Hi Ann! I got your contact info from the GGS site. Awesome work and always great advice and clarity!
Question, I’m a Personal Trainer, and I have a client who’s recently been diagnosed with Scoliosis. Can you share some info on what actions and exercises she should avoid or include to stay as safe as possible? Per usual most resources are giving me conflicting advice….
Thanks so much for reaching out, AB! I’m sure that many GGS readers have the same question.
First, let’s talk about the spine. Our spine is made up of 33 individual bones stacked on top of each other. We have 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused bones that make up the sacrum, and 4 fused bones that make up the coccyx (tailbone). So we have 24 articulating (moving) vertebrae and 9 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.
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.
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 treating clients with scoliosis is as follows:
- If the client complains of pain, please refer them out to a licensed physical therapist for an evaluation. The PT can make recommendations for follow-up with a physician if needed. The client is more appropriate for physical therapy if pain is limiting their function. We promise we’ll send them back to you when they are appropriate for coaching and training.
- If the client is not complaining of pain, but looking for generalized strength and conditioning, avoid any exercises or stretches that cause pain. If the client has worked with a physical therapist before, reach out to the therapist to learn about the client’s treatment and possible limitations. We are always happy to coordinate with you to facilitate the patient’s progress.
- Focus on movements that stretch tight muscle groups (on the concave side of the curve) and build strength in the muscles that are weakened from being on stretch (the convex side of the curve).
- Avoid forceful motions if the client has a history of pain. For example, don’t teach them aggressive foam roller extensions if they haven’t been cleared for that.
- Don’t provide manual therapy to your clients with scoliosis. I have seen trainers perform “adjustments” to client’s spines, and not only is this outside the scope of practice for a trainer, but it can also be dangerous to the client. If you are also a licensed massage therapist and working with clients with scoliosis, opt for pain-free soft tissue mobilization as an adjunct to training and recovery.
- Focus on exercises to develop control in rotation and anti-rotation, integrating the deep central stability system and the pelvic floor, as described here.
- Go slowly with weight progressions. Increase load to the spine slowly for back squats, and avoid overhead presses if that increases discomfort.
- If you are trained in the use of Kettlebells, they can be a fantastic way to increase strength and motor control. I love using the Turkish Get Up and Windmills to develop flexibility and control.
If you’re looking for more information about the use of Kettlebells in rehab, I’ll be talking about that topic at The Women’s Fitness Summit in Kansas City next month—join us!