A CONVERSATION WITH AN ORTHOPEDIST
I see so many people seeking out Pilates because of back pain. When I sat down with an orthopedist about to begin fellowship in spine surgery, Ashley Rogerson, she informed me that low back pain is the second most common reason people visit their doctor, next to upper respiratory infection. I wanted to share with you some insights from our conversation that highlighted issues I've seen in my 10 years of instructing.
Damaged Discs: What are they, who gets them, what can you do for them?
Often times hearing the words "bulging disc" or "herniated disc" results in a nod of recognition. "Oh yeah, my sister had that. It was painful." However, many don't know exactly what that diagnosis means or the difference between the terms. Let's break it down.
Disc: Cartilaginous tissue between each vertebrae in the spine that allows for cushion and support. This "pillow" separates each vertebrae allowing for articulation, movement, and shock absorption throughout the entirety of the spine. In addition, discs protect the spinal cord and all the nerve roots that run down and out of the spine to innervate the rest of the body.
Bulging Disc: Damage to discs is a common finding on MRI and is often associated with aging or “wear and tear” process. A bulging disc is defined by the inner layer of disc protruding into the thicker outer layer. Most often a bulging disc causes little, if any, pain. With this type of damage Dr. Roger suggests we focus on what the damaged disc is doing that creates pain. In addition, a patient’s response (or lack of response) to conservative treatment and the presence of persistent pain helps the patient and their surgeon determine whether surgery is needed. Dr. Rogerson said she sees equal occurrence of the fairly typical wear and tear disc bulges in both men and women. This is most likely to happen starting in your 40s-50s.
Herniated Disc: If the inner layer of a disc protrudes all the way through a tear in the outter layer there is a herniation. In this case, an MRI will most likely show spinal nerve impingement and a patient will experience pain radiating down the leg, and potentially, muscle weakness. These symptoms are more commonly seen with a disc herniation than a bulging disc. A surgeon may offer to remove the herniated disc through a microdiscectomy, which is an outpatient surgery to remove the fragment of the disc that is pinching the spinal nerve. Many patients experience significantly diminished leg pain immediately following the procedure. Even more astonishing, patients are up and walking as soon as they recover from general anesthesia. Surgeons consider the procedure to be a success when patients are back to daily life within 6 to 8 weeks!
How Can Pilates help your discs?
Pilates exercises are not only known, but designed, to lengthen the spine. By becoming aware of your supportive postural muscles you naturally become more mindful of your posture. Put very simply, if you have a more functional and efficient posture moving you through space you are much less likely to encourage "wear and tear" on your discs. If you are gliding through your environment with ease and fluidity, you can be confident that your vertebrae and discs are gliding supportively along one another in the same way.
Osteoporosis: With Pilates/Without Pilates
Age-related or post-menopausal osteoporosis is a condition in which there is bone loss that leaves an individual's bones weak and brittle. There are many factors that can predispose to osteoporosis, some of which we can control. An unbalanced diet lacking sufficient vitamin D and calcium, a sedentary lifestyle and smoking can be major contributors to developing osteoporosis that patients can control. Being a postmenopausal caucasian woman however, is not something we can change! What we'd like to highlight is an active lifestyle. Studies have shown that continuous weight-bearing exercise is vital for maintenance of bone density and health.
According to the National Osteoporosis Foundation the condition can be not only painful, but dangerous. Weak and brittle bones are highly susceptible to fracture, even from minor falls or bumping into furniture. Dr. Rogerson spoke of extreme cases involving vertebral body compression fractures - a vertebra is severely broken - sending people to the emergency room and sometimes even admitted to the hospital for pain control and surgery. "By definition, if you experience a vertebral compression fracture after minor trauma, you have osteoporosis."
Not only is Pilates a movement practice that can help to prevent osteoporosis, its something that can safely be done to recover from complications of the condition. Many of the exercises require different levels of whole body weight-bearing. In addition, practicing with the equipment can continue to challenge your strength - thus ensuring bone health - or assist you as you recover your strength.
Bridging the gap between a Pilates Instructor and a Surgeon:
We live in a land of quick fix pills. With conditions that limit movement like disc degeneration or osteoporosis there is no one pill that will solve the problem. In serious cases opting for surgery makes the most sense. It's true that recovery can vary, but life is drastically improved. Even in situations where surgery is performed Dr. Rogerson says "patients need to be active participants in their therapy and/or recovery." I have said so many times that "the body will forgive, but it doesn't forget." If you want to increase your chances of staying out of the doctor's office it's imperative you develop awareness to move efficiently. This is where wellness practitioners and surgeons can stand on common ground. When a patient is not a surgical candidate, the surgeon often launches into a "speech" about anti-inflamitories and physical therapy. Adding to this well recited speech, Dr. Rogerson personally plans to motivate and educate her patients in the variety of options they have to become a more active participant in ending their back pain. She feels having a connection to movement practices like Pilates will greatly assist in helping her patients before or after surgery. I, for one, feel the exact same way!