Pilates for Lumbar Spine Herniation

Transcription

1 Pilates for Lumbar Spine Herniation Michelle Hawley Date: Module 12, 10/21/2012 Course Year: July October 2012 Location: Chandler, AZ

2 Abstract Research has demonstrated that non-surgical methods for treating lumbar disc herniation are just as effective as surgical methods over the long term. Common ailments and symptoms of a patient with a lumbar disc herniation are low back pain, radiating pain down the legs, and a worsening posture including a reduction in the natural lumbar spine curvature, scoliosis, and unilateral slightly flexed and externally rotated hip and knee joints. Although physical therapy is effective, a method that focuses on correcting alignment, posture, and improving the strength and endurance of synergistic muscles is preferred for successful treatment of a herniation. Because Pilates addresses these specifically, it is the most appropriate method to treat my client who has a lumbar spine herniation. A timeframe of 10 weeks will be used for this program which will mainly target the Transverse Abdominals and Multifidus muscles while avoiding contraindicated movements. 2

3 Table of Contents Title Page Number Abstract... 2 Anatomical Description & Picture...4 Introduction... 5 Conditioning Program...6 Conclusion...9 Bibliography

4 The Human Spine Pictured above is a normal spine viewed from three perspectives: anterior, lateral, and posterior (7). Included are pictures that demonstrate a herniated disc compared to a normal disc and a diagram of the disc itself displaying its main components which are the annulus fibrosus and the nucleus pulposus (8, 1). Type I and Type II collagen fibers compose the annulus fibrosus in the shape of a ring, structurally allowing it to contain the nucleus pulposus which has a jelly-like consistency resulting from its high concentration of proteoglycans (2). In the case of a herniation, the annulus fibrosus has degenerated either from dehydration, fragmentation, or excessive loading, causing the nucleus pulposus to also fragment and become exposed to the outer environment (2). Once this fragmentation occurs, one or more of the nerve roots suffers compression which ultimately causes pain that may radiate from the low back down into the legs (3). There have been instances in which a herniated disc has spontaneously healed (2, 3). 4

5 My client, Wes, is a 30 year old male firefighter with a herniated disc between the 4 th and 5 th lumbar vertebra (L4-L5). He injured himself last year on the job while part of a 4 man team who carried a 400 pound patient on a cloth stretcher down a flight of stairs. This excessive overload on his spine resulted in his L4-L5 herniation, which was confirmed by MRI. Upon diagnosis, an epidural and physical therapy were recommended by his doctor who is a prominent spine specialist. After two epidurals and twelve physical therapy sessions, neither has offered long lasting pain reduction, resulting in sleepless nights, decreased mobility in his spine in movements of lateral flexion and rotation, and muscular tension in the compensating musculature causing chronic pain in his neck, upper back, and mid back along the spine. Wes is now searching for a safe and effective program that will help reduce his low back pain while still providing the benefits of physical activity. According to current research on lumbar disc herniation, non-surgical methods are just as effective as surgical methods in the long term when the measurement outcomes are spinal mobility and pain, yet are much more affordable (2, 3). Herniation in the L4-L5 disc is the most common and may lead to several mechanical misalignments in the body such as scoliosis as a result of leaning away from the painful side, a reduction in the natural lumbar curvature, and slight flexion and external rotation in the hip and knee that are experiencing pain from nerve root compression (2). A period of 3 to 4 months is required to determine if the non-surgical therapy is successful and is also the maximum amount of time that can elapse before surgical treatment is no longer a viable option (2, 6). Although physical therapy has proven to be a favorable nonsurgical method, a form of exercise that allows the patient to be in a supine position and that also focuses on re-educating correct alignment in addition to strengthening and improving the endurance of the synergistic muscles in the trunk is preferred (5). 5

6 Pilates is a form of exercise that not only improves muscular strength, endurance, flexibility, and balance but is also a main proponent of teaching correct alignment with proper recruitment of agonistic, antagonistic, and synergistic muscles. Rael Isacowitz, the founder of BASI Pilates, promotes it as a bridge... between rehabilitation and healthy movement... [and] a solution to those with restricted mobility (4). Therefore, Pilates is the most advantageous method for my client to help reduce his low back pain and improve his alignment. The transverse abdominals and the multifidus are the primary muscles in stability and function which work together to create a cylinder of muscular support in the center of the body and will appropriately be the center of Wes conditioning program (4). Wes customized program will emphasize building strength and endurance in his back extensors and deep abdominal muscles while also ensuring balance in his appendicular muscles. Specific movements that will be avoided are major spinal flexion, major rotation, spinal flexion in combination with rotation, deep flexion, and spinal extension with excessive load on the lumbar spine as these are contraindicated for a client with a herniated disc. Wes will come to the studio 3 days per week for 10 weeks to allow sufficient neuromuscular adaptation, adequate overload, and time to reach his goals which include pain reduction and a stronger more stable core. Thorough assessments of posture and alignment will be conducted at the first visit and every 3 weeks thereafter to track progress in addition to assessing his pain. Every session will be based on the BASI block system with a chart to include notes for each exercise to determine areas of weakness and tightness for appropriate modifications and/or changes to his lesson plan. The Reformer and the Cadillac will be the apparatus of choice since they require the client to lay supine for the exercises that are suitable for this program, while the warm up will consist of mat exercises. The Magic Circle, pole, and leg weights will also be utilized in the appropriate blocks. 6

7 The first 10 sessions will be comprised entirely of fundamental exercises in order to educate proper muscle recruitment and stability. A progression into intermediate exercises, spinal articulation, and full body integration will then begin at the eleventh session. Wes will also progress into lateral flexion and supine rotation with a *shortened range of motion. The mat work bridging block will be added to this program because of its benefits in increasing stability of the shoulder girdle and the core muscles. The full body integration 2 block will be omitted from this program as the exercises are not suitable for this client. Sessions 1-10 represent the fundamental exercises while progressing into intermediate exercises for sessions and The chart below shows which exercises will be incorporated into the repertoire available for this client after the specified number of sessions so there will be a growing variety of exercises to combine for each session. This program will cover 30 sessions, a point at which Joe Pilates has claimed a client will feel like a new person, while also remaining within the surgical decision timeframe. Block Sessions 1-10 Sessions Sessions Warm Up Pelvic Curl *Spine Twist Supine Double Leg Stretch Mat Chest Lift *Chest Lift with Rotation Single Leg Stretch Leg Lifts *Criss Cross Leg Changes Foot Work Reformer Cadillac Cadillac (+ Hip Opener) Reformer, Cadillac Abdominal Work Hundred Prep Coordination Hundred Reformer, Cadillac Mini Roll-Ups & Mini Double Leg *Roll-Ups Obliques 7

8 Hip Work Reformer- basic Ext. Frog, Ext. Frog Single Leg Supine Series Reformer, Cadillac Reverse Basic Leg Springs Spinal Articulation None Bottom Lift Bottom Lift w/ Extensions Reformer Stretches Standing Lunge Side Split Kneeling Lunge Reformer, Pole Pole Series (no twist) Bridging Front Support Front Support Leg Pull Front Mat Back Support Leg Pull Back Full Body Integration None Round Back, Flat Back Long Stretch Reformer Arm Work Arms Supine Series Arms Standing Series Side Arms Kneeling Reformer, Cadillac, M.C. Standing Series Arms Sitting Series Series (*slight side bend Magic Circle for triceps) Additional Leg Work Gluteals Side Lying Series Gluteals Kneeling Series Single Leg Skating Leg Weights M.C. Prone Series M.C. Supine Series Hamstring Pull Magic Circle M.C. Adductor Squeeze Reformer Lateral Flexion/ None None *Side Lifts Rotation Reformer Back Extension Mat Reformer Back Extension Breaststroke Prep Pulling Straps 1 Pulling Straps 2 Breaststroke 8

9 Conclusion Lumbar disc herniation is the result of excessive spine loading, causing the fragmentation of the nucleus pulposus which then extrudes from the disc, compressing the nerve root. Low back pain, radiating pain down the leg, and mechanical misalignments are the consequences of herniation, worsening posture and decreasing mobility. Because Pilates is a form of exercise that centers around reeducating proper alignment while strengthening synergistic muscles, it is the safest and most effective method for treating a client with a lumbar disc herniation. Wes, a 30 year old firefighter, has tried non-surgical methods such as physical therapy and epidurals, but neither has offered long lasting relief of the pain and muscular tension he experiences as a result of his lumbar disc herniation. Pilates has the potential to lessen his pain and improve his alignment. Utilizing the Reformer, Cadillac, and other pieces of equipment will allow Wes to exercise while lying in a supine position which is recommended for someone with this medical condition. Therefore, a 30 session program lasting 10 weeks and excluding the contraindicated movements for a client with a herniation is the next step in Wes nonsurgical journey to treating the symptoms of his herniation. 9

10 Bibliography 1. Abitbol, Jean-Jacques, et al. Lumbar Herniated Disc. [image] Retrieved from 2. Awad, J.N. & Moskovich, R. (2006). Lumbar Disc Herniations: Surgical versus Nonsurgical Treatment. Clinical Orthopaedics and Related Research, 443, Ciaccio, E.D., et al. (2012). Herniated Lumbar Disc Treated With Global Postural Reeducation: A Middle-Term Evaluation. European Review For Medical and Pharmacological Sciences, 16(8), Isacowitz, Rael. (2006). Pilates: Your complete guide to mat work and apparatus exercises. Champaign, IL: Human Kinetics. 5. Iwamoto, J., Sato, Y., Takeda, T., and Matsumoto, H. (2010, December). The Return to Sports Activity After Conservative or Surgical Treatment in Athletes with Lumbar Disc Herniation. American Journal of Physical Medicine & Rehabilitation, 89(12), Postacchini, F. (1999). Management of Herniation of the Lumbar Disc. The Journal of Bone & Joint Surgery, 81(4), Tumminello, Nick. (2010, May 27). An Inside Look at Spinal Osteoporosis, Scoliosis and Osteophytosis. [image] Retrieved from 8. WebMD, LLC. (2012, January 24). Slideshow: A Visual Guide to Low Back Pain. [image] Retrieved from 10