June/July 2020 Issue
Focus on Fitness: Scoliosis and Exercise
By Jennifer Van Pelt, MA
Today’s Dietitian
Vol. 22, No. 6, P. 52
June is National Scoliosis Awareness Month, designated to increase public awareness of the condition’s prevalence in children and adults and communicate the importance of early detection. According to the Scoliosis Research Society, scoliosis affects 2% to 3% of the population, or approximately 6 million to 9 million Americans. Scoliosis is the most common spinal deformity in children.1 As many as 4 in 100 adolescents may develop scoliosis; the primary age of onset is between the ages of 10 and 15.
Some forms of scoliosis may be congenital or associated with certain other diseases, such as cerebral palsy or muscular dystrophy; however, in the majority of cases (80%), the cause is unknown (idiopathic). Because between 20% and 30% of children with idiopathic scoliosis have a relative with the condition, there may be a genetic link that isn’t yet fully understood. Depending on the extent of scoliosis, visible symptoms may include the following:
• A side-to-side spinal curve that may twist the spine: On an X-ray, a spine affected by scoliosis is shaped like either an “S” or a “C.”
• A rib “hump” or protrusion: When a person with scoliosis bends forward, one side of the ribs looks higher than the other.
• Leaning of the torso: For those who have a single curve in the spine, one hip may appear to be higher than the other and one leg may appear longer than the other. The torso leans to the right or left to help with balance.
• Asymmetrical shoulder height: One shoulder appears higher than the other due to the spinal curvature.
Approximately one-third to one-half of children with idiopathic scoliosis can suffer pain. Other symptoms may include respiration difficulties, reduced quality of life, and mental health issues, depending on the severity of their condition.2
Treatment of idiopathic scoliosis in adolescents depends on the degree of curvature in the spine and includes observation of curve progression, bracing, surgery if needed, and scoliosis-specific exercises. Of note, the prevalence and severity of scoliosis is greater for girls, who are eight to 10 times more likely than boys to progress to a curve magnitude that requires treatment and may be observed more frequently than in boys.1
Scoliosis often is considered a childhood condition, but it’s common in adults. Idiopathic scoliosis can follow an adolescent into adulthood in up to 8% of cases, and curvature may progress.1 According to the Scoliosis Research Society, adolescents with spinal curves less than 30° don’t progress significantly once they reach adulthood. Those with larger spinal curves require monitoring through adulthood.
Adults have more symptoms due to compensating for imbalances and age, which causes spinal disc degeneration, arthritis, and bone spurs. Symptoms include the following:
• low back pain and stiffness;
• fatigue from muscular straining; and
• numbness, cramping, and shooting pain in the legs from pinched spinal nerves.
Adults also can develop degenerative scoliosis, which is attributed to spinal disc degeneration, collapsing of the space between discs, and arthritis in facet joints. More than 60% of adults older than 60 may be affected.1 This type of adult scoliosis, which typically occurs in the lower back, causes the lumbar spine to straighten and lose its natural curve. Older adults may develop a “hunchback” as a result of trying to compensate for imbalances created by low back scoliosis. Symptoms are similar to those of idiopathic scoliosis. Treatment generally involves pain management and physical therapy; surgery and other interventional procedures may be performed, depending on the severity of spinal degeneration and the age of the adult.
The Role of Exercise
Physiotherapy scoliosis-specific exercise (PSSE) is used to treat children with scoliosis, with the goal of reducing the progression of the spinal curve in those with or without spinal braces. It’s not intended as a substitute for bracing.3 Although there are several different methods of PSSE, in general, all focus on exercises to stretch and expand the chest wall to improve posture and address activities of daily living; some include breathing exercises and cognitive behavioral therapy.
PSSE is individualized for the patient’s condition and curvature, and personalized plans are developed by physical therapists. Initial sessions are supervised by the therapist, who teaches the patient (and caregivers) how to perform the exercises. After several one-on-one or small group PSSE sessions, physical therapists give individuals with scoliosis supporting materials for home practice and set up a schedule of follow-up visits. PSSE generally requires at least two to three sessions per week for 30 to 45 minutes per session, or daily exercises for 15 to 20 minutes per session.
Research has shown that PSSE can reduce the progression to bracing for children, decrease pain, reduce body asymmetries, and improve muscular endurance, respiratory function, and quality of life.2,4-6 Evidence-based guidelines issued by the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment recommend PSSE for children with idiopathic scoliosis.7
PSSE also is used with adult patients to help manage pain and muscular imbalances caused by scoliosis. Unfortunately, few studies have been published on its effectiveness for adults with scoliosis. Nevertheless, one small study did find that stabilization and task-oriented exercises improved pain and quality of life. However, more research is clearly needed in the adult population.8
In addition to PSSE, those with scoliosis are encouraged to exercise regularly as their condition allows and with a physician’s approval. Recent research suggests that core stabilization exercises can benefit those with scoliosis. A small 2017 randomized study found that core stabilization exercises effectively corrected vertebral rotation and reduced pain when added to traditional PSSE.9
A small 2019 randomized study found that core stabilization exercises and PSSE were equally beneficial in improving rotation, symmetry, and deformity for girls with scoliosis who wore braces. However, core stabilization, but not PSSE, also improved pain.10
A 2014 study of 25 people aged 14 to 85 with idiopathic or degenerative scoliosis found that holding the side plank yoga pose improved the angle of curvature by 32%. Side plank was held for about 90 seconds daily for six days a week over six months on the convex side of their spinal curve.11 In addition to the side plank, other core stabilization exercises performed in research studies include the following:
• pelvic tilts (“bridges”);
• bridges with extended leg;
• cat-cow pose (rounding, arching back);
• abdominal crunches;
• kneeling spinal balance (one arm and opposite leg extended); and
• “Superman” exercise and locust pose (laying on stomach with arms and legs stretched overhead and then back toward hips).
Water exercise also is appropriate for those with scoliosis. Swimming can provide cardiac and muscular conditioning, and also strengthen lungs. However, an individual with thoracic scoliosis that affects respiration may need to modify or shorten swimming sessions. Water walking or water jogging in shallow water, or water running with a flotation vest in deeper water may be more comfortable for those with respiratory effects from scoliosis.
Older adults also may enjoy water aerobics classes. In addition to water exercise, for those with degenerative scoliosis, any land-based activity suitable for those with arthritis or osteoporosis also is appropriate. These include tai chi, qigong, chair yoga, modified yoga and mat Pilates, and low-impact cardiovascular activities.
— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Lancaster, Pennsylvania, area.
References
1. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013;7(1):3-9.
2. Ceballos Laita L, Tejedor Cubillo C, Mingo Gómez T, Jiménez Del Barrio S. Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis. A systematic review. Arch Argent Pediatr. 2018;116(4):e582-e589.
3. Hresko MT. SRS statement on physiotherapy scoliosis specific exercises. Scoliosis Research Society website. https://www.srs.org/about-srs/quality-and-safety/position-statements/srs-statement-on-physiotherapy-scoliosis-specific-exercises. Published May 19, 2014.
4. Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al. Physiotherapy scoliosis-specific exercises — a comprehensive review of seven major schools. Scoliosis Spinal Disord. 2016;11:20.
5. Negrini S, Donzelli S, Negrini A, Parzini S, Romano M, Zaina F. Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: a practical clinical trial. Ann Phys Rehabil Med. 2019;62(2):69-76.
6. Anwer S, Alghadir A, Abu Shaphe M, Anwar D. Effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis. Biomed Res Int. 2015;2015:123848.
7. Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3.
8. Alanazi MH, Parent EC, Dennett E. Effect of stabilization exercise on back pain, disability and quality of life in adults with scoliosis: a systematic review. Eur J Phys Rehabil Med. 2018;54(5):647-653.
9. Gür G, Ayhan C, Yakut Y. The effectiveness of core stabilization exercise in adolescent idiopathic scoliosis: a randomized controlled trial. Prosthet Orthot Int. 2017;41(3):303-310.
10. Yagci G, Yakut Y. Core stabilization exercises versus scoliosis-specific exercises in moderate idiopathic scoliosis treatment. Prosthet Orthot Int. 2019;43(3):301-308.
11. Fishman LM, Groessl EJ, Sherman KJ. Serial case reporting yoga for idiopathic and degenerative scoliosis. Glob Adv Health Med. 2014;3(5):16-21.