Back in 2014, Dr. Loren Fishman’s side plank theory for scoliosis research was published in the Wall Street Journal, and it caused quite a stir. In case you need a refresher, the study claimed that doing a yoga side plank on one side every day will decrease the curves in people with scoliosis.
What an easy fix that would be! As I dug into the research, however, I found flaws in his research and also disagreed with some of his main concepts:
- It advocated planking on the incorrect side.
- Simply doing a side plank alone will not work for the majority of people. Modifying exercises is crucial for those with scoli. A one-size-fits-all exercise approach, like the one recommended in the article, doesn’t exist. There is no magic exercise or “magic pill.”
I have been vocal about my disagreement with Dr. Fishman’s research since its release in 2014, and that hasn’t changed. What has changed is the number of movement based solutions I have researched and created that do use specialized exercises to help people manage their scoliosis. I’ve made these accessible online to help people around the world affected by scoliosis.
Some of my favorite resources are:
- A scoliosis resource page with personalised, actionable lists
- The 5 best exercises for scoliosis
- Online scoli workout videos
- A scoliometer app (iTunes and Android) and worksheet to track your scoliosis
- A special Scoliosis Intensive workshop for people who don’t live in Nashville so you can learn my methods and keep your scoliosis healthy at home
- Analyzing Scoliosis, a book that teaches movement practitioners my research-backed method of working with scoli clients
- Scoliosis workshops for movement practitioners
The rest of this post is an updated compilation of the posts I made in the immediate aftermath of the study and the following months. It covers all things related to the side plank theory. I suggest you read the parts that pertain most directly to you. You’ll be able to read more about:
- My rebuttal of the original research
- What happened to a teen in Norway who contacted me after following Dr. Fishman’s planking program
- How to correctly perform a side plank for scoliosis
Rebuttal of 2014 research study: Side plank theory for scoliosis
A recent, widely-reported research article states doing a yoga side plank only on one specific side will actively decrease the curves in people with scoliosis. As a certified Pilates instructor with scoliosis and an advocate for movement in treating scoliosis, I was definitely intrigued.
With an estimated five to seven million people in the United States living with scoliosis, a miracle cure (as in, a simple exercise done for one-and-a-half minutes, five days a week) would of course garner national attention. But, after doing extensive research on my own, I’ve discovered a huge problem with this recent research: the plank was done on the wrong side. However, despite unknowingly having their participants conduct the plank on the wrong side, the researchers were still able to report that an overwhelming majority of the participants experienced decreases in their individual Cobb angle measurements. How could this be? I had to figure out what was going on.
Before I detail my own findings, which directly contradict the aforementioned research, it’s important to note that I’m a huge proponent of studying the effects of exercise on scoliosis. So little research exists, despite a demonstrated need that the medical world at large and the millions of people living with scoliosis have a hard time discovering exercise is indeed a viable therapy for managing scoliosis.
Why the findings didn’t make sense
The study said the plank should be performed with the CONVEX side of the curve facing towards the floor. I was startled when I first read this because it was counterintuitive to everything I had been taught, practiced on myself, and taught to my clients. I sent out emails to trusted colleagues around the world, and they too, were just as confused as I was. At the same time, I received numerous emails asking for my opinion on the side plank “cure.”
A quick note about curves
The study never specified which curve the researchers focused on. Scoliosis often presents with more than one curve. In these cases, one curve is typically more significant than all the others. It is referred to as the major curve and is usually found around the ribcage. All the research and my experience has taught me to treat the major curve. For the rest of this post, when a curve is referred to (or its convexity or concavity), it is the major thoracic curve.
I studied the research report meticulously, and for final reference, I consulted Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine by Christa Lehnert-Schroth, P.T., and located the exact side plank exercise referenced in the study. There, contrary to the recent report, I found that the exercise is supposed to be done with the CONCAVE side of the curvature in the ribcage aiming down towards the floor. The researchers had done the opposite; patients did a plank with the CONVEX side down. Even so, the subjects still reported positive results. How was this possible? I had to dig deeper.
In the study, the researchers relate the spine and its muscles to wires holding up a tower. The spinal extensor muscles that run parallel on the sides of the spine are the wires holding up the spine (tower). The researchers state that the left extensors are bending the tower to the right because they are shorter. They conclude that the right extensors need to be fired to pull the tower (the spine) back up. There are a lot of issues with this theory.
If you’ve ever looked at the bare back of someone who has scoliosis, the spinal extensors on the CONVEX side are big and beefy looking (despite physically being longer compared to the concave side). The CONCAVE spinal extensors (despite being shorter) are usually atrophied to almost nothing. Sometimes they don’t even fire. To illustrate, imagine a person like the one shown here. They have an “S” scoliosis curve that starts to the right in the ribcage and goes to the left in the lumbar area. (To make things less confusing we will assume this is the curvature we are talking about for the rest of the post.) The researchers refer to the right bulkier muscled side (convex) as being the “weaker side.” While the right side is the longer side of the spinal extensors, it is not necessarily the weaker side.
In my experience, the main focus should not be to make the long, overworked spinal extensors work more and become shortened. That’s simply incorrect. Initially, you’ve got to look at another group of muscles to help. Those muscles are the trapezius and rhomboids. They are further away from the spine than the extensors and actually act as more efficient wires for that scoliotic spine than the spinal extensors do.
In our drawing, the spine is physically closer to the shoulder blade on the right side. What you don’t want to do is make the spine become even closer to the shoulder blade by shortening the muscles that connect them (the spinal extensors the study recommends working). If your right hand is on the floor for a side plank, CONVEX side down, you’d fire the right rhomboids and trapezius muscles, strengthening already beefed up muscles. It makes no sense. If you focus on the muscles on the right side, they’ll end up in spasm.
Muscles don’t push on bones, they pull. If the goal is to pull the spine back to a more neutral position, you’d do a plank with the left hand down (CONCAVE side down). This would fire the left rhomboids and trapezius muscles, which would then pull the spine back towards the left shoulder blade to a more neutral position.
Yet despite my disputing the researchers’ choice of side plank, the research subjects still reported a decrease in Cobb angle measurements by doing the side plank with the CONVEX side down. I had to look further into the research sample.
The flaws in the research sample
Flaw 4: One subject’s data skewed the results
When comparing the beginning and ending Cobb angle degrees for 22 patients in the research, everyone who had an initial Cobb angle ABOVE 40 degrees showed a huge decrease in their final Cobb angle measurement. Only one person with idiopathic scoliosis had an initial measurement above 40 degrees, the other six were below. The study’s results were not nearly as impressive when the starting measurement was under 40 degrees. In fact, three subjects’ curves actually increased. The sole patient who started with a 43 degree Cobb angle had a huge decrease in the final measurement, ending around 12 degrees. As the mean research statistics were combined, that huge decrease figure offset the other six patients’ changes. It turns out the numbers aren’t as impressive as initially suspected.
Flaw 2: Two incomparable types of scoliosis were treated as comparable
Two vastly different types of scoliosis were allowed in the study: adolescent idiopathic scoliosis and degenerative scoliosis.
Idiopathic scoliosis usually has at least two curves and typically shows up during the teenage years, hence the “adolescent” part of the diagnosis. Degenerative scoliosis usually shows up after the age of 40 and is oftentimes associated with osteoporosis and a single curve.
Of the 19 active participants in the study, seven patients had two curves. This means that seven patients with had idiopathic scoliosis and 12 patients with a single curve had degenerative scoliosis. Therefore, less than half of the study participants had idiopathic scoliosis. However, most of the news coverage stated that this research was applicable for people with idiopathic scoliosis. The majority of the participants didn’t even have idiopathic scoliosis so that claim isn’t valid.
Of the seven people that had idiopathic scoliosis, the curvatures in their initial x-rays ranged from 6 to 43 degrees. Of the 12 people with degenerative scoliosis, their initial curves ranged from 10 to 120 degrees. Even though there were a few low numbers in the degenerative group, their degree of curvature was much higher on average than those with idiopathic scoliosis. That’s a huge discrepancy in curvature that makes it hard to draw comparisons.
Flaw 1: The sample size was very small
There were 25 people in the study initially, but only 19 complied with the parameters for regular planking. The researchers acknowledged this was a very small sample size.
Flaw 5: The timing of the follow-up x-ray varied widely
The follow-up x-ray took place anywhere from 3 to 22 months after the initial one. That’s a wide range of time.
Flaw 3: Participant data wasn’t reported consistently
The study initially had 25 participants and 19 completed it successfully. Yet 22 patients’ info was reported on a graph, indicating that data is either missing or data that shouldn’t be included was included. This happened on a graph comparing the initial and ending Cobb angle degree measurements.
Regardless of the lengthy follow-up timeframe, the differences between idiopathic and degenerative scoliosis, the expansive range of the initial Cobb angle, the small, inconsistent number of subjects, AND doing the side plank on the wrong side, this study showed an overall decrease in scoliosis curves. This still wasn’t making sense.
How the study got positive results
I think the secret to the positive results reported by Dr. Fishman’s study lies in core engagement and correct alignment. The subjects were taught to elevate the ribcage towards the CONCAVE side (which would be the ceiling in the researchers case) before doing the exercise. This instruction would bring their spine into better overall alignment before the exercise was started, thereby decreasing the negative effect of performing it on the wrong side.
Also, despite there being only 25 people in the study initially, a total of seven different modifications of the side plank were given. This important information was not included in any of the articles that reported the study. Many of the plank variations included some kind of strengthening for the CONCAVE side, be that pushing the free hand down on yoga blocks or holding a yoga strap to pull the top leg up. Again, the researchers were, probably subconsciously, modifying the side plank to work the CONCAVE side at least a little bit, despite working the incorrect CONVEX side with the side plank.
Finally, the majority of people with scoliosis in this study had degenerative scoliosis, likely had osteoporosis, and were probably over the age of 40. We have no idea what their exercise routine and strength level was before the study. I’ll bet that just the act of firing all the muscles in the body in an anatomically correct posture was the reason for the profound decrease in their Cobb angles and Dr. Fishman’s positive results.
Unfortunately, there isn’t a magic pill for people living with scoliosis. I mean, come on, with a mere 25 subjects SEVEN modifications were given for just ONE exercise. The researchers couldn’t even find one simple exercise for this small group to perform the same way! This proves that you must mold exercises for each and every (scoliotic) body in front of you…and that’s what these researchers did. That is a big reason for their success.
Even with all of the flaws in this study, the researchers still found an overall improvement in Cobb angle measurements by doing an exercise one-and-a-half minutes a day, five days a week. That’s incredible! This would lead one to believe that exercise, no matter how incorrect it may be, can still have positive results on scoliosis if correct alignment and firing the core muscles is done. Now THAT’S something to consider, and certainly something that needs to be studied further.
Can you imagine the results if they redid this study doing the correct side plank?
Norway case study, 2015
Now that you know where I stand on the findings from the side plank theory study, let’s put my ideas into practice with a small case study. It originally came to me in the form of an email from a man in Norway who’s been performing the yoga side plank as recommended by the study in an effort to decrease his curve.
This first photo on the left was taken before he began doing side planks multiple times a week. After he read my rebuttal of the yoga side plank theory study, he began to panic that perhaps he was performing the plank on the wrong side, and had made his scoliosis worse. This is when he decided to reach out to me.
Well, what do you think? Does it look like his scoliosis has gotten worse based on the photos above? Make up your own mind and then watch the video below for my original decision.
How to correctly perform a side plank
If planking makes your scoliosis feel better, watch this video on how to perform it correctly. Remember, I am showing you which side would work for my individual scoliosis. I have a right thoracic curve (ribcage) and left lumbar curve, therefore I believe that I would do my side plank with my left hand down. This is the opposite of what the side plank study recommends.
If you’ve made it all the way down here, bravo! Please remember that even if you choose do the side plank on the correct side for your body, I believe it is not the best exercise to help your scoliosis. Why? Because extensive research and over 10 years of working with scoli bodies has shown me otherwise. I have developed many products, including books and at-home workouts, based on that information and believe these are the best resources for helping manage your scoliosis.