I have a large herniated disc at L34 that is very painful and limits my activities. In preparation for spine surgery to repair the problem, I've been doing a modified program of Pilates exercises. How soon after surgery can I start doing these exercises again?

Pilates is a form of exercise that strengthens the core muscles of the trunk and spine. When done properly, spinal stabilization is increased. However, if not done correctly, you can actually increase the pressure and load on the disc.

After spine surgery, you will probably go through a rehab program with a physiotherapist. This is done before returning to your former type and level of exercise. Active trunk and spinal stabilization exercises will be a part of your rehab program.

The therapist will work with you to make sure you are doing these in the best way possible. You will learn good breathing techniques that avoid the Valsalva maneuver. Valsalva is the bearing down on the pelvic and low back muscles while holding your breath. This movement can increase pressure all the way up the spine to the brain.

Usually between eight and 12 weeks after surgery you'll be doing an easy, modified program of Pilates. The program can be gradually increased according to your therapist's direction and your own tolerance. Pay attention to how your body responds to these exercises. Stop or modify if you have any increased symptoms of back and/or leg pain. Report these symptoms to your doctor.

Paul A. Anderson, MD, et al. Work Status as a Predictor of Surgical Outcome of Discogenic Low Back Pain. In Spine. October 1, 2006. Vol. 31. No. 21. Pp. 2510-2515.