Post Operative Recovery Lower Back

David, aged 34, was referred by a physiotherapist for continuing Pilates rehabilitation recovering from an L5 microdiscectomy and L4 prolapse. He still had some pain in that area and down the right leg.

On Assessment we noted:
Soft foot arches more so right hand side, the right tibia slightly externally rotated, patella a little high and laterally displaced and a slight anterior pelvic tilt.
Very flat back with hardly any thoracic curve. Upper lumbar L1 to 3 in slight flexion. Slight sway upper back.
Hamstrings tight, on the Right he can raise the leg to about 40deg, Left 60deg.
Suffers from some foot drop on right side and some neural pain and complains of tightness in calf.

After a series of stability tests we noted:
Good control of pelvic stability from initial rehab work, but was weak in almost every area; pelvic floor and adductors very weak; gluteals weak and overwhelmed by hamstrings.

Initial Treatment:
The priority was to improve stability and control, then strength and flexibility. Most sessions included all of those elements usually concentrating on a specific area or two.

David responded very well to all exercises. Global stabilisers worked well but the deep back multifidi stabilising muscles especially were weak and lazy. A series of stretching lumbar fascia and latissimus dorsi combined with extensor strengthening followed to help decompress and support the spine. Exercises to control thoracic spine in flexion with segmental control were incorporated once he was more stable and stretched. Continual exercises for strengthening the gluteals and stretching hamstrings and improving abdominals and core stability were followed.

First Review
After 8 sessions the David had a review with the Physiotherapist who reported that calf strength had improved greatly over the six weeks and lumbar flexion was better. She noted some rotation at L3 recommending careful work to ensure stability at that joint.

With core control re-asserted he could then concentrate on getting more lower lumbar flexion whilst controlling the point of give in the upper lumbar vertebrae. By the end of 12 sessions he no longer complained of any pain or twinges in lower lumbar and had much more control and strength in all movements of the spine. He even had some thoracic curve restored. The issues remaining were stiffness in lower lumbar and although foot drop had improved he was still bothered by some neural tightness in his right calf.

Final Review
Over a period of two months and 16 sessions David’s rehabilitation had improved enormously. His stability had improved with more control of the ‘give’ in the lumbar spine regions L1 to L3; and has no more pain; a little more flexibility L5/4; a lot more control and strength over the whole spine in flexion and extension with some restoration of it’s natural curves; lateral flexion and control likewise; hamstring length increased enormously to around 80 degrees both legs.

He responded very well to the exercises sometimes with almost immediate results almost as though the neuromuscular system was being woken up in whichever area was being targeted. He became very body aware and this helped throughout the sessions.

He progressed very well and each session would highlight an area of improvement and lead on to another one to be addressed.

Post Script
David still comes to weekly Pilates sessions after over a year and is now performing some of the more advanced exercises with appropriate strength and control particularly with spinal movement which seems to have undergone a complete awakening process.

 

pilates . movement therapy . myofascial bodywork

Chiswell Studios,
33-34 Chiswell St.
London EC1Y 4SF