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How to treat a disc prolapse (Pilates version).

What is a disc prolapse

A disc prolapse, also known as a herniated disc or slipped disc, is where the soft tissue in between the vertebrae in your spine, called an intervertebral disc, pushes out of place.

The intervertebral disc is made up of 2 parts, the inner part has a soft, jelly like texture and is called the nucleus pulposus, the outer part is tougher and more rubbery and is called the annulus fibrosus.

A herniation can happen when part of the nucleus pushes or bulges (it doesn’t really slip!) out through a weakness or tear in the annulus.

The bulge can potentially place pressure on surrounding nerve roots coming from the spinal cord which is encased within the vertebral structures of the spine. This can cause pain, tingling, weakness and numbness and depending on the nerve root affected, symptoms can be in the surrounding area of the spine or travel down to parts of the glute, leg or foot.

A prolapse can happen anywhere in the spine but is more common in the lumbar/lower area in particular around L4/L5/S1.

Why does it happen

Clients I have seen over the years often describe movements such as hoovering, making the bed, bending down to pick something up as an onset to their back pain and prolapse diagnosis.

This may be the ‘straw that broke the camel's back’ but it’s not what created the prolapse. Often it’s the repetition of movement, our posture, how we hold ourselves dynamically and statically, what we do day to day, week to week and year in year out that creates imbalances and misalignment that can leave this area vulnerable.

Examples of this can be sitting in a fixed position all day working at a computer or driving for long periods, strenuous movement i.e lifting something heavy where we can’t maintain intra-abdominal pressure, this is the force built through diaphragmatic breathing to support us as we move and carry out daily activities such as lifting.

Age, genetics, diet and lifestyle factors can all play a part too.

What do I do

When treating someone with a disc prolapse, the first initial session involves a full health history and then assessment of movement, in particular how the spine flexes and extends. Often someone with a prolapse will have difficulty and discomfort when bending forwards.

I also look at breathing and diaphragm function as this is important for building intra-abdominal pressure and core stability, it’s also useful to incorporate muscle testing of the spine and core to see where the dysfunction might be.

The reason I look at breathing and the core in such depth, especially if the prolapse is at L4/5 S1, is because the only support we have on the anterior aspect of those vertebrae (at the front of the spine, behind the belly button and towards the pubic bone) is our breath.

The surrounding structures that attach to the sides and the posterior parts of the vertebrae such as the spinal muscles, the transverse abdominis, internal abdominal obliques and also the pelvic floor respond and move in synergy with our diaphragm and our breath.

The better our breathing / diaphragm function, the more support we have in this area of the spine, this in turn will help strengthen, stabilise and support the vertebrae.

Once breathing is optimised and core function is improved, we move on to exercises that will build on this either using matwork based movements or the springs and support of the trapeze table and reformer. This will improve posture, spinal strength and stability and will eventually rebalance the area around the prolapse, relieving pain which will help you to move better, more freely and can vastly improve the prolapse itself.

If you are struggling with a disc prolapse and would like further information, please get in touch.

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