In my last blog I looked at exercises for adolescents with scoliosis, but what about adults? How do you stay in shape, actively age and limit pain? Are there safe exercises for scoliosis?
Up until recently there has been very little guidance for the adolescent who likes to exercise, and even less for the adult. Many people with scoliosis are nervous about exercising. Will the wrong exercises make my scoliosis worse? Will the right exercises make the curves smaller? Does exercising cause or prevent pain?
Most activity advice is based on opinion and is often conflicting. Some experts believe that the only exercise you should ever do is ones that are tailored to your specific curves. This approach recommends you work with therapists who know Schroth, Scoliologic or other Physiotherapeutic Scoliosis Specific Exercises (PSSE’s). Some people believe you can do everything. Others tell you to leave it well enough alone and do nothing.
Fortunately, research is slowly providing more clarity and in October I was pleased to sit in on a paper presented at the World Low Back Pain Congress in Antwerp which proposed guidelines for choosing safe exercises for adults with scoliosis. The authors pulled together an expert group to review the existing research and used this to develop guidelines that can assist in making better decisions. I find the advice pragmatic, although sometimes complex to execute.
Here are the three factors they recommend you take into consideration when choosing exercises:
Recommendation #1 – Pain
Many people with scoliosis don’t have pain or any other symptoms. If you have pain, the recommendation is to see a scoliosis specialist prior to starting a general exercise program.
At The Orthopaedic Therapy Clinic we recommend seeing one of our physiotherapists prior to starting an exercise program. This will ensure that the source of pain is assessed and appropriate modifications can be incorporated into your program.
Recommendation #2 – Control your curves while you exercise
It’s important to not allow your curves to increase as you exercise. This requires good core support and body awareness to limit the compression on your spine. Visually the curves should not be seen to collapse during the exercise
At The Orthopaedic Therapy Clinic we recommend that you initially work one-on-one with a good core specialist as this will help you to develop sufficient postural control to reduce the demands on your curves. All of our physiotherapists, kinesiologists and Pilates/Yoga instructor are trained in core control and can help you to become aware of how to support your spine while exercising.
Recommendation #3 – Exercise in neutral if your scoliosis is complex
This is the most difficult of the guideline recommendations to execute. Much of the information required to categorize your scoliosis as complex or non-complex is not readily available. It requires specialized tests and possibly exposing you to unnecessary X-rays. In addition to the standard scoliosis measures of degree and location of the curve, this recommendation requires advanced measures  such as sacral slope and pelvic incidence angle. I seldom see these measures standardly included on a scoliosis X-ray however if you are having imaging completed you can ask these measures to be calculated by the radiologist.
In the absence of complete information, the authors give us another option. You can exercise in neutral providing your curve is in the lumbar or thoraco-lumbar area. This eliminates the need for an X-ray as a therapist with experience in scoliosis can visually determine the location of your curves.
Practically, this option is quite restrictive. It means that almost everyone with scoliosis, who doesn’t have their curves fully documented, should exercise in neutral. This restriction can be unrealistic as many sports require the spine to be in more extreme postures i.e. tennis serves, golf rotation. In Yoga and Pilates this would eliminate positions such as Downward Dog or Cobra. Applying this restriction would rule out many enjoyable sports activities.
What are safe exercises for scoliosis?
People with scoliosis should stay active. Good bone health and strong muscles are important throughout all of our lives and exercise helps to build this.
Ultimately the choice of activity is yours as these guidelines are based on expert opinions and the authors indicated that they did not find any high-quality studies which showed a problem caused by exercises performed out of neutral.
In my practice I prefer to help people stay active. Here is an overview of my advice for adults with scoliosis:
- Modify any activities that cause pain during, or shortly after exercise.
- Learn to control your curves through Scoliosis Specific Exercises or Core control exercises.
- Avoid postural extremes if you choose to go out of neutral i.e. try ½ Cobra and not full, work with a golf pro to learn a more limited swing, etc.
- Be aware that competitive sports increase your risk for back pain. Irrespective of whether or not you have scoliosis, high-level competitive sports are hard on the spine.
Here’s a link to the article I wrote for the Canadian Orthopaedic Division that has more information on exercise and scoliosis. If you have any questions on how to exercise with scoliosis or are having back pain, please contact us at 416-925-4687 to book an appointment or firstname.lastname@example.org
 Stolze H, Berdishevsky H, et Al, Safe exercises for adults with Scoliosis: A Scoping review with Proposed Algorithm, presented Antwerp 2019 low back pain congress.