There have been a lot of questions on whether or not exercise is helpful for people with scoliosis. The key is knowing which exercises are good for the condition and which exacerbate its symptoms. Weight-bearing exercise promotes bone health by putting more stress on muscles and joints and working against gravity.
I feel like one of the big misconceptions out there regarding scoliosis is that people with the condition have to lead sedentary lives of limitation. While scoliosis can take many forms with symptoms varying drastically from one patient to the next, it still doesn’t have to be as debilitating as many people think.
The main factors that affect the mobility of people with scoliosis are age, condition severity, cause, and curvature location. In some cases, the larger the spinal curvature, the more likely the patient is to experience scoliosis-related symptoms, but that is never exact.
Many people live with scoliosis for large portions of their lives without even knowing they have the condition. In fact, many cases of adult idiopathic scoliosis are extensions of adolescent idiopathic scoliosis that progressed undiagnosed into adulthood.
Maintaining a healthy activity level is essential in promoting health and wellness for everyone; people with scoliosis are no exception.
Activities thought to exacerbate the symptoms of scoliosis include sports that rely on overusing one side of the body, such as golf or tennis, or those described as ‘collision sports’. Sports that favor the use of one side of the body more than the other can speed up progression, while high-impact collision sports such as football and hockey can lead to spinal fractures and disc degeneration that can cause scoliosis to develop or speed up pre-existing condition progression.
That being said, a scoliosis diagnosis doesn’t necessarily have to mean giving up your life’s passion. Even the aforementioned activities that carry additional risks for people with scoliosis can be incorporated into a healthy lifestyle if they are approached cautiously, the condition is being treated, and its progression is managed effectively.
The key is being able to find that perfect activity balance for each and every patient. One sport or activity that needs to be eliminated or limited with one patient could be safe for another.
As adolescent idiopathic scoliosis is the condition’s most common form, adolescents are the largest age group we treat. We recognize the need for adolescents to remain active and engaged in the sports and activities they love throughout treatment and beyond.
Patients who are fit and healthy have an edge over those that aren’t. Not only are active patients more physically fit with bodies better equipped to handle the rigors of their condition and treatment, but the proven benefits of regular exercise to mental health and wellness also can’t be understated.
The most highly-recommended activity for scoliosis patients is swimming. The simulated weightlessness reduces the compression effect of gravity on the spine; this not only provides patients with relief, it can also improve spinal-disc health. Swimming also utilizes the body’s muscles in a perfectly symmetrical and balanced manner, more so than in other activities and sports.
Additional activities such as walking, hiking, yoga, and cross-country skiing don’t involve jarring motions or encourage asymmetrical muscle development known to exacerbate spinal curvatures. These weight-bearing exercises carry numerous health and wellness benefits for scoliosis patients and work to strengthen the body and the mind.
Any physical activity or sport that causes a scoliosis patient pain or discomfort should be avoided, and all types of activities should first be cleared by a doctor, as scoliosis is a complex condition that differs widely from patient to patient.
Here at the CLEAR Scoliosis Institute, patients of all ages, condition severities, and fitness levels come to us. We first treat the condition structurally, and then we augment that treatment with at-home practices and exercises that are effective and sustainable.
We work closely with our patients to design a proactive customized treatment plan that takes into account both the individual’s abilities and limitations.
The earlier a treatment plan is started and the harder a patient is willing to work, the more likely achieving a curvature reduction is, and by extension, the more likely it is that the patient will still be able to participate in the activities they love.
Again, there is great variation from one person’s condition to the next, and that includes mobility levels, but in the majority of cases, if a patient is being effectively treated, and any condition-related limitations have been accounted for, mobility is not a huge issue for people with scoliosis.
While no new exercise regime or sport should be attempted without first consulting a doctor, people with scoliosis can often continue living as active a lifestyle as they did before they were diagnosed with the condition.
Back in the 40s and 70s, a fair amount of research (Woggon’s reference?) was done on scoliosis and exercise, and the results revealed that the popular exercises of the day (pull-ups, sit-ups, and push-ups) didn’t help at all.
From these studies, the idea grew that exercises didn’t help with scoliosis, but in fact, they were studying the effects of exercises that impacted the condition negatively, without further investigating the potential positive effects of different forms of exercise.
We now know that those three types of exercises are the worst for people with scoliosis as they can actually aggravate and accelerate a patient’s condition.
In fact, even today, sit-ups are no longer recommended because of the compression forces placed on the spinal cord while it’s bent in an unnatural curve.
Scoliosis-specific exercises cannot be generalized. At CLEAR there is no “one-size-fits-all” exercise to help every person with scoliosis. CLEAR prescribes scoliosis-specific exercises customized to each patient as part of the CLEAR Scoliosis Treatment Protocols.
Here at the CLEAR Scoliosis Institute, we are frequently asked to recommend exercises that can help with scoliosis. Let’s explore those exercises
While there are a number of exercises that are effective in providing relief, strengthening the core muscles that support the spine, and facilitating the spine’s flexibility, an in-person consultation with a CLEAR certified doctor is the best way to ensure an exercise plan is fully customized to the patient’s individual condition.
Two scoliosis exercises that should be performed daily are the spinal rotation warm-up exercise and the spinal molding cool-down therapy. These exercises ensure that the spinal discs are adequately prepared for exercise and cooled down after exercising while in proper alignment, encouraging spinal health.
These exercises should be performed every morning upon waking and every night before going to sleep. Performing these exercises daily help scoliosis patients maintain spine health.
We like to describe these exercises as hitting the ‘reset’ button on your spine as the stress of gravity gets redistributed from the muscles back to the spine where it should be; this provides relief from muscle soreness, neck, and lower back pain.
The cervical flexion exercise works to strengthen the flexor muscles at the front of the neck (cervical flexors). This exercise involves lying on your back with a roll under your neck and your fingertips on your forehead. Without moving your head, you try and push back on the fingertips while tucking the chin and not moving the head.
This exercise helps balance the muscles in the front of the neck with the muscles in the back of the neck (cervical extensors). This balance helps to preserve the neck’s healthy curve (lordosis) and can help alleviate forward head posture.
The cervical extension exercise we recommend works to strengthen the back of the neck’s extensor muscles.
This exercise involves sitting with the hands clasped at the back of the head and the elbows tight together. The hands apply resistance while the head is tilted back. Holding this position for short intervals helps to preserve the neck’s healthy curve and ability to support the weight of the head.
The lumbar extension exercise works to strengthen the lower back’s extensor muscles. It involves sitting, looking up, and arching the lower back.
We recommend the cervical extension and lumbar extension exercises be performed multiple times daily when sitting for long periods of time.
The chest expander exercise works to restore the thoracic kyphosis (upper back rounded curvature), stretches the rhomboid muscles (upper back muscles located between the shoulder blades), and improves lung capacity.
This exercise involves inhaling and exhaling while bringing the hands down from above the head, pushing them into the diaphragm, and then away while in a seated position and expanding the rib cage.
This exercise is most beneficial when the person leans into their primary curve; this helps engage the lungs and respiratory muscles more on one side than the other. This exercise should also be done multiple times daily.
As it turns out, the best thing for people with scoliosis, in terms of exercising, is to strengthen the core muscles.
Core muscles are unbalanced and unequal, and when you work those core muscles effectively, you end up with stronger and equally-forced core muscles.
In regards to our CLEAR protocols, what we want to focus on specifically is spinal isometric exercises. This is because the core muscles of the spine don’t respond to isotonic exercises; they respond to isometric exercises.
Isotonic exercises are performed with motion, such as lifting weights and going up and down with weights. Isometric exercises are performed against resistance, without motion, and involve push-and-hold movements.
Isometric exercises are more effective than isotonic exercises when it comes to strengthening the body’s core postural muscles, so these are the types of exercises we work into our scoliosis treatment plans.
Normally, with isotonic exercise, you work the muscles for a day, rest them for a day, work them for a day, rest them, etc. With isometric exercise, the need is to work those muscles every day.
If you skip isometric exercises for two days, the muscles become 50-percent weaker; after three days, they become 90-percent weaker. Committing to an isometric exercise regime means working those muscles on a daily basis.
Our CLEAR protocols utilize uneven spinal weighting with types of side-lever arms that get the body to react to the uneven forces we’re putting on the spine.
I’ve spent a lot of time in airports observing travelers, and there are an awful lot of people walking those hallways with bags or backpacks slung over one shoulder; their bodies are going to react to that uneven weight by leaning away from it, rather than leaning towards it.
As they’re leaning away from that weight, their bodies are reacting to that external force, and it’s this idea that’s behind the practice of unequal spinal weighting. Our treatment goal with uneven spinal weighting is to get the spine and its surrounding muscles to react to its external world. This is the treatment strategy at work in treating a child with a brace as it applies compression to the entire spine.
The Guyton and Hall Textbook of Medical Physiology discusses how human beings adapt to the time and needs of their environment. In the context of scoliosis, by manipulating conditions of its external world, we can get the spine to react in a way that’s beneficial to the condition.
This is an effective approach because rather than simply pushing a spine into a healthier position, we can get it to respond in the way we want it to. By doing this, the mechanoreceptors in the joints will actually change the messages they’re sending up to the brain and the messages that the brain sends back down to the body.
Once the messages that are sent up to the brain change, the messages sent back down are to hold the body’s new position, and this reduces and stabilizes a patient’s scoliosis.
Our understanding of how various exercises can impact a patient’s scoliosis has come a long way over the years. We now see exercise as not only an effective part of treating scoliosis patients, but a necessary part.
When we implement specific isometric exercises, they’re based upon the patient’s X-ray results. We find out which muscles will actually pull the spine in the way we want it to, and we activate those muscles with the specific spinal isometric exercises.
The core exercises work to help balance out the core muscles by strengthening and correcting the weaker ones, rather than just trying to make both sides of unequal core muscles stronger.
While early research didn’t find a lot of connection between exercise and positively managing scoliosis progression, current research has shown that exercise is an essential part of an effective treatment plan.
In the 60s, the Milwaukee Brace was a popular treatment option. The brace went from under the chin to the top of the hips, and kids wearing it were told to take it off for an hour a day to do exercise.
When the Boston Brace became popular, even that mere hour of exercise was eliminated. I’d say over the last 10 years, modern research has really shown how important exercise is for scoliosis patients.
Here at CLEAR, we see patients from all over the world, and we try to give them some exercises to start before they even have their first in-person consultation with one of our CLEAR certified doctors. We sometimes suggest this because it takes 90 days to develop muscle physiology: being able to change muscles and retrain them. As there’s no way to speed up those 90 days, if a patient starts the process early, by the time they come to see me, we’ve got a headstart on everything.
It’s now commonly accepted that certain scoliosis-specific isometric exercises can help manage and treat the condition. While early studies focused on the effect of sit-ups, pull-ups, and push-ups, we now know that those exercises actually jam the thoracic spine forwards, encouraging the loss of the spine’s healthy curves.
When appropriate weight-bearing exercises and practices such as uneven spinal weighting are used effectively, those external forces can help get the spine to move in a direction that counteracts the unhealthy curves, helping to reduce and stabilize the scoliosis.
Exercise carries numerous health and wellness benefits for our patients. Other than the ways in which exercise can help us achieve structural changes to the spine, it also increases our patient’s overall health and better equips their bodies to handle the challenges of living with scoliosis.
If you or a loved one has a recent scoliosis diagnosis, one of the many questions you are likely asking is which forms of exercise can be helpful to the condition. Our CLEAR certified doctors work closely with their patients to determine which muscle groups to target with weight-bearing exercise, adjustments, and which types of activity levels are ideal for working within the patient’s abilities and limitations.
“The author’s views are his or her own and may not reflect the views of CLEAR Scoliosis Institute.”