Pilates for injury recovery and prevention?

[scrubbyfish]

I injured myself, dammit!

I think the relevant stuff is as follows:
-probably separated my SI joint, but we can't know for sure
-I have extremely flat feet and am prescribed orthotics
-since the injury three weeks ago, I have gone from being 100% immobile and in agony to walking, using stairs, driving, bending, etc, and being reasonably comfortable (so to speak) most of the time
-I still have to lie down most of each day
-I have used acupuncture, heat, senar machine, etc
-so, great progress but still some pain and limitations
-I now have an SI belt to wear
-the primary remaining challenge is sitting (as in, I can't)

The injury has cost me about $1000 so far and the acu-physio loses its effectiveness after 2-3 days. I'd like to find a sustainable program to resolve and prevent injury, preferably at home.

Would it be effective enough to learn the basics from a book? (I have The Pilates Bible.)
Or is it important/critical that I access a one-on-one trainer (another $700)?
Is a DVD a sound option?

What are your experiences, or what is your knowledge?

[sheepstache]

So sorry to hear!

A tae kwon do instructor I worked with said pilates was either the best thing you could do for your back or the worst. It's great to build the core, but you can totally hurt yourself doing the exercises wrong.

I didn't find one specific thing with back pain except that doing the best I could to keep moving around, as normally as possible, seemed to be the best course. Rather than taking it easy which is what used to be recommended. I actually switched to a field where I had to do physical work rather than sitting in a chair all day.

[pdxbator]

I have been doing pilates for more than 2 years with a trainer at first solo and then in a small group session. I didn't ever try it through a book.

From what I have experienced though there is nothing like learning through an experienced pilates instructor. They know the right technique and how to help you, and you should inform them right away of your injury and there are many changes to the moves that will make it comfortable for you.

I started pilates from a lower back injury. I injured my back very badly a dozen years ago, and had flare ups yearly a couple times  a year. I thought that was what life was going to be like. I decided to give pilates a whirl and SOOOOO glad I did. It has been life changing for my back and my core strength and flexibility. My back has improved so much plus my posture is better.

So I would highly recommend it. You may want to give yourself more time to heal though.

[Ms. Maggie]

So sorry to hear about your injury! I've been there, and it is not only very painful, but incredibly expensive.

May I recommend a good starting point - Pete Egoscue's books, Pain Free, and Better Health Through Motion. These have wonderful do-it-yourself routines to get your pain under control, and start rebuilding correct alignment to prevent future injury. He also has a website - www.egoscue.com. After doing the exercises from the book for a few months, I did take the plunge and seek one-on-one sessions with a guy in my area, but it is not completely necessary.

I tried everything for a debilitating shoulder injury three years ago (acupressure, PT, OT, yoga, tai chi) and this was the only thing that worked permanently, quickly, and was actually the cheapest option in the end! After doing the exercises about 20-30 minutes everyday, I am back to complete functionality!

Good luck and I hope this helps!

[Mrs. PoP]

So sorry to hear about the back pain!  I was rear-ended in a car accident 4.5 years ago and still have lower back (disc protrusion and tear) and SI (it pops out sometimes due to the ligaments) difficulties because of it. 

What helps me the most:
- yoga - stretching and core work.  I did yoga before the accident but it was really helpful to get back to it after and my instructor was great about showing me how to accommodate the injury - nursing it when needed, and gently challenging it as it got better
- SI belt.  I still wear this when doing high impact exercise (all running + biking is done with this), though I no longer wear it ALL THE TIME the way I did for a few months after the accident
- chiropractic care - recommend one that does SOT, a practice that focuses on whole body, not just spinal adjustments since it's one big interconnected system.  I went often right after the accident.  Now I only go as needed, usually about 1x per year. 
- inflatable seat pillow - stiff seats are killer on my back now, but this helps.  This is the only thing that makes plane rides bearable now.
- Varidesk - got one of these at work this year and it's great to be able to change positions as needed.  For me, staying in one position for too long is what is the worst.
- Get rid of shoes with HEELS.  Wearing heels (sadly even small ones like those on my cowboy boots or kitten heels) for even a short time can pop something out or cause swelling.
- Voltaren Gel - for me, oral NSAID pain relievers did basically nothing for my lower back inflammation which when it flares up results in visible lumps of swollen tissue on my lower back. (And ya know, the pain that goes with it.)  Opioids and muscle relaxants left me unable to feel much of anything, so weren't a long term solution, though I used them for a few days right after the accident.  This is a topical NSAID that I use as needed now.  Getting insurance approval is a pain in the butt, but worth it. 

Back injuries are really terrible, so I'm so sorry for what you're going through.  But you can get through it! 

[scrubbyfish]

Thank you very much, all of you!! All very, very helpful input!!

I don't wear heels, so that one is easy :)   However, I've been very sad to have to move from barefoot and flat sandals to fancy runners with custom orthotic inserts. I trust I'll be able to let these go again after training my body's alignment.

I did take painkillers the first few days, but not since. (It was painkillers *or* everything else, because they left me too impaired to drive to any appointments, plus I didn't find them critical once I started the acu/physio.)

I do feel I'm getting excellent results now from diet, stretching, the initial Pilates positions I'm doing from the book, rest, and the belt. I'm now free of the canes, can get out of bed with almost no pain, can walk pretty comfortably, etc.

I'm going to check out all the resources, such as Egoscue's book, inflatable pillow, etc. I think I'm also going to go for it with the one-on-one Pilates training too. I like that she can teach me how to accommodate for the injury, and create a program for me. She generally teaches on the machines, but I was firm that my goal is to have a program I can do at home (free, not having to leave my rural space regularly) so she said she'd be willing to create that for me instead.

Even though all I've done from the book so far is learn the relaxation position, compass, neck rolls, standing, and sitting, I'm really excited. Through these over three days I've become aware of how I'm standing and moving generally, and adjusting accordingly.

[frugaliknowit]

I herniated my disk approximately 20 years ago.  It was strongly suggested I have surgery.  Instead, I went to physical therapy for a few months. 

After that, I returned to the gym, starting very slowly, lifting very light and concentrating on my core with very gentle leg lifts.  As I got better and better, I worked my core more and more.  This made me better and better to the point of being pain free. 
Every 5 years or so, I get a touch of Psyiatica.  When this happens, I do yoga classes, until it subsides.  I have not needed a chiropractor since the injury.  BTW, swimming laps is also great therapy.  It stretches and exercises your back and core mucles.

Wholistic therapy with a focus on stretching and ab work is the way to go.

If any exercise hurts or doesn't feel right (pilates, yoga, or whatever), just skip it (maybe return to it later when you are stronger).

[scrubbyfish]

The catch (and often difference) with SI joint injury, according to the medical doctors and holistic practitioners I've seen so far, is that SI joint injury is one of few that movement is not good for, and that you often won't know a given movement is bad until the day after, when you are suddenly in agony again.

Their notes aligned with my experience: With a pulled back muscle, for example, movement was key. With this one, though, I went for a gentle, slow walk one day and felt great...until the next day when I was in agony again.

They're saying healing the SI joint demands heaps of rest and limited movement. Following that advice I've had excellent gains in mobility and no further agony. I'm trying to support the healing while also improving my body to prevent re-injury (anywhere).

I've now ordered the book mentioned above, but am lost re: Pilates as to whether to start with one-on-one, or a book, or a class, and if a class or one-on-one, machines or mat, and Stott or classical, etc. Sigh.

[scrubbyfish]

Realized what I need to do.
Considering:
-extremely flat feet such that even the contemporary Pilates instructions are not yet true for me (my feet can't land like that)
-recent injury, and current status of 'recovering'
-a difficult emotional anniversary tomorrow (which frankly, I think has everything to do with this injury)
-conflicting info about which style of Pilates is "good" vs "dangerous", especially with an injury/susceptibility
-the biggest logistical challenge being lack of home internet, such that I must carry bedding and laptop to lie on the floor of any other building

...I am going to a physiotherapist next. That person will be able to assess the SI joint + flat feet, give me the next phase of home exercises, incorporate pain relief therapies (including acupuncture, if indicated), point me to a safe rebuilding option (swimming, aquafit, Pilates, etc), help me design a lifestyle for injury-free contribution, etc. I will keep my acu appointment tomorrow to support me through the emotional anniversary, end the service there, and attend a physio appt Friday.

...and hiring someone to install an internet line to my home.

For sanity's sake, I will assume this injury will cost me $3000, budget accordingly, and enjoy the ride.

It's very difficult for me to spend money only as a result of "not knowing" (not having information). Scrambling around trying to find the critical pieces can be so expensive! I'm happy to spend money on things that have big results, but struggle with spending on anything less.

[Anatidae V]

Hi Scrubbyfish! I saw physios for 3+ years for hip issues and an overactive pelvic floor that was pulling everything else out of alignment/usefullness before I started one-on-one pilates with my pelvic floor physio (where "one on one" means she has up to 4 of us doing our own thing at a time). I think your next course of action is a very good one, and try a few different physiotherapists if you don't like the first one, as like anything else they are all a little different :)

[Chranstronaut]

SF, my dad is a PT and the one thing I can tell you to get the most out of your appointments is: be honest and do your homework!  The better you follow the at-home training regime, the quicker you will recover (or the quicker they will realize what is or isn't working).  Sounds like you're motivated to do it!  Good luck.

---Once your back is feeling better----
As a person with super flat feet, I was in orthotics at my dad's recommendation since around age 12.  Within the last year, I started researching weight training for my own interests.  I have definitely noticed an improvement in foot strength and arch comfort by engaging in heavy lifting and I no longer wear orthotics at all.  I didn't eve plan for this, I just noticed that my feet felt better in shoes without them! I think the best exercises have been deadlifts and barbell squats >50lb (which isn't all that heavy, you just have to learn the form and work up to it for a few weeks) in bare feet or "zero-drop" tennis shoes.  This forces your feet to get stronger, whereas traditional weight lifting shoes support your feet a lot (MMM does something similar).
My flat feet have given me ankle, knee and lower back issues all through my teens and 20s, and they literally disappeared after 2 months of regular weight training.  I know it's tangential to your question, but if you can get access to weight equipment once your back is healed (even just dumbells), I would recommend discussing with your PT on adding them into your fitness routine.  You can do body weight exercises with no equipment, but load bearing exercises will strengthen your bones more, as well as make you feel totally badass ;)
---End of anecdotal advice---

[Cromacster]

Realized what I need to do.
Considering:
-extremely flat feet such that even the contemporary Pilates instructions are not yet true for me (my feet can't land like that)

My wife deals with complications from flat feet and SI area pain.  As such I have looked into it a bit.  I will share what I have discovered when trying to help her.  She has seen some great results, especially with her feet.  The SI is being a little more stubborn.

Flat feet is somewhat of a debatable topic.  From my experience people who have flat feet believe there is nothing to be done or that it is genetic, but there are some in the physio industry that believe flat feet can be corrected.  Some believe the cause is due to motor patterns learned as a child, especially if a parent or primary caretaker had flat feet.  Other hypothesis is that the modern shoe has ruined the human foot.  That support in shoes has led to atrophy of muscles in the foot.

Some interesting videos for feet specifically, but I'd also recommend browsing Mobility Wod as it has a ton of corrective and preventative exercises you can do with minimal equipment.  You don't have to pay for it, the stuff available for free is plenty.

Bro your navicular bone dropped

Rebuilding your feet with Brian Mackenzie

Pinchy Ankles and Week Feet (This has horrible sound, but has the best information sadly).

Your situation for the SI might be something else, but this is another video I find helpful for SI area stuff.

SI Area Pain

I hope your road to recovery is smooth!

Edited to add +1 to ChransStache.  I'm always an advocate for adding barbells into someones life :)

[SilveradoBojangles]

So I have had extensive SI issues, and have orthotics as well. When my back was having issues I actually found it difficult to do Pilates because I couldn't bend at my waist or do any kind of plank, which a lot of pilates exercises require. So even though it seems low impact, I just couldn't manage it when I was in serious pain. I had these muscles in my low back that just seemed to lock up at the slightest provocation. 2 things that helped me get moving again:

- Check out the book "Pain Free" by Egoscue. This had a number of extremely low impact stretches and exercises that were really helpful in getting me out of the depths of my severe, I-cant-do-anything-but-lie-on-the-floor pain. I'm sure your library has it, or you can buy it used for a few bucks.

- I second ChransStache's suggestion about strength training once your initial inflammation dies down. There are a lot of muscles in your butt/hips/back that can get lazy, and others overcompensate for them. I realized I needed a serious program to build my glute muscles. But I couldn't do squats or lunges (see inability to bend, above). I found an article by Bret Contreras, who calls himself the glute guy, that just recommended clenching the glutes for 30 seconds in a standing position, a couple of times a day, to engage them. Even though that seems like nothing, it actually helped the spasming muscles relax though muscle inhibition. From there I was able to move on to some of the easier glute exercises Brett suggests. In the last 6 months I have been more pain free than since before the original injury 6 years ago. And my ass looks better.

Hope that helps, good luck! Back pain is the worst.

[scrubbyfish]

Hi folks,

Thanks so much for continuing to be here for me and sharing ideas and experiences! I only have internet every few days these days (in large part due to the injury), so sometimes it takes a bit for me to reappear. But, I always return to listen and take more notes!

The last three days have seen remarkable recovery! I'm not at 100% yet, but very close! I'm comfy and happy, while continuing to be gentle and taking care. I'm doing 2-3 sessions per day of stretching and beginner's core work. I've ordered two of Egoscue's books through the library, and in the meantime am working out of a Pilates book for basic stances, using an exercise from an SI joint injury video, adjusting my posture throughout each day, and this morning started through a DVD. All of these resources align with each other and with my intuition. The improvement is wonderful!

Adding to the conversation here...

Flat Feet
I land in the school that says orthotics are not necessary. This is because I eliminated all foot (and upward) pain by changing my diet several years ago. I went from decades of severe pain to none in a very short time. This is why I hadn't been wearing them. However, when I read that flat feet can be a source of misalignment, and that custom orthotics can help resolve that, I put them back on to support the acute healing phase. They provided relief.

I don't plan to use them long term. I plan to repair my whole body alignment through: core strength, stretching, optimal posture as close to 24/7 as I can manage, etc. This pieces are new to me, and where my learning needs to occur. A local Pilates instructor said Pilates increased her ankle, etc, strength such that she is now free of orthotics. So, yep! I absolutely believe we can go another way.

My acupuncturist recommended, for both me and my son, a site called barefoot science. I'll be looking into that, too.

Physio

The appointment was okay. I liked it, and the therapist, but I also came out of it understanding several things:

1. There are a gazillion schools of thought about posture, ideal exercises, etc.
2. No one health practitioner (of any kind) will know up front what one person needs to do. Healing and optimizing the body is about experimentation, a bit hit and miss. That's totally okay by me, and this awareness helps me decide how to invest my time, money, and energy going forward.
3. Separately from any practitioner (i.e., via body intuition, past knowledge, internet, you guys) I have figured out several key pieces.

[curlyfry]

Also agreeing with Silverado that Bret Contreras is definitely the expert on glutes! 

Some pilates exercises overload the SI joint but you will be able to tell which ones.

You want to start with less unilateral loading & then slowly progress. Key is to eventually build up to doing all the things you had to avoid previously!