My client is a mother of three, non-stop kind of woman. With the weight gain of three children and the deconditioning of her TVA, she has developed a bulging L1. She has tried all methods short of surgery. We are working with a few of the exercises from the PTN Research Corner, but she continually has cramping in the hamstring and gastroc. She has also had repeated bouts of numbness down the leg. With incredible tenderness in the piriformis, it can be difficult to complete even a series of floor bridges without discomfort/cramping. Any suggestions?
First, I would recommend an MRI to rule out red flags. Once you understand what her structure exhibits, you can then proceed to enhance her function. Attempts at trying to improve function without an understanding of WHY the structure may be causing the problem are usually futile. Please, never forget… her function is HER function and is only relative to her and not an exercise found on a web site or in any book. So, how is the spine affecting her hamstrings and calves? If the nerve root or periphery is irritated, exercise can make matters worse. You may have to refer to a physical therapist for the acute problem as a means to “calm” things down before addressing her function. If she’s already been this route, then I would recommend staying clear from floor bridges and any other isolated exercise that places too much tension in any one area. Remember, regardless of the problem, if they came in to see you, they are successful at some level. This means they walked in, therefore you can assess their ability to walk. Where are they successful? What planes of motion do they NOT exhibit discomfort? What positions do not exhibit discomfort (position is different than motion)? Example, you may find that walking with an exaggerated arm swing helps to create a counter-rotation, thus “turning on” the abdominal wall while reducing the stress to the hamstrings and calves. This total body approach is the key. Please stay away from exercises that chop the body up into parts. The key is to tweak the motion/position to create the right reaction at the right time to enhance your client’s ability to move more efficiently. If she’s moving inefficiently, an overuse injury is likely. Assess and apply the appropriate WHOLE-body movement. Good luck with your YOU versus YOU approach!