This blog is part of the Analyzing Scoliosis series, which is designed to teach movement practitioners how to work confidently with clients who have scoliosis. Previous posts have discussed the typical scoliotic body, common types of scoli (AIS and functional scoliosis), how to decide when to work with a client and how to handle a misdiagnosed client.

 

At this point you may be wondering, “How do I help someone with scoliosis?” You get them moving! It’s that easy.

Many people with scoli are told that movement is not good for their bodies. They’re made to believe that exercise could make their condition worse. This incites fear in them, so of course, they stop moving.

In recent years, extensive research has proven that movement can actually help people with scoli. Here are a few general findings [1,2]:

  • Participation in sports and physical activity should be encouraged for people with scoliosis, as no evidence shows it’s harmful
  • Conditioning should focus on spinal flexibility and core strengthening
  • Cardiopulmonary capacity was better in those who did regular aerobic activity

Clients with scoliosis, especially those with AIS, need to move. The research findings above focus on the benefits of overall movement, but there is lots of research showing that specific corrective exercises can stabilize and even reduce scoliotic curves (especially in those with AIS who are still growing [3]), as well as provide pain reduction:

  • Physical exercise is important during growth to delay or prevent need for bracing and/or keep scoliosis under 30 degrees
  • Physical exercise positively influences breathing function, strength, and postural balance

Suffice it to say that movement is good for scoliosis.

One of my favorite bodies of evidence on corrective scoliosis exercise is a book called Scoliosis and the Human Spine by research scientist Martha C. Hawes. When Martha was 11 years old, she was diagnosed with scoliosis. Doctors told her that her scoliosis would progress to a “deadly degree” as she grew to adulthood, and the only treatment option was a spinal fusion surgery. Doctors told Martha that unless she accepted surgery, nothing could be done to treat her scoliosis. She recounted her experience at the beginning of her book:

“Recoiling instinctively at the concept of a lifetime spent avoiding activities that might damage my spine, I declined surgery. Instead I chose to use torso-strengthening exercises taught to me during a six-week training period by a physical therapist […] In the ensuing decades I faithfully performed a daily exercise regimen [4].”

Although her surgeon had made “dire predictions” about the potential progression of her scoliosis, the severity of Martha’s curve remained almost exactly the same for thirty years after her diagnosis. In fact, it had “improved in middle age with mobilization exercises despite popular belief that adult scoliosis is untreatable except by surgery [5].”

Even at 11 years old, Martha wasn’t satisfied with the way the medical community had handled her case, and her personal experience with scoliosis and exercise negated the idea that surgery was the only option for treating or improving scoliosis. As an adult she decided to investigate the relationship between scoliosis and movement further, and found evidence that her childhood doctor was sorely misguided.

“It appears that there is not one single published study, let alone a body of interpretable scientific research, which can be construed as evidence  to support the hypothesis that scoliosis cannot be treated with exercise-based therapies [6].”

In other words, surgery is not the only option, and there is no proof that movement makes scoliosis worse. And yet, many doctors continue to tell scoli patients that exercise will do more harm than good. Martha points out that even if a doctor doesn’t tell a patient that movement is “bad” for them, they don’t consider it to be a viable treatment option, so they don’t even mention movement. Instead, they “watch and wait” until the curve is severe enough to warrant surgery.

Martha C. Hawes calls this a “conflict of interest,” and I tend to agree. Let’s say that a person is diagnosed with scoliosis by their trusted pediatrician or family doctor. That first doctor refers them to an orthopedic surgeon (which is the chosen type of specialist for most scoliosis patients). Without hesitation, the patient and their family go to an orthopedic surgeon without doing much research themselves.

Now, that surgeon is going to base a treatment plan around their own specialty: surgery. Of course they’re not going to recommend an alternative therapy—that would mean losing a client, and from a business standpoint, they would no longer have the opportunity to make money from an expensive procedure performed on your body.

With your Pilates background, however, you can offer a different plan, a movement plan! Pilates is often perfect for people with scoli. It gets scoli clients moving, and can easily be adapted and modified for the unique body characteristics that scoliosis can cause. With all that in mind, your job as a Pilates instructor is more important than you may have previously thought.

 

Sources
Green, Bart N., Johnson, Claire, and Moreau, William. “Is physical activity contraindicated for individuals with scoliosis? A systematic literature review.Journal of Chiropractic Medicine, vol. 8, no. 1, 2009, pp. 25-37.
2 Jianxiong, S. et al. “Cardiopulmonary exercise testing in patients with idiopathic scoliosis.” Journal of Bone and Joint Surgery American, vol. 98, no. 19, 2016, pp. 1614-1622.
3 Negrini, S. et al. “Physical exercises as a treatment for adolescent idiopathic scoliosis. A systematic review.” Pediatric Rehabilitation, vol. 6, no. 3-4, 2003, pp. 227-235.
Hawes, Martha. “The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature.Pediatric Rehabilitation, vol. 6, no. 3-4, 2003, pp. 171-182.
5 Hawes, Martha. “The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature.
6 Hawes, Martha. “The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature.

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