Sunday, November 14, 2010

Specific Exercises for Scoliosis and a Spinal Fusion

Pilates Consult


The "Featured Reader" article showcases a member of the Pilates community who has approached us with specific issues and questions regarding Pilates and how it will help them.

If you are interested in becoming a "Featured Reader," please contact us at:

Featured Reader: Kimberly Brock
By: Angelie Melzer

Kimberly is a Pilates enthusiast, first introduced to the Method when she moved to Seattle, WA in 1997. Kimberly had a spinal fusion at the young age of 13 years old. At that time, the doctors diagnosed her with Idiopathic Scoliosis. She immediately went into TLSO brace for sixteen hours per day until her growth spurt period was over. During that time, her curve progressed quickly from 41 to 62 degrees in the Right Thoracic, with a compensatory curve in the Lumbar region. She was declared a brace failure. She was told that surgery was her only option as physical activity alone would not be sufficient. Being that Kimberly was an active young lady and a young budding dancer, this news was quite a blow to her.

After surgery, Kimberly felt so grateful they had "stopped" the disease, but felt such a sense of loss. She was left with poor flexibility and a fear that she'd never feel the same. However, she kept a good attitude and remained healthy and moderately active throughout her youth. She had no complications and has been very happy with the strength and flexibility she had gained over time. Still, Kimberly was left with feelings that a part of her musculature and nervous system had been "turned off". She felt disconnected as if she was placed into someone else's body. She learned to compensate and had three successful pregnancies. After her third pregnancy, she began to have acute lumbar discomfort. Her medical doctor looked at her current X-rays to diagnose the pain, but she felt like it was guesswork. He suggested a Chiropractor, to which she declined. Her other options were physical therapy or another surgical procedure. She was so disappointed that she contacted her Pediatric Orthopedic Surgeon's office, but they had no answers, except to seek a new Orthopedic Surgeon. She found very little information on the Internet for Spinal Fusion Patients later in life, and what she did find, scared and discouraged her.

Following her own intuition, she sought out Physical Therapy as it had done the most good for her in the past. Paying out of pocket, she found a Physical Therapist at Body-n-Balance in Apharetta, GA, who was also a Pilates Instructor. At this point, she was in constant pain and had begun to take medication on a regular basis. She was experiencing a dull, broad pain in her lumbar region that made her feel nauseous. The Physical Therapist slowly introduced Pilates into her sessions over the course of several months and it made an immediate improvement in her pain level. She felt as though she could work through her pain and stretch her muscles. The relief was great! Within a year, she had almost no pain, and when she did, it was very manageable. Kimberly is now pursuing her Pilates Certification through PhysicalMind Institute at Body-n-Balance and is so grateful to this gracious group of instructors who have changed her life through their openness, warmth and professionalism.


This section deals with specific issues the Featured Reader is experiencing, and solutions through Pilates exercises.

Kimberly had specific questions on exercises for her Scoliotic condition:





We have answered her with the following Featured Exercises:

Mat Exercises:
Lying supine, hug both legs into your chest by holding onto both knees. Gently pull the knees towards your chest in a rocking motion to release your sacrum and lumbar spine.

Lying prone, grab one ankle at a time. Lift yourself into the bow pose by gently lifting and lowering your sternum 1-2" off of the floor. Then lift and lower your thighs gently 1-2" off of the mat. Combine these two movements together and hold for 10 seconds. Release and repeat 4 sets. You may choose to advance to the "Rocking" mat exercise.

Reformer Exercise:
Modified Lunge:
Place 1 yellow or blue spring on the reformer. Standing on the floor on the spring end of the Reformer within the springs. Place your hands onto the shoulder rests. If your right psoas is the tight side, place your left leg onto the front edge of the carriage ensuring your heel is slightly below the carriage and the arch is securely on the carriage.

Gently push the carriage out with your left leg as you drop your pelvis straight down towards the floor. Make sure you are in a slight posterior pelvic tilt. Hold this position and then continue forward 2-3" at a time to your maximum range of motion, holding each time at least 30 seconds. Return to the original position and repeat 4-6 sets. You may choose to advance this to Eve's Lunge.

Trapeze Table Exercise:
Lunge on the swing: Face away from the swing and place your right foot into the white strap. Lung forward on your left leg and press your pubic bone forward into a posterior pelvic tilt. Hold this position for 30 seconds, then release and reverse the position, moving your pelvis into an anterior pelvic tilt. Arch and curl your lumbar spine to release the lower back and right Psoas muscle.

Mat Exercise with an Exercise Band:
Lying Supine on an Exercise Band placed underneath the tips of your scapula. (Ensure the Band is spread out evenly.) Hold the tips of the Band and pull them upward towards the ceiling, giving your scapula and mid-back region a tightening sensation from the Band. Pulse upward with the Band 20 times. Hold the final pulse up for 30 seconds and slowly release back to a resting position.

Mat Exercise on a Foam Roller:
Lying Supine with the Roller parallel to your spinal column and your entire neck supported. Reach your arms up towards the ceiling, spreading the scapula apart. Pull the scapula back together and wrap them around the Roller. Repeat.

Chair Exercise:
Kneeling Lateral Flexion with Scapular Strengthening: Kneel on the floor next to the Pedal of the Chair. With one spring placed in the lowest setting, place your left elbow onto the pedal by laterally flexing to the left. Hold this position and pulse gently downward with the pedal 10 times, focusing on the movement of the scapula up and down along the spine. Hold the final pulse for 10 seconds and then slowly release the pedal completely until you are completely vertical with your torso and in the starting position. Repeat the exercise 4 times. *See below for modified version.

*Modified version of the above exercise: Depending upon your fusion, this can be modified to suit your spinal column and specific needs by taking out the lateral flexion. With the same low setting as above, sit or kneel next to the Chair and depress the pedal all the way to the floor with your left hand. Pulse upward about 1". Repeat this movement 10 times with the scapula moving along the spine and the shoulder elevating and depressing slightly with each pulse.

Modifications for Deep Flexion exercises on the Mat: As with any exercise program, not all exercises are appropriate for all bodies. Roll Over, Open Leg Rocker and Roll Up involve deep and very active flexion of the Spine which is both contraindicated and not possible with certain Spinal Fusions. Therefore, these exercises need to modified or replaced. Always ensure that as you perform the exercises below, the Pilates Principles are being utilized and your breath, form and alignment are all in check.

Modified Roll Over: Place a yoga block or small prop under the sacrum, lifting the pelvis 1-2" off of the floor. Pulse upward with the pelvis lifting gently off of the prop. Focus on the downward movement being slow and controlled as the sacrum comes back onto the prop. The hands can be placed on the pelvis for additional support.

Open Leg Rocker: Seated with bent knees, hook the knees over the hands. Balance against the wall when first attempting this exercise. Give yourself enough space from the wall with the sacrum so that you can perform a posterior pelvic tilt while maintaining the position. Return to an upright, neutral spine and repeat the posterior pelvic tilt.

Roll Up: Place a Yoga Strap or Band around the balls of the feet. Lying Supine, place the feet flat on the mat. Bend the elbows 90 degrees. Maintaining a neutral Lumbar Spine, look towards your knees as you pull gently on the Strap or Band.

"Waking up your Neuromuscular System"
Many times with Scoliosis, nerves surrounding the affected areas begin to lose their capacity to send messages. Whether it is due to a surgical procedure or lack of movement due to the Scoliosis present in that particular area, these areas need special attention through manual techniques, palpation or Tactile Cueing. Through Tactile Cueing, the muscles in these "dead" areas are physically touched in order to cue the nervous system and allow them to contract as we would like them to. Many times, this simply entails placement of the instructor or therapist's hand on the area, gently pressing and pulsing in the direction of pull that is desired. This manual work and Tactile Cueing allows the muscle to "feel" again and enables it to learn the desired contraction and movement. It is very possible that the Tactile Cueing will need to be done every time a certain exercise or movement is performed. However, as the individual gains strength, they may begin to "wake up" in these areas and be able to maintain a contraction for longer periods of time; and possibly contract these muscle without Tactile Cueing all together.


Feature Article
Pilates & Scoliosis: From the inside and outside
By: Michele Larsson, Founder of Coredynamics Pilates

I have seen a number of excellent articles on scoliosis lately, but all have addressed the condition from an outsider's point of view. I would like to present this topic to you from both the inside of a curve (as someone with scoliosis), and from the outside (what you see in your client).

Scoliosis is a lateral curvature of the spinal column in either a C or S shape. These lateral curves usually involve a rotation in one or more of the vertebra at the point of the curvature.

Outside view

Always speak about the scoliosis as if viewing the individual from behind. You can identify a curve by having the individual bend forward as you watch to see if one side of the back is overdeveloped. The spine curves to the overdeveloped side of the back. The body of the vertebra rotates to the side of the convexity and the ribs follow, causing the rib hump. In a C scoliosis, the shoulder is low on the high hip side. In an S scoliosis the shoulder is high on the high hip side.

The most common kind of scoliosis a Pilates teacher will see is a structural scoliosis. About 70 percent of all diagnosed cases of scoliosis are structural. It is classified by age of onset: infantile, before 3 years of age; juvenile, from 3 to onset of puberty; and adolescent, from puberty to maturity. This form is more frequent in girls.

1-Thoracic Curve
This is more common to the right. The curve usually extends to and includes T 11, 12 or L 1 up to T 4, 5, or 6. This curve is usually very deforming and tends to develop rapidly.

2-Thoracolumbar Curve
This is a longer curve than the thoracic and can occur either right or left. The lower end of the curve can include L 2, 3 or 4 and extend to T 4, 5 or 6. This curve is usually less cosmetically deforming.

3-Lumbar Curve
This is a common curve and is more often to the left. It runs from L 5 to T 11 or 12. There is usually not a large compensating curve above the lumbar. They are not very deforming but can become rigid and lead to severe arthritic pain with age.

4-Double Major Curve
This curve consists of two major curves of almost equal degree. Because these curves are symmetrical and balanced they are less deforming, but they can become a problem if very severe.

Six basic rules

1-Find individual's special one-lung breathing pattern (a technique used to teach/bring awareness to one-sided thoracic movement).
2-Do nothing to make the curve more pronounced.
3-Pad up the hollows (supine), short leg (standing or footwork), or low hip (seated) when needed for warm-up. This also teaches awareness in space.
4-Create a different agenda for side bending and rotation. They may need to side bend and rotate differently from one side to the other so look at the avoidance pattern and structure movement to compensate for the pattern.
5-Imbalance the limbs to balance the work of the trunk muscles.
6-Stabilize the whole body.

View from the inside

Scoliosis is normal to me. It is the way I have been since my mid-teens. I do not feel crooked. I have not been limited in my career choice by the curve-there are many professional athletes, dancers, actors, doctors, bankers, etc. who have scoliosis. On occasion I have pain, which always seems to occur for no apparent reason. The pain is like the irritation of chalk on the blackboard; it is not usually sharp or specific. I become aware of my scoliosis pain when someone remarks on how crooked I am that day. Unfortunately, I do not have the same kinetic sense of center as someone without a curve. I cannot find "center" without a visual aid or specific instruction.

To me, a head-to-tail movement is not this: I, but rather this: ).

For the most part, there are no rules when you work with clients with scoliosis.

At my studio in Santa Fe, we have four clients over 60 who have double major scoliosis. As you will see below, each client reacts differently to Pilates movement and can tolerate differing types of movement.

Client 1 enjoys stabilizing exercises and likes to stabilize to keep the outside very strong. No traction or mobilizing of spine.

Client 2 loves traction, warms up on the slant mat and then does a standard Pilates workout.

Client 3 loves to curve, but cannot perform hyperextension, rotation or side bending unless very modified and small.

Client 4 loves to arch. She is strong and can do most Pilates.

In closing, Pilates is excellent exercise for people with scoliosis. Enjoy your time with your scoliosis people. If you pay attention to their needs and modify accordingly, they will enjoy their workout sessions and reap the many positive benefits that Pilates offers.

*We would like to extend our gratitude to Michele Larsson and PEAK Pilates for sharing this article with us.

Featured Author:
Michele Larsson

Michele Larsson has over 40 years of experience teaching fitness, dance, movement and rehabilitation. She is a former dancer and choreographer who trained at the Julliard School of Music in New York City and received a bachelor's degree in Holistic Health and Dance Theatre from Antioch College. Larsson worked with Eve Gentry for nine years prior to the founding of the Institute for the Pilates Method in June 1991, where she served as the Director of Training. She maintains a diverse local clientele at the Santa Fe studio teaching athletes, post injury/special needs individuals and other Pilates teachers.

Wednesday, July 14, 2010


Fast Facts on Scoliosis

Scoliotic curves of 10° or less affect 3-5 out of every 1,000 people

Scoliosis usually occurs in those older than 10 years, but the condition can be seen in infants
2% of women and 0.5% of men are affected by Scoliosis.

The prevalence of curves less than 20° is about equal in males and females.

85% of the time the cause is unknown. The other 15% of cases fall into two categories: Nonstructural and Structural.

Nonstructural is caused by a temporary condition such as one leg being shorter than the other due to a muscle spasm.

Structural is caused by another disease such as a birth defect, connective tissue disorder, muscular dystrophy, metabolic diseases or *Marfan Syndrome.

* Marfran Syndrome is disorder of connective tissue, the tissue that strengthens the body's structures. Disorders of connective tissue affect the skeletal system, cardiovascular system, eyes, and skin.

Benefits of Pilates for Scoliosis
Written by: Angelie Melzer, BS, CPT

Pilates utilizes specific exercises to reeducate the movement patterns of an individual. Therefore, a specialized plan can be put into place for each client. This is ideal for Scoliotic clientele.

When living with Scoliosis, an individual gets into certain patterns of movement caused by the curves and rotation in their spine. In addition, these clients have muscular imbalances caused by the curvatures.

A specific example is with an S curve. Most of the time with an S curve, the main curve is seen in the Lumbar Spine. As the Lumbar Portion of the spinal column is pulled in one direction due to the tightening of the concave side of the curve, the muscles on the convex side become too long and are weakened. Their is then a compensatory curve in the spine, most of the time in the thoracic cage. This curve many times comes with a rotational pattern as well. All of these factors cause the spinal column to become immobile. It is key to keep these individual's spines as "fluid" as possible to avoid future problems from occurring such as disc and compression issues.

The Scoliotic client must utilize specific stretching in the concave portions and strengthening in the convex portions of their spines. They also need overall lubrication of the spinal column due to the nature of Scoliosis and the rotational patterns that are often present. Pilates exercises focus on lengthening of the spine; along with the principal of Spinal Sequencing inherent in most Pilates exercises. The control that is taught by these techniques and Pilates Exercises are extremely beneficial.

(References: National Scoliosis Foundation, Scroth Method, Emedicine Health.)

Scoliotic clients become deconditioned on the convex side of their curvature due to the continual line of pull from the muscles on the concave side. Therefore, hands on cueing is very important. The client's muscles must be touched/palpated on the convex side to aid them in contracting.

Pilates Mat Program for Scoliotic Clients

Below is a general protocol for a Pilates Mat exercise program for clients with Scoliosis. (Please note that each Scoliotic curve is unique and specific protocol will vary with each client.)


Pelvic Lift
(Modification: Place a small prop underneath the convex side. Cue the client to press into the prop to heighten the awareness of movement away from the concavity.)

Pelvic Lift with a Wag Side to Side

Roll Up
(Focus on Spinal Sequencing and lengthening of the spine.)

Kneeling Cat

Standing Roll Down
(Modification: Press gently into the muscles on the convex side to allow these muscles to "awaken" and contract during movement.)


(Modification: Press gently into the convex muscles to aid them in the contraction during the extension portion of the exercise.)

Side Lying: Banana Lift
(Perform this exercise lying on the concave side first. On the concave side, focus on keeping the ribs up away from the mat. Lift both legs and hold for 10 seconds. Roll over onto the convex side. On the convex side, do not lift the legs. Instead, lift the upper body by pressing down through the supporting arm and lengthening the upper body towards the ceiling, thus lengthening the convex musculature.)