Forum / Let's Discuss! / Bulging/Herniated Lumbar discs....modifications or alternate exercises

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On: June 07, 2015 17:05 PM
Hello! Let me first say how amazing it is to have this resource at hand, I don't know where else I would turn...thank you! THe question...the studio where I teach is amazing and the owner is wonderful about allowing everyone into class, it definitely makes us work harder as teachers to be creative about providing a challenging but safe workout for all. I am struggling with a host of clients who, for one lumbar disc bulge or another, do not do lumbar flexion. The studio as a rule has told those clients to hinge back and hold and return, for each roll up or other lumbar flexion exercise the rest of the class does. I am wondering if you have any other ideas for alternate exercises? or possibly just talk about how you would handle the class? Thanks so much!!
On: June 08, 2015 12:54 PM
Hi Jaclyn, We are thrilled you are getting so much out of our site. Hearing the positive feedback keeps us going. This is a great question. There are a number of individuals that cannot tolerate flexion and a question that I have been asking myself more and more is even in healthy bodies in our culture do we really need to be training flexion so much? The classical work is so heavy into flexion choreography and to balance our clients coming in the door we need more side bending, rotation, extension , neutral and transitional choreography. When a client comes in and says " I can never go into flexion", I ask them how they pick up anything from the floor, how they brush their teeth and I guess they are not doing any yard work. The point is that to live daily life we have to at least explore flexion a bit. The studio should be a place where the client can explore this in a safe way. I think the options your studio has for these clients are good. They could also do a flat back bridge and they could even have a head start by placing a pillow under their tush. If using the pillow set up some may be able to articulate back down into the pillow. You could also do a very deflated overball at the mid back with a pillow behind the head and ask them to do a small head float . Another idea is to put the deflated overball behind the pelvis and have them do a very small pelvic rock. I will be sure to answer this question in an upcoming Pilates Show so you can actually see some of these on film. Love Jen
On: June 08, 2015 19:24 PM
Hi Jen! Thanks so much as always for the quick replies. I am so so glad to hear you say that "to live daily life we have to at least explore flexion a bit". I had a conversation with a client this evening, and I shared a similar sentiment: Over 6 months I have seen Elaine, a "non-flexor", make actual changes; she has a strong desire to learn, feel, and understand her body. Tonight she told me she's been feeling stronger and she went for a run today. I asked her when she was last seen for her slipped disc (2 years ago). I didn't want to go against studio protocol, or suggest anything unsafe for her; so I suggested that she go see her physician to check the staus of the bulge. I explained my thinking was that flexion of the spine is a normal healthy movement, and especially if she is feeling this good, it would be a wonderful thing if she could begin exploring this movement pattern again. I hope you would agree with my recommendation. I can't wait to try all of your suggestions and I look forward to the video. Can't thank you enough, thanks for being awesome!
On: June 10, 2015 05:58 AM
I think it is a great idea to get the doctor's go ahead, and then ease into supported flexion like Jen talked about below! As the old Yogi saying goes... "We are only as young as our spine is flexible!" I could not agree more on what you and Jen have discussed... Keep up the good work! Love, Casey
On: June 18, 2015 04:48 AM
I was going to post a similar question, and this was just the information I was looking for. I have a client with a herniated lumbar disc who was showing me some of the ways she was taught by a PT to pick up items lower to the ground, etc. by using a flat back and "T-Rex arms", and using a flat back in general as opposed to any sort of flexion when she is "bending over" in her everyday activities. Just as you all mentioned, my thought was that she still needed to experience safe exercises with some flexion/mobility in the spine. So I really like all the suggestions here! Would this also apply to another client of mine who is missing a lumbar disc? Or are there any other additional modifications needed for that? Thanks, as always, for your support and guidance! Cailin
On: June 19, 2015 04:58 AM
Hi Cailin! Great questions! In reference to your client with the lumbar disc injury, make sure they are well healed and out of pain before you start to experiment too much with flexion. That is the best way to approach introducing gentle, unloaded flexion. A nice way to start would be MJ's breath work with the smartspine tubbies under the pelvis! Now for your client without a lumbar disc... were they born without it, or did they have a discectomy? Are there any other spinal issues, or support structures in place? That will help in the answer! Let me know so we can mull it over! Typically the area where the disc isn't needs lots and lots of space and cueing. The discs above and below the site usually take on much of the load that the missing disc leaves behind. Get back to me so we can brainstorm! Love, Casey Marie
On: July 29, 2015 17:27 PM
Hi Casey! Yes, I love MJ's breath work with the tubbies under the pelvis, and have been using this with clients with great success! Even with regular long-time clients, there are days when they come into the studio and really need this in the session because the low back is super tight and they just can't move the pelvis with ease. The tubbies are wonderful! Nice idea to introduce gentle flexion for those with lumbar disc injuries as well. Thanks! For the client with no lumbar disc, she told me that she was born with the disc but that she believed a sports injury many years ago (and she couldn't recall one specific incident since she was very active) was the start of the issue, which led to degenerative disc disease and eventually no disc. She has been doing Pilates for years, currently works with me in a group class one day per week and another instructor in group classes 2 days per week. She prefers groups instead of privates. She said that flexion makes her back feel really good, and extension is what bothers her. She has no other spinal issues or support structures, but she does have recurring pain/discomfort in her left hip. Thanks for working this through with me! Every single client keeps me on my toes :) Cailin
On: July 31, 2015 10:38 AM
Ahhhhh I see! Well, figuratively so! I would really work hip point release work with her and start to work her into some gentle spinal extension with lots of length. Maybe even on the sitting box as to get out of any hip tension tissues that would impede spinal movement in prone. Sounds like she needs work in that department as that gives her some pain. I am guessing that she probably does a good bit of butt gripping because of that, and how active she has been in the past. It is so hard to work with people with spinal issues in group classes... nearly impossible really! See if she will do 30 minutes with you before or after class to fine tune what would otherwise be missed! I would work her with lots of support props (heated smartspines especially!) so she can establish length in movement. And obviously TONS of multifidus activation throughout every moment of her exercises! Neutral spine should be supported and please please make sure before you do any long lever leg work she has complete command of her femur "slurp". This detail can often get over looked and under used in matt classes. As a note it would be a great idea to check in with her PT or doctor to gather additional info as how to proceed in group classes and privately! Hope this helps! Much Love, Casey Marie Herdt
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