JP Case Study
A Pelvis, Hip and Spine Pilates Therapy story…with a happy ending!
The following blog is based on a real patient
How JP first came to me
JP first came to see me after New Year January 2014 having never done Pilates before. She grew up in a family of runners and had been a long distance runner until December 2012 when she had to stop due to low back pain. Her diagnosis was L5-S1 disc herniation and was presenting with nerve irritation and altered sensation in her right foot (numbness in her big toe joint and down the outer aspect of her foot). Walking, swimming (breast stroke surprisingly) and hot baths were the only things that seemed to ease her discomfort but sitting, bending and lifting all made it worse which made her job as a nurse difficult. Her neurologist had given her a steroid injection in June of 2013 after diagnostic testing identified her disc issues and she was referred to me by her Osteopath who often sends me the patients he believes will benefit from Pilates. She had replaced her running with swimming and walking twice a week as being active is part of her who she is.
What do I, as a Pilates Therapist, do that is different from other Pilates teachers?
I screen my clients objectively and utilise therapy skills acquired over 20 years of teaching and continuously taking courses to add more tools to my toolbox. All with the goal of being able to help my clients move better, with less pain and without having to cue them constantly to ‘adjust’ and ‘correct’ their movement. Pilates is an amazing movement system but on its own, sometimes isn’t enough to get them there. I appreciate this a controversial opinion but if Pilates ‘cured’ all movement related dysfunction we could charge what we liked for our sessions. I work with other like minded practitioners and professionals who also recognise there are no ‘therapies’ that solve all puzzles which is why I refer clients to them, and they refer clients to me. This is how I came to start working with JP at the beginning of 2014.
When I first meet a client one of the questions I ask is ‘what is their goal’?
What would they like to be able to do that they are not able to now. In JP’s case she wasn’t confident in setting the goal to be able to run again and was happy with reducing her pain and being able to get through her days without discomfort. One my beliefs is when working with movement we can set goals with an open mind, without limiting expectations. JP was afraid to imagine she could run again (spoiler alert, May 2015, she did and recently completed a 5K run and beat a family member who regularly runs marathons – a very happy day!).
What did we do during our sessions that helped her get there?
We screened her from day one to evaluate what she was and was not able to do. We started with focusing on screening her pelvis and found her right PSIS was lower than her left and the sulcus on the left was deeper than on the right suggesting her sacrum was twisted to the right. She also presented with a functional a leg length difference with the left leg longer (this made sense as her left ilium was anteriorly tilted relative to the right). If this is all gibberish, come and join us because this is what we are teaching on our course.
Objective evaluation for JP was key
Knowing how to evaluate the pelvis, hip and spine objectively and address what is found before starting a Pilates practice means our clients are moving better from the start. Putting her on a reformer before we had addressed the pelvic issues would not have been helpful. Using muscle energy techniques, soft tissue and neural therapy skills we evened things out, calmed down what was overworking and woke up what had been asleep. It is a ‘do with’ process and she has done her homework and earned a body that is now more balanced and free from neural symptoms and most importantly, she is enjoying running and has her active lifestyle back. Her disc issues were her bodies way of getting her attention. It worked, but the disc problem was the result of unresolved pelvic dysfunction we uncovered that went back to her two pregnancies over twenty years earlier.
The luxury we have as Pilates teachers is that we get to spend an hour with our clients and we get see them move, most other practitioners don’t. The additional tools we have as Pilates Therapists makes our time with our clients even more productive as we can screen, intervene and then get them moving.
“When you have exhausted all possibilities, remember this: you haven’t.” Thomas Edison