Adolescents with scoliosis and their families have questions concerning exercise. These questions are usually about two general areas:
- Can exercise correct or stop the progression of the scoliosis curve?
- Are recreational exercise and sports participation advised?
In this article, we will present some of the advantages and limitations of exercise for adolescents with scoliosis. Adults with scoliosis, including those with corrective surgeries, often also seek advice about exercises, especially if they begin experiencing discomfort and stiffness in their backs. Therapeutic and recreational exercise for adults will be presented in a future article.
Several programs aimed at correcting or arresting scoliosis have been proposed over the decades. Through these programs one attempts to exert corrective forces on the spine by active contraction of trunk muscles in directions thought to reverse the scoliosis curves. Some approaches seek positions and postures which are noted to reduce the scoliosis deformity.
Additionally, stretches are often performed, which aim to increase the mobility of the spine in a corrective direction. After mastering these exercises, postures and stretches under the supervision of a physical therapist, attempts are made to maintain corrective muscle tone and postures during daily activities.
Some programs also include breathing exercises. Chest movements noted during deep breaths cause temporary rotation of the thoracic vertebrae in a corrective direction in some people with scoliosis. Minor reductions in measurable lung capacities are often found in people with scoliosis and large thoracic curves, and breathing exercises have also been directed at improving this.
Bracing and Exercise
Exercise programs have often been prescribed for those wearing corrective scoliosis braces. These are intended to help the wearer adapt to the brace, to encourage the active correction of the spinal deformity, and to maintain the trunk musculature during the bracing program. This is done by actively shifting laterally in the direction of the correction (away from the brace pad), by extending the trunk while in the brace, and by taking deep breaths.
Other trunk and pelvic exercises are also taught and the brace-wearer is instructed to perform these several times per day. Most programs are initially supervised by physical therapists, and are followed by the development of daily home exercise regimens.
Benefits of Exercise
In general, little scientific evidence exists about the effectiveness of exercise programs for preventing progression of scoliosis curves, or for reversing curves to any clinically or cosmetically significant degree.
By scientific evidence we refer to carefully designed clinical studies where a true effect of exercise has been demonstrated. Some short-term reduction of curve angles (by several degrees), and minor improvement in breathing volumes have been observed for small groups of people with scoliosis who have undergone exercise programs.
Others in these programs, however, were not helped, and some were noted to have curve progression during exercise. For those with slight improvement in curves, it was not determined whether these changes had any lasting effect, nor were these noted to be cosmetically or functionally noticeable.
Even for exercise programs directed at improving the results of scoliosis bracing, the results have been disappointing. Bracing alone has been found to be as effective as bracing and exercise.
Because of this, therapeutic exercise programs are not universally recommended by scoliosis experts. When prescribed, exercise programs are usually initiated in addition to, and not instead of bracing treatment. Careful monitoring of curve angles remains essential, regardless of exercise.
Therapeutic exercise should never be considered as an alternative to recommended surgery when a scoliosis curve is severe and progressive, and the patient and family have decided on surgical correction.
Fortunately, most people with scoliosis are completely normal in their ability to participate in sports and recreational exercises. For some with severe deformities leading to respiratory function changes, and for those post-scoliosis surgery patients, some sports restrictions may be advised. Your scoliosis specialist can make recommendations concerning these. No information exists to suggest that recreational exercise and sports participation worsens, or in any other way affects scoliosis curves.
“Scoliosis is not caused by a deficiency of strength or flexibility, and therefore exercise is relatively ineffective in correcting scoliosis. Equally important, scoliosis is not a result of exercise, and therefore normal physical activities can be enjoyed by people with scoliosis without concern”.
Children and adolescents with scoliosis can be expected to participate in organized sports, school physical education programs, and normal neighborhood recreational activities. For most, resistive exercise training to build muscle strength and endurance training to improve cardiovascular conditioning can be performed when desired.
Children enrolled in a scoliosis bracing program are generally allowed out of the brace for organized sports. In addition to the lack of adverse effects and improved fitness, regular recreational exercise can reinforce that one is normal and healthy despite scoliosis.
The causes of scoliosis appear to be independent of exercise. Scoliosis is not caused by a deficiency of strength or flexibility, and therefore exercise is relatively ineffective in correcting scoliosis. Equally important, scoliosis is not a result of exercise, and therefore normal physical activities can be enjoyed by people with scoliosis without concern.
The NSF would like to thank co-authors, James Rainville, M.D., and Frank Rand, M.D., for their work on this article. Dr. Rainville, a Physiatrist, is Assistant Clinical Professor, Department of rehabilitation Medicine, Tufts University Medical School-Boston, and also Director of rehabilitation, New England Spine Care Center, Chestnut Hill, MA. Dr. Rand is Instructor in Surgery (Orthopedics), Harvard Medical School, Boston, and Director of Orthopedic Programs, New England Deaconess Hospital, Boston