Pilates and Stenosis

A friend of mine suffers from lumbar stenosis.  Like a number of individuals who are over 50, she has a narrowing in her spinal chord  that causes nerve pinching which produces ongoing pain in her buttocks, lack of feeling in her legs, limping, and a reduction of her overall physical activity.  One system of exercise that offers her some relief is Pilates. So I was very glad when she came to see me for help after her physical therapist recommended Pilates.

If you have spinal stenosis, working with an instructor who is both carefully trained and experienced can be very beneficial to help relieve your symptoms.   Be aware that there are a number of the Pilates movements that are contraindicated for stenosis, especially extension of the spine.  And it may be wise to skip much of the mat work on the floor and move right to the Reformer, using lighter springs and always avoiding extending the legs straight out to 45 degrees.  The springs and the padded surface of the Reformer can help the stenosis client to feel supported and comfortable. Keeping the legs in a table top position or extending them to 90 degrees is best. All of the choreography must be modified to minimize torso rotation and lateral flexion. This will vary from client to client as each stenosis patient has his or her own unique set of symptoms.  Keep the  pelvis  in neutral, although a visual of lengthening the spine towards the carriage might also be used (without actually going into a full imprint).  Many exercises from the extensive Pilates repertoire can be done under the watchful eye of a good instructor:  all kinds of footwork and arm work, and the knee stretch, short box, and long stretch series all modified to flat back positions with very slight twisting or side bending. Flat back versions of rowing back II and rowing front I and flat back stomach massage will work provided the client can sit.  Some flexion can be added into the workout,  depending on the type and severity of stenosis.  In fact, often lumbar flexion such as roll downs in front of the Chair can bring some relief to the lower back as long as proper engagement is used to recruit the muscles involved.  The push through bar on the Cadillac also provides safe tension and variety, working from supine positions with the bar sprung both from above and below. The essential factor is finding an instructor who has experience working with spinal stenosis, so that you can relax and look forward to the strengthening and stretching each session provides.  Take the time to nicely interview your potential Pilates teacher about his or her qualifications.  Do not work with a teacher with whom you do not feel comfortable, as teaching methods and styles vary greatly.You may have to pay a little more for a great classical Pilates teacher who has been therapeutically trained, but the rewards will be worth it!

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