How do I work with someone with scoliosis?
December 15, 2008 by Melanie Byford-Young · Leave a Comment
This question was sent and responded to through email, but we thought others might be interested!
Dear Leslie/Melanie,
I have a scoliosis client and she has been coming for pilates for two months. She has a convex curve to the right on her thorax and to the left on lumbar spine.
Can she does lateral flexion exercises like mermaid or side bend?
In term of breathing, lateral aspect expansion on which side (convex or concave side) would you focus on?
When come to roll down with roll down bar (cadillac) how could I focus on her spine? I know she won’t be symmetry roll down on both side of her spine. How do u cue on scoliosis clients?
I understand that is no passive stretching for their spine, would you do “spine stretch forward” exercise for them?
Appreciate you could give me some idea how to work on scoliosis clients.
Thanks
Jeff.
From Melanie Byford-Young
Hi Jeff,
Great questions about your client.
Pilates is excellent for clients with scoliosis. Your goals and outcomes will vary depending on whether it is structural (change in the boney shape) or acquired through sports, habits, work etc.
Can she do lateral flexion exercises like mermaid or side bend?
You can do lateral flexion to both sides. As you said, you do not want to hang passively into side flexion; You want her to have dynamic, eccentric and concentric control on both sides, and you will want to cue your client to avoid giving into her curve. If there is a concern about osteoporosis, you may choose to avoid side bending.
In terms of breathing, and focus of lateral aspect expansion (convex or concave side).
You will use breath patterning to expand the concave side, and fill the rib cage three dimensionally. You can also use breath to facilitate rotation. In your clients case, her thoracic curve is rotated to the right, so you could use an inhale with left rotation to mobilize the ribs and work the small stabilizer muscles of the region.
When it comes to roll down with roll down bar (cadillac) how can I focus on her spine? I know she won’t be symmetrical on both sides of her spine. How do I cue this?
Remember that change has to be earned through repetitions and that you do not want to force symmetry on an asymmetric spine. With roll down, I often begin with one arm at a time, challenging the clients local stabilizers against rotation. Then I will progress to both arms and cue the client to find length and as much symmetry as possible. You have to be careful not to over-compensate with the scapulae to ‘fake’ symmetry.
I understand that I should not do passive stretching for the spine. Would you do “spine stretch forward” exercise with them?
The concern is with prolonged passive stretching, not just holding a position for a couple of breaths. Spine Stretch Forward is a great exercise, as long as she does not have osteoporosis. The focus is on the segmental control in the rolling down and up phases. You can vary the arm position to challenge the curve and rotation even more.
The concern with prolonged passive stretching is that after the stretch to reverse the curve, the client will not have the neuromuscular ability to support the new position. Therefore, you potentially have taken away their local stabilization, and increased the inter-segmental movement and shearing, and the client will sink back into their curve pattern. Your goal is to earn change and develop control.
Good luck with your client. Please let us know how it goes!
Melanie