Your disks are made up of a soft centre (nucleus pulposus) and a tough outer layer (annulus fibrosus). They are fixed in position in between each vertebrae in your spine. Completely fixed. This means they can’t ‘slip’ anywhere. This is a common misconception, and leads us to believe that we could just ‘slip’ it back into place, and all would be fine.
In reality, what happens is the disk has been squeezed or stretched beyond where it can cope causing it to bulge, rupture, herniate (split and spill out) or become prolapsed (damaged). This causes the disk to press on nearby nerves (sometimes the sciatic nerve) causing pain and discomfort.
Some clients will have their symptoms clear up in 4-6 weeks, others will require spinal injections or surgery. For Pilates, it is important your instructor is aware if you have ever had a ‘slipped’ disk, and if it was medically diagnosed, how it was treated, and if you had surgery. Tell your instructor if you have been advised to exercise, and at what stage of recovery you are (pain levels and triggers).
Avoiding spine flexion
The rear surface of the disk is the weakest part. When you bend forward, the soft centre of your disk presses on the weak part. So if you have had a herniated or prolapsed disk, this should be avoided until you are cleared by your physio or consultant to do so. This means no mobility roll downs, no ab prep, no rolling back, no cat cow stretch, no knees to chest stretch and no roll up. It also means adjusting your seated position to avoid bending forwards, being more aware of your posture in daily activities and reminding yourself at regular intervals.
Where do I start?
The best place to start with a newly diagnosed herniated or prolapsed disk is on your back. Spend time really making sure you understand neutral spine, and how to engage your TVA and pelvic floor. These are super important as you need these muscles more than ever to support your spine. If you are new to Pilates, it is worth understanding you will not get this right immediately. This is a complicated chain of events that requires a huge amount of body awareness to correctly achieve. When you are able to maintain your neutral, with your TVA contracted and the pelvic floor engaged, you can discuss with your instructor modified versions of:
- 100 (initially lift alternate heels with pelvic stability, then lift 1 leg to tabletop)
- One Leg Stretch (heel slide)
- Shoulder bridge (no articulation through the spine, perform glute raise in neutral)
- Double leg stretch (arms only)
- One Leg Circle (with a band for support)
As you become more confident and pain free, and you understand the TVA contraction, you may progress to a prone swan dive (lower layers only).
If pain worsens, changes or persists beyond 6 weeks, please consult a medical professional.
