Prolapsed Disc & Pilates

Prolapsed, Herniated, Ruptured, Slipped - these are all basically the same condition resulting in the same symptoms.

The only description that we should question is "slipped". An intervertabral disc cannot slip. The more correct description would be prolapsed intervertebral disc. The reality is that the disc actually bursts.

The popular term slipped disc is misleading because an intervertebral disc is tightly sandwiched between two vertebrae to which the disc is attached - so it cannot "slip" or "slide", It can however be squeezed, stretched and twisted but in small degrees. It can also be torn, herniated and degenerate.

As Pilates teachers, how we think about a prolapsed disc is important, if we think about the disc "slipping" out of position - we might begin to think it might just as easily slip back in. However, one vertebral body can slip relative to an adjacent vertebral body. This is called Spondylolisthesis and can damage the disc between the two vertebrae.

This compounds the reason why we need to know that a client who says they have a herniated or prolapsed disc has been medically diagnosed.

Spinal Discs

The disc is a soft, spongy material between the bones of the spine. Each disc is made up to two parts - the outer covering called the Annulus, the inner core is the Nucleus.

The terms prolapse means that the nucleus moves and presses against the annulus but it is contained within the Annulus. A prolapse can produce a bulge in the disc. If it becomes large enough it can press against nearby spinal nerves causing pain.

Herniation describes a nucleus that has broken through the Annulus. A herniation can come into contact with the nerve root to irritate the nerve. The end result is the same and may involve pain, muscle weakness, numbness and or tingling sensations. Any disc in the spine can prolapse, however, the most common is between the 4th and 5th lumbar vertebrae as well as between the 5th lumbar and the top of the sacrum.

Most often ruptures occur at the back of the disc but to one side or the other (postero-lateral). Occasionally it may occur directly backward in the middle (central posterior prolapse).

Symptoms

Discs have virtually no nerve supply only when the prolapse presses onto a nerve or other vulnerable part of the spine will symptoms occur.

Pain is deep, dull and persistent, pain can also radiate to other places such as buttocks, hip or groin.

So what to do when a client tells you they have a problem such as a prolapsed disc?

First and foremost you need to be clear that the condition has been medically diagnosed, that the client understands their own position with regard to exercising. It is difficult these days to get a medical professional to confirm in writing that it is safe for a client to exercise. However there are some steps we can take as Pilates teachers to cope with a client who has disc issues.

Questions to ask your client when they present with a prolapsed disc:

1. Has your condition been medically diagnosed?
2. Are you seeing a physiotherapist or taking any physical therapy?
3. Are you in pain?
4. What make the pain worse?
5. What makes it better?

Sometimes a client will tell you that bending in some ways increases or causes pain, or that when they stand up straight it causes discomfort. Gathering as much information as possible will be helpful.

Recovery

People who suffer prolapsed discs often recover quickly, although they may always be vulnerable to future bouts of low back pain working with a Pilates programme will help to either delay or completely reduce the risk of re-occurance.

What types of movement will be helpful?

If the prolapse is recent then supine work is the best place to start. Modified versions of:

• 100
• One leg circle
• Single Leg Stretch
• Double Leg Stretch
• Scissors
• Shoulder Bridge without the articulation

Prone Exercises such as modified Swan Dive will also be helpful together with prone single leg raises (prone swimming modified) All of the above will focus on stability and core strength as well as some mobility.

Client Responsibility

Of course you need to keep in close communication with the client - they need to take responsibility for their situation and let you know if they feel nervous about anything or experience discomfort or pain.

Personal training is a safer option than a group class. You will more easily be able to control the speed and quality of the movements in a one to one situation.

Activities that aggravate a prolaped disc

• Sitting for long periods of time
• Bending
• Lifting with poor technique
• Coughing
• Sneezing

Potential Causes of Prolapsed Disc

• Poor posture
• Sedentary lifestyle
• Being overweight
• A lifestyle that includes a lot of sitting, bending or lifting

Pilates Is The Answer

When we consider some of the reasons for the degeneration of spinal discs we can see why Pilates is the ideal fitness programme to help with rehabilitation. The important thing is the need for modification of the original programme. Teaching a client how to find and maintain their neutral spinal alignment whilst performing modified version of the exercises will be a key element to a client's recovery.

Follow the bouncing ball?

A simple recommendation for a client with a prolapsed disc is to suggest they sit on a stability ball and gently bounce up and down. This easy activity will keep blood flowing to the spine bringing with it nutrients that will help to heal the injury.

Finally

First and foremost when we are faced with a client who wants to take our Pilates sessions but presents with disc issues - a prolapsed disc is very common, we need to ensure that we are clear about the level of discomfort the client has at the moment also that they have been cleared to exercise.

Modified versions of the Pilates repertoire together with clear guidelines for finding and maintaining neutral alignment whilst performing the exercises is the basis for improving core strength, stability, flexibility and movement control. All of the above will assist with the recovery and rehabilitation of the client. In an ideal world some guidance from their medical professional is always helpful. There are many things we can offer this type of client, the question to ask the medical professional is what we must not attempt with their patient.

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