In the realm of spinal health, lumbar radiculopathy, slipped discs, and sciatica stand as formidable foes, affecting millions worldwide with their debilitating symptoms.
But who is most vulnerable to these conditions? What options exist beyond surgery, and what are the potential outcomes?
Moreover, can Pilates, known for its focus on core strength and flexibility, serve as both a preventative measure and a treatment avenue for alleviating sciatica symptoms?
In this article, we'll delve into the demographics most at risk, the considerations surrounding surgical interventions, and the transformative potential of Pilates in managing and even mitigating the impact of lumbar radiculopathy, slipped discs, and sciatica.
Additionally, we'll uncover the critical modifications needed to tailor Pilates exercises to this specific population, ensuring safety and efficacy in their pursuit of relief and restoration.
Pinched nerve caused by slipped disc
RADICULOPATHY ("pinched nerve")
Radiculopathy is a condition where the spinal nerve roots are compressed, irritated, or inflamed, causing pain, numbness, tingling, or weakness.
Causes:
Herniated or slipped disc: Disc material presses on nerve roots.
Degenerative disc disease: Wear and tear on spinal discs.
Spinal stenosis: Narrowing of the spinal canal.
Bone spurs: Abnormal bone growth on the spine.
SCIATICA is a TYPE of radiculopathy because it specifically involves irritation or compression of the sciatic nerve roots.
Usually the last lumbar nerve root ― L5 ― or the first sacral nerve root ― S1 ― as they exit the spine.
A SLIPPED DISC is one of the common CAUSES of radiculopathy, including sciatica, as it can compress the nerve roots and lead to symptoms like pain and numbness.
Healthy spine vs slipped disc
SLIPPED DISC
A slipped disc, also known as a herniated disc, happens when the soft inner material of a spinal disc protrudes through the tough outer layer.
When this protrusion occurs in the lower back (lumbar spine), it can press on nearby nerves, including the sciatic nerve, causing sciatica symptoms.
Causes:
Wear and tear on spinal discs.
Sudden injury or trauma to the spine.
Repetitive strain on the spine from activities like heavy lifting or improper lifting techniques.
SCIATICA
Named after the sciatic nerve (largest nerve in the body).
Sciatica is pain that radiates along the path of the sciatic nerve, typically from the lower back down through the buttocks and legs.
Who are most commonly affected?
Lumbar radiculopathy and sciatica can affect individuals of all ages, but certain populations are more commonly affected due to various factors. Here are some groups that are often affected by these conditions:
Middle-Aged and Older Adults:
Lumbar radiculopathy and sciatica tend to become more prevalent with age, particularly in individuals over 40 or 50 years old.
Age-related degenerative changes in the spine, such as disc herniation, spinal stenosis, and facet joint arthritis, can increase the risk of nerve compression and radicular symptoms.
People with Sedentary Lifestyles:
Individuals who lead sedentary lifestyles or have jobs that involve prolonged sitting or heavy lifting may be at higher risk.
Lack of regular physical activity and poor posture can contribute to muscle imbalances, spinal misalignment, and increased pressure on the lumbar spine, predisposing them to lumbar radiculopathy or sciatica.
Individuals with Obesity:
Excess body weight can place additional strain on the spine and increase the risk of developing conditions such as herniated discs and spinal stenosis, which can lead to radicular symptoms.
Obesity is also associated with inflammation and metabolic changes that may exacerbate nerve-related pain.
Pregnant Women:
Pregnancy can predispose women to develop sciatica due to hormonal changes, weight gain, and alterations in posture and spinal alignment.
The growing uterus can also exert pressure on the lumbar spine and sciatic nerve, leading to nerve compression and radiating leg pain.
Workers Engaged in Heavy Lifting or Repetitive Activities:
People who perform heavy lifting, repetitive bending, or twisting motions as part of their occupation, such as construction workers, nurses, and warehouse employees, may be at increased risk of developing lumbar radiculopathy or sciatica.
These activities can strain the muscles and structures of the lower back, leading to disc herniation or nerve compression.
Athletes and Active Individuals:
Athletes who participate in sports or activities that involve repetitive or high-impact movements, such as running, cycling, or contact sports, may experience lumbar radiculopathy or sciatica due to overuse injuries or trauma to the spine.
Improper training techniques, inadequate warm-up or cool-down, and insufficient recovery periods can contribute to spinal injuries and nerve compression.
Individuals with Previous Spinal Injuries or Conditions:
People with a history of spinal injuries, degenerative disc disease, or spinal abnormalities, such as scoliosis or spondylolisthesis, may be more susceptible to developing lumbar radiculopathy or sciatica.
Prior spinal surgeries or interventions can also predispose individuals to recurrent or new-onset radicular symptoms.
Can you have radiculopathy / slipped disc without pain / sciatica?
Yes, it's possible to have radiculopathy or a slipped disc without experiencing pain or sciatica symptoms. Here's how:
Radiculopathy:
Radiculopathy can occur without causing noticeable pain in some cases. For example:
Mild compression or irritation of the spinal nerve roots may not produce significant pain but could still lead to other symptoms like numbness, tingling, or weakness.
Some individuals may have asymptomatic radiculopathy, meaning they have nerve root compression but do not experience any noticeable symptoms.
In other cases, radiculopathy may cause pain only when certain movements or positions aggravate the nerve compression.
Slipped Disc (Herniated Disc):
Similarly, a slipped disc can occur without causing pain or sciatica symptoms for several reasons:
The extent of disc protrusion or compression on nearby nerves may be minimal, leading to no noticeable symptoms.
Some people may have a high pain threshold or may not be sensitive to the pain caused by a slipped disc.
The location of the slipped disc and the nerves it affects can also influence whether or not pain or other symptoms develop.
Additionally, some individuals may have a slipped disc incidentally discovered on imaging tests (such as MRI or CT scans) performed for unrelated reasons and may not have any associated symptoms.
In summary, while radiculopathy and slipped discs commonly cause pain and other symptoms such as sciatica, it's possible for these conditions to exist without causing noticeable discomfort. The presence or absence of symptoms can vary depending on factors such as the severity of nerve compression, individual pain sensitivity, and the specific location of the affected nerves.
What exercises / movements should I avoid?
Can Pilates help as both prevention & cure? How effective is it?
How To Modify Pilates For Your Condition
GOLDEN RULE: Do what makes your body feel safe, good and pain-free - or at least doesn't increase pain. (What causes pain in one may be fine for another.)
Prioritise stability and control.
Footwork on the reformer
FOOTWORK
Keep spring tension at a moderate level (focus on core activation) vs heavy level (favours leg strength) as it may lead to compression of the spine.
Experiment with different parts of the feet on the footbar (heels / arches / balls) in both parallel and turnout positions.
Keeping feet hipwidth / wider apart may feel more comfortable for the lower back than feet together.
Feel safe and strong with both feet before moving on to single leg footwork.
Bridges on the reformer
BRIDGING
If articulating spine creates too much "disturbance" in the lower back, do hip hinge with a neutral spine / pelvic tuck. This stabilises the spine & core / back muscles and isolates the movement to the hip joints.
If core / hamstrings are weak and carriage is pushed out during bridge, increase spring tension. This keeps the length of the body / spine in a fixed space vs potentially sliding in and out.
Do your bridges on reformer vs. mat. The added height of the footbar allows you to lift the torso at a bigger angle, creating more space in the shape of the pose and your body.
Softball under sacrum
AB WORK
SUPINE
Place a soft ball or slip your two hands underneath your bum / sides of the hips (palms facing down).
The softball elevates the pelvis and rounds the lower back, enabling you to maintain a pelvic tuck with support.
Your hands beneath your hips minimally increases pelvic elevation, but enables you to maintain a neutral spine with greater ease and comfort.
Both these modifications prevent spinal extension which tends to increase lower back pain / sciatica.
SEATED
Place softball behind for lumbar support. This keeps the body weight in the legs and front of the body / core musculature.
Be careful when extending arms up to ceiling / beside ears. If your core is too weak to maintain this shape, the lower back will be forced to bear the body weight, causing pain.
If instructed to hold and squeeze Pilates ring, simultaneously exhale and contract the abdominal muscles slowly. Avoid quick, jerky movements.
SIDE-LYING
Place top arm in front of your chest, hand on the mat for support.
Lean body slightly back at an angle vs perpendicular to the ground.
"Fire hydrant" exercise
QUADRUPED
Maintain neutral spine and gentle core activation.
Avoid collapsing lower back to the ground (spinal extension may cause pain).
Look in mirror to observe and feel what neutral spine is for you.
Limit range of motion of externally rotated leg in "fire-hydrant" as a tight hip may cause spinal extension (and pain) in this exercise.
Swan on the reformer
PRONE
Swan: Perform this exercise facing the footbar. This way, your hands have a higher support to make it easier for you to keep your upper body lifted and easier to conrol the amount of back extension. Facing the other way has your hands on the reformer frame, your body is stuck in a lower position making it more "heavy".
Facing the other way with hands in straps is a variation of Swan that is more challenging. It demands more core activation to lift the upper body off the box because the hands in straps press down and sweep to hip level, there is not much "lift off" help.
Swimming: Fold your arms and rest your forehead on your arms. Taking the arms out of the equation minimises spinal extension while allowing you to focus on glute and leg strength.
Swimming
Elevated plank
PLANKS
Elevate the upper body (as shown above.
Keep the knees on the ground.
Get strong in your planks on stable surfaces (mat / floor) before progressing to unstable surface (Bosu ball), moving surface (reformer / Exo chair).
In side planks, allow the top leg to support some of the body weight (as shown below).
Supported side plank
LEGS
FEET IN STRAPS
Lighter spring tension to keep the pelvis "heavy" on the carriage. This is the weight placement you need to maintain so that the legs can move freely and you can engage the core - without tailbone / sacrum lifting off the carriage.
Smaller range of motion for leg circles: Abduction may aggravate pain.
Having larger props such as the Pilates ring between the legs may be too much for the lumbar spine. Opt for smaller props such as soft ball or glider between the ankles / feet.
For supine single leg in strap, the "free leg" can be in tabletop with a soft ball gently squeezed behind the knee. This holds the free leg in an elevated, supported position, so that the lower back doesn't bear the weight of the leg.
For side-lying single leg in strap: Lean the body back at an angle vs perpendicular to the carriage. Keep a smaller range of motion in the moving leg.
Side-lying single leg in strap
CARDIO JUMPBOARD
Practise footwork with moderate vs heavier spring tension. This minimises spinal compression.
For jumping: The impact of landing can be a shock for the spine. Always remember to land with bent knees vs straight legs.
Choose a lighter spring tension for jumping. This lets the body focus more on core activation vs. leg strength - and is also safer for softer landings.
Feel safe and confident jumping and landing on both feet before you switch to single leg jumps. When only one foot is landing, the shock impact is higher.
Eve's lunge on the reformer - have the back knee resting on the carriage
BALANCE
For balancing exercises like lunges / single-leg balancing exercises, prioritise alignment and stability by holding onto barre / footbar before going hands-free or holding springboard yellow spring handles.
For lunges on the reformer, keep your back leg knee on the reformer vs in the air (as shown above). Having the back knee resting creates more space in the lumbar spine. Having it lifted can increase spinal extension and pain.
Avoid standing on the reformer with both / one leg on the moving carriage. The elevation and added challenge of moving surface can be dangerous. Stay on the ground and build your strength before progressing.
In conclusion, while lumbar radiculopathy, slipped discs, and sciatica can present significant challenges, there is hope for relief and restoration through a comprehensive treatment approach that includes Pilates.
However, it's crucial to recognize the importance of working with a qualified Pilates instructor who possesses experience and expertise in guiding students with spinal issues.
Each individual's pain origin and experience are unique, underscoring the necessity for personalised attention and tailored exercises.
By fostering a collaborative relationship between instructor and student, rooted in understanding and addressing the underlying causes of pain, Pilates can not only alleviate symptoms but also empower individuals on their journey toward healing and improved spinal health.
References:
‘Pilates improves pain, function and quality of life in patients with chronic low back pain: A randomized controlled trial’.
June 2014
‘Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art’.
January 2019
‘The effect of exercise on cervical radiculopathy: A systematic review and meta-analysis’November 2019
‘Surgical Management of Lumbar Radiculopathy: a Systematic Review’
March 2020
‘Effects of exercise/physical activity on fear of movement in people with spine-related pain: a systematic review’
July 2023