I have a client who had a hysterectomy three months ago. She has started to work out again. She has had significant loss in abdominal strength and has lower back pain and sciatica in her left leg. We have been working on core strength and very light resistance training. Do you have any other suggestions or recommendations?
The surgical removal of the uterus has probably caused your client to experience neurological changes in the abdomen region, etc. A comprehensive assessment of the entire kinetic chain is a must to determine the proper exercise prescription. A starting point in your assessment process is to release the tension your client is experiencing, followed by the re-educating the inhibited areas. Once control is gained, progress into a re-conditioning phase (release, re-educate, re-condition). Why release first? Any localized pain will act in a reflex manner at the spinal segmental level; therefore, interaction between muscles, joints, skin, viscera can potentially occur. The typical reaction of the periphery to pain is increased tension/inhibition.
With weakness (inhibition) in the deep abdominal wall, low back pain and “sciatica,” many clients will exhibit a lower crossed syndrome. Because we are unable to assess your client, we can’t provide you with a definitive answer; therefore, utilize the following information as a guideline, and modify as needed.
LOWER CROSSED SYNDROME
An individual who has increased lumbar lordosis and an anterior pelvic tilt characterizes the lower crossed syndrome. This pattern of tightness and weakness/inhibition (refer to chart below) causes predictable patterns of joint dysfunctions, movement imbalances and injury patterns (see references).
|Short Tight/Overactive Muscles
- Rectus Femoris
- Tensor Fascia Lata
- Short Adductors
- Erector Spinae
- Upper Rectus Abdominus
- Gastrocnemius, Soleus
|Weak or Inhibited Muscles
- Posterior Tibialis
- Anterior Tibialis
- Gluteal Muscles
- Transverse Abdominus
- Internal Oblique
- Deep Erector Spinae
- Assess for tight overactive muscles; if positive, relax in the beginning of the fitness program.
- Facilitate the inhibited areas using stabilization strength exercises (neuromuscular isolation).
- Slowly build your client back into a functional strength program.
- A functional strength program should always precede a traditional bodybuilder/cosmetic exercise program!
In addition to the titles listed under "related articles" at right, I also strongly recommend you check out the book Muscle Energy Techniques by L. Chaitow, available through Amazon.com.