by Mary Thornton BSc Hons MCSP HCPC
When you get a new enquiry from a client with scoliosis, does it fill you with dread or excitement? Personally, I love the thought of assessing a new client with a scoliosis. As with many other conditions, you never know how the individual will present and what challenges lie ahead.
A scoliosis is a side ways curve of the spine with rotation of the vertebral bodies. It can occur anywhere along the spine and even present as two specific curves. There are many reasons why someone might present with a curvature of the spine: a difference in leg length, a hemi-pelvis to spinal degeneration or even a neuromuscular condition, but the most common curve you will probably see in the studio is a idiopathic scoliosis. This means the cause of the curve is unknown. It generally first appears during puberty and can progress rapidly during this period then generally slows down as the body reaches skeletal maturity.
The medical profession determines the severity of a curve using what is referred to as a Cobb angle. The Cobb angle is measured by looking at the end points of the curve and the angle formed from the intersection of these two lines and a curve greater then 10 degrees is deemed a scoliosis.
On physical examination the client may present with:
- Rib hump
- Elevated / winging scapula
- Pelvic or torso shift
- Decreased lung expansion
- Leg length discrepancy
The management of a scoliosis varies depending on the severity of curve, pain and probably location in which they live. Generally surgeons do not intervene unless the curve is greater then 45 – 50 degrees and in the first instance they are generally referred for Physiotherapy, or fitted with a back brace. Traditional fixed braces like the Boston are rigid restrictive devices that are difficult for the client to use but there is a new wave of dynamic braces that are proving very effective and more user friendly.
As a movement therapist, there are many things we can do to help manage the scoliotic spine. While we must not be under the illusion that we can make a curved spine straight, we can certainly help manage the muscular imbalances that occur.
We must also be very aware of the psychological effect of the scoliosis on the client. Though outwardly they may seem ok with their diagnosis, their self esteem and body image can be effected. Avoid the use of negative words and limit the use of mirrors during sessions. Although mirrors give feedback about where the client is in space and can aid the develop of new motor patterns, be sensitive to their reaction. With a little sensitivity, we cannot only help the individual develop a better understanding of balance within their bodies, but also enhance self esteem.
As a teacher, it is easy to get to bogged down by terminology, but with a few basic assessment rules, it can be easy to devise a safe and beneficial exercise regime. However, like all pathologies, to really benefit from Pilates the client initially needs to be seen on an individual basis to determine their specific needs and teach them how to adapt in a group situation.
So the next time someone mentions they have a scoliosis, start to be inspired by the challenges that lay ahead. With a little research and insight, you can make big changes to their life.