Tag Archive | back rehab encinitas

Sciatica Pain Caused by Piriformis syndrome and Treatment (Carlsbad, Oceanside, Encinitas Pilates)

Piriformis syndrome, Sciatic Pain and treatment

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The piriformis muscle is a small muscle located deep in the buttock under the gluteus maximus. The muscle runs very close to sciatic nerve and some people the nerve even can run through the muscle. Piriformis muscle function is assisting to rotate the hip, turn the leg and foot outward (hip external rotation).

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Piriformis syndrome may caused by muscle spasm or excess tightness in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as sacroiliac joint ( SI joint) or hip. Most commonly, clients describe acute tenderness in the buttock and sciatica-like pain down the back of the thigh, calf and foot. Pain Increases after prolonged sitting, walking or running and it also may limit range of motion of the hip joint, especially hip internal rotation. Piriformius syndrome is very common in long-distant runners and those who’s sport requires repetitive external rotation of hip (ice hockey).

Many of my client who got a Piriformis syndrome, have also problem with their SI (sacroiliac) joint and visa versa. By saying that, SI-joint dysfunction may be sometimes root of pain, not piriformis muscles itself. Piriformis syndrome, SI-joint dysfunction and hip pain have very similar symptoms and they are hard to diagnose. Sciatica pain may also be caused by piriformis syndrome as well as SI joint dysfunction.

Almost every treatment approach for piriformis syndrome will include a focus on carefully and progressively stretching the piriformis muscle.
However, stretching only piriformis muscles may not be enough to treat piriformis syndrome. Piriformis syndrome may cause or caused by muscle imbalances in lumbo-pelvic-hip region. Stabilization of the pelvic may be affected by tight and short muscles hip flexors, hamstrings, piriformis and SI- joint dysfunction, resulting in overuse and spasm of the piriformis. So, muscle balance around your hip, pelvic and SI-joint are also important to treat. Faulty movement patterns are common for people who is suffering from piriformis syndrome. Piriformis spasms limit pelvic movement and in turn leads to gait deviations and compensations. If the muscle imbalances and faulty movement patterns left untreated, piriformis syndrome may return.

If you go to Physical therapy and did not get help, try Pilates with experienced Teacher. Pilates one-on-one training treats your whole body, not just a pain. So, you get help also your overall possible muscle imbalances and compensations – That is priceless.

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Best Treatment for Degenerative Disc Disease – Proper Exercise Program

Importance of exercise for degenerative disc disease

Degenerative%20Disc%20Disease_WebDegenerative disc disease is one of the most common causes for low back pain. The diagnosis of “degenerative disc disease” is not really a disease but a term used to describe the normal changes in our spinal discs as we age. All people experience the changes in their discs that are consistent with greater or lesser degree of degeneration, but not all people will develop symptoms like pain, sciatica or spinal stiffness.

Degenerative disc disease involves the intervertebral discs. Those are the pillow-like cushions between your vertebrae in your spine. They help your back carry weight and allow complex motions of the spine while maintaining stability. As you age, the discs can lose flexibility, elasticity, and shock absorbing characteristics. They also become thinner as they dehydrate. When all that happens, the discs change from the support that allows fluid movement to a more stiff and rigid state that restricts your movement and causes pain.

A regular routine of back exercises can prevent low back pain and/or reduce the severity and duration of any “flare-ups.” Controlled, gradual, progressive back pain exercises can help the back retain its strength and flexibility. Also, back movement promotes the delivery of nutrients to spine, keeping discs, muscles, ligaments, and joints healthier. Prior to starting a new exercise program, it is always advisable for patients to first see a spine specialist who is trained in developing individualized back exercise programs and in instructing patients in using a correct form and technique for each exercise. Low back pain exercise regimens varies widely depending on the patient’s diagnosis and level of pain.
The best treatment regimen is a proper Spinal Stabilization exercise program

exercise-therapyProper Spinal stabilization exercises with knowledgeable teacher or physical therapist is recommended for treating disc degeneration and the sciatica pain. Alleviating sciatic pain caused by degenerative disc disease includes finding the most comfortable position for the lumbar spine and pelvis (neutral pelvic) and training the body to maintain this position during activities. In doing this correctly, one can improve the proprioception (sense of movement) of the lumbar spine and reduce the excess motion at the spinal segments. This will in turn reduce the amount of irritation at these segments, relieving pain and protecting the area from further damage.

These dynamic lumbar stabilization exercises often require specific hands-on instructions because they offer much less benefits if done incorrectly, and they tend to be much more difficult than they appear. This type of exercise program is progressive, starting with the easier exercises and advancing to the more difficult exercises once the lower level program is mastered. The most important aspect of using these sciatica exercises is sensing and controlling motion in the spine. Once learned, the body can eventually take over and do this without the level of concentration it takes early on.

Pilates is a good way to back rehab

Pilates training in one-on-one settings is also a good way to rehab and prevent back problems. Pilates is a low-impact whole body exercise regimen. Pilates foundation stabilizes your core by contracting deep abdominal, back and pelvic floor muscles with proper breathing. If you are looking for Pilates to help your back pain caused by degenerative disc disease, as a physiotherapist I recommend you to work with a very experienced Pilates instructor. Doing Pilates by DVD’s, books or in group settings (mat and reformer classes) are not good ways to learn proper Pilates and may even cause more harm. You may need a instructor or physical therapist who has good hands-on skills and can correct you as needed. Once you find a good instructor you’ll be in your way to get rid of your pain – and that is PRICELESS!

For more about PilatesWise SpinePilates program for people with Degenerative Disc Disease, Sciatica and Lower Back pain in Carlsbad, California, Please visit our website and click HERE

Kinesiophobia – The hidden reason why the back pain becomes chronic

Kinesiophobia – The hidden reason why the back pain becomes chronic

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Kinesiophobia is a disorder where a person believes that movement can cause more injury and pain. A constant cycle of pain, fear, disuse and depression can be a result of kinesiophobia and it definitely slows down a normal recovering process from injury. This can also lead to a long-term problems and chronic pain.

Persons with kinesiophobia tend to believe that the pain what they are experiencing may worsen if they do exercises and certain movements. They start to decrease their physical activity which unfortunately causes even more problems like joint stiffness, unnecessary muscle tension, supporting muscles weakness, etc. People with kinesiophobia are in a pain cycle (picture below), and getting out of this circle is very hard to do on their own.

pain cycle

As a Physiotherapist and Pilates Instructor I have treated many chronic back pain clients who are terrified exercising but want to get better. Some of them have already had bad experiences on Physical Therapy and doctors care. Painkillers do definitely not help if the source of pain mostly comes from patient’s fear, compensations and guarding. In Physical Therapy the trend is to work on many clients at same time, so they probably don’t have any extra time to concentrate or realize your fear and compensations. It is not either a good idea to give home exercises to people who has a kinesiophopia because they find it hard to do them correctly. Fear of pain also effects negatively to neuro-muscle connection and muscle recruitment, so exercises may do more harm than good. However, the truth is that movement heals and it has a crucial role of chronic back pain treatment, but it really does matter what kind of exercises and instruction you get to actually help you.

exercise-therapyOne-on-one Pilates with skilled Physical Therapist or very experienced Pilates instructor can help those who have kinesiophobia and chronic back pain. Well designed, slow, graded and progressive Pilates program which aims on practicing control of movement, breathing and proper muscle work will definitely help reduce fear of movement and also gradually overcome kinesiophobia. In Pilates every movement has to be PAIN FREE! Pilates with a good teacher helps you get your confidence in your ability to move. Returning to normal movement is an important step in breaking the kinesiophobia pain cycle. Pilates exercises help you rebuild normal movement and function which in turn relieve pain and improve your overall quality of life. Staying active is a critical component of chronic pain and back pain treatment. Don’t let your fear ruin your full potential recovery and stop you to do the activities that you love.

More about PilatesWise program in Carlsbad California, please visit our website www.pilateswise.com, our SpinePilates program is now also available via SKYPE for people around US and world!!! MORE ABOUT SKYPE TRAINING, PLEASE CLICK HERE.

Is Pilates All That Clients Need to Get Rid Of Back Pain?

   

Is Pilates as good to relieve back pain as many instructors advertise? Back pain is very complicated issue and there is no only one way to get rid of it. Many treatments fail because they only treat symptoms of back pain – not the real underlying problems. For 80% of back pain sufferers the most typical underlying problems are poor posture and muscle imbalance. Pilates is a well-known exercise form which is claimed to improve posture, core stability and strength. It is true that Pilates works better for back pain sufferers than other exercise forms, but results are often as good as the Pilates instructor is.

Muscle Imbalance

Pilates is a wonderful tool to strengthen deep stabilizer muscles (transverse abdominus and multifidus muscles) which support your spine. Studies have found that weak spinal muscles are typically found from people with back pain. Unfortunately, improving back stabilizer muscles is not enough. The pelvic and hip region muscles are also important and when they are unbalanced, they tend to impact back and spine function as well. For example hamstring, piriformis and hip flexor muscles tightness put tremendous pressure to the lower back and changing the pelvic alignment. Many Pilates exercises involve hamstrings, hip flexor and piriformis muscles which may actually further add imbalances and tightness of those muscles. Pilates focuses stretching by lengthening extremities and aiming the joints full range of motion. Unfortunately, just Pilates “lengthening” is probably not enough for a person who has  back pain and extreme tightness of these muscles. So, it’s a good idea to add also some traditional stretching to help better reduce tightness and relieve back pain.

Better Posture

Body alignment is a Pilates foundation which is very important for people with back pain. It’s a big help for back pain sufferers to know what alignment they have to keep and carry themselves, because with the optimal posture the pressure of the lumbar spine is minimal. Neutral pelvic & spine position is important but also the rest of the body’s proper alignment – from head to toe. Pilates instructor who teaches the back pain clients only on the supine position (lying on back) can’t improve much the clients’ posture. It’s important to teach spine and pelvic alignment in both standing and sitting positions where the muscles are working as a daily basis. Pilates improves posture and muscle balance if the Pilates instructors have a good eye and good knowledge of anatomy & biomechanics. Unfortunately, many Pilates instructors lack the knowledge of these areas.

Compensation, Muscle Recruitment

Always when pain is persisting, the muscles work differently. The other muscles “shut down” when the other muscles have to overwork by taking care of the others job. Researches have shown that of the people who has back pain the muscle recruitment changed. Deep spine stabilizer muscles are not working correctly and efficiently and superficial muscles take over, unfortunately with poor outcome. This often makes the back very vulnerable for re-injury. Back pain clients lose the control of deep stabilizer muscles -transverse abdominus and multifidus muscles – and so it’s very important to re-educate these muscles working correctly to help support spine. Pilates is a great tool to re-educate those muscles working correctly because all the movements start by contracting transverse abdominal muscles. Also many back pain clients overuse piriformis, hamstrings & hip flexors muscles and superficial back muscles and under use glutealis muscles. To identify and correct faulty movement patterns as well as faulty muscle recruitment needs again a knowledgeable and experienced instructor who has more in-depth anatomy and body mechanics education than a basic comprehensive Pilates education program can offer.

Fear of Re-Injury

Biggest fear for people with back pain is a chance of re-injury. There are many movements in Pilates which are not suitable for people with back pain and are even contraindicated. Every back pain clients are different, and so are Pilates programs. The biggest mistake is to teach too difficult movements too soon, which can cause even more pain and client is definitely not coming back after that experience. One-on-one Pilates sessions with an experienced instructor are essential! Clients have to have full trust to instructors skills so that they can get over their fear and let the movements heal. As a Physiotherapist I do not recommend group mat Pilates class or reformer class for anyone who have back pain!.

Pilates repertoire has many good exercises for back pain sufferers and it’s a wonderful exercise regimen to improve postural muscles strength and stability by giving more support for spine. Unfortunately, even that Pilates is a good exercise method, it does not mean that it’s completely correct to all problems and issues the back pain sufferers might have and very often good results depend on how good, knowledgeable and skilled the Pilates Instructor actually is. Working with back pain clients needs a more carefully designed program and much more knowledge about suitability of movements, rehabilitation and healing process. And in addition to Pilates it is a good idea to add some classical stretching exercises to loosen tight muscles. The tight muscles (hamstrings, hip flexor, piriformis) might cause the back pain or caused by back pain and they might be the reason why some people’s back pain is continuing or returning later.

Our Active Back Pain Rehabilitation is combination of Pilates and Spinal Stabilization training. Spinal stabilization training and Pilates are both clinically proven to be effective and safe way to rehabilitate back pain and prevent future injuries. Our program is available for clients in San Diego North County. Our studio is located in Carlsbad, just short driving distance from Oceanside, Encinitas, Vista, San Marcos, Leucadia, Solana Beach. Please click HERE and read more about our programs.

Is Pilates Instructor Capable Rehabilitate your Back Pain

 

Pilates is generally a good exercise method for those who suffer from back pain. Pilates focuses on core strength, stability and spine range of motion, all those areas which need the most improvements by back pain sufferers. However, all those improvements are up to the particular Pilates Instructor. When rehabilitating back pain clients the most important thing is to have an experienced and knowledgeable instructor. Pilates instructor needs to know much more than just Pilates specific exercises. And while Physical Therapists and Physicians recommend Pilates for back pain, the problem is that they don’t often know what kind of exercise Pilates really is, what kind of education Pilates instructors go through and how ready and knowledgeable they are teaching Pilates for those who has fragile spine and chronic back pain.

Many, even comprehensive, Pilates programs do not give enough tools and knowledge for the instructor to teach people with back pain. As both a Physical Therapist and certified Pilates instructor myself, I’m puzzled how openly and confidently many Pilates instructors market their services and teach people with back pain without any anatomy or back pain education in addition to their basic Pilates Instructor certification program. Many comprehensive Pilates teaching programs are just “certification businesses”, and there is a lot of competition in the marketplace where those certification programs don’t have any real, verifiable requirements to people who want to start Pilates education, so basically anybody can become a Pilates instructor. Most programs also lack any knowledge about anatomy, musculoskeletal disorders and body’s, especially spine’s, biomechanics. A basic Pilates instructor is not meant to be a therapist, but  it’s definitely not enough to know just how many vertebras there are on the spine or knowing wide Pilates repertoire and how to cue them verbally. In my professional opinion, a skilled Pilates instructor has to understand in details how the spine is moving and how exactly it should move, what muscles the client should contract or not contract, and most importantly know all contraindicated exercises and how to properly modify Pilates movements individually based on the need and condition of back pain of the client.

Every back pain is different, so should the Pilates program be. There are no “one size fits all” Pilates exercises for back pain. Designing the Pilates exercise regimen should always aim at underlying problems. These problems are usually a poor posture, weak deep abdominal and back muscles, tight low back, hamstrings or hip flexor muscles, and limited spine range of motion. Pilates gives a wonderful toolset to improve all of those elements – but only if the Pilates instructor knows how to use those tools safely, correctly and efficiently. It’s important to notice that if Pilates exercises are taught unprofessionally, they may cause more problems or even re-injuries. Pilates instructor should never teach fitness and back pain clients similarly. Instructors have to be very cautious, especially when teaching clients who have osteopenia, osteoporosis, osteoarthritis, spinal stenosis, spondylolisthesis, spondylolysis, herniated disc or bulging disc.

In Pilates market the competition is hard these days and it’s getting even harder. Many studios have financial problems and some studios even have more instructors than clients. Consequently, there are many Pilates instructors who claim to be specialized in post-rehab and rehab without any education (except certified Pilates instructor), so be cautious when choosing a studio or instructor to rehabilitate your back pain – always ask for instructor‘s education, credentials and real experience. Also, never go overcrowded mat class or your fitness centers mat class with back pain. Many mat Pilates instructors get their certifications through a short, one weekend course or, even worse, by internet. Pilates for back pain should always be individual, one-on-one private session. Check always instructor’s background and previous client referrals too. Many instructors might have a story about their own back pain and injury and how the Pilates “saved their lives”. Good for them, but while not only being subjective, own experience does not necessary mean that they are capable of rehabilitating others back pain. In my opinion, much more education is needed in this area anyway.

I’m very positive that Pilates is a wonderful movement therapy and treatment to rehabilitate back pain. However, quality and education are the key to choosing the right Pilates instructor and studio. Try to find a well educated instructor who understands your specific needs and conditions. When you find a good one to work with, you will be surprised about the results – and that will be priceless!

High Heels Cause Back Pain

Wearing high heel shoes can be sexy and feminine but is not the best thing for your body.

The body is a long chain from head to toe, and when the chain is working optimally your body parts such as bones and spine are on a proper alignment and muscles are working without extra fatigue or tightness. Wearing high heels creates faulty biomechanics and body alignment and put unnecessary stress on your ankles, knees, pelvic and throughout your spine.

High heels force your body weight to be thrown forward and make your legs, feet, hip and spine work against the way they were designed to work. The natural balance is thrown off and your muscles have to make constant adjustments to keep your body somehow balanced. Since high heels cause the body to lean forward, it is compensating that by tilting pelvis forward and changing your spine curvature- increasing lordosis on your lower back. This all creates more stress for the nerves of the lumbar spine and tighten your lower back muscles – causing back pain.

Back pain is not the only problem what you can get by wearing those sexy high heels. You can develop trouble walking, and high heels change also the way the muscles of pelvis, legs and ankle contract. Many of your body muscles have to work more than normally. The hip flexor muscles have to work harder and longer by helping move your leg forward because the toes are pointed downwards and can’t do they normal work. Hip flexor muscles become overused and hip flexor shortness might cause more back pain by changing spine curvature in unwanted direction. High heels also add shortness of hamstrings and calf muscles.

The legs and feet are the foundation of your musculoskeletal system and shoes support your entire body as the only contact between you and the ground. A shoe has everything to do with your posture and how your back, and whole body, feels. The shoes should provide comfort, stability and proper posture for you. Wearing high heels can be fashionable and sexy but think about the total price when you are wearing them! Podiatrists , Chiropractics and Physical Therapists get nice business from those who suffer back, hip, knees or foot pain by wearing high heels. Well, there’s nothing wrong about it but the actual problem will not be solved as long as you continue to wear high heels on a daily basis. Think which one is more important your spinal health or your sexy look. 

Sciatica Back Pain – Is Pilates really helping?

The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that travels from the low back through the buttock and down the large sciatic nerve in the back of the leg. Sciatica occurs most frequently in people between 30 and 50 years of age. Often any particular event or injury does not cause sciatica, but rather it tends to develop as a result of general wear and tear on the structures of the lower spine.

Common causes of sciatica are Lumbar Herniated disc, Spinal Stenosis, Degenerative Disc Disease, Spondylolisthesis, Piriformis syndrome and Sacroiliac Joint Dysfunction.

Exercise is usually better for healing sciatic pain than bed rest. Sciatica exercises are also important for the healthof the spinal discs. Movement helps exchange nutrients and fluids within the discs to keep them healthy. Many sciatica exercises focus on strengthening the abdominal and back muscles in order to provide more support for the back, so do Pilates.

Many Pilates studios are marketing their services as a treatment for lower back pain and sciatica, but does Pilates really help? Yes, it really helps if you find a good Pilates instructor who has back pain rehabilitation experience and who is familiar with your diagnosis, diseases and symptoms. Why Pilates instructor knowledge is so important? Because all Pilates exercises do not fit all sciatica clients and some exercises might be even contraindicated.

Here are briefly some underlying exercises that spine specialists recommend for each diagnosis of sciaticaThese exercises help to relieve pain and prevent further back problems:

  1. Spinal stenosis: Focus on flexion exercises (forward bending). Flexing the lower spine relives pain and nerve irritation for people with spinal stenosis. They often feel better bending forward than standing up straight. Still it’s important to strengthen back and abdominal muscles and teach posterior pelvic tilt which allows the client perform more activities and exercises with less pain.
  2. Degenerative Disc Disease: Focus on spinal stabilization exercises, back extension exercises including the McKenzie method. All Pilates exercises are focusing spinal stabilization, so Pilates for DDD is really beneficial. However, back is fragile for DDD clients, so full flexion and intermediate spine articulation exercises are in some cases contraindicated.
  3. Herniated disc. Focus on spinal extension with McKenzie method and Spinal Stabilization training.  Pilates is good, but has to be pain-free range.
  4. Spondylolisthesis: Focus on flexion based exercises and spinal stabilization program. It’s important to teach how the lumbar spine remains stable in a flexed position.
  5. Piriformis syndrome: Focus on stretching piriformis muscle, hamstring muscles and hip extensor muscles. Maybe only stretching exercises is enough to help to decrease this painful symptom. Finding neural pelvic position, spinal stabilization training and hip range of motion are all important for people with piriformis syndrome.
  6. Sacroiliac Joint Dysfunction: Focus on restore range of motion in SI-joint, which can be limited if the joint is inflamed. So, spinal stabilization, pelvic and hip exercises are all good.

All the above diagnoses cause sciatica pain but as you see the recommended exercises are very different. Pilates in general is good but definitely there is no “one size fits all” exercise for sciatica pain clients. Sometimes Pilates instructors are too confidence to taking care of people who suffer back pain, caused by sciatica. Many Pilates programs don’t give enough information about back disorders and many instructors don’t have enough experience either. It’s very important for Pilates instructors to know the client’s history of sciatica pain before they plan any Pilates program for their client. However, carefully planned Pilates program with a good hands-on skilled instructor make the life of sciatica pain client easier by relieving pain, strengthening and stretching muscles and increasing spine and joints range of motion. “Motion is lotion” is true here.

Please visit PilatesWise.com and read more about our SpinePilatres bacxk rehab program which is specifically designed for people with back pain and sciatica. Program is combination of Pilates and Spinal Stabilization, click HERE and learn more. This program is available also via SKYPE, so not need to live in North County, San Diego, California.