If you've been diagnosed with scoliosis, you might be wondering if there are movements or exercises you need to avoid, and what you can do to stay safe and continue training. Or perhaps you're a personal trainer and have a client with scoliosis. In either case, if you've ever searched for resources and information online, you've probably found yourself swimming in an ocean of conflicting information.
Today, I want to help you better understand this condition and how to proceed with training. Let's start by taking a look at the spine.
The spine is made up of 33 individual bones stacked on top of each other. We have seven cervical vertebrae, 12 thoracic vertebrae, five lumbar vertebrae, five fused bones that make up the sacrum, and four fused bones that make up the coccyx (tailbone). So we have 24 articulating (moving) vertebrae and nine fused vertebrae.
In most people, the vertebrae stack right on top of each other, giving the appearance of symmetry to the spine and ribs. I say the appearance of symmetry because in reality, none of us are perfectly symmetrical, and slight deviations aren’t a cause for concern.
Scoliosis is a condition in which the person’s spinal axis has a three dimensional deviation. Although a plain x-ray may show what looks like a C or S curve to the spine, the vertebrae actually deviate in all three planes (flexion/extension, side-bending, and rotation). Scoliosis is typically classified as congenital (present from birth), idiopathic (unknown cause at any age), or secondary to a primary condition such as cerebral palsy or other neuromuscular condition.
Scoliosis can range from very minor deviations of the spine to severe deviations that can begin to limit heart and lung function causing shortness of breath or chest pain. Scoliosis is typically diagnosed if the spinal curvature is more than 10 degrees to the right or left as the examiner faces the patient. When the person bends forward, they may have a noticeable rib hump viewed from the back, as the rotation of the spine causes the ribs to rotate along with it.
Image Source: National Institute of Health
Most mild cases of scoliosis can be addressed with physical therapy to stretch tight muscles, strengthen weakened muscles, and develop neuromuscular stability around the spine. More severe cases may require surgery.
As an example of surgical fixation, here is a picture (shared with permission) from one of my clients. She underwent fixation with instrumentation with a fusion of T1–S1 with rods from T3–4 to S1 with stabilization into the ilium (hip bones) to treat a severe scoliosis. When she first came to see me, she was in incredible pain, and walked slowly with a cane. (Image shared with permission.)
When I looked at her x-rays, I wasn’t sure she would be able to move much at all; but, she continually surprises me. With lots of hard work on her part, she now takes Pilates, weight lifts, and walks community distances with no problems. This is a great case example of the necessity to treat the patient in front of you, as they present, rather than treating what the x-ray looks like!
My general advice for working with a client who has scoliosis is as follows:
Note from GGS: A condition such as scoliosis usually requires specific treatment and training protocols. If you are not diagnosed with a particular condition and are simply feeling achy, stiff, or locked up, we strongly recommend including injury prevention strategies in your training program to address mobility, stability, and overall movement.
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