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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.