Karyn session 4-12

I am very guilty for not being able to record Karyn's progress promptly. So here is what happened in the past 1.5 month.


Since Karyn has completed her study she managed to squeeze out more time to do Pilates twice weekly amidst her super hectic child-caring schedule.


Though her pain was initially relieved by few pilates sessions, her baby boy is growing fast and is making it even more stressful on Karyn's back whenever she carries him. Thus the pain on her left lumbar area originating from her herniated disc continued to come and go over the weeks, and severity varies depending on how much she carries him.


One day she called me to complain about numbness on the lateral side of her right knee, I suspected it might be due to her twice weekly jog or due to her aggravated disc condition, but on the safe side I asked her to consult a doctor.


She consulted a private orthopaedic doctor and, based on verbal description of her symptoms, he concluded (without any physical/ manual/ functional check-up) that Karyn was suffering from ITB symdrome. So she was told to do some ITB stretch and given anti-inflammation cream. To my surprise, she was also told that she could continue her jogging as per normal. Both me and Karyn felt that this particular doctor was not very helpful as he did not really investigate the real cause of the problem, he just wanted to get his patient out of his office asap. With the recommended stretch and medicated cream, the numbness at Karyn's knee did not really go away.


Then she developed numbness at her right toes. She thought it was due to her new running shoes. But I was skeptical and urged her to consult another doctor instead.


An orthopaedic surgeon from Tan Tock Seng Hospital who specialises in spine finally confirmed what I suspected. The numbness at her knee and toes were actually symptoms refered from her herniated disc. He advised against surgery as the herniation is still very much preliminary, and he also discouraged the use of pain killer or analgesic cream as they only masked the symptoms. He ordered Karyn to continue with Pilates as main treatment as it can help correct mechanical problem in the spine. He also advised her to swim regularly.


With few Pilates sessions focusing on core control, lumbar stabilisation and spinal extension, the numbness dissipated gradually. Karyn was all excited and got herself into the pool soon after the consultation. She swam so hard and long that after her swim her back pain turned from bad to worse! Karyn was totally puzzled as swimming was "supposedly" good for back pain but yet it made hers worst instead.

Moral of the story? always get 2nd medical opinion if you feel that the doctor was not detailed or proficient enough to help alleviate your problem. And be easy on your body if you have not done certain exercise for a long time. For Karyn she probably overstrained from the swim as she had not swim for years! Too much good thing is not neccessarily good and moderation is the key :)

Karyn - Session 2 & 3

Session 2 (Feb 2008)
Karyn indicated that her back pain was aggravated in the week after session 1. But she felt that the pain was not entirely caused by the Pilates exercises but possibly due to the intense childcare duties that she did over the week.

In session 2, lateral breathing, pelvic tilt and chest curl were repeated to reinforce their proper execution. However basic bridging was removed to prevent any lumbar flexion since pain was active. Side kicks on elbow were added to strengthen core, arm and shoulder girdle. Karyn has very good body awareness thus was able to disassociate her hips beautifully. Prone press up was highly emphasized and encouraged to practice on her own as it can improve spinal extension through the thoracic spine and improve control to stabilize the lumbar area.

Thorough postural and home ergonomic analysis were done to correct any harmful postures used when Karyn takes care of her children. For example, it was suggested to bathe the baby in a basin on the dinning table instead of on the bathroom floor so that she could stand in proper posture; also Karyn was advised to kneel rather than sit cross-legged on the floor when caring for her baby so that she could maintain neutral spine.

After session 2, Karyn reported that her back pain has gone. I would attribute such improvement to the extension work done during the session.

Session 3 (12 August 2008)
Karyn had to stop training due to her study and could only resume after 6 months. Her back condition has gotten from bad to worse, and her quadratus lumborum area was swollen due to active inflammation. Her left and right side muscle imbalance in upper body also became more severe.

Breathing exercise, dead bug on foam roller, prone press up were performed. Mermaid was done but range of motion was reduced (only reached up instead of “reach up and over”) on the inflicted side to prevent aggravation. I have advised Karyn to consult a physiotherapist who is trained in Pilates to do a spine check so that I could work her in safest and most optimal range in future sessions

Case Study - Karyn 1

Background
Karyn, mother of 2, underwent C-section 4 months ago. While caring for her new born she developed moderate lower back pain during recent Chinese New Year. MRI confirmed that she suffered from L4/5 disc herniation. She does not want to take oral pain killer as she is nursing, instead she choose to manage her pain by practicing Pilates.

She has always been active. Prenatally Karyn runs regularly to build stamina and resistant trains to strengthen joints. She then switched to cross-trainer until 7th month pregnant when her weight gain induced knee pain.

She has also tried fundamental Pilates matwork & reformer at a professional Pilates studio in HK.

Medical History

• Hip injury from a fall
• Carpal tunnel symdrome on right wrist, treated with physiotherapy
• Lateral knee pain due to running
• Ankle sprains
  

Body Assessment

• Forward neck posture
• Slight thoracic scoliosis, contributing to unbalanced shoulders and raised, prominent left sacrum & leaning on right ankle
• Moderate knocked knees & foot pronation.

Fitness Assessment
Score = 2.6
Generally she has good flexibility (possibly due to the post-natal oxytocin level in her body) but lack of upper body and core strength. Her prenatal fitness level and Pilates experience may have contribute to her good body awareness.

Exercise for Today

1. Lateral Breathing - to learn efficient breathing pattern thru fully utilise intercostal space intead of purely thru accessory breathing.
   
2. Pelvic Tilt - to find neutral spine
3. Chest Curl - to learn to initiate deep transverse abdominus
4. Basic Bridging - to learn spinal articulation, strengthen hamstring