Scoliosis is briefly an abnormal curvature of the spine to the side. It is a state not a disease. It can be unstructured or structural. Deviations of up to 50 degrees do not require surgery, so they are only treated conservatively. In order to be able to get to know scoliosis in depth, we need to start at the source.
This is in the spine, as it is this body structure that is affected by scoliosis. If we didn’t have it, we wouldn’t be talking about it now, and we would most likely be swimming around the Adriatic with other jellyfish colleagues. The spine consists of 7 cervical, 12 thoracic and 5 lumbar vertebrae, sacrum and occiput. The last two are also divided into vertebrae, which in the vast majority of people merge into one. Together with the intervertebral discs, the spine acts as a spring that transmits forces from the environment to the body and vice versa. Because it must be very firm and flexible at the same time, the spine is prone to injury and pain.
Prerequisite for the health of the spine are strong and flexible muscles and ligaments that surround it, developed quality movement patterns and the quality of breathing.
All of the above is also greatly influenced by our environment – stress, emotions and interpersonal relationships. About this some other time and written by an expert.
In addition to the vertebrae, the spine is also made up of intervertebral discs, nerves and a huge number of small muscles and ligaments. Intervertebral discs vary in thickness and size depending on the position in the spine, which determines how much load is transferred to them. The spine is most flexible in the neck, which carries the least weight, the middle in the lumbar part, which carries the most weight, and the least in the chest. The muscles along the spine are also called postural, as they are active most of the time we stand, sit, walk, run, cycle and also lying down if our sleeping position does not correspond to the anthropometry of the body. These muscles receive commands from the brain through the spinal cord, which runs through a tunnel down the spine. Has it even dawned on you that the spine is the true center of the body?
Scoliosis is divided according to the cause into true and untrue, but can also be structural or non-structural. The first scolioses are those that developed during development in childhood due to a disorder in the development of the vertebrae, diseases of these or surrounding structures, or a permanent disorder in postural activity. Untrue or unstructured scoliosis, however, is often the result of improper muscle activation, varying limb lengths, degenerative changes, or fixed contractures (stiffness) in the hip. Scoliosis is most reflected in a person’s growth, as then the vertebrae thicken and increased, prolonged and uneven pressures on the growth cartilage cause rotation. Milder forms of scoliosis manifest as lower growth or an aesthetic problem, but more severe can also cause heart and respiratory disorders due to incorrect rib position. Don’t avoid burdens and physical activity, but still carry school bags on both shoulders!
What have we found out so far? Scoliosis can occur during the growing season or in adolescence, and in both cases, if properly diagnosed and treated, it is conservatively remediable at least to some extent, offering a quality of life. This, of course, does not apply to those scolioses caused by tissue diseases, where surgery is often required to restore a better condition, and only then can kinesiologists contribute to long-term health by strengthening the torso muscles. Don’t be intimidated if your doctor diagnoses you with scoliosis! Let this be the red flag that now you really have to start with an exercise that is not only aesthetically but also of survival important.
It would be great if we could always point the finger at the culprit for a particular condition. The vast majority do not know the exact cause of this and so it is with scoliosis, so it can also be divided into idiopathic and secondary cases of scoliosis. If you have been diagnosed by an orthopedist, most likely some of this will be written on the report and in the following lines I will tell you where you belong or what it means.
Idiopathic scoliosis is the most common, and it is not known exactly what caused it. They represent 90% of cases and can develop from birth until the end of skeletal growth. They are more common in girls (4: 1) and in some cases go away on their own, while in others severe deformities can develop. In any case, it is necessary to monitor, follow the doctors’ instructions regarding the wearing of a corset and ensure proper motor development.
Before moving on to scoliosis testing, we should also mention neuromuscular scoliosis. They belong to the group of scoliosis for which we know the cause, which is a malfunction of the motor neuron, e.g. in polio. However, neuronal damage can also be a secondary consequence of rheumatic conditions, Marfan’s disease, surgery, and spinal injuries. Are you still wondering why your doctor, if he cares, prescribed physiotherapy after a fall on a bicycle? Be aware that any injury represents a potential malfunction. Sometimes a few weeks of limping is enough to shift the pelvis.
How to tackle diagnostics? Before you find out that everyone who reads this has scoliosis, I put it to your heart that self-diagnosis is just a very rough basis for visiting a specialist. You will always notice the changes most easily! Answer the following 5 questions:
• Do I feel pain in the lumbar / thoracic / cervical spine?
• Do I feel uneven pulling to the side?
• Do I always put my shoes on by turning to one side and take off my T-shirt over the same shoulder?
• Do I always carry my purse / backpack on the same shoulder?
• Do I feel a change in walking?
If the answer to most of the questions was yes, you can start with the next step. Observation in the mirror:
• Are both shoulders at the same height?
• Can I raise both arms the same high above my head?
• Are both sides at the same height?
• Are both ears at the same height?
• Do I have my head turned to the side?
If the answer to most of the questions was yes, you can start with the last step, for which you will need an assistant. They will perform two tests, namely:
• Leg length test,
The Adams test is a forward bend where we observe a twist in the chest as a sign of scoliosis. Stand with your feet together and perform a forward bend with your legs outstretched. Let your assistant stand behind you and watch you. If your shoulder position is similar to the one in the picture, then I advise an examination by a doctor who will send you for an X-ray. Even if you have other problems described in the above series of questions, I advise you to contact your doctor if they persist for a longer time. Sometimes it takes a little nagging, but it’s worth it.
Okay, I have scoliosis, what now?
Up to a 25 degree angle, nothing special will happen to you. You will be prescribed a training system that suits your age, schedule and type of scoliosis. Between 25 and 40 degree you will most likely get a corset, especially if you are still in a period of growth. At the same time, you will need to perform specific exercises to normalize the situation as much as possible on its own. Between 40 and 50 degrees is the area where we can risk surgery (no surgery is 100%!) or risk with corset and exercises. Why do both take risks? Because we don’t know to what extent the therapy will work. Above 50 degrees there is usually no other option than surgery to reduce the angle. This is followed again by wearing splints and mandatory therapeutic exercises to strengthen the body. There is no guarantee that scoliosis will not return if you do not invest your work in exercise and a healthy lifestyle!
Last part of this blog but not least – exercises to strengthen key muscle structures at the diagnosis of scoliosis or simply as a preventive measure. Let me point out at this point that therapeutic exercises are different from those that will be presented here. I will show you basic exercises that may not be compatible with your diagnosis. Contact your chosen therapist or ask me a question. If you are reading this after surgery, after a visit to the doctor, or before being diagnosed with scoliosis, in any case, start with breathing exercises. This will strengthen the respiratory muscles and diaphragm, open the chest, improve oxygen saturation and calm the body and mind. The simplest exercise is bretahing square. Each side represents a change. Start by inhaling, followed by holding, exhaling, and re-holding. How long the side of the square will depend on your current capabilities – a good start is 4 seconds.
Stretching exercises will follow. Increased muscle tone is high on the scale of scoliosis pathogens, especially in adulthood. We have to take care of all directions of movement of the spine, that is, forward, backward, rotation left-right and deflection left-right. The first exercise is called Cat. Place yourself on all 4s and try to make a semicircle with your spine. This means that when the navel goes up, the pelvis goes inside and the head goes down and conversely, when the navel goes down, the pelvis goes up and the head goes back. Perform the movement slowly and with self-awareness. I recommend about 10 reps.
The second exercise is Windmill. Step with feet for the length of the stride apart. One of the feet points in the direction of the step, the other turns 90 degrees, and the hips turn in the same direction. With your exhale, lower yourself to the side towards the floor and look at the ceiling. Hold the position and take a deep breath into your chest. Repeat five times and switch sides.
We move from the spine to the stretching exercises of the muscles around the pelvis. We will start with Knee extensions lying on your back. At the same time, we will relax the back thigh muscles and, with the knee fully extended, also the fascia. Both structures can negatively affect the position of the pelvis and thus the spine. 10 reps on each leg.
The second exercise for the hip muscles will be the Pigeon. An advanced exercise for the hip flexors and internal hip rotators, which are often the Achilles heel of the sedentary population. If you have a problem with getting into the correct position during the exercise, you can put a pillow under your hip. Put yourself on all 4s and with right knee reaches to right wrist. Then rotate the foot outward so that the foot of the right foot lies at the left wrist. From here, use your hands to move the weight back and stretch your hind leg. Make sure the front leg does not move. Hold until you feel relaxed and repeat on the other side.
We move higher, this time to the chest. We will perform a Sock deflection and stretch the Broad back muscle on the sofa. For the first stretch, sit in turkish sit or on your feet. Take the sock in your hands and extend your elbows as far above your head as possible. From here, perform deviations alternately left and right, eight times on each side. We will use a sofa to stretch the back muscles. Sit on your ankles and lean your elbows against the sofa. From here, simply push your chest toward the floor, which you do ten times.
Now that you are warmed up and your muscles are back to normal lengths, you can start strength exercises. We will strengthen the torso and buttocks, which will have the best effect on scoliosis. In any case, you must not forget to develop or re-establish quality movement patterns of basic movements, such as crawling, crawling, carrying, squats, hip hinge, pulling and pushing.
Start with the Bird dog exercise. Stand on all fours and, while controlling your torso extend your leg and the opposite arm. Exercise will require firmness in the torso and awareness of the position of the spine, so use an assistant. Stretch each side eight times and repeat this three times with a short break in between.
The second exercise is Glute bridge. Lie on your back and bend your knees so that your feet are about 1 palm away from your buttocks. Now lift your hips off the floor by squeezing your back thigh muscles and buttocks. Make sure the movement really happens with the hips and not the spine! Repeat the movement in three sets of 15x and if it is too easy you can do it on one foot.
The third exercise is the Side plank. Lean on elbow and feet. Lift your hips off the floor by forming a straight line with your body from head to toe. The elbow should be just below the shoulder and hips in a straight line even from a bird’s eye view. Hold for 30 seconds and repeat on the other side. Do it all together three times with a short break.
The fourth exercise is designed to prevent torso rotation and control the hips. You can perform the Pallof press by stretching an elastic band or using a towel and helper. The body should be parallel to the elastic / towel and the knees should be slightly bent for a better feeling over the movement. You will start with your hands on your chest and end with them straight in front of you. The exercise has many variations, such as pushing up or static holds. Adjust the difficulty to your abilities and perform the Pallof press 8 times on each side, repeating it all three times with a short break in between.
The last exercise is for the broad back muscle, as this devil causes problems if it is too strong or too weak. Kneel on one knee and use an elastic band or cord with weights. The pull should take place at a slight angle, so not straight up and down, the body should remain in line with the device this time as well. Do 12 reps on each side and continue until you do 4 sets. In the meantime, take a break if necessary.
So what are my chances of having scoliosis?
No one can give exact numbers here, as many adult scoliosis remains undetected. People simply come to terms with pain and limited movement, as long as it is not too severe. In children, the prevalence is 2-3%, which is relatively low, but can have major consequences, so I advise regular monitoring during development. If you have back pain, I advise you to see a doctor. If he will advise you on the operation straight away, I advise you to seek another opinion. Criticism is beautiful chastity.
Take your health seriously!
The kinesiologist’s professional motor assistance will remain the first instance until we learn to change limbs like mechanics change tire.
Till next time,