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What are the best exercises for scoliosis?

Written by Ashleigh Prowse, Scoliosis Physiotherapist


Exercises specific to scoliosis are becoming an increasingly common and favoured treatment of scoliosis. Exercise therapy as per Schroth method for scoliosis is usually recommended by your physician as a first line treatment of scoliosis, sometimes in combination with a brace, or while awaiting surgery. There are many differences of scoliosis specific exercises to traditional exercises. The program design and approach, is determined by the patients age, absence/presence of symptoms, and risk of curve progression, and the quality is determined by the training and experience of the therapist/s; typically, PSSE physiotherapy is only performed by professionally trained instructors.




What is scoliosis specific exercise?

The primary goal of scoliosis specific exercise is to influence the "progressive cycle" that occurs with structural postural conditions. The spine is designed to sit with balance: that is, the head on top of shoulders, on top of ribcage, on top of pelvis, hip and ankles. Disturbance in the balance of the system means compensations occur and the body looks at strategies to maintain upright posture in response, this can results in increased loads on certain structures of the spine.

 

For those growing, that is, a lateral spinal curvature produces asymmetrical loading of the skeletally immature spine, which in turn, causes asymmetrical growth and a progressive wedging deformity. Offloading the growth plate and opposing these forces encourages more symmetrical vertebral growth and a slowing/prevention of further changes in the scoliosis, and in some cases improvement. For adults, the goals is to prevent further asymmetrical degenerative changes and loss in ligamentous strength that leads to progression of the scoliosis with aging.

 

Scoliosis specific exercises teach the person to "hold out of their curve",/ and often including exercises that oppose the curve/ achieve maximal correction. Once able to maintain this posture, strengthening of the spinal musculature is added. Through the exercises the body is able to return to a more ‘normal’ physiological position and lessen the progressive "cycle" through improving posture and restoring muscle symmetry as well as offloading structures that may have been overloaded and contributing to pain. 

 

Stoke’s Vicious Cycle of Pathogenesis:  Adapted from, “Scoliosis and the Human Spine” by Martha C. Hawes (2002)



What is the evidence for each school?

The SOSORT states that physiotherapy and exercise therapy used for the treatment of AIS differs from nonspecific exercises and physiotherapy in that it aims at treating three-dimensional nature of scoliosis and includes the following principles; self-correction of posture and spinal strengthening of key muscle groups, and patient education on postural modifications and integration into daily activities . The frequency of PSSE physiotherapy varies from 2 to 7 days per week. 

 

The most well-known PSSE physiotherapy schools operating under the SOSORT are as follows:

  • Schroth, Germany;

  • Lyon, France;

  • SEAS (Scientific Exercise Approach to Scoliosis), Italy;

  • BSPTS (Scoliosis Physical Therapy School), Spain;

  • Side Shift, UK;

  • DoboMed, Poland; and

  • FITS (Functional Individual Therapy of Scoliosis), Poland


Supporting research exists for each of these methods, and therapists often use a number of methods for their patients (Marchese et al), thus, there has been a move in recent years toward collectively naming the exercises from each of these schools as "scoliosis specific exercise".

  • “Rehabilitation schools for scoliosis” thematic series: describing the methods and results. Scoliosis 2010, 5:27

 

 

What is the “Schroth Method”?

The Schroth Method is a specialised form of exercise therapy specific to the 3D nature of Scoliosis - considering the flattening of usual curves in sagittal plane, the side bending in the frontal plane, and the rotations in the transverse plane. It was developed by Katerina Schroth, a Physiotherapist in Germany, and is the oldest, most widely used and most researched method of physical therapy/ exercise in the treatment of Scoliosis with various studies supporting its use. 

  • Three-dimensional treatment for scoliosis. A physiotherapeutic method to improve deformities of the spine. Palo Alto, CA, The Martindale Press 2007


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