Pilates with Cervical Disc Herniations

Dear Lynda, I have been a pilates instructor for 4 years. I have a client: 34 yr old Female 2 cervical disc hernias at age 18 ex gymnast works in an office swims once a week flexible weak muscles (especially in arms)

She wants her body back in shape.

She has some tingling in her hands and sometimes gets dizzy.

She wants to do group lessons because of the hours and cost.

I started her out on the Trap table doing Pre Pilates exercises: Breathing exercises Neutral spine w/disassociation exercises Shoulder girdle stabilization

Basic Reformer routine: Foot Work Frog Leg Circles Short Box Series: Round Back Twist Side bends Knee Stretch Stomach Massage Seated Long box Arms Basic Rowing Back

My questions are:

What exercises should I NOT DO with her(obviously no full short spine / bottom lift / shoulder bridge ect. that might put pressure on her neck)?

Are there any specific exercises that would help?

Would neck mobilization help or could it possibly worsen the situation?

Thanks, Michelle

Dear Michelle,

First, have you seen her since the first session? How did she feel? That will give you some basis on which to proceed. Any pain or numbness lasting longer than one day is a problem.

Second, NO NECK MOBILIZATION! Think about it--she's hypermobile already with weak enough intervertebral muscles to cause weakness in the cervical spine. Plus you mention that she is weak and flexible, which is not good.

Third, looking at the first session almost everything you give her is in forward spinal flexion. She needs some work in extension and side lying and maybe some supine arm work. Bridging and bottom lift are not necessarily bad if she doesn't go all the way up to her neck.

I would avoid weight bearing on arms right now (no knee stretches) and too much flexion (stomach massage and back rowing is too much). And you are right about avoiding weight bearing on neck in things like short spine, long spine, etc.

So for extension--basic prone straight leg lifts, single leg kick with head down, swimming, beginning swan, flight (extension with arms at sides). Side lying--side kicks, magic circle work.

On the reformer you could do supine arm presses and circles with legs in tabletop position, very light prone pull straps, seated chest expansion (light springs).

She is bound to be tight in the chest/front of shoulders her mid back/lower ribcage, and in her hip flexors. So you need to help her stretch these while strengthening the complementary muscles (triceps, back of shoulder blades, obliques and abs, pelvic floor, gluteals, leg abductors, inner thighs, hamstrings.

Has she been cleared by her doctor to exercise?

Feel free to ask more questions!

Regards,

Lynda