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TRANSCRIPT
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PILATE FOR HERNIATED DISC
AND SCIATICA
7 MAY 2019
By:
Wai Fun, LOW
Kuala Lumpur, Malaysia
Comprehensive Global Pilates Course
Dynamic Pilates Australia/Manly, AUSTRALIA
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ABSTRACT
This paper discusses herniated disc and sciatica, its related causes as well as symptoms and
how programming selected pilates exercises with the necessary modifications can be
beneficial for an individual with herniated disc and sciatica. Several precautions when
performing pilates practice may need to be taken depending on the causes of herniated disc
and sciatica in order not to aggravate its symptoms. Certain exercises may not work well
with clients faced with this condition and modifications may be required or leaving out
selected exercises completely may be best in order for clients not feeling the pain in the next
day or during the exercise.
It is also very important for a pilates instructor to ask the relevant questions and find out as
much information as possible from the client in regards to their condition. In addition,
working with a medical practitioner would also be beneficial in order to have a clear picture
as to the actual cause of the condition since different causes or symptoms may require
different exercise programming and pilates modifications.
This paper discusses the relevant pilates exercise programming in relation to the case study
of a client. The objectives when dealing with herniated disc and sciatica clients would be to
focus on core stabilisation and strengthening as well as regular stretching on a neutral spine
(avoiding extreme flexion, extension and twisting) and stretching out the lower extremities.
This will assist to ease the pressure on the disc causing compression on the nerves.
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TABLE OF CONTENTS
Title Page 1
Abstract 2
Table of Content 3
Anatomy – The Spine 4
Herniated Disc Definition 6
Sciatica Definition 8
Case Study 10
Contraindications and Goals 11
BASI Block System Exercise Programming 13
Conclusion 16
References 17
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ANATOMY – THE SPINE
The spine is made up of 33 bones called vertebrae. They are stacked one upon the next to form column like structure. The vertebrae are arranged in five (5) regions namely: -
Cervical
The top seven (7) vertebrae that span from the head to the base of the neck. Essential for movements of the head and neck.
Thoracic
The next twelve (12) vertebrae are the thoracic vertebrae. They span from just below the neck to the last rib. Key movements of thorax and upper back.
Lumbar
The next five (5) vertebrae are the lumbar vertebrae, which spans from the last rib to the pelvic girdle. Key movements of lower back.
Sacrum
The next five (5) vertebrae are called the sacral vertebrae. Movements at this joint have a profound influence on alignment of the lower back and pelvis.
Coccyx
The last four vertebrae are often collectively referred to as the tailbone.
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Intervertebral Disk
Between each vertebra is an intervertebral disc. The discs are filled with a gelatinous
substance, called the nucleus pulposus, which provides cushioning to the spinal column. The
annulus fibrosus (Outer layer of the disc) is a fibrocartilaginous ring that surrounds the
nucleus pulposus, which keeps the nucleus pulposus intact when forces are applied to the
spinal column. The nucleus pulpous has a high-water content and the discs can be likened to
little water cushions between the vertebrae that are vital for shock absorption and protection
of the spine during everyday activities such as walking, running and jumping.
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HERNIATED DISC
While the intervertebral discs do not actually "slip," a disc may bulge, split, or rupture. This
can cause the disc cartilage and nearby tissue to fail (herniate), allowing the inner gel portion
of the disc to escape into the surrounding tissue. This protruding, jelly-like substance can
place pressure on the spinal cord or on an adjacent nerve to cause symptoms of pain,
numbness, or weakness either around the damaged disc or anywhere along the area supplied
by that nerve.
The layman's term "slipped disc" is, therefore inaccurate and actually refers to a condition
whereby portions of an abnormal, injured, or degenerated disc have protruded against
adjacent nerve tissues. This condition is also known as a slipped disk, herniated disc,
ruptured disc, or prolapsed disc. The most frequently affected area is in the low back, but any
disc can rupture, including those in the cervical area.
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Causes and Risk Factors of a Herniated Disc
Risk factors that lead to a herniated disc include aging with associated degeneration and loss
of elasticity of the discs and supporting structures; injury from improper lifting, especially if
accompanied by twisting or turning; and excessive strain forces associated with physical
activities.
What Are Symptoms of a Herniated Disc?
The nerves of the body exit the spine at each spinal level in the low back, mid back, and neck.
A herniated disc can produce symptoms anywhere along the course of that nerve, though the
injury and irritation of the nerve are at the spine itself. (This is known as referred pain, as the
pain is "referred" from the source of the problem in the spine to the area supplied by the
affected nerve.) A herniated disc can produce varying degrees of pain in the back or neck
along with numbness or weakness in the corresponding organs, arms, or legs as follows:
For herniated discs in the neck: Neck symptoms and other associated symptoms
include numbness, tingling, weakness, or pain in the shoulder, neck, arm, or hand.
Symptoms of a herniated disc in the neck often increase or decrease with neck
motion.
For herniated discs in the lower back, back symptoms include
o Pain down the back of each leg from the buttocks to the knee or beyond (this
is called sciatica, as it affects the sciatic nerve)
o Numbness, tingling, weakness, or pain in the buttocks, back, legs, or feet or all
of these as in sciatica
o Numbness and tingling around the anus or genitals
o Pain with movement, straining, coughing, or doing leg raises
o Difficulty controlling bowel movements or bladder function
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SCIATICA
Source: https://medicalartlibrary.com/sciatic-nerve/
The sciatic nerve is the largest nerve in the body and arises from the L4 through S3 spinal
nerves (and their roots). Sciatica describes as pain radiating from your back, into your
buttock and down your leg. The sciatic nerve provides most of the motor and sensory activity
to the lower limbs. Pressure on the sciatic nerve anywhere along its pathway can cause
irritation and inflammation, therefore causing increased pain. Sciatic pain tends to occur
only in one leg. It is generally aggravated by sitting and bending. Leg pain is described as
burning, tingling of the affected leg.
The most common cause of sciatica is impingement or compression of a nerve root by a
herniated disc (as described above) . A lumbar disc can bulge or herniate putting pressure on
the sciatic nerve. Likewise, osteoarthritis can cause overgrowth of bone which narrows the
spinal canal or foramen. Other causes of sciatic include (sciatic nerve may be compressed by
piriformis muscle as it exits the pelvis) spinal stenosis, degenerative disc disease,
spondylolisthesis, piriformis syndrome and sacroiliac joint dysfunction.
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CASE STUDY
ST is a 55 years old male with a herniated disc between the 4th and 5th lumbar vertebra
(L4-L5). ST injured himself during the younger days playing games such as football and
badminton. He had several times fell down during sports and despite the pain for many
years, left it untreated. He had been experiencing pain on the back and neck for many years,
tingling as well as numb sensations on arms and legs and until approximately 4-5 years ago
only started seeing an orthopaedic which confirmed a herniated disc on L4 and L5 via MRI
scan. He also suffered from sciatica. He underwent physio for six (6) months and started
seeing a chiropractor for manual adjustments but did not find long term relief. Coughing,
sneezing, sitting, driving, and bending forward may at times make the pain worse due to the
pressure on the nerve.
ST is now searching for a safe and effective program that will help reduce his low back pain
and complimenting Pilates with massage and chiropractor adjustments.
Issues faced by client:
Low Back pain
Neck pain
Numbness and tingling sensations occasionally on buttocks, back, arms and legs
Experience occasion pain with movement, straining, coughing, or doing leg raises
Tight hamstrings and hip flexors
Core weakness
Weak arms
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CONTRAINDICATIONS AND GOALS
Disc Herniation
General precautions and contraindications
Goals
Avoid deep lumbar flexion
Avoid compression
Avoid severe rotation
Initially avoid flexion, lateral flexion,
rotation and combined flexion and
rotation unless directed otherwise by
treating practitioner
Use neutral to extension exercises to
increase stability and reduce symptoms
Work small pain free range of motion
and increase range gradually
Unload disk
Extension based exercises
Core stabilisation
Increase strength
Improve lower extreme
flexibility
Improve posture
Reference: Pilates For Rehabiliation by Samantha Wood, p230
Reference: http://nationalpilates.com.au
Sciatica
General precautions and contraindications
Goals
Specific precautions depend on the source
of nerve compression, most likely due to
disk pathology, therefore to follow the
above table and as listed again below:-
Avoid deep lumbar flexion
Avoid compression
Avoid severe rotation
Unload disk
Core stabilisation
Increase strength
Improve lower extreme
flexibility
Improve posture
Source: Pilates For Rehabiliation by Samantha Wood, p236
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“Generally, the following positions or movements may not be suitable for sciatica clients
depending on the individual or the cause of sciatica.
1. Exercises that involve straight leg raise
2. Exercises that involve strong spinal rotation
3. Avoid exercises that involve spinal flexion
4. Avoid exercises that involve vertical loading (seated, standing or inverted) positions
Source: https://ballsbridgephysio.ie/news/pilates-exercises-to-ease-sciatica/
“Specifically, if the sciatic pain has come on due to spinal stenosis, or spondylolisthesis,
flexion based exercises will provide most relief. Examples of this would be doing a rest
position or cat stretch.
Sciatic pain originating from compression by the piriformis or glute medius muscles will
respond best to gentle stretching of the glutes, by pulling your knee diagonally across
towards the opposite shoulder.
If sciatic pain is being caused by impingement or irritation from a lumbar disc bulge,
extension based exercises are most suitable. One common example would be the basic back
extension, which is performed by lying prone, and pushing through your arms to extend your
lower back.”
Source: https://ballsbridgephysio.ie/news/pilates-exercises-to-ease-sciatica/
“If the sciatica is coming from a herniated disc, then we have to take all the disc
precautions. Disc precautions include not going into unnecessary flexion, and
sometimes extension. Avoid overusing the buttocks and the piriformis muscles.
Avoid putting the nerve on stretch. Avoid too much flexion (forward bending) in
the lumbar spine which could irritate the nerve if there is a disc lesion. Again,
work from a neutral spine, get things to move and relax, and get the core strong.
You can do a lot of Pilates and still remove stressors on the sciatic nerve. ”
Source: https://sumofusstudio.com.au/pilates-sciatica-treatment/
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BASI BLOCK SYSTEM EXERCISE PROGRAMMING
The following programming serves as a guideline for client, ST. Nonetheless, it is important
to communicate with the client constantly on how he feels throughout the exercise as every
individual is different. Modifications and necessary adjustments are to be made during
every pilates session with the client. And everyday and every session, client may feel
different.
Sessions 1-10 Sessions 11-20
WARM UP Pelvic curl
(neutral position)
Spine Twist Supine
Chest Lift
(on spine corrector in neutral
position)
Chest Lift with Rotation
(on spine corrector in neutral
position)
Pelvic curl (neutral position)
Spine Twist Supine
Chest Lift (on spine corrector
in neutral position)
Chest Lift with Rotation (on
spine corrector in neutral
position)
Maintain the above warm up until client feels
good to perform intermediate warm up:
Pelvic curl/Roll up
Spine Twist Supine
Double leg stretch (head
down)
Single leg stretch (head down)
Criss cross (head down)
FOOTWORK Reformer
Parallel heels
Parallel toes
V-position toes
Open V-position heels
Open V-position toes
Calf raises
Prances
Prehensile
Single leg
Single leg toes
Wunda Chair
Parallel heels
Parallel toes
V-position toes
Open V-position heels
Open V-position toes
Calf raises
Single leg heels
Single leg toes
ABDOMINALS Reformer
Hundred prep – Head down
Hundred – head down
Cadillac
Breathing with PTBar
(neutral spine)
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Bottom lift with RUBar
(neutral spine)
HIP WORK Reformer
Supine Leg Series:
Frog
Circles Down
Circles Up
Openings
Reformer
Extended Frog
Extended Frog Reverse
SPINAL
ARTICULATION
- Bottom lift (neutral spine)
Bottom lift with extension
(neutral spine)
STRETCHES Reformer
Standing lunge
Reformer
Side split
FULL BODY
INTEGRATION F/I
Reformer
Knee stretch (Flat back)
Reformer
Down stretch
ARM WORK Reformer
Arms Supine Series
Extension
Adduction
Circles Up
Circles Down
Triceps
Reformer
Arms Kneeling Series
Chest Expansion
Circles Up
Circles Down
Triceps
Biceps
FULL BODY
INTEGRATION I/A
- Reformer
Long stretch
LEG WORK Chair
Leg press standing
Reformer
Single Leg Skating
Chair
Hamstring Curl
LATERAL
FLEXION/
ROTATION
Chair
Side Stretch
Reformer
Mermaid (if client feels good
to perform the exercise)
BACK EXTENSION Chair
Swan Basic
Reformer
Breast stroke Prep
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Progression
Pulling straps 1&2
Observation
Initially, client feels very limited in terms of its range of motion. After several pilates sessions, client
starts to feel stronger and able to increase the range of motion. He feels taller and manage to
maintain a better posture. He also feels that there is less strain on his back, neck and shoulder and his
flexibility improves.
In summary, client feels better in terms of the following:-
Back initially feels a bit sore but feels great thereafter
Neck pain decreases
Shoulder feels more stretched and opened
Back feels stretched and good
Feels tired after class but after resting he feels better. His energy improves after several sessions
Client feels that the slow controlled movement of pilates coupled with right breathing makes him feel
good, stronger and more stretched after class.
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CONCLUSION
In conclusion, Pilates can be tailored to specific individual with various conditions. It is vital
to communicate with clients constantly on how they feel before starting class, during and
after class to better understand their individual response towards the exercise programming.
Exercises should also be performed following the principles of pilates which is awareness,
balance, breath, concentration, center, control, efficiency, flow, precision and harmony in
order to deliver the best results. Integrating the pilates principles when performing pilates
exercises will result in smooth, controlled movements increasing its effectiveness. When
performed right with correct breathing, precision and focus, quality matters more than
quantity.
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REFERENCES
Rael Isacowitz and Karen Clippinger, Pilates Anatomy, 2011
Samantha Wood, Pilates For Rehabilitation, 2019
https://painstopclinics.com/condition/sciatica/
https://www.verywellfit.com/how-pilates-exercises-can-help-relieve-sciatica-2704621
https://painstopclinics.com/stop-sciatica-pain-with-pilates/
https://www.spineuniverse.com/conditions/sciatica
https://paindoctor.com/pilates-for-sciatica/
https://www.pilatesfoundation.com/assets/Uploads/member-resources/Sciatica-Holly-
Nuttal.pdf
http://pilates-pro.com/pilates-pro/2008/4/21/teaching-pilates-clients-with-sciatica.html
https://theverticalworkshop.wordpress.com/2013/02/17/colleague-questions-sciatica/
https://en.wikipedia.org/wiki/Intervertebral_disc
https://medlineplus.gov/ency/imagepages/19469.htm
(https://ballsbridgephysio.ie/news/pilates-exercises-to-ease-sciatica/)