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Where do I Start a Pilates student who has a Disc Herniation?

Where Do I Start with Someone Who Has a Disc Herniation?

adaptations Feb 17, 2021

An important part of recovery from a herniated disc is exercise. But which specific exercises can help a person ensure the long-term health of their spine? Here's my answer from one of my Live Q&A Calls:

Where do I start with someone who has a disc herniation? My student has seen a surgeon who said that, because there is no longer any pain (only a numb foot), he should strengthen his core. He had not exercised prior to the disc herniation, is middle-aged, overweight, and in a physical job where the injury occurred. He is currently wearing a brace. While I realize extension exercises initially help, when does a Pilates instructor introduce gentle flexion and rotation?

You mentioned that your client is no longer in pain, but is still experiencing numbness. Unfortunately, numbness can take quite a while to undo itself. It takes time for the nerves to grow back.  Nerves send signals to the muscle to get it to fire. If the nerve doesn't send that signal, then the muscle is not getting the message to work. It's a little bit frustrating and sometimes hard to strengthen that area.

It's important to know which segment of the spine is herniated and focus on that. Start with neutral spine exercises and do a lot of core work. If the student tolerates it, gentle extension may be appropriate, too. The goal is to strengthen the core so it can keep the injured segment of the spine stable while mobilizing all the areas around it so they can still move.

If your student can tolerate the gentle flexion of an imprinted position, give them mat homework exercises for the core. Emphasize the importance of daily home exercise. Doing a full apparatus session at the studio once per week is going to be less effective than a daily 20-minute home routine. Explain that if he'll do his exercises in the morning, he'll prepare his body for the day. His back and core muscles will be better able to support his spine during the day. It will set the tone for the whole day. If he can only fit in his exercises in the evening, then that's okay too, although the benefit will be slightly reduced. The home program doesn't have to be long. As always, quality over quantity. 15-minutes of great core exercises can be highly beneficial. Try Marching, Chest Lift, Table Top, Dead BugsSingle Leg Stretch, and a regression of Double Leg Stretch, if tolerable. Try Front Control, Back Control, Quadruped Knee Hover, and one or two frontal plane core stability exercises, either Side Balance, Side Plank, or Kneeling Obliques.

On apparatus, try Flat Back Hinge on the Trapeze Table/Tower, Short Box Flat Back and isometric Side Sit Up on the Reformer or Ladder Barrel, Side Balance on the Chair.

I recommend that you incorporate gentle traction exercises to increase the space between the discs. This will help free up the area and allow it to move a little better. A great traction exercise is to hold on to the top bars of the Cadillac, let the lower body get really heavy, and bend your knees to unweight your legs until the lower body is almost dangling. (Do as much as tolerated). At home, your student could use a Pull-Up bar.

Include hip dissociation exercises to help teach him to move from the hip instead of the spine. Examples are Hamstring I on the Chair with a flat back, Squats to get the hip crease movement going. Footwork and Feet and Straps on the Reformer are also great exercises because you can maintain a neutral spine throughout them. 

Think about how to help prepare your client for their physical job. I would ask them what types of movements they do on a daily basis and work on improving those. If there's a lot of lifting and bending over, definitely teach him how to hinge from his hips and use his legs to lift (basically a squat) which requires leg strength. 

Since one leg is weakened from the nerve pain, work on recreating symmetrical leg strength by training the weak side until fatigue but not the strong side in Single Leg Footwork on the Reformer. I wouldn't choose the Cadillac/Tower for this because the lumbar spine gets pushed into the mat quite a bit there (flexion).

A great way to introduce gentle flexion or check for tolerance is Segmental Bridging. Watch what happens through each segment of the spine. Does one area move excessively? Does another not move enough? Is there discomfort in a specific section? You can aways choose a flat back bridge which will strengthen his hip extensors and transition to more articulation when he's ready.

Improve mobility in the thoracic spine so that the movement in the lumbar spine can be minimized. Short Box Side Bend and Twist on the Reformer or Ladder Barrel is a great way to practice that. Even sitting in a chair (for his homework) will do.

Lateral flexion and gentle rotation of the thoracic spine are okay with a lumbar disc herniation. Be sure the movement is coming from the thoracic spine and keep the lumbar spine stable. We all need more movement in our ribcage. I would definitely do rotation and side bending there. 

One more reminder about pain. Pain is not the result of a structural issue.  Pain is a signal of the brain and nervous system indicating a problem. It is anticipated fear. That's why a positive movement experience during your student's Pilates practice is the single most important factor to make him feel better. (Thank you Brent Anderson of Polestar for lodging this message in my mind forever.) Meaning, he needs to perceive the exercise as doable, safe, and non-threatening. It should not be too challenging. The feeling that he can successfully do the exercise will help reduce his pain and bring back a full range of pain-free movement.

To hear the rest of my answer check out the Q&A Call Replays. They're all available as part of the membership.

Do you have a burning Pilates question? Register for my upcoming live Q&A call and submit your question. Attending live is free and open to anyone.

Have you had experience with a herniated disc? What helped you or your student? Tell me in the comments.

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