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  • Symptomatic Lumbosacral Dysfunction and the Management & Rehabilitation through Pilates

    zge Gow November 2015

    Body Arts and Science International Comprehensive Teacher Training Program 2015

    Brisbane, Australia

  • 2

    Abstract

    The purpose of this paper is to explain and identify chronic lower back pain (CLBP)

    and related lumbosacral dysfunctions. The paper will focus heavily on congenital

    conditions mainly the sacralisation of the lumbar vertebrae. In addition, this paper

    will examine the effectiveness of Pilates exercises in the management and

    rehabilitation of these conditions.

  • 3

    Table of Contents

    Abstract ......................................................................................................................................2

    Table of Contents ...................................................................................................................3

    Chronic Lower Back Pain ....................................................................................................4

    What is Sacralisation? ...........................................................................................................4

    Why Sacralisation Causes Pain? .......................................................................................5

    What can Pilates do? .............................................................................................................7

    Case Study .................................................................................................................................7

    Session Plan ............................................................................................................................10

    Conclusion................................................................................................................................12

    Bibliography............................................................................................................................13

  • 4

    Chronic Lower Back Pain

    Chronic low back pain affects approximately a quarter of the population.1 This

    physiological burden can lead to difficulties in everyday life and if untreated can lead

    to irreversible degeneration.

    There are many causes for lower back pain that have been put forward. These can be

    summarized into five main areas, which Dharati (2012) identifies as;

    1. Actual pressure on nerves or nerve trunks.

    2. Ligamentous strain.

    3. Compression of soft tissue between bony joints.

    4. By an actual arthritis if a joint is present.

    5. By a bursitis if a bursa is present.2

    These disorders make up the majority of lower back pain however Dharati ignored an

    often overlooked cause for pain in the lower back which can be caused by a congenital

    mechanical dysfunction, mainly that of sacralisation.

    What is Sacralisation?

    The lumbosacral spine protects the spinal cord and spinal nerves but another

    important function of the region is to support and transmits the weight of the body to

    the inferior extremity and in doing so plays an important role in posture.3

    Sacralisation occurs when the transverse process of fifth lumbar vertebra and the last

    lumbar vertebra becomes larger than normal on one or both sides, thus causing fusion

  • 5

    to the sacrum, or ilium and or both.4 It is believed to occur in about 3.6 % to 18 % of

    the population. 4

    Why Sacralisation Causes Pain?

    Pain is first recognized in the early stages of development due to the improper

    formation and union of somites, which cause vertebral abnormalities. 5 This is

    amplified by the fact that the lumbar spine experiences more abuse from the everyday

    functions than any other part of human body and it explains why, without

    intervention, pain increases as a person ages.

  • 6

    Its important to note that sacralisation wont always cause pain, often the condition is

    asymptomatic. Wazir (2014) explains that pain occurs as a result of disc degeneration,

    L4/L5 disc prolapse, lumbar scoliosis and/or lumbar extradural defects.6 According to

    Castellvi (1983) the transitional vertebrae has the potential to cause abnormal torque

    movements above these anomalous vertebrae, which can be a direct result of disc

    degeneration.7

  • 7

    What can Pilates do?

    Sacralisation usually goes undiagnosed because it is difficult to diagnose without the

    access to x-ray. However, sacralisation itself it is not generally the cause of discomfort

    and pain but the chronic failure of lumbar and pelvic biomechanics.

    According to Eyo (2001) to be able to give support to and bear the weight of the body,

    the integrity of all the vertebrae in the spine, particularly in the lower back must be

    maintained7 The 2014 Delphi Study examined the affect of Pilates exercises as a

    treatment for people with complex lower back pain associated with sacralisation.8 The

    study found that Pilates exercises may benefit people with lower back pain by

    increasing their functional ability and their confidence with movement, exercise, and

    activities.9 The research also showed improvements in body awareness, postural

    control and movement patterns. 9

    Case Study

    zge is a 32-year-old woman with chronic lower back pain. The pain has existed for

    over five years. The origin of the pain is not known but the client did mention that she

    slipped on ice during primary school and injured her lower back. The client is not on

    any medication however she does take the occasional ibuprofen when the pain

    becomes unbearable. The ibuprofen seems to help.

  • 8

    Postural Assessment and Physical Examination

    The client presents hypertension in her lower back, gluteus muscles, hip flexor

    muscles as well as in the quadriceps muscles. Secondary concerns show a posterior

    tilt in the pelvis, which has caused a minor lordosis affecting muscles throughout the

    thoracic and cervical regions, particularly in trapezius muscles. Due to the

    hypertension caused the trapezius muscles the client presents cervical pain and

    occasional headaches.

    Exercise Plan

    An exercise plan has been devised for zge, which consists of movements designed to

    strengthen and stretch affected muscles. The main focus was strengthening her

    abdominal muscles, her upper thorasic muscles, back extensor muscles, hip flexors as

    well as gluteal. Exercises were chosen from the mat, reformer, cadillac, avalon and

    wunda chair repertoire.

    During the first few sessions she was having trouble keeping the pelvis in a neutral

    position while performing supine exercises while actively using hip flexors. The

    warm-up exercises involved a lot of pelvic tilts as well as pelvic curls. We also did

    quite a bit of abdominal work in order to strengthen her core. At the beginning she

    was very cautious with her back extensions, so we did a lot of swimming, cat stretch

    until she felt stronger through her back and abdominal muscles. The intensity of the

    exercise plan I have created can be upgraded or downgraded for different apparatuses

    depending on the strengths and weaknesses of the client during the session.

  • 9

    On the left a normal lumbar X-ray, on the right is zges lumbar X-ray. As you can see

    the image on the right has a much lower L5 vertebrae which is in line with

    sacralisation.

  • 10

    Sessions

    BASI Block 1-10 11-20 21-30 Warm Up Pelvic Curl

    Spine Twist Supine Chest Lift Chest Lift with Rotation Leg Lifts

    Roll up with Rub Spine Twist Supine Mini Roll ups Mini Roll ups with oblique

    Pelvic Curl Roll up Spine Twist Supine Double Leg Stretch Single Leg Stretch Criss Cross

    Foot Work Reformer: Parallel Heels&Toes V Position Toes Open V Heels&Toes Calf Raises Prances Prehensile Single Leg Heels&Toes

    Cadillac and Reformer: Parallel Heels&Toes V Position Toes Open V Heels&Toes Calf Raises Prances Single Leg Heels&Toes

    Cadillac, Reformer and Wunda Chair: Parallel Heels&Toes V Position Toes Open V Heels&Toes Calf Raises Prances (except Wunda Chair) Single Leg Heels&Toes

    Abdominal Work

    Reformer: Hundred Prep Mat: Chest Lift Chest Lift with Rotation Hundred Prep

    Reformer: Coordination Short Box Series Mat: Hundred Hamstring Pull 1 Cadillac: Roll up Top Loaded

    Reformer: Hundred Cadillac: Roll up Bottom Loaded Avalon: Hundred

    Hip Work Reformer: Frog Circles Down-Up Openings Cadillac: Frog Circles Down-up Walking Bicycle

    Reformer: Extended Frog Extended frog reverse Cadillac: -Single Leg Series Frog Circles Down-up Hip Extension Bicycle

    Cadillac: -Single Leg Series Frog Circles Down-up Hip Extension Bicycle Avalon: Frog Circles Down-Up Openings

    Spinal Articulation

    Pelvic Curl S

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