Pilates Community Forum > Scoliosis Guidelines

It seems that many of you work with clients with scoliosis. There is a dearth of literature on the subject of Pilates and scoliosis, so I am looking for some practical guidelines on what you have found works best for your clients. Mine is a teenage boy, still growing, who has very poor posture and doesn't exercise. We are doing basic reformer,and leg springs, as he feels much better lying flat. We finish with wall work. Loaded flexion bothers him if we stay in it too long. I would love to hear from those with years of experience to help guide me in my path. I have been teaching private clients for two years, in a small town, and have limited experience with special populations. Any suggestions will be graciously accepted.

March 2, 2009 | Unregistered CommenterCarriage House Pilates

There are some good video's around, "The Scoliosis Series" PArt I and II by Dr Suzanne Martin through www,pilatestheraputics.com are very informative and features tutiorals about scoliosis. Dr. MArtin uses wall springs and demos a 20 minute flow on the springs.
BTW You should not have any client in loaded flexion for too long, whether thay have issues or not, loaded flexion is not the place for anyone to hang out.

March 3, 2009 | Unregistered CommenterLA

Thanks for the advice, LA. I have watched those videos and they are helpful - I am ready to move beyond those. My teenage boy client is not the most patient, so I'd like to hear what works for well for you experienced instructors.

March 3, 2009 | Unregistered CommenterCarriage House Pilates

I worked closely with a Rolfer who had 2 different approaches to scoliosis - passive relase and active release - after a warm up. In passive relase, you prop up the shorter lifted side of the spine (on a small roller or folded towel) and allow it to slowly release into the support. Actively, you prop up the heavier longer side and the shorter side drops more quickly. Once you've achieved some bit of equality, then you strenthen the side that doesn't want to contract as much, and stretch and lengthen the side that is more contracted and shortened. All of us have some preference on side to side work, so I always ask my clients during single arm, leg or oblique work which side felt harder to perform. I go back to that side for a few more reps to try to "even out" the work. I haven't seen any of the videos mentioned before, but will most likely view them as it seems a large number of people I see have some degree of scoliosis.

March 3, 2009 | Unregistered Commenterluann klein

Keeping Luann's ideas in mind a great exercise on the cadillac or wall springs is to have the client sit on a box facing away from wall or tower,put a pad under the longer side, hold the spings in hands as in cactus(elbows bent to 90 ), and lean out lifting the spine and lengthening the back through the arm into a side stretch and resist the return, keep the arm reaching away even as you return to the start position, (the opposite arm will remain neutral in a bent position) then do the same on the short side holding the stretch and resisting the return. Then repeat with the pad reversed.

March 3, 2009 | Unregistered CommenterLA

I approach scoliosis from a different point of view, having several clients with this issue with curvatures ranging form mild to severe.

I have never experienced success using the technique of strengthening the weak side and stretching the strong side.

Since the body moves by way of a series of rotations, I have found success working the counter rotations and prescribing a series of exercises performed in a linear plane to correct the curvature.

Rotational movements tend to increase the curvature and side bending has to be supported to avoid collapsing. I avoid those movements until there is enough strength developed in the body.

To make any correction to the curve, frequency is a factor. 2-3 times per week minimum in the beginning and then regular maintenance from then on. I also prescribe a set of exercises to be done at home on a daily basis.

When it comes to scoliosis the client has to be proactive. I talk to my clients on the importance of taking an active role in their physical maintanance. Without their commitment, working with severe curves can be very frustrating.

We should also be mindful that most forms of scoliosis are not due to 'muscular weakness'. There will always be weak musculature found in various components of a scoliotic curve and body as a whole, as the condition is not merely of the spine but as much the legs and pelvis too.

So it's important to honor and respect the 'causes', known or ideopathic, when trying to 'right' someones curves. If the condition is caused by structural situations (bony deformation, hemi-vertebrae, extra/fused ribs, etc) there will be limitations on the ability to 'correct' it. Efforts should be made to balance it instead and keep the individual strong and adaptive.

It may also arise for reason relating to incomplete spatial organization of the organs or nervous system structures. In which case all the strengthening in the world will not change the situation, and may harm the individual if the internal restrictions are stressed by the 'corrective' movements.

Rotational work is the way to go in general though, as scoliosis is a 3-dimensional rotational issue as well as lateral bending... the two are always coupled together. The more they rotate into the pattern, the worse it gets... Much like ringing a bath towel so much that it shortens and buckles on itself. Counter-rotation work to the primary pattern is helpful... as is lateral bending to open the concave aspect of the curvature.

Don't get caught up in the "weak" or "strong" side methodology of treatment or assessment. The concave side will present musculature that is shortened and neurologically inhibited. If activated to 'strengthen' it will pull them further into the pattern. Etc...... .

Just getting folks to move is a reasonable and helpful task at the level of pilates teaching. Scoliotic curves are complex and very unique to the individual, so there is no magic recipe or protocol for working with it. Despite some attempts to suggest so. Use the basics to work in oppostion to the scoliotic pattern and be patient and conservative. You're most likely not going to 'correct' anyones curve through strengthening work, but it doesn't mean you can't help in other ways.

March 5, 2009 | Unregistered Commenterjustwondering

"Just getting folks to move is a reasonable and helpful task at the level of pilates teaching. Scoliotic curves are complex and very unique to the individual, so there is no magic recipe or protocol for working with it. Despite some attempts to suggest so. Use the basics to work in oppostion to the scoliotic pattern and be patient and conservative. You're most likely not going to 'correct' anyones curve through strengthening work, but it doesn't mean you can't help in other ways."

I agree with you 100% here, JW. I have many students with scoliosis and find that over time, most of them experientially learn how to move in a more symmetrical fashion. In other words, I don't need to tell them, as if I knew how, what to do. Their bodies tell them what they need to do.

March 5, 2009 | Unregistered Commenterdropshot

dropshot,

Well put! I think the greatest gift one could offer someone is how to 'feel' their own unique selves more acutely and perceptively. And no matter how much insight we might bring forth, what sticks with our clients are those personal felt insights they experience within. Keep 'em empowered to find their way with gentle guidance!

March 5, 2009 | Unregistered Commenterjustwondering

Why try to fix it? Can it be fixed? I don't think we're in a position to fix anything. Just do the work and things will work out or not.

I apologize if I'm re-hashing things. It seems as if we've talked about these topics before but I learned not to dwell on what they can't do (i.e. the problems) and just do the Work.

When a person comes to me and tells me he has scoliosis or it is apparent that he has it, I don't think, "Now, let me see. What program am I going to prescribe to this person?" First of all, I'm not a prescriber. Second, I tell him to get on the Mat and we start doing the work, the Classical work. Then we might go over to the Reformer and do exercises there. A few more reps on the weak side isn't going to "even things out."

March 5, 2009 | Unregistered Commenterdropshot

All true from dropshot and JW et al but the original question was Can you suggest any exercises that might help. I know from first hand experience as I have scoliosis myself and so I use my own body as a a guide. Some exercises are helpful, while ohters cause discomfort so I ask my clients how does that feel?They guide me to create a program that gives them more enhanced movement.

March 6, 2009 | Unregistered CommenterLA

Before you start dismissing the idea that scolisis can't be "fixed" maybe you should start asking yourself if it is possible?

99.9% of the population has some degree of curvature aka scoliosis, which unfortunately increases with age.

I don't know about the rest of you, but I spend my day unwinding, balancing and strengthening spinal postures with some level of success. The younger the person the easier, the older ones are harder. True, the more severe curves are trickier, but they are not as hopeless as some of you are implying.

If I was trying to survive as a business based on fraudulent claims I would have been made to close my doors a long time ago. Consumers aren't stupid.

Try being a little more open minded. It is amazing what we can learn from each other when we start asking the right questions.

March 6, 2009 | Unregistered CommenterStacey Redfield

Stacey,

Yes, some can be helped to varying degrees.... But there are so many variables involved in that that you can't make any claims whatsoever to anyone. And, it remains true that scoliosis is not a result of muscular weakness in the vast majority of cases, if not all. Neural deficits would be the closest thing to that idea.

And I would demand evidence via before and after x-rays before taking anyones word for claims of "fixing" a scoliosis! Proof is in pudding. That doesn't mean I'm saying it's not possible... it just means, 'show us the proof'. I've heard far to many 'accounts' of scoliotic correction from various health practitioners from raindrop therapists to chiropractors who make this claim.... and the evidence (viax-rays) showed a very different story when they finally came to me a got them.

"Scoliosis" is a term to describe a lateral curvature of the spine greater than about 10 degrees. It's just a term, not an illness/disease that someone "has". To be born with or develop scoliosis early in life is different than to have a lateral bend in the spine from postural imbalances/habits or occupational strains or injury. The ones from early in life or fetal development are VERY DIFFERENT than the latter. So where exercises may help the latter more often than not, that is different than a true ideopathic or structural scoliosis. Those should not be 'forced' back with strengthening exercises without knowing what caused the initial deviation in the first place.

I think dropshot hit the nail on the head. Just get them moving and you've done them a tremendous service. Who are you to decide that you can "fix" their scoliosis? How do you know why they have it? And do you honestly believe that every scoliosis can be "fixed" with exercise? Haven't you heard of the Scroth Method of Physical Therapy designed/developed specifically for scoliosis? Even that is nowhere near 100% effective, not even half that.

I get a little annoyed when people mislead the public like this. And you know what, there are a lot of people out there who are doing things that aren't effective or legititmate but their still in business... they're everywhere unfortunately. So no, you wouldn't "have been made to close your doors a long time ago". And no the public isn't stupid, but they are ignorant about these types of things... and they look to health professionals for 'answers'. So I'm saying be careful what you promise them or say to them, because false hope is the worse kind.

March 6, 2009 | Unregistered Commenterjustwondering

So great to hear everyone thinking of my passion, scoliosis. Watch the site for my next article here to address my take on some of the scoliosis issues. We are the ones addressing this incedibly prevalent problem, and it's important to keep working with clients although it may not be 'fixed' or 'cured'. Kudos to everyone grappling with this issue.

March 6, 2009 | Unregistered CommenterS Martin

I tried LA's exercise (March 3rd post) on my client with a leg length discrepancy - she has a tight hip on one side and a looser hip on the other. We also did some side work on the spine corrector (hey - maybe that's why it's called that!). The next day she said it is the first time that she has been able to maintain the feeling of length on her shortened side. Your exercise is great for anyone just to teach them the feeling of lift of their core muscles. Thank you so much! Luann, I will try the rolfer's technique - it fits my experience of achieving muscle lengthening. My mentor always taught me that if I really want to stretch a muscle then to first heat the client up with a good work out and then let them cool down while holding the stretch. I will report back with results from my scoliosis client.
I will happily try out everyone's suggestions - thank you so much for the continuing education. I'm very thrilled to have found this site and appreciate the more experienced instructors mentoring us along this wonderful path.

March 6, 2009 | Unregistered CommenterCarriage House Pilates

Re : Pilates for the Scoliotic participant

I have worked alot with many people suffering from different stages of scoliosis, and had great success with all of them. Even though much of the above debate is quite heated and interesting, I have to say, that yes, although each and every person is different, and the way their scoliosis presents differs, much of our work can be applied in a 'protocol' format due to the limitations of the equipment and how it is used. Just as with prenatal, there is a protocol we have established at Boditree. Whether it be with regards to how the exercises are executed (with breath, spring load, or set up), with scoliosis, we have also devleoped a format of beginner/intermediate/advanced exercises to integrate into a client's program, that specifically adresses scoliosis. Keep in mind our style of work is NOT group led, we offer groups with custom designed workouts as well as privates, so we have a greater ability to respond to these sorts of variations in client needs with greater ease.

Most of my work with scoliosis comes from Michele Larsson, her scoliosis workshop is incredible. Additonally,I have integrated components from dance therapy, and stretches given to me from an Australian Osteopath, to help me with MY scoliosis !

So if you are in the US, do your best to get to a Michele Larsson workshop. If you are in Canada, then you can attend our scoliosis workshop in Vancouver. It's always best to learn in person rather than from a book or video.

Good luck !
Risa, Vancouver

I draw on the work of Karen Clippinger, Suzanne Martin (DVD's mentioned above) and Kathy Corey (see IDEA site, conference presentations) when working with scoli clients. But for me personally, gyrotonics has been the most wonderful release for my tightly bound scoli body. After the session I can feel where my ribs and pelvis are in space, in relation to each other, something I struggle with generally due to neuro pathways being messed around owing to imbalances. Felt fantastic, and one of the rare times I could feel my left side obliques and QL actually working.

May 26, 2009 | Unregistered CommenterMelissa Turnock

I noticed this delightful exchange of ideas and wanted to offer some insight into the idea of fixing or not fixing scoliosis. The fact is that, as just wondering indicated, each scoliotic client is extremely individual and should be treated accordingly, so a 'one size fits all scoliosis approach' just won't work--not even close to that. I have had many clients over the years and each and every person was unique in more ways than one. The fact is that pilates addresses the entire person--holistically, so just confining the "fix" into strenghtening the weak side and stretching the opposite side will accomplish very litte. There are many other things to consider, including the other systems in the body along with pilates. However, the Instructor has to also have knowledge of and a certain degree of maturity and understanding to teach in this matter. As to the Schroth Method, I spent an average of eight weeks out of every year for three and a half years in order to learn their way of treating scoliosis and I can assure you, the success rate is a lot more than 50% as opposed to what 'just wondering' was implying.

Just wanted to add more fuel to the fire

September 30, 2009 | Unregistered CommenterPG

PG,
I am assuming you are a PT?

October 1, 2009 | Unregistered CommenterDeborah McKeever Watson

Golly, you all took a very good question and went in so many directions.
I am an adult with a 55-degree lumbar-spine curve, as well as, severe cervical-spine deformities.
I did not have scoliosis as a child.
I did have two bad injuries (falls) in my adult years.
First, I would like to say that ~ just getting someone with scoliosis “moving” is a very correct beginning.
Second ~ Christa Lehnert-Schrfoth’s is the best physical therapy.
Third ~ Pilates, and Yoga are both helpful physical therapies.
Fourth ~ your clients must know and understand that physical therapy must be a life-long endeavor, for any person suffering from scoliosis.

This is a great discussion. I am a parent of a 12-year-old with scoliosis. I have spent the last month researching how to help her improve posture and balance. I understand that now is the time to make these changes when her bones are still growing and can change and adapt to change. Pilates, Yoga and the Schroth method all seem like great alternatives. Can you recommend a practitioner in NY or Connencticut?
Thanks so much!
Nisa
contact me at nisa@firtree.com

April 27, 2010 | Unregistered CommenterNisa

Hi everyone,

Just wanted to make sure you've seen the material on scoliosis that's been published here on Pilates-Pro.com after this thread was started. First, there's Pilates for Scoliosis by Suzanne Martin, PT, DPT (who's mentioned in this thread). We also reviewed a great resource for those with scoliosis in The Pilates Bookshelf: Curves, Twists and Bends: A Practical Guide to Pilates for Scoliosis.

Hope that's helpful!

Best,
Lauren/editor

April 27, 2010 | Unregistered CommenterPilates Pro editors