Symptomatic Lumbosacral Dysfunction and the Management & Rehabilitation through Pilates

Transcription

1 Symptomatic Lumbosacral Dysfunction and the Management & Rehabilitation through Pilates Özge Gow November 2015 Body Arts and Science International Comprehensive Teacher Training Program 2015 Brisbane, Australia

2 Abstract The purpose of this paper is to explain and identify chronic lower back pain (CLBP) and related lumbosacral dysfunctions. The paper will focus heavily on congenital conditions mainly the sacralisation of the lumbar vertebrae. In addition, this paper will examine the effectiveness of Pilates exercises in the management and rehabilitation of these conditions. 2

3 Table of Contents Abstract...2 Table of Contents...3 Chronic Lower Back Pain...4 What is Sacralisation?...4 Why Sacralisation Causes Pain?...5 What can Pilates do?...7 Case Study...7 Session Plan...10 Conclusion...12 Bibliography

4 Chronic Lower Back Pain Chronic low back pain affects approximately a quarter of the population. 1 This physiological burden can lead to difficulties in everyday life and if untreated can lead to irreversible degeneration. There are many causes for lower back pain that have been put forward. These can be summarized into five main areas, which Dharati (2012) identifies as; 1. Actual pressure on nerves or nerve trunks. 2. Ligamentous strain. 3. Compression of soft tissue between bony joints. 4. By an actual arthritis if a joint is present. 5. By a bursitis if a bursa is present. 2 These disorders make up the majority of lower back pain however Dharati ignored an often overlooked cause for pain in the lower back which can be caused by a congenital mechanical dysfunction, mainly that of sacralisation. What is Sacralisation? The lumbosacral spine protects the spinal cord and spinal nerves but another important function of the region is to support and transmits the weight of the body to the inferior extremity and in doing so plays an important role in posture. 3 Sacralisation occurs when the transverse process of fifth lumbar vertebra and the last lumbar vertebra becomes larger than normal on one or both sides, thus causing fusion 4

5 to the sacrum, or ilium and or both. 4 It is believed to occur in about 3.6 % to 18 % of the population. 4 Why Sacralisation Causes Pain? Pain is first recognized in the early stages of development due to the improper formation and union of somites, which cause vertebral abnormalities. 5 This is amplified by the fact that the lumbar spine experiences more abuse from the everyday functions than any other part of human body and it explains why, without intervention, pain increases as a person ages. 5

6 It s important to note that sacralisation wont always cause pain, often the condition is asymptomatic. Wazir (2014) explains that pain occurs as a result of disc degeneration, L4/L5 disc prolapse, lumbar scoliosis and/or lumbar extradural defects. 6 According to Castellvi (1983) the transitional vertebrae has the potential to cause abnormal torque movements above these anomalous vertebrae, which can be a direct result of disc degeneration. 7 6

7 What can Pilates do? Sacralisation usually goes undiagnosed because it is difficult to diagnose without the access to x- ray. However, sacralisation itself it is not generally the cause of discomfort and pain but the chronic failure of lumbar and pelvic biomechanics. According to Eyo (2001) to be able to give support to and bear the weight of the body, the integrity of all the vertebrae in the spine, particularly in the lower back must be maintained 7 The 2014 Delphi Study examined the affect of Pilates exercises as a treatment for people with complex lower back pain associated with sacralisation. 8 The study found that Pilates exercises may benefit people with lower back pain by increasing their functional ability and their confidence with movement, exercise, and activities. 9 The research also showed improvements in body awareness, postural control and movement patterns. 9 Case Study Özge is a 32- year- old woman with chronic lower back pain. The pain has existed for over five years. The origin of the pain is not known but the client did mention that she slipped on ice during primary school and injured her lower back. The client is not on any medication however she does take the occasional ibuprofen when the pain becomes unbearable. The ibuprofen seems to help. 7

8 Postural Assessment and Physical Examination The client presents hypertension in her lower back, gluteus muscles, hip flexor muscles as well as in the quadriceps muscles. Secondary concerns show a posterior tilt in the pelvis, which has caused a minor lordosis affecting muscles throughout the thoracic and cervical regions, particularly in trapezius muscles. Due to the hypertension caused the trapezius muscles the client presents cervical pain and occasional headaches. Exercise Plan An exercise plan has been devised for Özge, which consists of movements designed to strengthen and stretch affected muscles. The main focus was strengthening her abdominal muscles, her upper thorasic muscles, back extensor muscles, hip flexors as well as gluteal. Exercises were chosen from the mat, reformer, cadillac, avalon and wunda chair repertoire. During the first few sessions she was having trouble keeping the pelvis in a neutral position while performing supine exercises while actively using hip flexors. The warm- up exercises involved a lot of pelvic tilts as well as pelvic curls. We also did quite a bit of abdominal work in order to strengthen her core. At the beginning she was very cautious with her back extensions, so we did a lot of swimming, cat stretch until she felt stronger through her back and abdominal muscles. The intensity of the exercise plan I have created can be upgraded or downgraded for different apparatuses depending on the strengths and weaknesses of the client during the session. 8

9 On the left a normal lumbar X- ray, on the right is Özge s lumbar X- ray. As you can see the image on the right has a much lower L5 vertebrae which is in line with sacralisation. 9

10 Sessions BASI Block Warm Up Pelvic Curl Spine Twist Supine Chest Lift Chest Lift with Rotation Leg Lifts Roll up with Rub Spine Twist Supine Mini Roll ups Mini Roll ups with oblique Pelvic Curl Roll up Spine Twist Supine Double Leg Stretch Single Leg Stretch Criss Cross Foot Work Abdominal Work Hip Work Parallel Heels&Toes V Position Toes Open V Heels&Toes Calf Raises Prances Prehensile Single Leg Heels&Toes Hundred Prep Chest Lift Chest Lift with Rotation Hundred Prep Frog Circles Down- Up Openings Frog Circles Down- up Walking Bicycle Cadillac and Parallel Heels&Toes V Position Toes Open V Heels&Toes Calf Raises Prances Single Leg Heels&Toes Coordination Short Box Series Hundred Hamstring Pull 1 Roll up Top Loaded Extended Frog Extended frog reverse - Single Leg Series Frog Circles Down- up Hip Extension Bicycle Cadillac, Reformer and Wunda Chair: Parallel Heels&Toes V Position Toes Open V Heels&Toes Calf Raises Prances (except Wunda Chair) Single Leg Heels&Toes Hundred Roll up Bottom Loaded Avalon: Hundred - Single Leg Series Frog Circles Down- up Hip Extension Bicycle Avalon: Frog Circles Down- Up Openings Spinal Articulation Pelvic Curl Spine Stretch Short spine Tower Prep Monkey Original Roll Over Avalon: Pelvic Curl Wunda Chair: Standing Pike 10

11 Stretches Standing lunge Kneeling lunge Avalon: Gluteals Hamstrings Adductors Hip Flexors Side Split Shoulder Stretch Full Body Integration (F/I) Scooter Elephant - Knee Stretch Group- Round Back Reverse knee stretch Up stretch 1-2 Sitting Forward Kneeling Cat Stretch Arm Work - Arm Supine Series- Extension Adductors Circles up Circles down Triceps - Arm Sitting Series- Chest exp Biceps Rhomboids Hug a tree Salute - Arm Standing Series- Chest Expansion Hug a tree Circles Up- down Punches Biceps Full Body Integration (A/M) Leg Work None None Saw - Supine Series- Knees Ankles Single Leg Skating Side Leg Lift Forward and Lift Forward with drops Adductor Squeeze Squats Avalon: Leg Press Standing Lateral Flexion/ Rotation Side Lifts Ladder Barrel: Side Over Prep Mermaid Spine Twist Saw - Short Box Series- Side over on box Back Extension Back Extension Cat Stretch Swimming Swimming Breaststroke Prep Prone 1 Wunda Chair: Swan Basic 11

12 Conclusion After following the conditioning program for five months, Ozge gained strength in her abdominal muscles, upper back muscles, gluteus and hip flexor muscles and gained length to her lower back muscles. Her tight trapezius muscles released as well. The program gave her better control over her pelvic function, which improved her posture and corrected her lordosis. The results showed that completion of a BASI Block System program can help improving conditions associated with chronic low back pain. 12

13 Bibliography Referenced: 1 - Balague F, Mannion AF, Pellise F, Cedras- chi C. Non-specific low back pain. Lancet. 2012;379: Dharati, K et al, A study of sacralisation of fifth lumber vertebra in Gujarat, National Journal of Medical Research, volume 2, issue 2 Apr June p213) 3 - Dharati, K et al, A study of sacralisation of fifth lumber vertebra in Gujarat, National Journal of Medical Research, volume 2, issue 2 Apr June p211) 4 - Dharati, K et al, A study of sacralisation of fifth lumber vertebra in Gujarat, National Journal of Medical Research, volume 2, issue 2 Apr June p211) 5 Wazir, S. Sacralisation of Lumbar Vertebrae International Journal of Anatomy and Research. 2014, Vol 2(2): (p.387) 6 - Castellvi AE, Goldstein LA, Chan DPK, Lumbosacral transitional vertebra and their relationship with lumbar extadural defects. Spine, 1983; 9: Williams, PC. The lumbosacral spine, emphasizing conservative management. New York, McGraw- Hill Book Company 1965, Eyo MU, Olofin A, Noronha C, Okanlawon A: Incidence of Lumbosacral Transitional Vertebrae in Low Back Pains, Patients West African Journal of Radiology, April 2001: 8(1) Wells, Cherie et al "Indications, Benefits, and Risks of Pilates Exercise for People With Chronic Low Back Pain: A Delphi Survey of Pilates-Trained Physical Therapists." Physical Therapy 94.6 (2014): P.811. Web.20 Feb Wells, Cherie et al "Indications, Benefits, and Risks of Pilates Exercise for People With Chronic Low Back Pain: A Delphi Survey of Pilates-Trained Physical Therapists." Physical Therapy 94.6 (2014): P.801. Web.20 Feb Sighted: - Isacowitz, R.(2015).Reformer Movement Analysis Workbook. Costa Mesa CA: Body Arts and Science International - Isacowitz, R.(2015).Mat Movement Analysis Workbook. Costa Mesa CA: Body Arts and Science International - Isacowitz, R.(2015).Cadillac Movement Analysis Workbook. Costa Mesa CA: Body Arts and Science International - Isacowitz, R.(2015).Wunda Chair, Ladder Barrel Movement Analysis Workbook. Costa Mesa CA: Body Arts and Science International - Isacowitz, R.(2015).Study Guide Comprehensive Course. Costa Mesa CA: Body Arts and Science International 13