Scoliosis is a lateral deviation or rotation of the spinal column that causes pain and postural conditions in sufferers to varying degrees. Scoliosis is a common term that some of us have memories of being lined up in primary school for ‘postural testing’ with a foreboding of surgery and braces and rods to effect good spinal alignment.
Thankfully those days of the ‘nazi youth’ are not around and we need not fear being whacked with a cane stick and told to sit up straight to avoid scoliosis. But for some people it is a condition that they have to deal with daily. However it is one of those subtle terms that can be awfully limiting to someone who doesn’t have a the perfect posture
Scoliosis is a description and not a diagnosis. There are many variations of the condition and some are helped with exercise and physical therapy, whilst others are more obstructive and can result in surgery and correction via braces and rods but these cases are extreme.
The typical S curve of scoliosis is a lateral deviation of the spinal column that can effect the pelvic and shoulder girdle alignment. Many people misconstrue a hip alignment issue with scoliosis, or in many cases people believe they have a leg length difference. Scoliosis affects the alignment of these postural elements and proper identification of curvatures can assist with influencing secondary complaints and treating effectively at the cause rather than the symptom.
Categories of Scoliosis
· Idiopathic (cause unknown)
o Infantile 0-3
o Juvenile 4-11
o Adolescent 11 -18
o Adult 18+
· Congential – present at birth
· Neuromuscular – caused from nerve/autoimmune function
In around 80% of cases, causes are idiopathic and thus identifying treatment can be a hit and miss exercise. Scoliosis is usually identified in teenage years with boys being more common in the juvenile stage and girls being more common in the teenage stage. Postural deviations at this age can have multiple factors. However to put some theories to bed, sleeping on soft mattresses, carrying heavy bags or even using ‘smart’ devices and wathing too much tv does not render you with scoliosis.
“Minor curves <25 degrees do not require any treatment and observation only is indicated throughout the growth phase. No restrictions are placed on the young person’s activities. Although scoliosis by definition (a curve of 10° or more) is present in one out of ten adolescent girls, only two to three per thousand come into the active treatment range. The surgery rate is approximately one per thousand.”
Adolescent Idiopathic Scoliosis is the most common type of scoliosis and this genre deals mainly with females. There is an ideology of a genetic predisposition to scoliosis in females but the evidence is not conclusive. The patterns of curvature are most often found at the thoraco-lumbar (beginning of the small of the back) region and can bend either left or right. This causes a hip to ‘jut out’ to one side or a shoulder to be higher than the other. In larger girls, this can often be hidden. The alignment of the shoulder blades is also an important tool in identifying curves in the thoracic region.
Bracing is often still used as a way to control the curvature and reduce the increase of curvatures. I remember a girl in high school who wore a brace for 3 years. She still played sport and was active and this is indeed possible for many sufferers. Surgery is only employed for those who have a curvature >50 degrees. Metal implants are inserted on the spine which are then connected by rods to decrease deformity and assist with fusing of the spinal segments. But these cases are extreme and are usually associated with congenital or neuromuscular causes.
The Minor Scoliosis Sufferer
For the most part scoliosis is a minor condition and can be influenced by physical therapy and exercise. Minimising the lateral curve or the rotational influence can be assisted with Exercise and Physical Therapy. As a bodyworker, my main focus is always on ensuring optimal spinal and pelvic alignment. Even if muscular tension may not be the causative factor in scoliosis, getting as much range of motion in the effecting muscles such as the spinalis muscles for rotation, the Quadratus Lumborum for lateral pelvic tilt or intercostals for rib aligment, all help in minimising the effects of scoliosis.
Introducing Range of Motion exercises can also assist in keeping the rotations at bay. Getting as much movement as possible through an articulation can sometimes minimise the effects of any postural adaption or pre-existing condition. This ensures that you, the client don’t feel as much restriction or pain in subsequent areas when and if you are trying to exercise or perform physical activities.
The secondary issue I deal with for scoliosis is how it affects the larger articulations of the skeleton. Any rotation of the spine is going to have repercussions in the way you use the appendicular skeleton (arms and legs). For example, if you are doing a bi-lateral movement such as a push-up and there is a rotation evident, then it follows that one side is going to be more active, or having to compensate for the rotation than the other. Without a secure trunk or pelvis, any movement that involves lifting or bracing at a distance from you is going to be influenced by the condition. Minimising the core issue of the rotation often helps alleviate the subsequent conditions in articulations such as the shoulder, the neck or the leg.
““Not every adult with a spinal deformity requires treatment. In fact, the vast majority of adults with deformity do not have disabling symptoms and can be managed with simple measures…. exercises are aimed at strengthening the core muscles of the abdomen and back and improving flexibility””
Core strength is another great way to stabilise the pelvis against rotation. But let’s not forget the role of the supportive muscles such as the Quadratus Lumborum (connects 12th rib to hip bone). If you are a runner and you have to land on one foot with a rotation or lateral deviation of the spine, then you are going to use these muscles over and over again to help reinforce an incorrect or insecure alignment. Working here to create space and to reinforce stability can often help with the niggling pain that kicks in around the 10km mark.
I have one client who has one of the worst cases of scoliosis I have ever encountered and she works as a barrista, working all day, long hours, standing and then does CrossFit and yoga after work. Building stabilising strength and identifying where your individual curvature influences your own body and its movement patterns is ideal. Knowing you have a predisposition to using your right shoulder more because your L hip has a weird rotation means you can work on ensuring the alignment of your L hip to help support your upper body. And you spend a bit more time stretching out the rotational muscles of your left hip.
As always, there is the ‘google diagnosis’ of scoliosis. It is a ‘go to’ word as a condition, but as you can see, there is a vast majority of cases that are not determinable by a physical cause. The idiopathic genre makes up 80% of cases and these cases are often able to be reinforced and treated by exercise and physical therapy. Range of motion and flexibility with stability are the keys.
Having someone identify where curvatures or rotations are in your body is a great way to identify why chronic pain may not be alleviating or why you are just unable to get that tennis serve just right. Knowing your alignment can lead to identifying the target for treatment to reduce pain. That’s our job. Managing the small influences on posture can have major implications to making your physical life, that much more enjoyable.
Peter Furness
