Pilates for Lower Back Pain

‘Pilates for lower back pain’
By Adam Donoghue
16 Roope St, New Town, Hobart Australia
May 2014
Maroochydore Course, Australia
ABSTRACT
Lower back pain (LBP) is a huge problem in society, it’s estimated that 25% of all physical
therapy visits in the U.S. are people with lower back pain*. World-wide there’s an
incidence of LBP with 80-90% of people during one’s life*.
There are a number of causes of LBP. This paper is focused specifically on a fairly typical
scenario. The case study is of a woman with poor posture (hyperlordosis) and disc bulge,
she spends extended periods sitting (shortening hamstrings) and limiting movement in
body, and does gardening in her spare time (over doing forward flexion).
It is recommended she start a tailored Pilates conditioning program. The program aims to
get balance in body to reduce load on her lower back. It does this by strengthening weak
areas (core muscles, hip abductors, upper back stabilizers). And stretching out tight areas
(psoas, hamstrings). There is an emphasis throughout the program to improve body
awareness and postural correction in the hope that she takes these new skills into her
work and play.
*Source: Basi Injuries & Pathologies Advanced Education Course Handout (2013)
Table of Contents
Page 2
Abstract
Page 3
Table of Contents
Page 4
Anatomical Description and Diagram
Page 5
Introduction
Page 6
Case Study and Conditioning Program
Page 7
Program Chart with Reasons for selecting & desired results
Page 8
Conclusion
Page 9
Bibliography
ANATOMICAL DESCRIPTION AND DIAGRAM
Lumber Spine- There are 5 lumber vertebrae (L1 to L5), 5 fused bones that form the
sacrum, and 3 to 5 fused bones that form the tailbone (coccyx).
Individual vertebra are made up of several parts. The body of the vertebra is the primary
area of weight bearing and provides a resting place for the fibrous discs which separate
each of the vertebrae. The lamina covers the spinal canal, the large hole in the center of
the vertebra through which the spinal nerves pass. The spinous process is the bone you
can feel when running your hands down your back. The paired transverse processes are
oriented 90 degrees to the spinous process and provide attachment for back muscles.
Spinal Nerves- The spinal cord is made up of nerves that extend from the brain into the
spinal canal and then out to various parts of the body. Nerve roots are the points where
nerves leave the spine and form nerve branches to parts of the body.
Main muscles of the lumber spine- the erector spinae are long muscles are on either
side of the spine; these are usually the culprits if there are muscle spasms in the back.
Under these are medium length muscles that extend from one vertebrae to the next. At
the front of the body the psoas muscle runs from the front and sides of lower spine across
the hip joint and attaches to the femur bone. The front of the body houses the all important
abdominal muscles (transverses abdominus, oblique’s, rectus abdominus, multifidus).
These muscles are critical to your spines forward movement and provide support for your
back.
HOW THE SPINE MOVES
There are four facet joints associated with each vertebra. A pair that face upward and
another pair that face downward. These interlock with the adjacent vertebrae and provide
stability to the spine. The vertebrae are separated by intervertebral discs which act as
cushions between the bones. Each disc is made up of two parts. The hard, tough outer
layer called the annulus surrounds a mushy, moist center termed the nucleus.
The movements of the majority of the spine (except the cervical spine) are limited by the
various ligaments that attach the vertebrae to one another and also by the shape of the
facets, discs and spinous processes. Movement between ant two vertebrae is quite
limited however the total amount of movement in a given region can be considerable.
Lumbar vertebrae are massive for weight bearing and are designed to bear 80% of the
weight. The facets have a sagittal orientation allowing little rotation, but a lot of flexion,
extension. With spinal discs the nucleus attracts fluid to keep it hydrated to absorb force.
The discs reply on regular movements of the spine to assist in the drawing in of fluid to
keep them healthy.
CASE STUDY
Client: Fiona Smith
Occupation: admin work, spends 8 hours + a day sitting
Age: 50 Hobbies: gardening (forward bending)
Limitations: lower back pain for 10 years + due to poor posture and disc bulge posterior
L2/L3 for 3 years
Rehabilitation treatments: has tried physio with some relief but keeps getting pain coming
back due to posture and muscle imbalance.
CONDITIONING PROGRAM
Problem: Poor posture with hyper-lordosis, therefore weak abdominals, tight psoas, weak
inner thigh muscles, poor knee alignment (locked in joints), tight hamstrings, shoulders
pushed too far back, chin and neck too far forward.
Programs General Goals: Get balance in body to reduce load on lower back. Strengthen
weak areas (core muscles, hip abductors, upper back stabilizers). Stretch out tight areas
(psoas, hamstrings). Improve body awareness and postural correction.
General Exercises: Back extension good to squeeze opposite way on lumber discs.
Flexibility and strength around the hip flexors and extensors. Strengthen knee extensors.
stretch calves. Alignment of core in neutral while doing exercise with arms or legs through
full range (eg. footwork, arm work and hipwork).
Avoid: avoid loaded flexion, vertical loading of discs and strong rotation.
BLOCK Warm Up
Foot Work
EXERCISE DESIRED RESULTS REASON FOR SELECTING lying on roller (shoulder Improving awareness and
Finding Neutral and core. Getting
retract/protract, pelvic
alignment of body. Preparing stability around pelvis.
hitches and tilts, arm
core for exercise. Awareness of
floats, balance awareness), centre of gravity.
Pelvic curl, chest lift +
Massage/release of erector
rotation. Single leg lifts. spinae.
Roll-like a ball.
Footwork on Wunda Chair Improved posture in sitting and Unsupported posture so better to
awareness of neutral spine.
ensure core in on while doing
Knee flexor strength & control. footwork. Also helps to get good
Hip flexor strength and control. sitting habits for her work.
Stretch calves.
Abdominal Work
Roll up with roll up bar
Abdominal strength and
control. Trunk stability
Hip Work
Hip work series on
reformer
Improve knee extensor control Core stability while strengthening
and pelvic lumbar stability.
legs.
Strengthen adductors and
hamstrings.
Spinal Articulation
Bottom Lift
Hamstring and Abdominal
strength. Smooth and
controlled spinal movement.
Can modify with springs and footbar
height to ensure theres good control.
Stretches
Standing Lunge
Stretch hamstrings and hip
flexors.
Also gets client keeping spinal
alignment while stretching these
tight areas.
Full Body Integration 1 Scooter
Strengthen abdominals.
Strengthen hip & knee
extensors. Trunk stability.
Shoulder awareness and scapula
stability. Body awareness.
Arm Work
Scapula control, Shoulder
Good to reinforce correct standing
strength and control, symmetry posture while working arms.
left to right. Functional
postural awareness.
Arms standing series
Get spine moving with control and
support. Can adjust springs to
ensure client has good form.
Full Body Integration 1 Down stretch
(instead of 2)
Shoulder control and stability. (Not ready for challenging FBI 2).
Trunk stability.
Getting Abdominals & back
extensors working together.
Additional Leg Work
Gluteals kneeling series
Strengthen hip extensors and Focus on pelvic lumber stability and
abductors. Improve stability at strengthening the hip area.
hip and torso while moving
leg.
Lateral
Flexion/Rotation
Side stretch on chair
Strengthen the obliques.
Stretch lateral flexors.
Back Extension
Breaststroke prep
Strengthen back extensors and Combines scapula stability with
shoulder stabilizers. Open out back extension.
lumber discs opposite to bulge
disc.
Good to find neutral spine in a
diagonal orientation and strengthen
core.
CONDITIONING PROGRAM
CONCLUSION
• Often pain inhibits movement so aim is to keep areas moving pain free to maintain range
and restore confidence in body.
• Strong focus of program is in postural re-education to improve posture and body
awareness in space (ability to correct to a functional position). This is important as pain
often changes the default way you use your body.
• Restoring balance in body by strengthening weak areas and stretching tight areas with
an emphasis on neutral spine while moving.
• Frequency of the program is important as we want to create good habits and obviously
the more practice the easier it is to break incorrect habits (recommend 2 to 3 sessions
per week one on one initially till suitable for a small group).
• Encourage client to take the core stability and awareness into their work (sitting at desk
posture) and hobbies etc.
• Give client some basic stretches and core awareness exercises to do daily.
(STRETCHES: hamstring, hip flexor. CORE: Pelvic curl, chest lift, leg floats, roll like a
ball).
BIBLIOGRAPHY
Basi Injuries & Pathologies Advanced Education Course Handout (2013)
Basi Movement Analysis Workbooks
Burn, Dr Loic (2007) Treating your back and neck pain for dummies, John Wiley & Sons,
UK.
Dru Yoga Teacher Training Notes
Fine Judylaine (2000) The Ultimate Back Book, Stoddart Publisher.
Highsmith, Jason (2011) The Complete Idiots Guide to Back Pain, Alpha, New York.
Jenkins, David (1991) Functional Anatomy of the Limbs And Back, Saunders, Sydney.
Lacey Laurie (2012) Yoga for Arthritis Workshop Handout, Hobart Australia.
Marcus, Norman (2012) End Back Pain Forever, Atria, New York.
McIlwain, Harris (2004) The Pain Free Back, Henry Holt, New York.
Robinson, Lynne (2002) The Body Control Pilates Back Book, Pan, London.
Siegel, Dr Ronald (2001) Back Sense, Vermilion, London.
Vad, Vijay MD (2004) Back Rx, Gotham Books, New York
Wharton, Jim & Phil (2004) The Whartons Back Book, Rodale, London.