I usually spend most of my time trying to encourage as many people as possible to get into Pilates. I love it, I love what it has done for me and I want them to love it too! Every now and again I regretfully have to tell someone that it is not the right exercise for them for now.
A few weeks ago I was greeting my clients for my 7am reformer class and one of my regulars, let’s call her Jane, came over for a quick word.
Jane told me that she had been experiencing some back pain after going to a Bikram class and wanted to let me know before the class started but felt that the Pilates class would probably help. Hopefully if any other instructors are reading this alarm bells are ringing in your heads too. At times like this the osteopath in me takes over and I asked Jane, as she thought the Bikram class was the cause of the back pain if she had experienced any pain during the class at all. Jane replied that she hadn’t but that she had woken with acute back pain the next day.
This is very typical of a disc injury in the low back. The shock absorbing discs that are fixed between our vertebrae have little to no blood or nerve supply and if they are damaged we may have very little feeling for the damage occurring. Like any tissue injury there will be some inflammation and swelling. It’s the same thing we see in a footballer whose knee swells up like a balloon after an injury as they roll around in agony as the knee joint has a far more generous blood and nerve supply. The swelling in the disc just takes a lot longer and can sometimes take up to twenty four hours from the time of injury until the disc has swollen significantly enough to impinge on and irritate its surrounding structures.
Discs consist of a gel like nucleus which is surrounded by rings of more fibrous material. If there are any tears in the fibrous rings some of the nucleus may leak out. If it comes into contact with the nerves in this area the resulting pressure and chemical irritation can be intensely painful.
Scary as this sounds most disc injuries start as minor tears with an intact nucleus. The tear may cause the disc to bulge slightly which can result in some unpleasant symptoms. However it is at this point that you need to really look after your back and NOT do that Pilates class!
Many Pilates moves involve forward flexion which can turn a small tear in the disc into a large rip. Imagine if you cut the skin over one of your knuckles in line with your finger bones. In order for the cut to heal you would keep the finger relatively still for a the day and avoid any flexion movements that would pull the skin apart. Skin heals quickly because of its rich blood supply. The same thing is happening with your disc, it’s just going to take longer because of its poor blood supply.
Jane was politely but firmly told that there was no way that she was attending the class today or for the next couple of weeks. Luckily she is one of those clients who actually listens when they are told something they really didn’t want to hear, I think that being an osteopath really helps here! One of the best things to do in this situation is acknowledge that an injury stopping you from training for a couple of weeks is frustrating but not as frustrating as turning a minor injury into a major one which stops you exercising for months. I sent Jane away with some instructions:
- To ice her lower back regularly to reduce the swelling.
- Take regular desk breaks if she was going to be sitting at work all day as this puts a lot of pressure on an already compromised disc.
- To avoid any bending twisting movements as these put the disc at a great risk of further damage.
- To call me if symptoms worsened or if she had an questions.
Jane returned to class after a couple of weeks pain free and this is usually the most dangerous time as it’s easy to think all is OK and go back to your usual exercise routine. Over the next few weeks we concentrated on more stabilising work and I just made it so hard that the class didn’t even notice that we were not doing the usual flexion and twisting! Now I’m confidant that Jane has fully healed her disc we are back to the usual routine and she is once agin one of my strong ladies who needs little correction during the class.