Ms D complained of severe pain in her neck and shoulders. It was aggravated by spending long periods at the computer, but improved with exercise. She worked out in a gym and did yoga and pilates regularly. This wasn’t her first episode of neck and shoulder pain, she was almost constantly sore in these areas and had had regular flare ups. She also revealed that she regularly suffered from low back ache. She worked at a computer and was worried about losing her job.
Ms D is tall and slender. Examination revealed widespread problems throughout her spine. Even more apparent was the winging in her scapular; neither of her shoulder blades sat snuggly on her rib cage and one was in an elevated position. This strongly suggested a lack of stability in her shoulder girdle.
Further questioning revealed that Ms D did a particularly dynamic form of yoga that involved a lot of weight bearing through the arms. The exercise sequences were fast and involved multiple plank-like postures. Ms D enjoyed her yoga and did not want to give it up. I suggested that she stop yoga and any other exercises that might stress this area for a few weeks, until things had calmed down. In the longer term it would be possible to strengthen her muscles and develop the kind of shoulder stability that would enable her to go back to her dynamic yoga. At present the yoga exercises were much too strong and were hindering rather than helping her shoulder instability.
After 3-4 sessions of osteopathy her neck and shoulder pain had lessened considerably, as had her low back ache. As part of the treatment sessions we worked on the stability in her lower back, as well as exercises to begin strengthening her shoulders using a small piece of pilates equipment called a magic circle. We continued to work on the long term muscle tension in her shoulders and neck whilst slowly building strength in the area and moving towards a more dynamic stability in her upper body. Slowly more exercises that involved weight-bearing in the arms were introduced, until we started to work on the plank-like movements that she would need to safely go back to yoga.
Mrs Y was in her mid-sixties and was facing spinal surgery. Over the years she had developed both a marked kyphosis and scoliosis in her spine. This meant that her upper back had a humped appearance, while her spine was S shaped when viewed from behind. In addition she had recently been diagnosed with osteoporosis and was on medication. Mrs Y was retired and wanted to travel as much as possible while she still could. She was resigned to always being in discomfort but was desperate to avoid back surgery. Could Pilates help?
At the time I had never used Pilates for anything as serious as this and was cautious about how much we could achieve. But I was willing to see if we could at least stabilise the marked curves in her spine enough for her to be able to avoid surgery.
I have been seeing Mrs Y for seven years now. She has had her ups and downs, but on the whole Pilates has been remarkable successful. Not only has she avoided spinal surgery, but the curves in her back have reduced. The medication has had a big effect on her osteoporosis, which is largely reversed. Mrs Y still sees me regularly but the frequency of her visits has lessened. She suffers very little discomfort, travels abroad frequently and is able to partake in activities that she thought were beyond her.
Mr B was very anxious when he arrived. He was in his early 50s and looked in good shape. However, he was suffering from wear in his lower back and was experiencing episodes of leg and back pain. His work meant that he had periods of lugging heavy equipment around and then long periods of remaining stationary. Neither of which helped his back.
He arrived with the results of an MRI scan that showed that the lowest 3 discs in his lower back were bulging and impinging on the nerve roots. It also showed something called early multifidus atrophy. Multifidus muscles are deep back muscles that can attach to up to 3 vertebrae. Although small, the multifidus muscles provide a great deal of spinal stability. In Mr B’s case they were weakening and reducing in size.
Most disc bulges are to the back and slightly out to the side. (This is usually recorded as ‘posterior-lateral’ in medical notes.) And this gives a therapist a good idea of what exercises to avoid and which will help. Mr B had one disc bulging to the front and the others were very much to the side – a much more complicated picture!
Mr B was self-employed and worried about his work. Moreover, he was worried about the effects on his general health and fitness. He had already tried several physical therapies with little success and was therefore reluctant to have any osteopathic treatment.
Mr B was treated only with Pilates. We avoided any extreme movements and took things slowly, carefully monitoring his progress and avoiding exercises that seemed to aggravate his symptoms. We gradually built up a full work out that restored strength and mobility without provoking pain. After 2 months he was stable and able to work on more challenging exercises. Mr B was so impressed with Pilates that he continued with me well beyond the rehab stage. His sessions became more like a fitness workout. He continued to train twice a week with me until he moved to another county a year later.