Pilates for Post-Op Cervical Spine Surgery Client
Erica Stuckey 11/6/14 2014 Breathe Pilates Studio The Woodlands, TX
Neck/back pain is one of the most common problems complained about in modern life. Our neck supports our brain and skull, which typically weighs 8-12 lbs. To maintain alignment we need appropriate musculature and correct posture. Some reasons that are attributed to neck pain today are: cell phone use, computer use, backpacks, and desk jobs. As we go through our daily lives we can injure ourselves, or chronic overuse conditions can cause more serious problems like bulging discs or herniated discs. These problems can require surgical repair especially when they accompany other symptoms like weakness, numbness and tingling, pain, and loss of function. This repair is called an anterior cervical micro-discectomy and fusion (ACDF). This surgery involves going through the anterior neck and placing new disc material between the vertebra, and fusing the spinal column with screws and plates. Surgical techniques have improved and success rates are very high.
Table of Contents
Table of Contents
Anatomical Descriptions and Diagrams
Anatomical Description and Diagrams
Normal Cervical Spine
Cervical Spine After Anterior Cervical Micro-discectomy and Fusion (ACDF)
The spinal column is the axis of the skeleton. Composed of 24 vertebrae, these vertebrae provide the protective bony corridor (spinal canal) through which the spinal cord passes; they can move to a certain extent and so give flexibility to the spine, allowing it to bend forward, sideways and, to a lesser extent, backward. In the areas of the neck and lower back, the spine also can pivot, which permits the turning of the head and torso. The seven cervical vertebrae, C1 – C7, which form the neck, support the skull. The head turns from side to side by means of a pivotal motion between the two highest vertebrae. Each vertebra is separated by a disc which acts as a cushion, and a spacer, between each space are nerves that branch off the spinal cord that innervate the head, face, neck and upper extremities. With injury or chronic overuse conditions damage to the discs can occur. The disc damage can be mild, minimal pain or deficits, or severe, with extreme pain, loss of function and disability. 4
Normal vs. Herniated Cervical Disc
Severely herniated discs, like the one pictured above, that cause spinal cord compression and nerve root compression require surgical intervention to relieve symptoms and regain functionality. If left untreated, there can be permanent nerve damage in the extremity affected. Surgeons may opt to have the patient stay overnight after surgery, and be discharged home the next day after walking is demonstrated. Typical recovery time is 6-8 weeks, but full healing takes much longer. Physical Therapy is usually started two weeks after surgery. Walking is considered one of the most beneficial recovery tools.
Pilates for Post-Op Cervical Spine Surgery Client
Erica is a nurse manager for a small free standing emergency room, prior to surgery she was an active and very busy person. She grew up dancing ballet, played viola and piano, and raised farm animals with her sister. Before her 39th birthday, she developed severe right shoulder and arm, pain and weakness with numbness and tingling in all fingers. She lost fine motor skills in her right hand, and had difficulty writing or starting IV’s on patients. This occurred overnight, she went to bed fine and the next morning had severe pain and difficulty raising her right arm. She was admitted to the hospital 3 days later for pain and possible stroke symptoms with the sudden occurrence of injury. A steroid injection in the neck was attempted to improve function, but only decreased pain. Two weeks later she underwent ACDF for repair of C5-C6, and C6-C7. After completing physical therapy and obtaining release from her neurosurgeon, she was referred to Breathe Pilates for additional therapy and strengthening. Treatment goals were to improve right arm strength and range of motion, improve spinal flexibility, and improve mobility. Initially she was unable to obtain flexion, and any use of the right arm caused tremors and shaking. After 1 year of Pilates she has decided to become BASI certified, inspired by the amount of strength and flexibility she obtained from Pilates. She is excited to use Pilates and body awareness to help her patients and future clients.
Conditioning Program Block System Using The BASI Approach This conditioning program will allow Erica to build core strength, without stressing the neck. If at any time she feels pain she is aware she should notify the instructor. As core strength and upper body strength improves then chest lifts and abdominal work requiring the neck to be lifted can be added as tolerated. Reformer All work done with head down, no chest lift, as core strength improves then chest lift is added as tolerated. Warm Up Pelvic Curl Leg Lifts/Leg Changes Single Leg Stretch (Head Down) Foot Work Parallel Heels Parallel Toes V-position toes Open V-position heels Open V-position toes Calf Raises Prances Single leg heel Single leg toes Abdominal Work Hundred Prep (Head Down) Arm Work (Block changed for flow) Arms Supine Series Extension Adduction Up Circles Down Circles Triceps Hip Work Frog Circles (Down/Up) Openings Spinal Articulation None for this client Stretches Standing Lunge Leg Work, Lateral Flexion/Rotation, Back Extension (Not done with this client in the beginning)
Cadillac Warm Up Pelvic Curl Leg Lifts/Leg Changes Single Leg Stretch Foot Work Parallel Heels Parallel Toes V-position toes Open V-position heels Open V-position toes Calf Raises Prances Single leg heel Single leg toes Abdominal Work Hundred Prep Mat Mini Roll Ups With Assist Hip Work Frog Circles (Down, Up) Walking Bicycle Spinal Articulation (Not done with this client in the beginning) Stretches Shoulder Stretch Arm Work Arms Standing Series Chest Expansion Hug-A-Tree Circles (Up and Down) Punches Biceps Leg Work Single Leg Side Series Changes Scissors Circles (Forward,Back) Lateral Flexion/Extension (Not done with this client in the beginning) Back Extension (Not done with this client in the beginning)
Auxillary and Mat Warm Up Mat Pelvic Curl Leg Lifts/Leg Changes Single Leg Stretch Step Barrel Chest Lift Reach Abdominal Work Mat Hundred Prep Roll Ups Hip Work Mat Leg Circles Spinal Articulation Mat Spine Stretch Stretches Arm Work Magic Circle Arms Bent Arms Straight Arms Overhead (if tolerated) Single Arm Side Press Single Arm Bicep Leg Work Sitting Series with Magic Circle Ankles Below Knees Above Knees Supine Series with Magic Circle Knees Ankles Lateral Flexion/Rotation Step Barrel Side Lift Back Extension Step Barrel Swan Prep 9
Conclusion Erica attended private sessions 2-3 times per week for 4 months and was fully released by her neurosurgeon. Goals attained were increased core strength, improved right arm strength and mobility, increased spinal extension (especially in the cervical area), improved shoulder flexability, and a general increase in muscle tone. Using the BASI block system and starting slowly, with stretches, limiting ROM, lighter spring settings for upper body, allowed Erica to meet and exceed her goals. All exercises that could possibly cause any additional pressure or injury to the cervical spine were removed. This training also increased her body awareness, to allow for corrections in posture and movement to prevent further injuries from occurring. Pilates is an excellent form of rehabilitation post-operatively or after injury, that allows clients to heal in a protective environment, it focuses on body alignment, balance and control. It allows for growth even with the fundamental exercises, and challenges you to improve each time you have a session.
Book “Study Guide: Comprehensive Course” Rael Isacowitz. ©2000-2014 Body Arts and Science International® (BASI Pilates®). “Movement Analysis, Mat Work, Reformer, Cadillac, Wunda Chair and Ladder Barrel, Auxiliary Equipment” Rael Isacowitz. ©2000-2014 Body Arts and Science International® (BASI Pilates®)
Website “Cervical Degenerative Disease.” SpineUniverse Case Study Library. 6 November 2014. http://www.spineuniverse.com/professional/case-studies/fessler/cervical-degenerative-disease Website “Normal Cervical Spine X-ray” EMed Handbook. 6 November 2014. http://www.emed.ie/Investigations/Xray_Spine.php