Pilates and Spinal Stenosis

I got an email recently from a woman who's been diagosed with spinal stenosis. Here is the email I received:

"Elaine, I just found your website, WOW.
I have recently been diagnosed with lumbar stenosis. Never had an issue with this or anything else physically. Just had an epidural, did get some relief, but it is still there. I ordered a pilates machine on QVC. I have done pilates once, about 5 years ago. I want very much to be on a preventive strengthening program, and not have surgery. Can you advise me in any way, or point me in a direction. It comes with two DVD’s."

A few of my clients in the past have had spinal stenosis, and I've seen how pilates has benefitted them by strengthening their backs and core muscles. In case you're wondering what spinal stenosis is, here is the definition according to http://www.spinalstenosis.org/:

Lumbar spinal stenosis is a condition due to narrowing of the spinal cord causing nerve pinching which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity.

If you have spinal stenosis, working privately with an experienced, certified instructor can be very beneficial for you. In my experiences, working with clients who have spinal stenosis, there are many movements and exercises that are contraindicated for the condition. Of course, there are also other movements that are great- so I'll go over both the Do's and the Don'ts!

Before listing some good exercises to do, here is a list of positions to avoid with spinal stenosis, as these positions worsen back pain and compress the already weaken spine and nerves:

-Avoid almost all matwork/floor work (with the exception of exercises listed below)

-When on the pilates equipment, use light springs

-Never reach the legs out to 45 degrees, bring the legs into a right angle (Table Top) or 90 degrees only

-Avoid very much twisting or side-bending

-Avoid arching the spine

-Avoid rounding or trying to articulate the spine, instead, keep a neutral pelvis at all times possible.

That seems like you'll have to eliminate almost every pilates exercise! But don't worry, there are still many exercises you can do:

Using the reformer is great for anyone with stenosis because of the assistance that the springs and pads give the body during each movement.

Good Exercises/Things to do:

-Footwork and variations of

-Arms in many positions

-Short box: variations of moves with flat back. Possibly add small twisting

-Longstretch series: try to do whole series without rounding or arching much

-Knee Stretches: with a flat back

-Stomach Massage: Eliminate round back version, or possibly eliminate Stomach Massage entirely if you're a beginner

-Remember, keep springs light

When working out on the Tower:
You can use the Push Through Bar on the tower to do many exercises for your abdominals, to stretch your legs, and to work your arms. Here are some good exercises:

-Push Through Extra stretches may be added (see bottom of this post for link).

-Abs: Laying face up, under the push through bar with spring from above, pulse up 10 times. Then, one arm holds the bar, cross the other arm over the body and pulse to work the obliques. Repeat on other side.

-Legs: With the bottom spring on push through bar, lay underneath with both feet on, as in preparation for the Tower exercise. Take variations of pointing and flexing the feet, bending and extending the knees. Repeat with one leg at a time.
This may not be suitable for every person with spinal stenosis.

-Arms: With both hands on the push through bar and a spring from below, lay underneath and push up on the bar. Also try one arm at a time.

Using the Chair:
-Leg Pumps are great

On the mat:
The only exercises my clients and I have found to not irritate the back are:

-Side Leg Kicks (incorporate the magic circle or one leg spring for variety)

-Inner thighs squeeze the magic circle

Remember, these are just some suggestions and everything here might not be great for every single person. If anyone has any thoughts or exercises that help them, please feel free to comment so other people can benefit from your experiences!

Here are links to spinal stenosis websites:
http://www.spinalstenosis.org/
http://www.mayoclinic.com/health/spinal-stenosis/DS00515

Here is another post I wrote about a variation on Push Through that is nice for some people with spinal stenosis:
http://headsuponyourbody.blogspot.com/2008/03/great-variation-of-push-through.html