Written by Glenn Withers
MSK Physiotherapist, APPI Co-founder and Director, B.Physio MCSP
Scoliosis or ‘curvature of the spine’ is a condition that affects a large amount of the population especially those in the age range of 10 – 18 years old.
A ‘scoliosis’ occurs when the curvatures of the spine is in excess of 10 degrees from the vertical, and occurs as a side-bending curve in the spine. However, it is a condition that is often misunderstood and poorly managed by many of us within the health and fitness world.
The most common form of a scoliotic curve is classed as a ‘idiopathic’ curve, meaning we are unsure exactly what the cause is. The good news here is that there is a lot that can be done for ‘idiopathic’ scoliotic spines.
The best choice of management largely comes down to the degree of the deformity. As we mentioned above the curve must be greater than 10 degrees for it to be classed as a ‘scoliosis’. The literature reports that for curves between 10 and 35 degrees the best form of management is in fact exercise! Larger curves begin to be managed by a combination of brace and exercises, and curves over 55 degrees are considered as a possible surgical management.
So, lets focus on the types of cures you would most likely see in a Pilates studio. Idiopathic curves between 10 and 35 degrees. The management of these curves is crucial and so much can be achieved. However, it is vital that this is a specialised program and not just a mildly adapted Pilates Matwork program.
Our tried and tested approach has seen our clients benefit by over 30 degrees of improvements in the curve. The key here is the use of gravity to assist with the correction. It may well be considered that gravity in fact causes the initial curve and the fragile spine tries to accommodate to any change in spinal angle by ensuring the head positions itself over the pelvis, hence the development of a spinal curve. Therefore, if we use this concept of gravity to begin to reverse the curve we may well achieve much better results for our clients.
I often talk to people about Pilates for scoliosis when they are beginning with exercises on the mat. I would suggest that in fact we apply a 5 phase program to the scoliotic spine.
Phase 1: Elongation.
Here we look to lengthen the spine to gain traction and correction. For example, the seated ball hang.
Starting position: Sitting on a ball, step or a box.
Action: Loop a resistance band over the top of a door (the Cadillac in a studio) and hold onto the ends. Hold as high as you can and then slowly start to lower the height of your seated position to gain some traction along the spine.
Variation: Bias the stretch to the shorter side of the upper curve.
Repetitions: Hold the stretch for around 5 seconds as it can be quite aggressive. Incorporate your breathing into the stretch position as a way of biasing the exercise.
Repeat 4 – 5 or as required.
Phase 2: Breathing.
Starting position: Lie over the ball, arc barrel, foam roller or stack of cushions with the shortened side uppermost.
Action: Place your hand or your clients hand on the upper most ribs to facilitate the breathing into this area. Ask the client to breathe deeply and widely into this part of their spine. Adjust position of support to bias a different part of the curve.
Repetitions: Repeat for 5 breath cycles. Repeat 2-3 times or as required.
Phase 3: Standing Stretch Combination.
Starting position: Standing beside a doorway.
Standing 1. Upper Curve Side Bend Correction:
Float the left arm up and overhead to perform a right side bend stretch.
Hold for 30 seconds.
Repeat 3 times.
2. Upper Curve Rotation
Reach the right hand across the body onto the wall and hold.
Hold for 30 seconds.
Now combine stretch 1 and 2.
While maintaining the above position, reach the right arm across to the opposite side.
3. Thoracic mobility – While maintaining the above position, add in small forwards/backwards movements to further mobilize your spine.
Phase 4: Strengthening: Clam
.
Starting position.
For the left gluteal strengthening. Position the client over a box or bosu. This is placed under the right hip. This allows you to focus on the left gluteal strengthening. As this is the weaker gluteal you begin on this side. The cue here is to lift up out of the underneath shoulder blade.
Action:
- Inhale to prepare. Gently draw the sitting bones towards one another to engage the gluteals.
- Exhale and lift the top knee upwards, keeping the feet together.
- Inhale and lower the top knee onto the bottom leg.
- Repeat 8 – 10 times on each side. Repeat twice on the left side for a 2:1 ratio.
For the right gluteal strengthening. Side lying. Hips flexed to no more than 45 degrees, knees flexed to 90 degrees.
Phase 5: Lengthen shortened side.
Starting position:
Sitting with crossed legs. Neutral spine and centre gently engaged. Arms long and placed beside the body with the back of the right hand resting on the top of the Pilates Small Ball.
Action:
- Inhale and float the left arm upwards over the left shoulder.
- Exhale as you lengthen and bend your spine up and over to your right, keeping your pelvis anchored to the mat. At the same time, keep the right arm long and roll the ball along the mat away from your body.
- Exhale, gently press down into the ball as you lengthen and return the body to the midline. Allow the left arm to return to the mat beside you. At the same time, keep your right arm long and roll the ball back to the starting position.
- Inhale and lower the left arm to the mat.
- Repeat 5 – 6 times each side or bias towards the lower curve.
The above program is just a snapshot of what the APPI’s unique approach to Pilates and Scoliosis brings, and there are many more exercises per phase that we can use. Importantly, we start by aligning the spine as best we can and only once we have achieved this, do we consider looking to strengthen the spine. This way we are constantly looking to create a new spinal position and not just reinforce the old position.
Please contact us if you’d like more help and advice. Our specially trained Physiotherapists, offer full examination and can develop a personalised treatment plan that specifically addresses your needs.