Tag Archive | pilates rehab carlsbad

Sciatica Pain Caused by Piriformis syndrome and Treatment

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).


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.

For More about PhysioWise program in Carlsbad, CA, please visit http://www.physio-wise.com


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.

Knee Injury – Torn Meniscus and Rehabilitation


The knee is the largest joint in the body. The knee joint has two crescent-shaped cartilage menisci, one inside (medial) and another on the outside (lateral) of the knee. The menisci stabilize the joint, absorbs shock, and disperse lubrication known as a synovial fluid. They are essential for an efficient functioning of the knee. A meniscus injury can lead to critical impairment and overall biomechanics of the knee joint.

Meniscus tear is the most common knee joint injury. The motions that require pivoting, twisting, over-flexing the knee and sports with sudden stops (tennis, basketball) may cause meniscus damage. The most commonly injured meniscus is the one on the inner side of the knee, the medial meniscus.

Meniscus tear onset of symptoms are gradual. The pain is in the inner side of knee and you may hear or feel a pop sound when the injury happened. The knee joint may also click and lock and feel that it is giving away. It may also be swollen and is hard to straighten up.

A blood supply on the meniscus in very poor, and that’s why the meniscus injury heals slowly. If you are an athlete and want to continue your sport, you may need an arthroscopic surgery. If you are middle aged and not that active anymore, the rehabilitation with physical therapy or even pilates with a physical therapist are good ways to rehabilitate your knee injury.

Knee rehabilitation with or without arthroscopic surgery should focus on re-gaining knee’s normal range of motion, enhancing strength of quadriceps (especially vastus lateralis and medialis) and hamstrings muscles and decreasing unnecessary muscle tightness of IT-band and hamstrings muscles. Close attention should also be paid to the overall muscle control, coordination, balance and proprioception.

Pilates for knee rehabilitation with a skilled Pilates Instructor and Physical Therapist is good, safe and efficient way to rehabilitate your
meniscus tear and knee injury. While traditional physical therapy helps you with your knee injury and pain, with Pilates you are going to rehabilitate and strengthen your whole body and prevent efficiently re-injuries by correcting your faulty movement and compensation patterns and improving your overall alignment and posture. We in Pilates rehabilitate the root of pain and injury, not only injury itself and that is what makes the difference resulting a pain and injury free body. Therapeutic / Clinical Pilates rehabilitate and prevent at same time. Pilates is something you should seriously consider when you need a rehabilitation or post-op rehabilitation on your knee injury.

More about PilatesWise knee injury rehabilitation and prevention program, please visit our website and click HERE

Pilates is very beneficial for Asthma


Breathing is something that everybody does, it’s automatic and we don’t need to think about it.  However, breathing is actually a pretty complex process that involves many joints and muscles and is responsive to both voluntary and involuntary control. For people with asthma, however, breathing has a total different meaning. Asthma causes airways to become blocked or constricted and that causes wheezing, coughing and dyspnea (shortness of breath).

Pilates exercises, with specific Pilates breathing technique, is a good and efficient way to control the breathing and get more awareness of it. Joseph Pilates himself had asthma as a child and he obviously got his own interest to create his exercise method around a proper, controlled breathing and mind-and-body connection.

The Pilates breathing, also called lateral breathing, encourages optimal movement of rib cage and increases its mobility, and helps also correctly contract and expand core muscles, which all are very important for people with asthma.

In essence, Pilates breathing technique helps asthma clients to

  • improve ventilation
  •  increase the effectiveness of cough mechanism and promote airway clearance
  • improve the strength, endurance and coordination of the muscles of ventilation
  • maintain or improve chest and thoracic spine mobility
  • correct inefficient or abnormal breathing patterns and decrease the work of breathing
  • promote relaxation and relieve stress
  • enhance better posture

A proper, effective lateral breathing is fundamental for all Pilates exercises. Unfortunately, some instructors don’t understand the importance of proper breathing technique while teaching Pilates. A correct Pilates breathing is a key to proper muscle contraction as these two functions go hand in hand. Pilates private sessions with experienced Pilates instructor are very beneficial for Asthma clients to improve not only controlled breathing and better ventilation but the overall functional capacity for daily life, occupational & recreational activities and sport.

For more about PilatesWise program for Asthma clients, please click HERE

Pilates and Spinal Stabilization training is the best way to relief the SI-joint pain


Did you know that 25% of lower back pain is sacroiliac joint related? However, sacroiliac joint pain and dysfunction is often misdiagnosed and overlooked by doctors and chiropractors. Si-joint pain may be referral pain into the lower limp, which can be mistaken for “true” sciatica from a herniated lumbar disc.

Si-joint dysfunction means Sacroiliac joint hypermobility (instability) or hypomobility which causes lower back and buttocks pain and stiffness. If there is hypomobility (too little movement) chiropractors manipulation may help, but if there is hypermobility (too much movement) chiropractors might be the last think what you want to do…you don’t want to increase movement which might cause even more pain. Unfortunately, sacroiliac joint pain is more often caused by SI-joint hypermobility (instability) than hypomobility. Sacroiliac Joint hypermobility may be traumatic, biomechanical, hormonal or inflammatory joint disease. I have been working with many Si-joint pain sufferers (mostly women) and they all have some issues about the lumbar-pelvis region biomechanics, which is very typical cause of SI-joint hypermobility and pain. Pain due to biomechanical injuries will usually come over a period of time and often due to increased activity or a change in occupation/sport.

Common biomechanical problems which cause SI-joint hypermobility are leg length discrepancy, overpronation, twisted pelvic and muscle imbalances. I’m helping people with the last two cases and podiatric job is to help first two. Usually Si-joint pain clients might have all of those problems. One of my client was a college basketball player who got first sprain ankle then two hamstring pulls and then a terrible SI-joint pain. When she came to me, she got pain all the time and the pain increased when she was active. It was hard to see how she was suffering, not only the pain but also being non-active. Working with her almost a year, she is today PAIN FREE and exercise again – that is the best reward what you can get! I have also been successfully worked with people with inflammatory SI-joint disease like Ankylosing spondylitis. Those clients have also imbalances and compensation of lumopelvic region because of pain. Surprisingly, proper motion is one of the best treatments for Ankylosing Spondylitis clients.

Pelvic & Spinal Stabilization training with Pilates together correct muscle imbalances and re-educate your body work more ergonomically, safely and efficiently. The both exercise methods are gentle and pain FREE.  The exercise/ rehab program has to be designed an individual special needs and focus on helping to strengthen the key muscles around your lumbopelvic region (deep back and abs muscles, glutealis muscles and hip rotators) and stretches tight muscles around your hip joint which are usually hamstrings, hip flexors and external hip rotators. If you are looking for Pilates program, please notice that not every Pilates instructor has enough knowledge about SI-joint dysfunction, neither back pain, so be sure that your Pilates Instructor has more education than just basic Pilates comprehensive certification program  before you start any Pilates sessions. Anyway, Therapeutic exercises and Pilates are great way to rehabilitate your Si-joint dysfunction and really increase your quality of life with less pain, or even better – totally pain free.

For More about PhysioWise program in Carlsbad, CA, please visit our website http://www.physio-wise.com.

Runners’ Knee Pain – Pilates Stabilizes and Prevents

The knee joint is the largest and most complicated joint in the body. Knee is subjected to an enormous workload during any sport activity, especially running. The running motion itself puts a lot of stress to the knee joints, and if there are also anatomical abnormalities and muscle imbalances the stress become higher and often leads overuse injuries. Prevention is most important way to keep away from knee injuries Focusing on muscular imbalances with Pilates helps knee joints working more efficiently and ergonomically. Pilates also works well as a part of knee rehabilitation by restoring joint function and re-educating correct (all) joints movement patterns.

The most common runner’s knee overuse injuries are patellofemoral pain syndrome (runner’s knee, chondromalachia) and iliotibial band syndrome (ITBS).

Patellofemoral pain syndrome (PFPS) has pain in front of the kneecap and may also include crunching and cracking sound when bending knees. Pain is most severe after hill running. The underlying cause is likely to be either anatomical abnormality (flat feet, foot overpronation, knock-knee, Q-ankle) or deficit of strength and/ or flexibility in the surrounding muscles. Runners who develop patellofemoral pain syndrome have often tight and strong outer quatriceps muscles (vastus lateralis) and weak inner side of quadriceps (vastus medialis). Both of those muscles stabilize kneecap and there has to be balance to provide maximal support and proper function.

Runners frequently underuse glutealis (maximus and medius) muscles. Hip muscle weakness also leads to dysfunction and increases forces on knees and feet while running. It is possible for weak hip abductors to contribute to knee pain since it will cause the femur to rotates inwards by causing patella misalignment (and patellofemoral pain). So, hip mucles are very important role for runner’s proper biomechanics as well as knee joint stability and function.

Iliotibial band syndrome (ITB) has pain and inflammation on the outside of the knee, where the iliotibial band (a muscle on the outside of the thigh) becomes tendinous. Tightness is felt also outside of knee and pain turns burning or stinging during running especially down-hills and disappears when stop running. Repetitive running motion causes ITB and anatomical abnormalities like foot overpronation and bow-knee increase the tightness of the iliotibial band. The muscle imbalance between weak quadriceps and tight hamstring and iliotibial band (ITB) can also cause the iliotibial band syndrome. Iliotibial band as well as quadriceps and hamstrings muscles function are the first place to provide knee stability.

Pilates is good for knee injury prevention and rehabilitation

Pilates is a good conditioning and cross-training program for runners. Adding Pilates can help runners restore muscular imbalances in the legs by increasing the flexibility of tight hip flexors and hamstrings, strengthen hip adductors, abductors and quadriceps muscles to help keep knee and hip joints more stable. Pilates foundation is about alignment head to toe and it is re-educating the muscles and joints work together by emphasizing body awareness. If you have underlying knee problem like iliotibial band syndrome, the best cure for it is a special ITB-stretching program, but Pilates is still a great addon to balancing your muscles weakness or tightness. It is recommend in Pilates training that instructor focuses on knee joints neural position and full, smooth range of motion. In Pilates leg and hip work the pillow or ball between legs helps the people with patellofemoralis pain syndrome to engage a weak vastus medialis. A specific Pilates program which is designed for your special needs helps you keep your body strong and balanced without injuries and enables you enjoy more of your sports that you love.

Please check out pilatesWise  youtube clip infos about patellofemorial pain syndrome and Iliotibilais Band syndrome http://www.pilateswise.com/pilates-youtube-videos.html