Tag Archive | pilates for back pain

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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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!