Post-Surgical Patient: Can’t activate Transversus Abdominus?

From Nikki Martin:

Sherri-

This is the medical history of a client I will be starting with in about 2 weeks.

Abdominal

1. Laparotomy x 3 (ovarian cysts & infertility)
2. C. section – which caused numbness from pubic area to half way to the navel.

Back

1. Anterior cervical fusion C6/C7 (20 years ago) which has limited cervical rotation.
2. February 2009 – Discectomy L5/S1
3. 2 degenerative discs – L5/S1 & L4/L5
4. March 2009 Right total hip posterior aproach

She is an RN in the OB department of a hospital, super nice and very interested in “getting into her body” and we are working on slowing down, getting into breath, and thinking more about the local muscular system instead of the the global muscles. So I was wondering if you had any advice on how to gain some awareness through the transverse and deeper abdominal layers. She is also osteopenic on top of it all but moves relatively well and is gaining some connection. When I palpate the transversus, and ask her to contract/kegel, I feel NOTHING, I just see her sternum lift and rib cage flare. I am starting to do some research in the different procedures she has gone through, I really want to help her gain connection and stability throughout her body. I respect t your education and experience so much, I was hoping you could point me in the right direction.
I hope all is well with you, your hubby, Cali, and the studio.
Thanks for your time,
-Nikki

 

Why can’t a person with Osteopenia flex the spine?

Regarding the difference between osteoporosis and osteopenia: Basically we must assume that if the person has osteopenia of the lumbar spine that they may very likely have osteoporosis of the thoracic spine. 1)The thoracic spine is more oriented to kyphosis and anterior loading of the vertebral bodies, 2)The vertebrae get smaller as we go up the vertebral column and 3) The most popular fracture site of the spine is at T6-T7 and T8. We also have no way of determining whether or not the disease is progressing as we are working with our clients. There is no way we can determine how much force it would take to cause a fracture in the spine. The statistics are clear; 1 in every 2 women over age 50 will have an osteoporotic fracture in their lifetime. Then after the 1st vertebral fracture the risk of having another one within 1 year is 500%!! We need to be very vigilant about preventing the 1st fracture. It’s not a good idea to “experiment” with clients when the research is very clear. A physical therapist is guilty of malpractice if they put a patient who has known osteoporosis in spine flexion.(Carole Lewis, PT) I am in support of “evidence-based” practice in PT and Fitness. I want to give my clients/patients SAFE exercises that WORK! Unfortunately with so many flexion exercises in our beloved Pilates method we are forced to be creative and compliant. Yes, we WILL narrow their options for movement somewhat but my clients from age 20-84 are completely happy with their exercise programs and feel very confident about their guidelines and exercises! They don’t want to have any/anymore fractures! I know very few people on the planet these days that need to increase their degree of thoracic flexion!

There is an article that explains all of the reasons for avoiding flexion, Modifying Pilates for Osteoporosis, published April 2005 in the IDEA Fitness Journal. It is downloadable on the Osteoporosis News page of this TheraPilates website.