Tamsin Thoren completed her Pilates instructor certification through MiraCosta College, where she is currently studying to become a Registered Dietitian.  The studio manager of Bella Forma Pilates in Carlsbad, CA.  Tamsin has an extensive background in anatomy, physiology and complimentary and alternative medicine.

Scoliosis is a general term given to a deviation in the shape of an individual’s spine. This can be one or more lateral curves and often includes a rotation that can twist the spine into a corkscrew-like shape in extreme cases. The altered shape of the spine can cause compression on proximal organs and structures, leading to such complications as chronic back pain, neuritis (caused by compression of spinal nerves,) spondylosis (osteoarthritis of the spine,) breathing difficulties, and dysfunction of the heart and lungs.

Mild cases of scoliosis may not require any treatment, but extreme cases may need to be treated by spinal fusion and implants to correct the spinal deviation. Approximately 85% of all cases of scoliosis are considered idiopathic, meaning that doctors don’t know what caused the condition. Scoliosis is a fairly common condition, occurring in about 2% of all adolescents and affecting seven times more females than males.

The awareness and muscle control that are essential to Pilates make it a very useful tool for achieving relief from some of the complications of scoliosis. According to Suzanne Martin, PT, DPT, “Pilates can excel in the long-term training needed to help change the many factors involved in a distorted spine and unbalanced musculature associated with scoliosis.”

As individuals gain muscular control, they can use their musculature to counteract the force of compression caused by spinal column distortion. Caution must be exercised, however. It should not be the goal of the instructor or client to overcome the spinal distortions, as this can lead to pain and spasm. Instead, the instructor should work within the limits of the individual, with the goal of gradually increasing awareness and strength in the muscles that support the vertebral column.

Contraindications and modifications will vary between individuals based on their age and the severity of their condition. Younger individuals (adolescents and up to about age 22) whose bones have not reached their maximum density and strength should be limited to fundamental exercises and lighter weights. “The soft skeleton is very plastic and does not have full development of bony prominence that guard joints from coming out of socket.”

For clients of all ages, working within the individual’s condition and spinal curvature will minimize the amount of strain placed upon already compromised structures. Using props like towels, spine correctors and the arc can help to position your client so that he or she can comfortably and safely complete their workout. Rotation should be done with caution and to both sides, but beginning with the side that is easier for the client. A wonderful set of foundational exercises for most clients can be found included in the article by Suzanne Martin, which is referenced below. A good rule of thumb for all clients, with or without scoliosis, is to begin with fundamental exercises and light resistance, gradually increasing the complexity and resistance as the individual is able to progress. Individuals with extreme cases that include complications like “spondylosis, spondylolisthesis (slipping vertebrae), and herniated or degenerated discs” will need to take precautions to protect against fracture, slippage, or aggravating herniations, respectively. These are serious conditions that require further research as well as consultation with the individual’s medical providers.

Not all clients with scoliosis will tell you, or even know, that they have the condition. Very mild cases may not have been diagnosed in adolescence and may have progressed asymptomatically and unbeknownst to your client. The telltale signs are uneven shoulders, hips, and/or waist length, leaning to one side, and “one shoulder blade that appears more prominent than the other.” If you notice a combination of these postural markers in a client it would be wise to proceed with caution as if they have scoliosis and help them to become aware of their postural deviations as you work with them.

There are many factors to consider when working with an individual with scoliosis. It takes education and effort on the part of the instructor and client to ensure a safe and beneficial Pilates workout. But, over time and with regular instruction, clients can receive the benefit of a reduction in many of the symptoms associated with this condition.

References

Martin, Suzanne. “Pilates for Scoliosis.” Articles. 3 April 2009. Pilates Pro. 1 December 2009. <http://www.pilates-pro.com/pilates-pro/2009/4/3/pilates-for-scoliosis.html>

Mayo Clinic. “Scoliosis.” Diseases andConditions. 14 December 2007. Mayo Clinic. 1, December 2009. <http://www.mayoclinic.com/health/scoliosis/DS00194>

MedLinePlus. “Scoliosis.” Encyclopedia. 17 September 2009 . National Institutes of Health. 1 December 2009. <http://www.nlm.nih.gov/medlineplus/ency/article/001241.htm>

Werner, Ruth. A Massage Therapists Guide to Pathology. Philidelphia:Lipincott Williams & Wilkins. 2002.