1

PILATE FOR HERNIATED DISC

AND SCIATICA

7 MAY 2019

By:

Wai Fun, LOW

Kuala Lumpur, Malaysia

Comprehensive Global Pilates Course

Dynamic Pilates Australia/Manly, AUSTRALIA

2

ABSTRACT

This paper discusses herniated disc and sciatica, its related causes as well as symptoms and

how programming selected pilates exercises with the necessary modifications can be

beneficial for an individual with herniated disc and sciatica. Several precautions when

performing pilates practice may need to be taken depending on the causes of herniated disc

and sciatica in order not to aggravate its symptoms. Certain exercises may not work well

with clients faced with this condition and modifications may be required or leaving out

selected exercises completely may be best in order for clients not feeling the pain in the next

day or during the exercise.

It is also very important for a pilates instructor to ask the relevant questions and find out as

much information as possible from the client in regards to their condition. In addition,

working with a medical practitioner would also be beneficial in order to have a clear picture

as to the actual cause of the condition since different causes or symptoms may require

different exercise programming and pilates modifications.

This paper discusses the relevant pilates exercise programming in relation to the case study

of a client. The objectives when dealing with herniated disc and sciatica clients would be to

focus on core stabilisation and strengthening as well as regular stretching on a neutral spine

(avoiding extreme flexion, extension and twisting) and stretching out the lower extremities.

This will assist to ease the pressure on the disc causing compression on the nerves.

3

TABLE OF CONTENTS

Title Page 1

Abstract 2

Table of Content 3

Anatomy – The Spine 4

Herniated Disc Definition 6

Sciatica Definition 8

Case Study 10

Contraindications and Goals 11

BASI Block System Exercise Programming 13

Conclusion 16

References 17

4

ANATOMY – THE SPINE

The spine is made up of 33 bones called vertebrae. They are stacked one upon the next to form column like structure. The vertebrae are arranged in five (5) regions namely: -

Cervical

The top seven (7) vertebrae that span from the head to the base of the neck. Essential for movements of the head and neck.

Thoracic

The next twelve (12) vertebrae are the thoracic vertebrae. They span from just below the neck to the last rib. Key movements of thorax and upper back.

Lumbar

The next five (5) vertebrae are the lumbar vertebrae, which spans from the last rib to the pelvic girdle. Key movements of lower back.

Sacrum

The next five (5) vertebrae are called the sacral vertebrae. Movements at this joint have a profound influence on alignment of the lower back and pelvis.

Coccyx

The last four vertebrae are often collectively referred to as the tailbone.

5

Intervertebral Disk

Between each vertebra is an intervertebral disc. The discs are filled with a gelatinous

substance, called the nucleus pulposus, which provides cushioning to the spinal column. The

annulus fibrosus (Outer layer of the disc) is a fibrocartilaginous ring that surrounds the

nucleus pulposus, which keeps the nucleus pulposus intact when forces are applied to the

spinal column. The nucleus pulpous has a high-water content and the discs can be likened to

little water cushions between the vertebrae that are vital for shock absorption and protection

of the spine during everyday activities such as walking, running and jumping.

6

HERNIATED DISC

While the intervertebral discs do not actually "slip," a disc may bulge, split, or rupture. This

can cause the disc cartilage and nearby tissue to fail (herniate), allowing the inner gel portion

of the disc to escape into the surrounding tissue. This protruding, jelly-like substance can

place pressure on the spinal cord or on an adjacent nerve to cause symptoms of pain,

numbness, or weakness either around the damaged disc or anywhere along the area supplied

by that nerve.

The layman's term "slipped disc" is, therefore inaccurate and actually refers to a condition

whereby portions of an abnormal, injured, or degenerated disc have protruded against

adjacent nerve tissues. This condition is also known as a slipped disk, herniated disc,

ruptured disc, or prolapsed disc. The most frequently affected area is in the low back, but any

disc can rupture, including those in the cervical area.

7

Causes and Risk Factors of a Herniated Disc

Risk factors that lead to a herniated disc include aging with associated degeneration and loss

of elasticity of the discs and supporting structures; injury from improper lifting, especially if

accompanied by twisting or turning; and excessive strain forces associated with physical

activities.

What Are Symptoms of a Herniated Disc?

The nerves of the body exit the spine at each spinal level in the low back, mid back, and neck.

A herniated disc can produce symptoms anywhere along the course of that nerve, though the

injury and irritation of the nerve are at the spine itself. (This is known as referred pain, as the

pain is "referred" from the source of the problem in the spine to the area supplied by the

affected nerve.) A herniated disc can produce varying degrees of pain in the back or neck

along with numbness or weakness in the corresponding organs, arms, or legs as follows:

For herniated discs in the neck: Neck symptoms and other associated symptoms

include numbness, tingling, weakness, or pain in the shoulder, neck, arm, or hand.

Symptoms of a herniated disc in the neck often increase or decrease with neck

motion.

For herniated discs in the lower back, back symptoms include

o Pain down the back of each leg from the buttocks to the knee or beyond (this

is called sciatica, as it affects the sciatic nerve)

o Numbness, tingling, weakness, or pain in the buttocks, back, legs, or feet or all

of these as in sciatica

o Numbness and tingling around the anus or genitals

o Pain with movement, straining, coughing, or doing leg raises

o Difficulty controlling bowel movements or bladder function

8

SCIATICA

Source: https://medicalartlibrary.com/sciatic-nerve/

The sciatic nerve is the largest nerve in the body and arises from the L4 through S3 spinal

nerves (and their roots). Sciatica describes as pain radiating from your back, into your

buttock and down your leg. The sciatic nerve provides most of the motor and sensory activity

to the lower limbs. Pressure on the sciatic nerve anywhere along its pathway can cause

irritation and inflammation, therefore causing increased pain. Sciatic pain tends to occur

only in one leg. It is generally aggravated by sitting and bending. Leg pain is described as

burning, tingling of the affected leg.

The most common cause of sciatica is impingement or compression of a nerve root by a

herniated disc (as described above) . A lumbar disc can bulge or herniate putting pressure on

the sciatic nerve. Likewise, osteoarthritis can cause overgrowth of bone which narrows the

spinal canal or foramen. Other causes of sciatic include (sciatic nerve may be compressed by

piriformis muscle as it exits the pelvis) spinal stenosis, degenerative disc disease,

spondylolisthesis, piriformis syndrome and sacroiliac joint dysfunction.

9

10

CASE STUDY

ST is a 55 years old male with a herniated disc between the 4th and 5th lumbar vertebra

(L4-L5). ST injured himself during the younger days playing games such as football and

badminton. He had several times fell down during sports and despite the pain for many

years, left it untreated. He had been experiencing pain on the back and neck for many years,

tingling as well as numb sensations on arms and legs and until approximately 4-5 years ago

only started seeing an orthopaedic which confirmed a herniated disc on L4 and L5 via MRI

scan. He also suffered from sciatica. He underwent physio for six (6) months and started

seeing a chiropractor for manual adjustments but did not find long term relief. Coughing,

sneezing, sitting, driving, and bending forward may at times make the pain worse due to the

pressure on the nerve.

ST is now searching for a safe and effective program that will help reduce his low back pain

and complimenting Pilates with massage and chiropractor adjustments.

Issues faced by client:

Low Back pain

Neck pain

Numbness and tingling sensations occasionally on buttocks, back, arms and legs

Experience occasion pain with movement, straining, coughing, or doing leg raises

Tight hamstrings and hip flexors

Core weakness

Weak arms

11

CONTRAINDICATIONS AND GOALS

Disc Herniation

General precautions and contraindications

Goals

Avoid deep lumbar flexion

Avoid compression

Avoid severe rotation

Initially avoid flexion, lateral flexion,

rotation and combined flexion and

rotation unless directed otherwise by

treating practitioner

Use neutral to extension exercises to

increase stability and reduce symptoms

Work small pain free range of motion

and increase range gradually

Unload disk

Extension based exercises

Core stabilisation

Increase strength

Improve lower extreme

flexibility

Improve posture

Reference: Pilates For Rehabiliation by Samantha Wood, p230

Reference: http://nationalpilates.com.au

Sciatica

General precautions and contraindications

Goals

Specific precautions depend on the source

of nerve compression, most likely due to

disk pathology, therefore to follow the

above table and as listed again below:-

Avoid deep lumbar flexion

Avoid compression

Avoid severe rotation

Unload disk

Core stabilisation

Increase strength

Improve lower extreme

flexibility

Improve posture

Source: Pilates For Rehabiliation by Samantha Wood, p236

12

“Generally, the following positions or movements may not be suitable for sciatica clients

depending on the individual or the cause of sciatica.

1. Exercises that involve straight leg raise

2. Exercises that involve strong spinal rotation

3. Avoid exercises that involve spinal flexion

4. Avoid exercises that involve vertical loading (seated, standing or inverted) positions

Source: https://ballsbridgephysio.ie/news/pilates-exercises-to-ease-sciatica/

“Specifically, if the sciatic pain has come on due to spinal stenosis, or spondylolisthesis,

flexion based exercises will provide most relief. Examples of this would be doing a rest

position or cat stretch.

Sciatic pain originating from compression by the piriformis or glute medius muscles will

respond best to gentle stretching of the glutes, by pulling your knee diagonally across

towards the opposite shoulder.

If sciatic pain is being caused by impingement or irritation from a lumbar disc bulge,

extension based exercises are most suitable. One common example would be the basic back

extension, which is performed by lying prone, and pushing through your arms to extend your

lower back.”

Source: https://ballsbridgephysio.ie/news/pilates-exercises-to-ease-sciatica/

“If the sciatica is coming from a herniated disc, then we have to take all the disc

precautions. Disc precautions include not going into unnecessary flexion, and

sometimes extension. Avoid overusing the buttocks and the piriformis muscles.

Avoid putting the nerve on stretch. Avoid too much flexion (forward bending) in

the lumbar spine which could irritate the nerve if there is a disc lesion. Again,

work from a neutral spine, get things to move and relax, and get the core strong.

You can do a lot of Pilates and still remove stressors on the sciatic nerve. ”

Source: https://sumofusstudio.com.au/pilates-sciatica-treatment/

13

BASI BLOCK SYSTEM EXERCISE PROGRAMMING

The following programming serves as a guideline for client, ST. Nonetheless, it is important

to communicate with the client constantly on how he feels throughout the exercise as every

individual is different. Modifications and necessary adjustments are to be made during

every pilates session with the client. And everyday and every session, client may feel

different.

Sessions 1-10 Sessions 11-20

WARM UP Pelvic curl

(neutral position)

Spine Twist Supine

Chest Lift

(on spine corrector in neutral

position)

Chest Lift with Rotation

(on spine corrector in neutral

position)

Pelvic curl (neutral position)

Spine Twist Supine

Chest Lift (on spine corrector

in neutral position)

Chest Lift with Rotation (on

spine corrector in neutral

position)

Maintain the above warm up until client feels

good to perform intermediate warm up:

Pelvic curl/Roll up

Spine Twist Supine

Double leg stretch (head

down)

Single leg stretch (head down)

Criss cross (head down)

FOOTWORK Reformer

Parallel heels

Parallel toes

V-position toes

Open V-position heels

Open V-position toes

Calf raises

Prances

Prehensile

Single leg

Single leg toes

Wunda Chair

Parallel heels

Parallel toes

V-position toes

Open V-position heels

Open V-position toes

Calf raises

Single leg heels

Single leg toes

ABDOMINALS Reformer

Hundred prep – Head down

Hundred – head down

Cadillac

Breathing with PTBar

(neutral spine)

14

Bottom lift with RUBar

(neutral spine)

HIP WORK Reformer

Supine Leg Series:

Frog

Circles Down

Circles Up

Openings

Reformer

Extended Frog

Extended Frog Reverse

SPINAL

ARTICULATION

- Bottom lift (neutral spine)

Bottom lift with extension

(neutral spine)

STRETCHES Reformer

Standing lunge

Reformer

Side split

FULL BODY

INTEGRATION F/I

Reformer

Knee stretch (Flat back)

Reformer

Down stretch

ARM WORK Reformer

Arms Supine Series

Extension

Adduction

Circles Up

Circles Down

Triceps

Reformer

Arms Kneeling Series

Chest Expansion

Circles Up

Circles Down

Triceps

Biceps

FULL BODY

INTEGRATION I/A

- Reformer

Long stretch

LEG WORK Chair

Leg press standing

Reformer

Single Leg Skating

Chair

Hamstring Curl

LATERAL

FLEXION/

ROTATION

Chair

Side Stretch

Reformer

Mermaid (if client feels good

to perform the exercise)

BACK EXTENSION Chair

Swan Basic

Reformer

Breast stroke Prep

15

Progression

Pulling straps 1&2

Observation

Initially, client feels very limited in terms of its range of motion. After several pilates sessions, client

starts to feel stronger and able to increase the range of motion. He feels taller and manage to

maintain a better posture. He also feels that there is less strain on his back, neck and shoulder and his

flexibility improves.

In summary, client feels better in terms of the following:-

Back initially feels a bit sore but feels great thereafter

Neck pain decreases

Shoulder feels more stretched and opened

Back feels stretched and good

Feels tired after class but after resting he feels better. His energy improves after several sessions

Client feels that the slow controlled movement of pilates coupled with right breathing makes him feel

good, stronger and more stretched after class.

16

CONCLUSION

In conclusion, Pilates can be tailored to specific individual with various conditions. It is vital

to communicate with clients constantly on how they feel before starting class, during and

after class to better understand their individual response towards the exercise programming.

Exercises should also be performed following the principles of pilates which is awareness,

balance, breath, concentration, center, control, efficiency, flow, precision and harmony in

order to deliver the best results. Integrating the pilates principles when performing pilates

exercises will result in smooth, controlled movements increasing its effectiveness. When

performed right with correct breathing, precision and focus, quality matters more than

quantity.

17

REFERENCES

Rael Isacowitz and Karen Clippinger, Pilates Anatomy, 2011

Samantha Wood, Pilates For Rehabilitation, 2019

https://painstopclinics.com/condition/sciatica/

https://www.verywellfit.com/how-pilates-exercises-can-help-relieve-sciatica-2704621

https://painstopclinics.com/stop-sciatica-pain-with-pilates/

https://www.spineuniverse.com/conditions/sciatica

https://paindoctor.com/pilates-for-sciatica/

https://www.pilatesfoundation.com/assets/Uploads/member-resources/Sciatica-Holly-

Nuttal.pdf

http://pilates-pro.com/pilates-pro/2008/4/21/teaching-pilates-clients-with-sciatica.html

https://theverticalworkshop.wordpress.com/2013/02/17/colleague-questions-sciatica/

https://en.wikipedia.org/wiki/Intervertebral_disc

https://medlineplus.gov/ency/imagepages/19469.htm

(https://ballsbridgephysio.ie/news/pilates-exercises-to-ease-sciatica/)