Rehabilitation Pilates

Herniated Cervical Discs & Pilates

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Here is a recent question I received regarding doing Pilates with herniated cervical (neck) discs.

Hi,

I have two herniated discs on my neck and I have been doing pilates for a while at the gym club. But my doctor told me that it may cause problems even if he wasn't sure what pilates was. It really helps me to gain my strength. But sometimes I feel pain in my lower back. What should I do?

Thanks for your response,

Naciye

Hi Naciye

If your neck is feeling OK with the Pilates you're doing you should be fine. Just be sure to avoid movements where there is weight on your neck (roll-over, jacknife) and watch that when you do any rolling exercises you don't roll back so far that all of your weight is in your neck.

Now, the pain in your lower back is most likely due to tucking your pelvis back and flattening your lower back during much of your routine. You want to try to keep the spine lengthened from your head all the way to your tailbone and NOT force your lower back flat to the mat. Your teacher should be able to help you there.

Let me know if you have any other questions or concerns.

I do recommend that if you have only taken group Pilates classes you should really try at least one private session with a teacher familiar with cervical disc herniations. It can hep you find better form.

Best,

Lynda

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

Rehab Pilates

Yesterday I taught a Rehab Pilates session to a Japanese journalist who told me that Rehab exercise and Pilates were not linked in Japanese culture. You go to a Pilates teacher for exercise, and a physician for any kind of Rehab exercises.

Now this is appropriate in acute injury cases, but when you are dealing with imbalances from an injury 20 years ago that still cause problems the physician usually shrugs her shoulders. This is where a Rehab-focused Pilates session can come in handy.

In a 60-90 minute session I can assess the imbalances and offer an exercise program to help strengthen what is weak and stretch what is tight, leading to better muscle balance and function. Email me for more information.

Pilates After Stroke

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44 year old Wade Johnson is a stroke survivor. He ad a stroke one year ago with extremely debilitating effects. Just a month ago he "had no mobility on his left side and could barely hold his head up." That was before he started rehabilitative Pilates.

After twice a week Pilates sessions with some homework in between, Johnson is already seeing improvements in his strength and mobility. And his wife is noticing too!

"'It's amazing. You know it's a long road, it's been a year but it seems like he's getting so much better. Each day adds a little more to what he can do. And I am so grateful for that,'" said [Carla] Johnson.

I have witness miracles teaching Pilates, and that is why I stick with it and continue to teach rehabilitative exercises using Pilates. It works!

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Back Into Pilates


Jennifer Whittemore of InnerPillar, a Pilates, Yoga, and Reiki practitioner who teaches in NY at my favorite studio, Lesley Powell's Movements Afoot, came to Pilates by way of rehabilitative exercise for a herniated lumbar disc.

She has an absolutely inspiring article on Lesley's blog, "Backing Into Pilates".

"During my investigation, I came across Joseph Pilates’ original mat series. Pilates was very much a part of the modern dance community, but was not widely known in other circles. After my first attempt at the exercises, I suffered a serious setback. Even though I had always been an active person, I wasn’t very core-connected. I didn’t understand how to use the triumvirate of musculature—the deep abdominal muscles, pelvic floor, and paraspinal muscles—required to stabilize my spine. My low back took over and I strained it as soon as I attempt to perform the hundreds.

I was lucky that I had friends in the dance community who directed me to an instructor with expertise and compassion. I first studied with a dancer and teacher who had extensive experience in Pilates and Body-Mind Centering. Her approach was rehabilitative and focused on helping me stabilize my spine. Cathie Caraker was a caring instructor who encouraged me to keep moving and exploring my relationship to my body. She offered far more than Pilates—she offered movement education, which helped forge a connection with my body that would serve me through many physical passions. Within three months, I was pain free.

It was years later that I decided to become a Pilates and Yoga instructor. The “cure” that I found as a young person morphed into a deep-rooted curiosity about the process of physical transformation. During my back pain episode, friends and family were crucial support systems, but the healing journey was ultimately my own. Pain, in the broadest sense, was an indicator that something needed to shift in my body, mind, and spirit to make way for a deeper understanding and appreciation of life. I had to face my fears and take on new ways of treating my body so that it could repair itself and stay well.

With back-pain clients, I am acutely aware of the distress that comes from living life in constant suffering. I see my role in the process as part inspiration, part expert, and part witness. My work focuses on identifying clients’ pain patterns, strengthening the core and deep spinal stabilizers, and improving whole-body functional movement. My mantra is awareness—when we perceive what is going on in the body, we can relax into our strength. We not only get longer, leaner, and more supple, we begin to move with intelligence. I have seen many clients shift from disability to athletic ability in a few short months."

Pilates is an amazing tool for body awareness and recovery, but as happened to Jennifer if you jump right in without the proper guidance you can strain the exact muscles you are trying to strengthen. So if you tried a class, a dvd, or with a friend and Pilates strained your back or made things worse, I highly recommend that you try it again with a certified teacher who is aware of your issues. It can make all the difference.

Pilates After Total Hip Replacement

In the last two weeks I received 2 separate email requests for Pilates teacher referrals from women who had bilateral total hip replacement surgeries. One had just redone one hip as the replacement had dislocated.

Pilates is perfect after THR as it strengthens the glutes, hamstrings, quads, pelvic floor, inner and outer thighs/hips, back and abs - everything you need to stabilize those new additions! But it is crucial to work with a teacher who understands the restrictions in mobility and contraindicated movements for hip replacements.

Question:
Can you recommend a practitioner experienced/specialized in dealing with titanium thighs? I was doing Pilates for about 2 years before my surgery on 11/2/09, and am looking forward to getting back into it when practical. My former instructor, though great, has no experience in this area. I live in Northbrook Il a northern suburb of Chicago. Thank you.

Answer:
Hi Sandra

I think you have several options here. One is to have your former instructor contact your surgeon or physiotherapist to simply discuss what not to do with you (no hip flexion past 90 degrees, no internal hip rotation or abduction across the body) as there is quite a bit within the Pilates system that you can do and it could be nice to work with someone you know.

I do advise taking privates on Pilates equipment and not simply doing mat Pilates.

There is also a rehabilitative Pilates studio re:fit in Glenview which offers PT and Pilates, with at least one Pilates teacher who is also a licensed Physical Therapist. This would probably be your best bet, even though there may be a 15 minute drive involved:

Let me know how this works for you!

Question:
Hi Lynda, Almost 13 years ago I had bilateral hip replacement surgery after being prescribed large doses of Prednisone. After those surgeries I became pretty active with walking, elliptical, strength training and in March '09 I began Pilates mat classes. I love these classes and saw the benefits in my weight and flexibility. Unfortunately, in Nov '09 I had a dislocation, and my surgeon performed a revision to my left hip in Dec '09. I live in Lansing, MI and would love to be referred to an instructor knowledgeable in how to work within my restrictions. My doctor and PT's aren't being very helpful. Are you able to make a referral in my area? Thank you.

Answer:
Dear Deana,

Tina Sarkey has the most rehabilitation training of any teacher near Lansing, and also is a massage therapist.

The folks at Pilates Zone also do quite a bit of post-rehab work.

Just be clear to anyone you work with that you dislocated once, had to have a hip redone, and are interested in stabilizing and strengthening the area to avoid going through that again. I highly suggest doing Pilates equipment training and not purely Pilates mat for the work your hips need.

And of course for yourself you know the drill - no hip flexion past 90 degrees and do not internally rotate or cross your leg past your midline (no sitting with crossed knees).

Be well & feel free to ask more questions.

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