Sunday, November 14, 2010

Specific Exercises for Scoliosis and a Spinal Fusion

Pilates Consult

NEW "FEATURED READER" ARTICLE!

The "Featured Reader" article showcases a member of the Pilates community who has approached us with specific issues and questions regarding Pilates and how it will help them.


If you are interested in becoming a "Featured Reader," please contact us at: info@pilatesconsult.com.


Featured Reader: Kimberly Brock
By: Angelie Melzer


Kimberly is a Pilates enthusiast, first introduced to the Method when she moved to Seattle, WA in 1997. Kimberly had a spinal fusion at the young age of 13 years old. At that time, the doctors diagnosed her with Idiopathic Scoliosis. She immediately went into TLSO brace for sixteen hours per day until her growth spurt period was over. During that time, her curve progressed quickly from 41 to 62 degrees in the Right Thoracic, with a compensatory curve in the Lumbar region. She was declared a brace failure. She was told that surgery was her only option as physical activity alone would not be sufficient. Being that Kimberly was an active young lady and a young budding dancer, this news was quite a blow to her.


After surgery, Kimberly felt so grateful they had "stopped" the disease, but felt such a sense of loss. She was left with poor flexibility and a fear that she'd never feel the same. However, she kept a good attitude and remained healthy and moderately active throughout her youth. She had no complications and has been very happy with the strength and flexibility she had gained over time. Still, Kimberly was left with feelings that a part of her musculature and nervous system had been "turned off". She felt disconnected as if she was placed into someone else's body. She learned to compensate and had three successful pregnancies. After her third pregnancy, she began to have acute lumbar discomfort. Her medical doctor looked at her current X-rays to diagnose the pain, but she felt like it was guesswork. He suggested a Chiropractor, to which she declined. Her other options were physical therapy or another surgical procedure. She was so disappointed that she contacted her Pediatric Orthopedic Surgeon's office, but they had no answers, except to seek a new Orthopedic Surgeon. She found very little information on the Internet for Spinal Fusion Patients later in life, and what she did find, scared and discouraged her.


Following her own intuition, she sought out Physical Therapy as it had done the most good for her in the past. Paying out of pocket, she found a Physical Therapist at Body-n-Balance in Apharetta, GA, who was also a Pilates Instructor. At this point, she was in constant pain and had begun to take medication on a regular basis. She was experiencing a dull, broad pain in her lumbar region that made her feel nauseous. The Physical Therapist slowly introduced Pilates into her sessions over the course of several months and it made an immediate improvement in her pain level. She felt as though she could work through her pain and stretch her muscles. The relief was great! Within a year, she had almost no pain, and when she did, it was very manageable. Kimberly is now pursuing her Pilates Certification through PhysicalMind Institute at Body-n-Balance and is so grateful to this gracious group of instructors who have changed her life through their openness, warmth and professionalism.


FEATURED EXERCISES

This section deals with specific issues the Featured Reader is experiencing, and solutions through Pilates exercises.


Kimberly had specific questions on exercises for her Scoliotic condition:

"I'D LIKE TO KNOW WHAT EXERCISES I CAN DO TO RELEASE AND STRENGTHEN A TIGHT PSOAS THAT IS PULLING MY RIGHT HIP FORWARD AND CAUSES PAIN IN MY PELVIS AND SACRUM EACH MORNING?

I HAVE WEAKNESS/TIGHTNESS IN MY SCAPULA, ESPECIALLY ON MY LEFT. I'D LIKE TO KNOW WHICH EXERCISES CAN HELP ME STRENGTHEN THIS AREA, WHERE I'VE HAD A LOT OF ATROPHY DUE TO THE FUSION?

CAN YOU SUGGEST MODIFICATIONS FOR EXERCISES IN DEEP FLEXION SUCH AS ROLL OVER, OPEN LEG ROCKER AND EVEN ROLL UP?

I'D LIKE TO KNOW MORE ABOUT "WAKING UP" MUSCLES THAT HAVEN'T BEEN IN USE DUE TO THE FUSION, WHETHER THOSE NEUROLOGICAL CONNECTIONS ARE LOST FOREVER OR IF THEY CAN BE REBUILT, AND HOW TO BEGIN DOING THAT?"


We have answered her with the following Featured Exercises:

PSOAS RELEASE WITH LUMBAR STRETCH:
Mat Exercises:
Lying supine, hug both legs into your chest by holding onto both knees. Gently pull the knees towards your chest in a rocking motion to release your sacrum and lumbar spine.

Lying prone, grab one ankle at a time. Lift yourself into the bow pose by gently lifting and lowering your sternum 1-2" off of the floor. Then lift and lower your thighs gently 1-2" off of the mat. Combine these two movements together and hold for 10 seconds. Release and repeat 4 sets. You may choose to advance to the "Rocking" mat exercise.

Reformer Exercise:
Modified Lunge:
Place 1 yellow or blue spring on the reformer. Standing on the floor on the spring end of the Reformer within the springs. Place your hands onto the shoulder rests. If your right psoas is the tight side, place your left leg onto the front edge of the carriage ensuring your heel is slightly below the carriage and the arch is securely on the carriage.

Gently push the carriage out with your left leg as you drop your pelvis straight down towards the floor. Make sure you are in a slight posterior pelvic tilt. Hold this position and then continue forward 2-3" at a time to your maximum range of motion, holding each time at least 30 seconds. Return to the original position and repeat 4-6 sets. You may choose to advance this to Eve's Lunge.

Trapeze Table Exercise:
Lunge on the swing: Face away from the swing and place your right foot into the white strap. Lung forward on your left leg and press your pubic bone forward into a posterior pelvic tilt. Hold this position for 30 seconds, then release and reverse the position, moving your pelvis into an anterior pelvic tilt. Arch and curl your lumbar spine to release the lower back and right Psoas muscle.

SCAPULAR AWARENESS EXERCISES:
Mat Exercise with an Exercise Band:
Lying Supine on an Exercise Band placed underneath the tips of your scapula. (Ensure the Band is spread out evenly.) Hold the tips of the Band and pull them upward towards the ceiling, giving your scapula and mid-back region a tightening sensation from the Band. Pulse upward with the Band 20 times. Hold the final pulse up for 30 seconds and slowly release back to a resting position.

Mat Exercise on a Foam Roller:
Lying Supine with the Roller parallel to your spinal column and your entire neck supported. Reach your arms up towards the ceiling, spreading the scapula apart. Pull the scapula back together and wrap them around the Roller. Repeat.

Chair Exercise:
Kneeling Lateral Flexion with Scapular Strengthening: Kneel on the floor next to the Pedal of the Chair. With one spring placed in the lowest setting, place your left elbow onto the pedal by laterally flexing to the left. Hold this position and pulse gently downward with the pedal 10 times, focusing on the movement of the scapula up and down along the spine. Hold the final pulse for 10 seconds and then slowly release the pedal completely until you are completely vertical with your torso and in the starting position. Repeat the exercise 4 times. *See below for modified version.

*Modified version of the above exercise: Depending upon your fusion, this can be modified to suit your spinal column and specific needs by taking out the lateral flexion. With the same low setting as above, sit or kneel next to the Chair and depress the pedal all the way to the floor with your left hand. Pulse upward about 1". Repeat this movement 10 times with the scapula moving along the spine and the shoulder elevating and depressing slightly with each pulse.

Modifications for Deep Flexion exercises on the Mat: As with any exercise program, not all exercises are appropriate for all bodies. Roll Over, Open Leg Rocker and Roll Up involve deep and very active flexion of the Spine which is both contraindicated and not possible with certain Spinal Fusions. Therefore, these exercises need to modified or replaced. Always ensure that as you perform the exercises below, the Pilates Principles are being utilized and your breath, form and alignment are all in check.

Modified Roll Over: Place a yoga block or small prop under the sacrum, lifting the pelvis 1-2" off of the floor. Pulse upward with the pelvis lifting gently off of the prop. Focus on the downward movement being slow and controlled as the sacrum comes back onto the prop. The hands can be placed on the pelvis for additional support.

Open Leg Rocker: Seated with bent knees, hook the knees over the hands. Balance against the wall when first attempting this exercise. Give yourself enough space from the wall with the sacrum so that you can perform a posterior pelvic tilt while maintaining the position. Return to an upright, neutral spine and repeat the posterior pelvic tilt.

Roll Up: Place a Yoga Strap or Band around the balls of the feet. Lying Supine, place the feet flat on the mat. Bend the elbows 90 degrees. Maintaining a neutral Lumbar Spine, look towards your knees as you pull gently on the Strap or Band.

"Waking up your Neuromuscular System"
Many times with Scoliosis, nerves surrounding the affected areas begin to lose their capacity to send messages. Whether it is due to a surgical procedure or lack of movement due to the Scoliosis present in that particular area, these areas need special attention through manual techniques, palpation or Tactile Cueing. Through Tactile Cueing, the muscles in these "dead" areas are physically touched in order to cue the nervous system and allow them to contract as we would like them to. Many times, this simply entails placement of the instructor or therapist's hand on the area, gently pressing and pulsing in the direction of pull that is desired. This manual work and Tactile Cueing allows the muscle to "feel" again and enables it to learn the desired contraction and movement. It is very possible that the Tactile Cueing will need to be done every time a certain exercise or movement is performed. However, as the individual gains strength, they may begin to "wake up" in these areas and be able to maintain a contraction for longer periods of time; and possibly contract these muscle without Tactile Cueing all together.

2 comments:

Adriana Contreras said...

Hello, I know that this is an old post, so I hope that you see this. I had a similar surgery (one year post-op) and am trying to get back into shape. I'm experiencing a lot of the same types of pain as is described above. Is there anyway that you can post a video of these techniques? I have been searching the internet and things are far and few.

Thank you so much!!

Adriana

K Lynn said...

Hi, I had the same surgery. A spinal fusion and a rod made from the bone if a few ribs and pelvis bone. After my 2nd childbirth, I started to experience the same symptoms and pain. I am constantly nauseated and experience vertigo. I been to every kind of orthopedic doctor around. I only been sent for physical therapy, steroids, & suggested surgery. I need help, Kimberly do you have any contact information or any suggestions. I'm in dire need & help for my pain. Thank you