistics, the likelihood of your encountering clients with back problems is quite high. This article will take you through one lumbar spine diagnosis, lumbar spinal stenosis, its 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.

The spinal cord begins as an extension of the brain and is surrounded by the bony vertebral column, which acts as a protective mechanism. Any sensory or motor information the brain needs to relay to the body travels via the spinal cord. An injury to the spinal cord will interrupt this important communication, resulting in impairments of movement, sensation and/or organ function.

The lumbar spine contains five articulating segments that move to flex, extend, side-bend and rotate the torso. Individual nerve roots exit on each side of the vertebrae to become nerves that enable sensation and movement in the lower body (Kibler et al. 1998).

Pilates Exercise as a Treatment Option
People with back pain and poor posture can benefit from Pilates exercise, but proper technique is key. You may have to modify lumbar exercises to adapt to an individual client’s abilities and needs.

Lumbar Spinal Stenosis
Spinal stenosis, which is the narrowing of spaces in the spine, can result in pressure on the spinal cord and/or nerves. Most cases of spinal stenosis occur in the low back (lumbar spinal stenosis), affecting the nerves that run down the legs. Lumbar spinal stenosis may result from a variety of causes, including normal aging, heredity, tumors, a traumatic event and bone disease, to name a few.

Individuals with lumbar spinal stenosis may have pain or discomfort in the legs, as well as weakness or “heaviness” in the lower extremities. Other symptoms may include numbness, tingling or hot and cold feelings in the legs. Lumbar spinal stenosis is diagnosed by a physician. A magnetic resonance image (MRI) or computed tomography (CT) scan or a myelogram (an x-ray taken after a special fluid is injected into the spine) may be performed. These and other imaging studies can offer details about the bones and tissues and help the physician pinpoint a diagnosis (Cleveland Clinic 2005).

Surgery may be indicated as a treatment option, but it is usually viewed as a last resort. Lumbar stabilization exercises may also be a viable treatment option, depending on the severity of the spinal stenosis.

Postrehab Pilates Exercises
As a general rule of thumb, individuals with lumbar spinal stenosis are more comfortable in positions of spinal flexion, as opposed to extension. Pilates exercises performed in a prone or standing position may be uncomfortable. If the client would like to lie prone, you might try placing a pillow under the stomach to create a small amount of flexion in the spine.

1. Single Leg Stretch (3 sets, 10-15 reps total)
● Lie supine on a mat with the right knee bent to the chest and the left leg extended at a 45-degree angle to the floor ─ or higher to begin with, to protect the back. (See “Beginners’ Modification,” below.)
● Place both hands just below the right knee and lift the head off the floor. Keep the head lifted throughout the exercise.
● Tighten the abdominals, exhale, kick the right leg out straight and bring the left knee in toward the chest. Inhale, exhale, and then continue to alternate legs.

Beginners’ Modification. Beginners should keep kicks high ─ toward the ceiling, at 90 degrees of hip flexion ─ since this is easier on the back, and advance to kicking out at a 45-degree angle as tolerated.

2. Double Knee-to-Chest Stretch (1 rep, hold for 10 seconds)
● Hug both knees to the chest to relax the spine.

3. Single Straight-Leg Stretch (3 sets, 10-12 reps total)
● Lying supine on a mat, extend the right leg toward the chest, placing the hands around the thigh or calf, and extend the left leg out at a 45-degree angle to the floor ─ or higher, if needed for comfort. (See “Beginners’ Modification” with Single Leg Stretch, above.)
● Tighten the abdominals while exhaling and switch legs, pulling the left leg toward the chest.

4. Double Knee-to-Chest Stretch (1 rep, hold for 10 seconds)

References
Cleveland Clinic. 2005. Back and neck conditions: Making the diagnosis. www.clevelandclinic.org; retrieved June 15.
Kibler, W.B., et al. 1998. Functional Rehabilitation of Sports and Musculoskeletal Injuries (pp. 192-200). Gaithersburg, MD: Aspen.