Pilates as Therapy for Non-Surgical Spinal Decompression Patients

Leciana Zappala June 1, 2016 2015 Costa Mesa, CA

Abstract Non-surgical spinal decompression is targeted unloading of the spine, using a computer controlled traction table or motorized device, to reduce disc bulges and herniations. It’s used to treat the following conditions: -Facetogenic back or neck pain -Sciatica (referred pain from the lumbar spine) -Bulging, herniated or degenerative discs -Worn spinal joints -Injured or diseased spinal nerve roots Although treatment protocols vary by patient most people require 20 sessions of decompression or “pulls” over a five-six week period. During this time the patient is to refrain from exercise or strenuous activity as the spine becomes vulnerable as it starts to heal. This case study will show how I used Pilates for lumbar spinal stabilization POST lumbar decompression treatment.

2

Table of Contents Abstract……………………………………………………………………………………………………………………………………2 Table of Contents……………………………………………………………………………………………………………………..3 Anatomical Description…………………………………………………………………………………………………………….4 Case Study………………………………………………………………………………………………………………………………..5 Conditioning Program………………………………………………………………………………………………………………6 Conclusion……………………………………………………………………………………………………………………………….8 Bibliography…………………………………………………………………………………………………………………………….9

3

Anatomical Description

Fig. 1 The spine is a column of 33 bones called vertebrae. The lumbar spine is the third major region of the spine; it is below the cervical and thoracic spine (Fig. 1). Although it is not unusual for someone to have six lumbar vertebrae, most people have five. Each vertebrae is stacked on top of the other and between each vertebrae is a gel-like cushion called an intervertebral disc. The discs help absorb pressure, distribute stress and keep the vertebrae from grinding against each other. 4

Fig.2 When the outer portion of the disc (annular fibers) is torn, the inner portion extrudes causing a herniation (Fig.2). This extrusion can compress the nerves around the disc and create pain and in some cases severe pain. A bulging disc is one in which the outer layer of the disc bulges into the spinal canal but the annular fibers are largely intact. (Fig. 2) Case Study Vicki is a 65 year old female who was diagnosed with bulging discs between L2, L3 and L4. She was an avid golfer until severe back pain caused her to stop the one sport she loved most. Outside of playing golf, Vicki was mostly sedentary. Having worked an “office” job most of her life she has the kyphotic posture that typically goes with it; rounded shoulders, tight hip flexors and weak abdominals and glutes. Being that Vicki had not had any other physical 5

trauma, we believe that the continuous golf swing, over a long period of time caused the damage to her spine as her core was not strong and stable enough to sustain that type of spinal rotation. Upon completion of her 20 decompression sessions, Vicki began her strengthening program with me. Conditioning Program Our goal was to decrease pain, increase mobility and strength and get her back on the golf course as soon as possible. This program emphasizes strengthening the abdominal muscles, especially the transverse abdominals and obliques; strengthening the back extensors and stretching the hip flexors. Vicki committed to doing Pilates twice per week for a minimum of four months. The first month was spent doing fundamental exercises and from there we slowly progressed to an intermediate level being mindful and cautious of exercises involving deep flexion of the lumbar spine. Sessions

1-10

11-20

21-30

Warm-up

Pelvic curl Spine twist supine Chest lift (no rotation)

Roll up with RUB Mini roll up Mini roll up oblique

Foot work

Reformer

Cadillac

Roll up Spine twist supine Double Leg stretch Single Leg stretch Criss Cross Chair

Abdominals

Reformer-Hundred prep

Cadillac- Roll up TL

Chair-Pike sitting

6

Hip work Spinal Articulation Stretches

Reformer-Supine leg series N/A

Cadillac-Basic leg springs

Reformer-Standing lunge

Reformer-Bottom lift Bottom lift w/ extention Reformer-Kneeling lunge

Full Body Integration

N/A

Reformer-Scooter

Arm Work

Reformer-Arms supine series Magic Circle-Sitting series

Magic Circle-Kneeling series Magic Circle- Supine series

Step Barrel-Side lift

Reformer-Mermaid

Step Barrel-Swan prep

Reformer-Breaststroke prep

Leg Work

Lateral Flexion Back Extension

Cadillac-Single leg supine series Reformer-Semi circle Reformer-Side split Reformer-Round back Flat back Reformer-Arms sitting series Chair-Leg press standing Hamstring curl Chair-Side stretch Chair-Swan basic

Although deep spinal flexion is not advised for disc patients, I did encourage movement through the lumbar spine as long as it did not cause pain. I did this by coaching Vicki on how to use her abdominals and hamstrings to produce the force behind mobilizing her lumbar spine while articulating her spine in Pilates. We were able to stay true to the above program most of the time. However, there were days we deviated due to flare ups of her bulging discs. On those days we refrained from any and all spinal flexion movements and incorporated isometric exercises.

7

Conclusion Although non-surgical spinal decompression has been around a long time and patients have had a lot of success with it, this case study demonstrated that doing Pilates post spinal decompression treatment is a vital part of strengthening and stabilizing muscles surrounding vulnerable vertebrae. After four months of Pilates Vicki’s goals had been met. Her mobility and strength increased significantly, her back pain was gone and she was back to playing golf. Additionally, Pilates helped Vicky regain a more athletic posture making her less kyphotic while standing over her golf ball. As a result, she has continued to incorporate Pilates into her lifestyle to maintain her hip mobility, core strength and thoracic extenstion.

8

Bibliography 1. WebMD, LLC (2015, January 27) http://www.webmd.com/back-pain/guide/spinaldecompression-therapy-surgical-nonsurgical. 2. Eidelson, Stewart, MD (2012, October 22) Lumbar Spine Low Back Anatomy [image] http://www.spinuniverse.com/anatomy/lumbar-spine 3. Mayo Clinic http://www.mayoclinic.org/diseases-conditions/herniateddisks/multimedia/bulging-and-herniated-disk/img-20007335

9