What Are the Best Exercise Programs for Scoliosis?

Scoliosis-specific exercises and scoliosis bracing are the scientifically proven treatment methods for both adults and children. The scoliosis-specific exercise programs that scoliosis clinicians and researchers have come up with are designed to stabilize the spine, reduce the curvature size, and improve the cosmetic appearance of the patient. 

So, what are the best exercise programs for scoliosis? Here is a list of the most popular exercise programs:
  • Lyon
  • SEAS (Scientific Exercise Approach to Scoliosis)
  • FITS (Functional Individual Therapy of Scoliosis)
  • CLEAR Scoliosis Institute
  • Side Shift
  • Schroth (three schools teach their own interpretation)
    • BSPTS (Barcelona Scoliosis Physical Therapy School)
    • Schroth Best Practice
    • Asklepios
  • Yoga for Scoliosis
  • DoboMed
  • Pilates for Scoliosis
While the SEAS and Schroth are the most famous of the scoliosis exercise systems, there are other systems that each have their own strengths and  weaknesses. For example, although Schroth is very popular and can be found at many physical therapy offices, many patients tend to have trouble using the approach at home due to its complexity. Most Schroth practitioners treat scoliosis as one condition amongst many and so never gain expertise in using the complex methodology.

 

The rest of this article will discuss key topics and questions related to scoliosis exercise programs:

  • The various scoliosis specific exercise programs
  • The strengths and weaknesses of the different exercise programs for scoliosis
  • The exercises and tools required for these programs
  • Can all scoliosis patients exercise without risk?
  • When should bracing be brought into a treatment plan?

Scoliosis is the most common orthopedic deformity in children and adolescents, and is seen in up to 60% of adults over 60 years of age. Most experts believe that 4.5% of the population has scoliosis, but the number may be closer to 10%. The mortality rate for people with scoliosis is 15%. Scoliosis can reduce life expectancy by up to 14 years. In a 1988 study, 12% of college-aged women were found to have scoliosis.  

Surgery should be seen as a last resort for the treatment of scoliosis. Sadly, most people who have the surgery return for a 2nd, 3rd, or 4th operation. Of those who have the surgery, 40% are legally defined as severely handicapped.  

Unfortunately, there is no way to predict who will get scoliosis, and there isn't an instantaneous and complete cure - patients must work to see improvement in their condition.

However, by performing a uniquely designed program of exercises and stretches, patients can see very significant changes to their scoliosis. They can even gain a cosmetic correction when their scoliosis curve requires it.

It is important to note that patients have noticed improvements using all of the primary exercise methods. It’s really important to understand each method's unique strengths and weaknesses.

All scoliosis specific exercise programs include the following advantages:

  • Curvature reduction, pain relief, and cosmetic improvement are all very possible, and even likely.
  • The programs include a variety of exercises.
  • Self-care routine. 

 

The Lyon Method

The Lyon method uses scoliosis-specific exercise along with the use of a unique brace called the new Lyon ARTbrace (Asymmetrical Rigid Torsion brace). Treatment includes: 3D mobilization of the spine, patient education, focusing on activities of daily living, such as the correct sitting position.

Strengths:

  • The earliest method that can be traced back to a book published in Lyon France in 1827!
  • Integration of bracing with exercise.
  • Spinal manipulation is included.


Weaknesses:

  • Lack of availability due to the few centers that offer this method of treatment.
  • Adherence to a single bracing system.
  • Lack of attention to postural retraining exercises.
  • Protocol has been unchanged for 50 years.
  • No attention to restoration of the normal neck shape, when curve is missing or reduced.

 

The SEAS Method for Scoliosis Treatment

SEAS, or the Scientific Exercise Approach to Scoliosis, is an individualized exercise program adapted to all aspects of conservative treatment of scoliosis that is based on the most current research. For mild to moderate curves in children who are still growing, SEAS is used alone to reduce the need for bracing. In moderate to severe curves in children who are still growing, SEAS is used in combination with bracing to slow down, stop, and possibly reverse curve progression, and in preparation to wean the patient off the brace. In adult scoliosis patients (either progressive scoliosis curves or fused spines), SEAS helps stabilize the spine and reduce disability. In severe adolescent idiopathic scoliosis (45°– 50° Cobb, or greater if the patient refuses surgery or is not a candidate for surgery), the goal is to stop progression (and avoid surgery), and possibly to even reduce the curve size.

Appropriate exercises are assigned to each patient based on their initial examination findings. Improving spinal stability is the main focus of SEAS and it is achieved through active self-correction. SEAS exercises train the neuromotor systems of the body to reflexively activate a self-corrective posture during activities of daily living.

Strengths:

  • Based on a scoliosis-specific active self-correction technique performed without any external props such as pillows, wedges, elastic bands or wooden poles. 
  • Continuously evolving with new information from recent scientific literature. 
  • Can be used with or without bracing, for different curve sizes and different age groups

Weaknesses:

  • Many of the therapists who use this system are not scoliosis specialists. They treat scoliosis as one aspect of a general practice.
  • Does not adequately address the sagittal (front to back shape) of the spine and can actually be counterproductive to re-establishment of the normal shape of the spine when viewed from the side.
  • Can be complex to learn and requires a highly skilled practitioner to get results.
  • Does not employ spinal manipulation but opts instead for more generic spinal stretching methods that are not as focused or effective in improving spinal mobility.

 

Schroth

“The goal of Schroth exercises is to de-rotate, elongate, and stabilize the spine in a three-dimensional plane. “ - John Hopkins Medicine

The Schroth method was originally developed by Katharina Schroth in 1920 as a treatment for polio patients who were afflicted with neuromuscular scoliosis resulting from paralysis caused by the poliovirus. The method has been continuously revamped and modified so that since 2008, there are now three different groups who have “Schroth” schools. There are thousands of physical therapists around the world who have added Schroth therapies to their general and sports based physical therapy practices. Research into Schroth is currently championed by Dr. Hans Weiss, a chiropractor and orthopedic surgeon from Germany, and Dr. Manuel Rigo from Barcelona, Spain. Originally an allergist, Dr. Rigo switched his specialty to scoliosis.

Working with the patient’s sense of their posture forms the core of the Schroth method of scoliosis treatment. Schroth also uses 3D posture correction through isometric exercises and breathing techniques that attempt to force air into specific parts of the lungs. These exercises are intended to reshape the rib cage and de-rotate the spine to halt progression and reverse the curve. 

The Schroth method is primarily used for treating teens with idiopathic scoliosis.

Strengths:

  • Oldest and most well-known non-surgical method for treating scoliosis.
  •  Many physical therapists are located all over the world.

Weaknesses:

  • The original Schroth method is considered outdated by many doctors and other medical professionals. 
  • The method has been divided into three different schools that offer their own unique interpretation and additions to the original methodology.
  • The very high expectations placed on an adolescent to perform a complex series of maneuvers using a variety of bands, balls, wall bars, pillows and rods to achieve a home correction. 
  • While the method works well in the therapist's office, it does not transfer home well. Many patients find the exercises difficult to replicate unassisted. 
  • The approach is difficult to use in young children to prevent progression.
  • Another issue is its insistence on the patient being able to force air into a specific part of the lungs. This is not physiologically possible and creates a conflict in the method's usability.
  • The cost of completing the program tends to run high if you purchase all of the equipment.
  • Aside from the wide variety of equipment necessary to complete this program, there are also plenty of exercises per piece of equipment. Knowing exactly how to perform these exercises is another area that tends to be problematic. While the program is made to be self-guided, many patients need to make multiple visits to learn all of the exercises, and even then find it confusing and too time consuming. 
  • Improper performance can end up doing more harm than good. Due to the complexities mentioned in this section, it's common for patients to become frustrated with the lack of improvement.

The DoboMed Method (Poland)

Developed in Poland in 1979 by Polish physiotherapist and physician Professor Krystyna Dobosiewicz, Dobomed is an expansion of the Schroth method. Like Schroth, the main technique involves active three-dimensional self-correction of the spine and ribcage, but Dobomed’s innovation is to introduce an emphasis on the “kyphotization,” or forward bending of the thoracic spine. Dobosiewicz’s method is a conservative management approach for idiopathic scoliosis that addresses both trunk deformity and respiratory function impairment. Since the beginning, the Dobomed approach has been used either as a sole physiotherapy method or in combination with Chêneau bracing. In adolescents and adults, the focus is on curve stabilizing exercises.

The following are distinctive features of the Dobomed method:

  • Symmetrical positions for exercising.
  • One-sided movements for curve reductions.
  • Mobilizing the thoracic (middle) spine to increase flexibility in the area.
  • De-rotation, with specific emphasis on the largest part of the curve.
  • Rib mobilization to expand and de-rotate the ribs.
  • Improved breathing.
  • 3D movement of the spinal bones.
The DoboMed approach to trunk derotation. Courtesy of ResearchGate

Strengths:

  • Based on Schroth, Dobomed has a strong foundation.
  • Clever innovations were amongst the first to assist with kyphotization, which is now recognized as vital to a successful scoliosis treatment program.

Weaknesses:

  • Dobomed is not recommended for young children who are unable to understand and perform the exercises. 
  • There is no spinal manipulation outside of the ribs and thoracic part of the spine (mid back).
  • Lack of availability, as relatively few practitioners use this method.

 

Side Shift

The Side Shift approach was developed by Dr. Min Mehta in 1984. She is one of the world's foremost experts on infantile scoliosis. This system comes from England and is built upon the idea that a young child with a flexible scoliosis can have their spine stabilized with sideways movements. Breathing exercises are included to expand the chest cavity. The approach is currently led by Tony Betts, a physiotherapist. Excessive side movements of the upper body correct the sideways curvature of the spine. These sideways movements reduce postural stress, which are thought to affect the development of scoliosis.

Dr. Mehta initially used this approach to treat congenital scoliosis curves in young children. She believed that growth could be harnessed as a corrective force for scoliosis in children. Through repetitive actions, properly directed growth can be used to resist the curve of the spine. While correcting the curve position with upper body shifts, the muscle forces and connective tissue stretches increase mobility and re-align the soft tissue aspects of the scoliosis. It is believed that repetition of these corrective movements also helps to promote a more upright and correct posture.

Strengths:

  • Can be used on young children due to its simplicity.
  • Was specifically designed to be used for children with scoliosis caused by some kind of bone irregularity present from birth.

Weaknesses:

  • This method has not received wide acceptance outside the UK.

 

Functional Individual Therapy of Scoliosis (FITS)

Functional Individual Therapy of Scoliosis, or FITS, was developed by Marianna Białek PT, Ph.D., and Andrzej M'hango PT, M.Sc., D.O. in 2004. This eclectic approach takes elements from various methodologies and alters and combines them into a more inclusive form of scoliosis treatment. FITS is not really a unique method, as it uses the methodologies of other scoliosis-specific exercise schools. It is used on its own for mild cases, or combined with scoliosis bracing in children who are scheduled for surgery. FITS is employed for the correction of shoulder and pelvic girdles postural disturbances after the child has had surgery. FITS is also used in other types of abnormal spinal curvatures.

Strengths:

  • Employs an eclectic approach.
  • Has the benefits of each specific approach it uses.

Weaknesses:

  • Not available at many centers.
  • Difficult for the therapist to gain expertise on all the various techniques, they wind up being a “Jack of all Trades and a Master of None.”

 

Pilates for Scoliosis

Pilates is an exercise system that was developed in the early 20th century by Joseph Pilates. It involves body conditioning routines with a focus on building flexibility and strength in the legs, abdominals, arms, hips, and back. Pilates has an emphasis on spinal and pelvic alignment, breathing to relieve stress and promote oxygen flow to muscles, developing a strong core, and improving coordination and balance. There are offshoots of the system known as “Pilates for Scoliosis” or “Scoliosis Pilates”, however they are not a complete program to fully treat either childhood or adult scoliosis. Pilates can certainly be used as a supplement to an effective customized established scoliosis treatment program, but not to treat scoliosis on its own. 

Strengths:

  • Exercise program that has specific protocols for people with scoliosis. 
  • Good for general fitness and for use along with a complete scoliosis treatment program.

Weaknesses:

  • Not a true scoliosis-specific exercise treatment!
  • Practitioners have limited scoliosis training and are typically exercise therapists or generalist physical therapists.
  • No connection to any kind of bracing.

 

Yoga for Scoliosis

Yoga for scoliosis is found in several forms being promoted by three major schools. The most popular was developed by Elise Browning Miller in California in 1976. It is based on the style of yoga founded by  B. K. S. Iyengar, called “Iyengar yoga”. It is sometimes referred to as “Furniture Yoga” since it uses aids like pillows, chairs and blankets to assist with the maneuvers. Scoliosis yoga uses a customized yoga program based on the individual's type of scoliosis and locale and shape of their curvature. The goal is to improve mobility, to relieve pain, and to stabilize the spine by strengthening the core.

Elise Browning Miller teaching. Courtesy of SFGate

Strengths:

  • Exercise program that caters to people with scoliosis and has specific instructions for  the major curve types. 
  • Good for general fitness and for use along with a complete scoliosis treatment program.

Weaknesses:

  • Not a complete scoliosis specific treatment!
  • Practitioners are typically yoga instructors with limited knowledge about scoliosis.
  • Not used in a specific way in conjunction with bracing.

 

The CLEAR Method

The CLEAR Scoliosis Institute was created in 2000 to teach chiropractors the latest information on conservative scoliosis treatment. With a background in a biomechanical approach to spinal function, the founder, Dr. Dennis Woggon, used his skills as an instructor in the Pettibon technique to pioneer a breakthrough method of treating scoliosis. The initial concepts of increasing mobility in the stuck areas of the spine, then using chiropractic manipulations to align the spine, and finally using highly advanced neurological exercises to gain the most permanent of corrections possible has stood the test of time. Over the past 20 years, other advances in scoliosis care have been introduced to create a constantly evolving approach that takes advantage of scientific breakthroughs in scoliosis treatment.  

“Currently, there are over thirty CLEAR Scoliosis Centers in the United States and around the world, and around five to ten new doctors make the decision to become CLEAR Certified each year. Collectively, our doctors have over 570 years of clinical experience in spinal rehabilitation.” CLEAR Scoliosis Institute

The goals of the CLEAR method include: 

  • Patient education in using their normal daily activities to reduce strain on the spine and, in fact, be corrective. These things include sports, carrying a backpack or purse, sleeping position, as well as how to sit or stand, taking into account the unique needs of each person's scoliosis (also known as ergonomics).
  • Integrating with bracing when needed.
  • Increased range of motion. 
  • Neuromuscular control of the spine, coordination, trunk stabilization, muscular strength. 
  • Improving breathing function.

The CLEAR method uses a wide variety of exercises, stretching, whole body vibration, and neuromuscular training to assist in correction and to help patients develop perception of their spine and their postural defects.

The CLEAR method helps patients develop the correct posture while sitting at a table to write or type on a computer. Encouraging patients to participate in sports and other forms of physical exercise is an essential part of the CLEAR method. Distinctive features of the CLEAR method include:

  • Proactive spinal corrections to avoid surgery.
  • Postural training to avoid or slow down curve progression.
  • Information to support a decision-making process.
  • Teaching a home-exercise program.
  • Support for patients managing their scoliosis from hom.
  • Prevention and coping strategies for pain.

Strengths:

  • Highly trained chiropractors who use specific spinal manipulations to release locked areas of the scoliosis and, most importantly, reduce or eliminate any pain associated with the scoliosis.
  • Uses powerful methods of postural retraining affecting the nerve system to gain permanent corrections.
  • Has specific protocols to restore the normal shape of a healthy spine, which is so often missing in patients with scoliosis.
  • Has specific protocols for both adults and children.
  • Protocols are constantly evolving as new breakthroughs in scoliosis become available.
  • Exercises are developed in the professional offices, but performed in the patient's home. This empowers the patient to self treat.
  • Works seamlessly with modern bracing methods when necessary (approx 30-40% of cases).

Weaknesses:

  • Requires extensive classroom and hands-on training of the chiropractor.
  • Requires purchase of sophisticated equipment by the doctor of chiropractic who wants to employ these methods.
  • Limited number of centers around the world.

 

Modern Exercise Programs for Scoliosis

Scoliosis is a painful situation as it is, so why add more pain to the process? Fortunately, you don't have to. 

Through modern scoliosis specific exercise programs, you can see quick results with a more straightforward method. 

The best programs for scoliosis allow patients to perform their exercises at home throughout 99% of their treatment. Proper education and additional helpful advice are also available to those who need a boost or a reminder.

Below are some of the main benefits of using a modern scoliosis exercise program:

  • Patients have everything that they need at home. Scoliosis is complicated enough, so there's no need to make it even foggier and harder to understand. 
  • By providing diagrams, instructions, and DVDs, modern programs help the patient through the program. Instead of trying to guess which exercises are next and how to perform them, you'll have the answers right at your fingertips. These prep tools also prevent unnecessary office trips.
  • The stretching recommended by modern scoliosis exercise programs works wonders on the muscle tissue. This allows braces to work much quicker.
  • Another benefit of modern programs is that they're completely painless. Patients can expect results without having to push through the pain or perform exercises that make them feel uncomfortable. Every program is custom-tailored to the patient's needs and ability to perform them.

Can Scoliosis Patients Exercise Without Risks?

As each program is designed for the patient in question, assuming that the patient performs these exercises correctly, there won't be any pain or risks in most cases.

In certain scenarios, patients might have to wear a scoliosis brace. These braces not only reduce pain and increase stabilization of the spine, but they also help to prevent potential curve progression. When you're wearing a brace, many stretches and exercises can be done in the brace to increase the effectiveness of the tool.

Final Thoughts

Scoliosis-specific customized exercise programs have given rapid improvements, curvature reduction, and pain relief to countless scoliosis patients around the world. This approach has been validated by science as the most effective non-surgical form of treatment.

Whatever you do, don't start a scoliosis exercise routine without consulting an expert in conservative scoliosis care. Some exercises might not be suitable for your specific situation. 

Additional Resources:

Author: Dr. Andrew Strauss

Dr. Strauss is a 1982 honors graduate of Palmer College. He is the director of the Hudson Valley Scoliosis Correction Center in New York. He has been actively engaged in scoliosis treatment for the past 37 years and has authored two books on the subject, Your Child Has Scoliosis and The Truth About Adult Scoliosis. He is Vice President of the CLEAR Scoliosis Institute and a lecturer for their introductory and advanced workshops. He is certified in Scoliosis bracing and in the use of specific scoliosis exercises. Dr. Strauss is a graduate of the ISICO World Masters of Scoliosis.
Reach out to Dr. Andrew Strauss

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This website is for informational and general purposes only. Information provided is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice because of something you have read on this site. 

CLEAR Scoliosis Centers are privately owned and operated chiropractic clinics. Doctors at CLEAR Scoliosis Centers are personally responsible for all clinical decision making. CLEAR Scoliosis Institute, a nonprofit organization, does not have any authority over the clinic, make any clinical recommendations, or dictate patient care.
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