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123: Don't Get it Twisted: Scoliosis Facts vs Fiction
1.3k Plays12 days ago
In this episode, Dr. Sarah Court unpacks scoliosis from the ground up, what it is, how it is diagnosed, the different types, and what we actually know about why it happens. She explains the Cobb angle, idiopathic versus congenital, neuromuscular, and degenerative scoliosis, and why muscle imbalances, heavy backpacks, or “bad posture” are not the root cause. Drawing on her own experience living with scoliosis and her time observing medical care in a pediatric hospital setting, she walks through current medical interventions, including observation, bracing, and spinal fusion, along with the real-world tradeoffs that come with each.
The episode then turns to exercise. Do you need scoliosis-specific methods like Schroth or SEAS, and do they meaningfully change outcomes? Sarah reviews the current evidence, which suggests small to modest short-term changes at best, with limited high-quality data, especially in adults. She makes the case that most adults with scoliosis do not need to chase curve correction or cosmetic symmetry. Instead, the focus should be on building strength, addressing meaningful side-to-side capacity differences, supporting breathing where needed, and improving function and confidence. Heavy lifting, including deadlifts and squats, is not inherently dangerous for people with scoliosis, and getting stronger is often the most practical, evidence-informed path forward.
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Transcript
Introduction and Purpose
00:00:00
Speaker
I'm Laurel Biebersdorf, strength and conditioning coach. And I'm Dr. Sarah Court, physical therapist. With over 30 years of combined experience in fitness, movement, and physical therapy, we believe in strong opinions loosely held. Which means we're not here to hype outdated movement concepts.
00:00:15
Speaker
or to gatekeep or fearmonger strength training for women. For too long, women have been sidelined in strength training. Oh, you mean handed pink dumbbells and told to sculpt? Whatever that means, we're here to change that with tools, evidence, and ideas that center women's needs and voices. Let's dive in.
Understanding Scoliosis
00:00:47
Speaker
Welcome to the Movement Logic Podcast. I'm Sarah Court. I'm a physical therapist. And today we are talking all about scoliosis, what it is, what it isn't, whether you need scoliosis specific exercises or treatment, and how lifting weights should be approached for someone with scoliosis, whether it is you or a client.
00:01:09
Speaker
Full disclosure, I have scoliosis, so part of what I'll be sharing today will be related to my own experiences. I also spent some time at Children's Hospital in Los Angeles, and I saw what medical interventions were being used for the teenagers who came in with scoliosis.
00:01:27
Speaker
Scoliosis is commonly diagnosed during those teen growth spurt years. We'll talk about structural anatomy, different types of curves, and what is the actual best evidence out there for scoliosis-specific treatment.
00:01:41
Speaker
But before we get into that, I'm going to talk about the Barbell Mini Course. Why? Because I can't. We have a free offering. In exchange, you give us your email. We don't think that's too much to ask because we are not annoying emailers. We send out content that is useful, and we don't send it out a ton. And that's also where you're going to hear about new courses first, discounts first, discounts specific to you because you're on the wait list kind of thing. So that's what it's like to get on our emailing list. I just wanted to give you like a big picture. This particular product that we've made is a video series teaching you how to do a deadlift, a squat, and a bench press, which are sort of the three big lifting moves that you can learn. If you've never learned how to lift anything properly, those are the ones you're going to learn. We teach with barbells because barbells are an efficient way to get you stronger. It's just sort of the bottom line.
00:02:36
Speaker
With that said, you could absolutely just use dumbbells and get a ton out of this course anyway, because it's teaching you proper alignment, good form, all kinds of weightlifting tools like reps in reserve and rate of perceived exertion, things like that. It's kind of a no brainer as far as I'm concerned. If you're wanting to start with lifting weights and you don't know where to start, you don't know what to begin with, get this course.
00:03:02
Speaker
And not only that, you then are going to be so excited about lifting weights that you're going to want to get into our longer course, Lift for Longevity. That's happening in the fall of this year.
00:03:14
Speaker
But before we get to that, let's just start you with learning how to lift. Barbell Mini Course, that's our product that we are giving you in exchange for your email address. You can get on that list at the link in our show notes.
00:03:29
Speaker
All right, let's get into it.
Debunking Scoliosis Myths
00:03:30
Speaker
So let's talk about scoliosis. If you have scoliosis, there's a strong chance you may have heard something like this at some point or another in your life.
00:03:40
Speaker
Your curve means you should never deadlift. Your pelvis is rotated forward, so you will always be imbalanced. You need scoliosis-specific workouts forever.
00:03:54
Speaker
Now, some of that stuff feels true. but a lot of it is not backed by real evidence. So today we're going to cut through the fear, the mystique, the overcorrections to talk about what scoliosis really is, what we do know, what we don't, and what helps people move, lift, and live well.
00:04:14
Speaker
So let's define it to begin with. Scoliosis is a three-dimensional spinal deformity. The word deformity is makes you think about like, you know, Master, I have the brains, right? Or like the hunchback of Notre Dame. It just means different than typical, let's say.
00:04:31
Speaker
The three-dimensional part that's important means it's not just a side bend of the spine, right? So the changes that can happen can include bending sideways, right? A lateral curvature, but it also can include rotation of the vertebrae. It is measured clinically by looking at something called the Cobb angle on your x-ray.
00:04:53
Speaker
I'm go to talk about that in a second. If your Cobb angle is 10 degrees or more, then that qualifies as scoliosis. Now, a note on the Cobb angle. So the Cobb angle measures the side bend of the spine. It doesn't measure the rotation.
00:05:08
Speaker
And the way it's calculated is by drawing lines along the superior end plate of the top vertebra and the inferior end plate of the bottom vertebra of the curve,
00:05:19
Speaker
and then measuring the intersection of those perpendicular lines. If I just lost you, here's what it is in layman's terms. If you imagine a stack of spinal vertebrae that have a slight curve to the right as they go up,
00:05:34
Speaker
you would draw a line at the bottom of the first vertebra that is part of the curve. And then you go all the way to the top of the curve and draw a line across the top of the last vertebra that is part of that curve.
00:05:46
Speaker
And then at some point, if you keep drawing those lines out, because it's curved, they will intersect. And they're going to make a shape of like a slice of pie, right? They make the end point.
00:05:58
Speaker
And then you measure that angle. And if that angle is over 10 degrees, you have scoliosis officially. Congratulations. Here's the thing. And I really want to emphasize this. Nobody's spine is ramrod straight.
00:06:12
Speaker
Everyone's spine has some slight lateral deviations and rotations, and that's normal. So what we're not doing here is pathologizing asymmetry because by nature, we are asymmetrical.
00:06:26
Speaker
Unless someone has a very strong curve or rotation, you're not likely going to be able to tell they have scoliosis just by looking at them from the outside. There has to be an x-ray for a true diagnosis.
00:06:40
Speaker
I am someone like that. If you just look at me, you can see that there's some asymmetrical stuff going on, but what you typically see is that one of my hips looks like it's living a little higher than the other. You don't see my spine curving, but that pelvic position is partly due to what my spine is doing.
00:06:58
Speaker
But you can't, even if I was wearing a bathing suit, you wouldn't look at my back and be like, oh, wow. Right? You just, you can't necessarily see it from the outside. So really the only way to get a scoliosis diagnosis is by using an x-ray.
Types and Causes of Scoliosis
00:07:14
Speaker
Okay. Now there are different types of scoliosis and we generally categorize them into four types. The first one is called idiopathic scoliosis. Idiopathic is a word that means we don't know why, essentially. Like the medical community does not know why this is happening.
00:07:32
Speaker
It's idiopathic. So idiopathic scoliosis is the most common type. This is what's interesting. For most people, we don't know why it's happening. There's a group of potential reasons that might all together, you know, in a perfect storm kind of a way,
00:07:47
Speaker
land so that you get scoliosis, but there's no one root cause. We can't point at a gene or a virus or something and say, that's why scoliosis happens. So idiopathic, no known cause scoliosis is the most common kind.
00:08:03
Speaker
There can also be something called congenital scoliosis. This is much more rare, and it is due to anomalies in how your vertebrae form as you are being grown in the womb, as you are developing, so that these abnormalities in the shape of the vertebrae then cause the spinal curve.
00:08:26
Speaker
Different from idiopathic, which is the spinal vertebra look fine, but this curvature just starts happening. So congenital is you've got a different kind of a spinal defect that is then in itself causing curvature of the spine.
00:08:40
Speaker
But again, that's more rare. Another version is neuromuscular scoliosis, which is in itself tied to neuromuscular conditions like cerebral palsy or muscular dystrophy, where the neuromuscular condition in itself is causing these muscular imbalances in such a strong way that it's pulling on the spine and causing this lateral and rotational change.
00:09:05
Speaker
But again, that's rare. That is a secondary result from a primary diagnosis of something of a neuromuscular or neurodegenerative disease like cerebral palsy, muscular dystrophy kind of thing.
00:09:20
Speaker
And then the last type that we see is degenerative scoliosis. And this is due to later in life, that kind of degeneration of the spinal vertebrae, where it might be asymmetrical, one-sided versus the other, and then it causes some scoliosis.
00:09:38
Speaker
If you are working with patients or clients, the most typical kinds of scoliosis that you are going to see is that idiopathic. And then if you're working with older people, you're going to see that degenerative scoliosis potentially. But most of the people that you see with scoliosis, it's going to be that idiopathic version.
00:09:58
Speaker
Now, just a quick note on my lovely lady humps. Sometimes you will see older women in particular, but sometimes older men as well with a distinctive kephotic hump, right? That kind of hunched over version that is also likely tied to spinal degeneration later in life.
00:10:16
Speaker
So degenerative scoliosis, it's a type of wearing down over time, which is different than having scoliosis develop during your teen years. And that one is idiopathic scoliosis. That's the most common one we think of when we think of scoliosis.
00:10:32
Speaker
So why does scoliosis happen? What do we know? What don't we know? Well, at this point, we don't know more than we know. There is no one single root cause of idiopathic scoliosis.
00:10:46
Speaker
The research strongly supports that it is a multifactorial polygenic condition where genetic susceptibility interacts with growth-related spinal biomechanics, neurohormonal regulation,
00:11:02
Speaker
and environmental or epigenetic influences. It's kind of just this perfect storm of several things together, right? So you may have a genetic susceptibility to it, but you may not end up developing it depending on all of these other influences, right? The spinal biomechanics, the neurologic, the hormonal, of the environment, all of these things have to kind of add up perfectly for the scoliosis to then develop. And it's still kind of a a vague catch-all description. You know, they can't specify the exact quantity or quality of each of these possible risk factors in any more specific way than that.
00:11:41
Speaker
What we do know that does not cause it is muscle imbalance and It's a too simplistic and there's no evidence to support it, right? So muscle imbalance is not strong enough to pull on your spine and cause scoliosis. Neither is a heavy backpack.
00:11:58
Speaker
Neither is your posture sitting at a desk or scrolling too much on your phone, right? None of those things are going to be sufficient to cause something so big, as to start to shift your spine.
00:12:11
Speaker
Here's what we do know. There's definitely a genetic component. Many people have scoliosis curves and don't have any associated pain. And so this is where we get into like, do we fix it? Do we not fix it?
00:12:24
Speaker
Right? Do we meddle with something that is basically functional in pursuit of some sort of perfect symmetry, right? the Spoiler, that's probably not a good idea.
00:12:36
Speaker
And also the severity of your curvature, interestingly enough, does not actually reliably predict the severity of your symptoms. And I have worked with clients where they have visible from underneath a shirt curvature going on in their spine, a few aches and pains here and there, but really nothing major.
00:12:56
Speaker
So this is going to impact how we should think about the interventions as movement teachers or as physical therapists. Think about what we're we're choosing to work on and our end goals are with our clients who have s scoliosis.
00:13:11
Speaker
And again, spoiler is like quote unquote, fixing the curve may or may not be that useful for people. Okay. Now, along with your scoliosis, depending on what kind of scoliosis you have, you may have co-occurring conditions that contribute to the condition, and you also may have coexisting conditions that occur because of the scoliosis.
00:13:35
Speaker
So some conditions that act as co-contributors are things like connective tissue disorders, like Marfan syndrome, where it's not just a muscle imbalance, but the underlying support structures maybe are not as strong as we need them to be to be able to support the spine properly.
00:13:52
Speaker
As we discussed, some neuromuscular conditions will contribute to the condition. Interestingly, congenital hip dysplasia is often seen with scoliosis because we have this impact of the spine on the pelvis and the pelvis on the spine. So This is actually my personal health history. I was diagnosed with hip dysplasia when I was 27. I had a few hip surgeries. I actually have a hip replacement now.
00:14:19
Speaker
But part of why it occurred and why it occurred on one side and not the other is because I have my curvature in my lumbar spine curves to the left and rotates to the left and then curves to the right in my upper thoracic spine. So something about that combination of my spinal curvature plus the shape of the hip socket plus time equals wear down of the hip asymmetrically, right? And so I ended up having arthritis in my right hip, you know, around age 27.
00:14:49
Speaker
So there are also conditions that occur because of the scoliosis over time, right? We talked already about degenerative changes to the adult spine that can happen over time. In severe curvature in the thoracic region, we can start to see reduced respiratory function, right? The the lungs start to become impacted and sometimes kind of crushed. It sounds intense, but let's put it this way. The ability to expand your lungs fully is impacted by the curvature of the spine.
00:15:18
Speaker
But that's something that you're going to see in more severe cases. You're not going to see that in more mild cases.
Scoliosis Treatment Options
00:15:25
Speaker
Okay, so before we talk about movement interventions, which is going to be our purview, I want to talk about what the medical interventions are out there and the sort of pros and cons of the medical intervention. So to begin with, if you have a low relatively low curvature, somewhere between the the minimum of 10 degrees to get scoliosis diagnosis, basically up to about 40 degrees,
00:15:50
Speaker
The protocol is to observe. So you're just going to watch the curve and its progression over time. Some curves develop more quickly than others. So depending on how fast the curve is developing, then a more aggressive intervention is what the guidelines call for. But in between that 10 to 40, you're just going to observe and see what happens.
00:16:14
Speaker
Now, If possible, a good idea in that period of time is to start to use bracing. And in particular, it's used for those teenagers in an adolescent period to slow the progression of the curve while their spine is growing.
00:16:30
Speaker
Compliance really matters. And this is a really difficult process. situation in a lot of cases, because you've got kids who are in this most sensitive, hormonal, emotional, psychological chunk of their youth. They're, they're trying to start to become grownups. They're really paying attention to what each other is doing.
00:16:55
Speaker
You know, there's this sense you need to belong to a group wearing a brace that covers your entire torso hard. is hard for a lot of kids because of that kind of social aspect of, of you know, making you look like ah a weirdo or an outsider. And hopefully kids are nicer than nowadays. I don't know. But certainly when I was a kid, wearing a brace to school would have been like an instant, oh, let's tease you because you're wearing a brace to school, right?
00:17:24
Speaker
So my understanding is that while bracing is a much more gentle intervention than surgery, which is the next step up, it can be difficult to get kids to be compliant with the brace and, you know, understandably so. There are better ones on the market now that aren't just these big bulky things that you cannot hide even if you wanted to, but you know, it's still, you still have this like orthotic on your body essentially, right? There's no way to hide it.
00:17:55
Speaker
So then if curves are more severe, if that Cobb ankle is roughly over 45 50 degrees, or the change is progressing really quickly, the surgical intervention is to go in and fuse using rods the entire curvature area.
00:18:15
Speaker
And so for some people, this means they're getting fused from something like C4, maybe somewhere in their in their cervical spine, all the way down to like L2 or something like that. I've seen many versions of that where The entire thoracic spine is fused with a little bit of cervical spine, a little bit of lumbar spine also included in that fusion.
00:18:41
Speaker
Now, obviously, the benefit of this is that it stabilizes the spine and prevents worsening of that curve. So that's a short-term positive.
00:18:52
Speaker
Long-term, what I see with patients who have had this kind of surgery is that directly above and below the fusion. So that sort of upper cervical and lower lumbar areas degenerate really quickly over time because suddenly all of the movement that you are able to make in your spine is limited to these two small spots. You still have to turn your head. You still have to go through the motions of your life.
00:19:18
Speaker
And so these areas wear down more quickly. You end up with pain and degeneration above and below the surgery. Surgery needs to be redone sometimes. it's It's a short-term solution, but it does not have, in my opinion, great long-term effects.
00:19:34
Speaker
Now, if you are in a situation where it has to be done, it has to be done. But I volunteered at Children's Hospital prior to going to PT school, when you go to PT school, you have to have inpatient hospital hours, outpatient volunteer hours as part of your application. So I did mine at Children's Hospital and I did it over the summer.
00:19:54
Speaker
And what that meant, what I didn't realize is that meant there were a ton of kids coming in over their summer break to get surgery for their scoliosis. And You know, i was I was absolutely the bottom of the pole of importance at the hospital. I was a volunteer.
00:20:13
Speaker
had to wear a blue apron that designated me as a volunteer over my, basically my my cater waiter outfit. It was, it wasn't my favorite thing. But anyway, since I was really just like the bottom of the bottom, when I was asking questions, I try not to bother anybody, right? But i I spoke to one of the
Living with Milder Scoliosis
00:20:30
Speaker
physical therapists who worked at the hospital and I brought this up because I was i was kind of,
00:20:36
Speaker
shocked at the number of kids who were coming in and just having spinal fusion for their scoliosis. So I asked one of these PTs, like, hey, is this just sort of, is this the the protocol? Is this what is in the guidelines?
00:20:50
Speaker
And he said, one of the older doctors at the hospital still would you use bracing before surgery, but the majority of the doctors would just use surgery.
00:21:02
Speaker
And the idea was they would kind of be promising that let's do surgery over the summer. And by the time fall rolls around, your kid is going to be able to go back to playing volleyball, go back to playing basketball, you know, whatever sport or activity they did in school.
00:21:17
Speaker
And, you know, I was trying to get the PT's opinion on it without being like, that sounds insane. but At this point in my life, I would have been much more vocal about it. But at that point, I was, you know, just trying to continue to be this volunteer. And so it was hard to tell. I didn't get the sense that the PT thought it was great.
00:21:35
Speaker
But i I also didn't get the sense that the PT felt like they had any control over the matter. So it seems like the sort of typical medical intervention at the moment, if it's a teenager, right, if it's a kid with a developing spine, they'll watch it.
00:21:53
Speaker
And then after a certain point, they just fuse it. With that said, there are plenty of people, myself included, who have a curvature that develops much more slowly And as a result, you don't have to go to this medical extreme, although you will still develop some imbalances or asymmetries in the body.
00:22:14
Speaker
So let's talk about what you might see on somebody and how their movement might be impacted if they have a milder version of scoliosis.
00:22:24
Speaker
So what you might see in the body is some rib asymmetry, depending. You might see ribs more prominent on one side or the other, you might see the head of the collarbone, right? The end of the collarbone where it attaches to your sternum, you might see, like for me, for example, one end of my clavicle, my collarbone actually protrudes out from my body more than the other one.
00:22:49
Speaker
And that is because of the curvature of my spine impacting my ribs, impacting my collarbone. If you just glanced at me, you wouldn't see it. But if you look at the two ends, you can see the difference.
00:23:02
Speaker
Something else that you might see is this apparent leg length differences. What that means is this person does not have a structural imbalance. They do not have one femur longer than the other, but because of the curvature of their spine, where the bottom of your spine, that L5 meets up with your sacrum and thus your pelvis,
00:23:24
Speaker
If the L5 vertebra is tilted to one side, you can imagine how that's also then going to tilt the pelvis, and then that's going to make one hip socket live higher than the other.
00:23:36
Speaker
And then that's going to make one leg look longer than the other, even though it isn't. You also might see things like the way somebody stands. They always stand with their weight more on one leg than on the other leg.
00:23:49
Speaker
And you're going to see you know some mild shifts in how muscles fire. That's not something you're going to observe. That's something that's going to take place. But here's the nuance about this. These are adaptations that the body is making to make the best of a structural pattern. It's not necessarily a dysfunction that requires correction.
00:24:08
Speaker
And frankly, and frankly, and frankly, you may or may not be able to change the actual pattern physical changes that you're seeing, right? I may work on strengthening one side of my rib cage versus the other in an attempt to, you know, quote unquote, balance it out.
00:24:27
Speaker
But that may or may not make any visual difference to how much the end of my collarbone protrudes from my body. So yes, exercise is important the way it's important for everyone.
00:24:38
Speaker
we may not need scoliosis-specific movement methodologies. Because there are scoliosis-specific exercise interventions out there, let's look at the evidence around them, not just people's opinions.
00:24:52
Speaker
So one of the most well-known scoliosis-specific exercise interventions is something called the Schroth method. And it is a scoliosis-specific physical therapy approach that uses individualized postural corrections This is how Schroth describes it.
00:25:10
Speaker
Individual postural correction, rotational breathing, I don't know what that means, and targeted muscle activation to address the three-dimensional nature of spinal curves. It was developed by Katerina Schroth in the 1900s in Germany.
00:25:25
Speaker
And so the Schroth method really attempts to address the whole 3D aspect of each person's individual spines. by creating treatments and exercises for each person. So the way they do that is this, what they call curve specific postural correction, right? They learn how to place their spine, their ribs and their pelvis into quote unquote, correct alignment.
00:25:47
Speaker
using mirrors, tactile cues, feedback, right? So there's videos of people doing this online. And if I might find one and shove it in the the show notes so that you can observe it. It's really interesting. You'll see people like holding onto something with their hands and then they're making these sort of minute adjustments to which muscles are contracting. And then they just kind of hold this position as an isometric contraction of all these muscles in their body.
00:26:13
Speaker
right But the second they let go, everything kind of goes back to where it was. But anyway, that's part of their treatment. They also do something called rotational angular breathing, which is directed breathing into the quote-unquote collapse side of the rib cage. right If you see someone with a really severe... curvature, one side of the ribs is going to kind of be that collapsed. And we talked about how that's going to then cause issues for lung function, cues, manual techniques, et cetera, to try to use the breath from the inside out to expand the area that is collapsed, right? Trying to reinforce the breathing, reduce the rib prominence possibly, although that's questionable, reinforce these postural corrections. Although again, that's not necessarily a plausible thing that's going to take place.
00:27:02
Speaker
And then they do a lot of these isometric holds, slow controlled movements that emphasize strengthening this trunk extensors. That is not easy to say, people. Strengthening the trunk extensors and these sort of spinal stabilizers, the lateral trunk. So it's a lot of not dissimilar to the kind of work we do in Pilates, for example, or like early rehab, maybe postpartum, things like that, where you're really focusing on the muscles of the trunk and how they all work together.
00:27:29
Speaker
Once you've you know made all of these quote-unquote corrections, patients that are taught how to like sit, stand, walk, carry using these corrected postures. So that's one methodology, the Schroth method.
00:27:41
Speaker
There's also something called C's, as in crossing the seven C's. It is from Italy. SEAS stands for Scientific Exercises Approach to Scoliosis.
00:27:56
Speaker
its bit of a mouthful. It's a physiotherapeutic scoliosis-specific exercise method that focuses more on active self-correction and motor control rather than passive positioning.
00:28:08
Speaker
This is what they claim. Patients learn to find and maintain a corrected spinal posture using their own muscle activation and then practice holding that correction during increasingly functional and challenging tasks. So it sounds like it's a little bit different from Schwath, but I don't know by how much exactly.
00:28:26
Speaker
Okay, so research suggests that both of these methods can produce small to moderate improvements in the Cobb angle, in pain and in quality of life, particularly in adolescence with mild to moderate idiopathic scoliosis and may enhance outcomes when combined with bracing, but results vary widely.
00:28:51
Speaker
They depend a lot on being consistent and And the information that we have is really only short to medium term. We don't have a lot of long-term data on using these interventions specifically for scoliosis.
00:29:06
Speaker
Bottom line is both of these methods are really best viewed as sort of a symptom management and maybe like a risk reduction strategy, but they're not a cure. So I went on Consensus, which is the AI tool that we use to do literature review.
00:29:23
Speaker
It just allows us to get through a ton of studies much faster. So I went on Consensus and I asked, is there strong evidence supporting specific exercise interventions as the best treatment for adults with scoliosis?
00:29:39
Speaker
And the answer is no. There is no strong evidence for something like Shroth or Seas. However, there is still evidence out there. It's just not strong evidence.
00:29:50
Speaker
So there are multiple systematic reviews and meta-analyses that suggest that exercise interventions that are scoliosis-specific, like SROTH or like SEAS, may create a modest reduction in that Cobb angle.
00:30:08
Speaker
It may improve some of that trunk rotation angle and some of the posture measures. It may improve quality of life scores, like on ah on a questionnaire. But the nuance is that the evidence quality is not high.
00:30:24
Speaker
If the evidence quality is not high, then that means we cannot take it as strong evidence. So a lot of the studies that are out there have a lot of methodological limitations.
00:30:35
Speaker
I can't imagine that this is an easy research study to put together. In particular, a lot of the studies are done on adolescents because that's when you're seeing the most change for people with scoliosis. So you're adding in an extra spanner in the works by trying to get teenagers to be consistent and compliant, right, when you're doing the studies.
00:30:56
Speaker
Very often the studies are very small sample sizes. There's not a lot of people in the sample. Again, i would imagine because it's just a difficult kind of research to put together and follow over time.
00:31:08
Speaker
And again, they also have short durations. They don't go on for for very long. Again, I would imagine because it's pretty difficult to do. So the evidence that's out there is not great saying that you need to do something scoliosis specific like Shroth or Seas.
00:31:26
Speaker
Even when we see changes occur in the Cobb angle, they're often small and the the significance is not clear, right? So let's say your Cobb angle changed from 40 degrees 38 degrees. How much is that changing your life as you're living it? Your pain, your functionality, all that kind of stuff.
00:31:45
Speaker
And as I said earlier, most of these studies are done on adolescents. They're not done on adults. So we can't extrapolate that data from adolescents to adults and just say, well, if it works on teenagers, it must also work on grown adult people.
00:32:00
Speaker
So exercise does not quote unquote fix scoliosis in the same way that surgical fusion quote unquote fixes the scoliosis, right? Although it causes problems later, but it can improve symptoms, quality of life function.
00:32:19
Speaker
It might possibly slow progression. Evidence does not conclusively support shroth versus seize. It is important to be consistent and, and it mattered in the research that people were supervised and doing the exercises correctly, which is is pretty standard.
00:32:37
Speaker
So what does this mean? If you're listening to this and you're an adult and you're like, well, I have some scoliosis and I notice that there are asymmetries in my body.
00:32:48
Speaker
Maybe sometimes those asymmetries give you a little achy pain, right? Maybe like one side of your low back always kind of hurts more than the other. If you were to do do certain activities, things like that, right? That's someone like me, for example, who has a pretty mild, verging possibly on moderate, but but not ah not a life-changing amount of scoliosis, what should we do?
Strength Training for Adults with Scoliosis
00:33:11
Speaker
Because i it does not seem from the evidence like it's in any way worth going and doing this kind of shroth or seize work if you're no longer a teenager, I would say.
00:33:22
Speaker
It doesn't seem like the evidence is really strong even for teenagers, but that's where the evidence is. So what does that leave for us? What quote unquote should we be doing? Should we be doing exercises to try to quote unquote correct the curve? Should we be trying to fix our asymmetries, right? All that kind of stuff.
00:33:42
Speaker
So if you are either a physical therapist, if you are maybe a personal trainer or a Pilates instructor, and you feel like working with the person that you're working with does not exceed your scope of practice, right?
00:33:59
Speaker
You're not diagnosing scoliosis. You're not treating scoliosis as a trainer or a some other movement teacher. You are just working with muscle imbalances that you're seeing, right?
00:34:10
Speaker
If you're a physical therapist, you're going to evaluate more things like pain-related limitations, maybe fear avoidance patterns, any sort of asymmetry that impedes function. For example,
00:34:21
Speaker
Do they rotate better through their spine to one side than to the other, to the point where it's like limiting their movements, right? Regardless of where you're coming from, we're not here to fix the spine.
00:34:33
Speaker
But what we do want to do is help people build more movement confidence so that if they have asymmetries side to side in their strength that are large, that we work to decrease the asymmetry, we're unlikely to make it completely even side to side. And and that's true of anybody, right? Everyone's asymmetrical.
00:34:54
Speaker
But if we want to train someone with scoliosis without chasing a sort of cosmetic symmetry, there's lots of really great stuff you can do.
00:35:06
Speaker
General strength training is going to be excellent and going to be very effective. And here's the thing, like sometimes people are like, well, how do I know my client's got a curve that does this? And I noticed this kind of thing, but how do I know, you know, which side is the stronger side, which side is the weaker side? You don't have to know. This is, and this is what I've realized as a PT as well. You just test and you test by having person do exercises, right? So for example, one-legged unilateral work.
00:35:35
Speaker
like a lunge or a squat, split squat, a single arm press up to the ceiling, a single leg RDL, right? Rotation exercise one way or the other.
00:35:47
Speaker
You'll be able to it's something as simple as a bridge sometimes or a side-lying leg lift, you're going to be able to tell, or the person is going to be able to tell you if it feels harder on one side than the other.
00:35:59
Speaker
And so then that becomes your treatment plan if you're a clinician or that becomes your exercise plan, right? So let's say somebody has a really hard time doing a step back lunge on one side versus the other.
00:36:11
Speaker
Easy. You just work on that step back lunge on one side or you regress it until it's something that looks good, quote unquote, good to you, right? Good meaning we're not seeing movement faults For example, like something like they're they're unable to load the hip properly when they step forward or something like that, right? Not that you are correcting what their spine looks like.
00:36:32
Speaker
So we're really just working honestly the same way that you would work with anyone where you're seeing these big big differences side to side, right? So any kind of unilateral exercise, whether it is a ah single leg arm or leg exercise, any of that, what they call anti-rotation work, like wood chops, paloff presses, like so lateral step outs, holding a band, all of that kind of like asymmetrical trunk stability work is going to be great because odds are there's going to be one side that's harder than the other. We're just trying to build better capacity.
00:37:04
Speaker
not correct a curve right so all kinds of unilateral strength work is going to be great another thing that you can work on is and this is sort of from that shroth style working on breathing for someone ah in particular for someone who if you're seeing a really noticeable one-sided shift or impact to their rib cage helping them to breathe more into those compacted areas is going to be helpful in some extent for stretching the soft tissue from the inside out, right? So you can do one-sided rib expansion work. You can do breathing lying on your side. So the collapsed side, you would lie on the non-collapsed side and try to breathe up into the more collapsed side, right? The ex exposed side.
00:37:51
Speaker
working through that sort of like thoracic rotational work, right? There's lots of stuff that you can do for rib mobility and breathing mobility that's probably going to be helpful as well. But the bottom line is just looking for these strength imbalances.
00:38:06
Speaker
And again, most people are asymmetrical. We're not talking about small, invisible differences that the person can barely feel or you can't see visibly. I'm talking about something like someone gets up into a bridge and then you have them lift up one foot for one leg.
00:38:22
Speaker
So they're doing a one-legged bridge on one side and they put it down and they pick up their other foot. The hip drops and Like hugely, right? That's something that you might want to work on strengthening.
00:38:33
Speaker
So we're talking about these big imbalances. We're not talking about small changes. So the takeaways that I want you to get from this episode is that, you know, scoliosis is not a life sentence.
00:38:44
Speaker
The biggest indicators for working on it in some way are going to be things like pain, impacted breathing, or a real noticeable impact.
00:38:57
Speaker
difference in functionality side to side.
00:39:02
Speaker
You can work on this as a personal trainer, as a Pilates instructor, as long as you are not talking about changing the curve or fixing or treating the curve in any way, right? You're not treating the scoliosis. You're just working on imbalances that you're seeing in the body.
00:39:15
Speaker
At the same time, we are not pathologizing or fear mongering around these imbalances, right? Exercise is not ever going to be a magic curve correction, but it can improve, as for everybody, the function and quality of people's life.
00:39:31
Speaker
Strength training is completely safe for most people with scoliosis, including things like deadlifts and back squats and front squats, right? It's not inherently dangerous and it's not inherently harmful to someone's scoliosis or their curve. Doing heavy lifting is not going to make their curve worse.
00:39:51
Speaker
We know that it's a much bigger group of factors that play into the shape and the progression of the curvature. You don't have to have a perfectly symmetrical spine to be strong.
00:40:03
Speaker
You just need evidence-informed guidance. You need progressive load, as for everyone, and you need realistic expectations. That's it. So as with most physical challenges in life, the answer is get stronger. stronger.
00:40:19
Speaker
If you feel like you need guidance for that, seek out some guidance, whether it is a trainer or a physical therapist, depending on how much guidance you feel like you need, depending on how many other co-conditions are going on. If it's something more complicated, go to a physical therapist. They've been trained in this. They know what to do. All right, that's our episode.
00:40:40
Speaker
I hope it's been helpful. I hope you have learned some things. I hope you are going to stop trying to perfectly line up someone's spine temporarily in the hope of correcting their scoliosis permanently because it doesn't work.
00:40:56
Speaker
I hope you are going to continue to focus on strength training for yourself and for the people that you work with. If you're a movement professional, everything I mentioned in the show will be in the show notes, including links to our phenomenal barbell mini course,
00:41:15
Speaker
And let's see, what else am I supposed to tell you? think that's it. Good job, team.
00:41:22
Speaker
We'll see you in two weeks.