Impact of Scoliosis on Quality of Life and Athletic Performance
I have always been very mindful about posture training, not only for better health and life quality but also to enhance athletic performance. Whenever I am out in public spaces (less due to restrictions) I like to observe people, and it has become very evident that many have postural defects when moving about. Due to remote work, online learning over the past 2 years, neglect of posture training, and lack of corrective exercises in pre-pandemic children and youth sports programs posture has deteriorated to an even greater extent leading to various serious health issues, especially back problems. The oversight is also due to the lack of knowledge or posture training of many sports coaches even though correct posture is the key to any athletic performance!
The German language is very unique because the vocabulary is much more expressive and lends itself to better visualization of specific words (Am I biased? – maybe...). ‘Haltungsschäden’ is much more descriptive than the English ‘postural flaws.’ The former actually translates to “holding” and “damage or defect”, whereby the latter is much more serious than ‘flaw’. In addition, “Haltungsschwäche” translates to “holding weakness” as a result of “incorrect loading” of vertebral joints and muscles of the growing body, and therefore leads to numerous ‘Haltungsschäden’ (Plural). A ‘Haltungsschaden’ (Singular) is evident when the spinal column denotes bony changes developed from incorrect loading. Good posture refers to "three natural curves that are present in a healthy spine", called “neutral spine.” Looking directly at the front or back of the body, 33 vertebrae in the spinal column should appear completely vertical.
According to German researchers, back pain has become a national ailment in that country. They actually traced defective conditions of the back to incorrect posture acquired during early school years! H. Junghanns stated in 1994 that ‘Unterforderung’ (under-challenge, lack of demand) on the back muscles actually begins as soon as children start school due to lengthy sitting and lack of physical activity (PE). In addition, time spent nowadays on computers, tech gadgets, and TV watching have increased the existing health dilemma.
Data based on several German studies show alarming results in that country:
Lack of movement and re-emphasis of bad posture related to sitting behaviour in schools contribute to bad posture and health issues among students
80 % of students show minor postural defects
60 % of students show moderate postural defects
16 % of students show the beginning of postural defects
45 % of students show shortening of muscles
Scoliosis
Scoliosis is a complex condition, and the type of postural deficiency traced back to early childhood but frequently not detected soon enough, according to medical experts. Parents need to consult their doctor if they notice any sign of scoliosis. However, mild curves can develop without parents or the child knowing it because the defects appear gradually and usually don't cause pain. Occasionally, teachers, friends, a coach, or teammates are the first to notice any abnormal curvature.
From the back, the condition looks like a sideways curve in a “C” or “S”-shape. The human naked eye however cannot see the vertebrae in the spine rotating as they form the curve when spaces between vertebrae become compressed in some areas and stretched in others. That is the reason physical therapy requires a 3-D approach to address the curve from all angles.
While scoliosis can occur in people with conditions such as cerebral palsy and muscular dystrophy, the cause of childhood scoliosis is still unknown. Most cases are mild, but some curves worsen as children grow older, and the condition is then diagnosed in adolescents. Severe scoliosis can be disabling, and an especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis should be monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some may need to wear a brace to stop the condition from worsening while others may need surgery to straighten severe curves.
Signs of Scoliosis
Uneven shoulders
One shoulder blade appears more prominent than the other
Uneven waist
One hip higher than the other
One side of the rib cage jutting forward
Prominence on one side of the back when bending forward; very noticeable when being engaged in tech gadgets while walking or sitting (addiction of most people) or working on the computer
Scoliosis Symptoms in Adults
Uneven shoulders and/or hips
Bump in the lower back
Numbness, weakness, or pain in the legs
Trouble walking
Trouble standing up straight
Tired feeling
Shortness of breath
Loss of height
Risk Factors for Developing Most Common Type of Scoliosis
Age - signs and symptoms typically begin in adolescence
Gender - although both boys and girls develop mild scoliosis at about the same rate girls seem to have a much higher risk of the curve worsening and requiring treatment
Family history - scoliosis can run in families, but most children with scoliosis don't have a family history of the disease
Complications
While most people with scoliosis experience a mild form, it may sometimes cause complications, including:
Breathing problems - in severe scoliosis, the rib cage may press against the lungs, making it more difficult to breath
Back problems - people, who had scoliosis as children, may be more likely to have chronic back pain as adults, especially if their abnormal curves are large and untreated
Appearance - as scoliosis worsens, it can cause more noticeable changes – including uneven hips and shoulders, prominent ribs, and a shift of the waist and trunk to the side. Individuals often become self-conscious about their appearance
Back pain - is often associated with scoliosis and for women can cause dysmenorrhea (painful periods)
Idiopathic Scoliosis
Definition:
Idiopathic scoliosis is one of three different types of scoliosis that cause the spine to develop an abnormal curve. “Idiopathic” means there is no definite cause. It is the most common type of scoliosis.
Other Types of Scoliosis
L to R: Thoracolumbar – Thoracic – Lumbar – Double
If the person is less than 3 years old, it is called infantile idiopathic scoliosis – or early-onset, that is associated with other problems like chest wall deformities, ⦁ spina bifida, and others.
Scoliosis that develops between 3-10 years of age is called juvenile idiopathic scoliosis.
People over 10 years old (10-18 years old) have adolescent idiopathic scoliosis.
"The most common type of scoliosis is known as adolescent idiopathic scoliosis which appears in active, healthy teens and preteens, sometimes in boys, but more often in girls,” according to Christopher Redman, M.D., board-certified orthopedic surgeon at the Children's Health Andrews Institute for Orthopaedics & Sports Medicine (Plano, Texas). Medical Doctors and authors, Charles Patrick Davis and Melissa Conrad Stöppler (2021) state on MedicineNet, that “about 2% of females and 0.5% of males” are affected.
Scoliosis is more than just the bending of the spine. It is a 3-dimensional deformity of bones in the back with twisting and rotation of the spine. Fortunately, most children with scoliosis do not need surgery to correct the condition. When necessary, there are a few non-operative options that can be applied to prevent a curvature from worsening as children grow or in some cases improve the curvature. Idiopathic scoliosis tends to ‘run’ in families and affects girls eight times as often as boys, according to the cited authors. The condition starts between the ages of 10 and 15 – in other words, around puberty. This is also the stage when most young girls start menstruating (presently at about 12 years). Many girls indicate that this stage of their life makes them feel insecure and confused even without adding any complication of idiopathic scoliosis at the same time, which can further increase negative feelings.
Scoliosis Severity and Spinal Flexibility
Scoliosis is a spinal deformity that cannot be cured, but its progression and severity can be managed with an effective treatment plan. The main characteristic that determines the severity is the size of the abnormal spinal curvature. Generally speaking, the bigger the curve, the more severe the condition, and the more work it takes to reduce it. That’s not to say the curvature can’t be reduced, just that the treatment plan has to be more intense, and likely include more mobility work at the beginning. One of the most significant results of larger curvatures is the loss of spinal flexibility, and as scoliosis progresses and the curvature gets larger, the spine tends to become more rigid. Therefore, the condition is more difficult to manipulate. When scoliosis is treated, the spine has to move in the direction that helps to improve the misalignment. The curvature needs to be reduced as much as possible to restore the spine’s healthy curves to a greater degree, and to improve the overall biomechanics. When curves become larger and the spine is more rigid, exercises become less effective at reducing the curvature.
Scoliosis – Adults and Spinal Flexibility
It is not just severity that contributes to spinal rigidity age also becomes a factor. As we get older, joints become stiffer and the spine becomes less flexible due to a loss of elasticity. It is part of the natural degenerative changes that accompany that process. Spinal rigidity is more of an issue while aging than with younger people as they have yet to face the degenerative effects of aging. When treating adolescents and children, there is less focus on improving spinal flexibility before moving on to the next steps of the program. Treatment of adults however is likely to concentrate more on improving spinal flexibility before addressing structural issues of scoliosis and stabilizing the spine.
Can Diet and Nutrition Improve Spinal Rigidity in Adults?
Proper nutrition of course always has a big impact on the overall health of people. Is it natural to assume that this can be effective for someone with scoliosis? While there is no harm in doing anything that improves one’s overall health, especially if the changes to nutrition make the body healthier, stronger, and better to handle the rigors of scoliosis treatment. However, that alone cannot make the spine more flexible. Once the condition has progressed to a certain point, it becomes a structural issue and needs to be mobilized.
Some forms of scoliosis develop in adulthood, although most cases arise during adolescence while progressing into adulthood when it becomes symptomatic as the condition had years to progress. The issue of spinal flexibility is like that of a “rusted lock that can be sprayed with oil to loosen it, but still has to be able to move in order to open.” Exercise and nutrition is the oil and can make minor improvement if specific to the condition and the patient themselves, but they don’t address the root of the problem, namely that scoliosis is a structural issue, which has to be addressed as such.
Scoliosis and Stress
Scoliosis has a noticeable effect on the appearance of the body. Uneven hips and shoulders are common symptoms, often leading to ‘feeling uncomfortable’, anxiety, and stress. Many children or teenagers (when idiopathic scoliosis most commonly develops) often feel different compared to friends and peers. As we know, children can be very cruel and exploit anything that makes others stand out. Thus, bullying and teasing can be a problem! Nevertheless, many think their appearance is much more dramatic than it actually is, creating unnecessary stress!
Managing Body Image Stress
If unhappy with one’s body image, several steps can be taken. Exercise-based treatments are just one way to help make the body to become more symmetrical, improve posture, and core strength. Prescribed exercises can be repeated at home and, if practiced regularly, can help to reduce body image stress.
Schroth Exercises for Scoliosis
German-born Katharina Schroth developed a nonsurgical option for scoliosis treatment in the late 1800’s. Suffering from scoliosis that was unsuccessfully treated with bracing, she subsequently developed her own breathing technique and specific exercises to manage her condition. She and her daughter opened a clinic, where they developed programs using exercises customized for each patient to return the curved spine to a more natural position. In essence, Schroth exercises are tailored to the person’s unique curvature of the spine and can be performed while standing, sitting or lying down. Props such as therapy balls, poles, and Schroth bars can also be used to assist in correcting scoliosis.
The main goal of Schroth exercises is to prevent scoliosis from advancing. Depending on the person’s age, bone maturity, and degree of curvature ‘bracing’ may also be a part of the treatment. Schroth-specific breathing complements ‘bracing’ as children are taught to breathe within their custom brace. Managing scoliosis with the Schroth method and ‘bracing’ may be an option for patients, who want to avoid surgery.
The main goal of her exercises portfolio is to de-rotate, elongate and stabilize the spine in a three-dimensional plane. This is achieved through physical therapy that focuses on:
Restoring muscular symmetry and alignment of posture
Breathing into the concave* side of the body
Teaching person to be aware of posture
*Concave- inward curve opposite to Convex, curve that bulges outward. The terms are used to describe gentle, subtle curves, like the kinds found in mirrors or lenses.
Muscular Symmetry
The changes in the curvature of a person’s spine affect the muscles of the back. On one side they may weaken and waste away. On the other side, they may be overworked and prominent. Schroth exercises are designed to address both problems, aiming for muscular symmetry.
Rotational Angular Breathing
Breathing is an important part and Schroth uses a special breathing technique called “rotational angular breathing.” The idea is to rotate the spine with breathing to help reshape the rib cage and surrounding soft tissue.
Awareness of Posture
Schroth relied heavily on mirrors in her original practice to help patients develop visual cues to correct their condition. Postural awareness is especially important when dealing with activities of daily living because people always need to be mindful of any position that may worsen their condition. Besides the correction of the curve, the outcomes of the Schroth program may include:
Improved posture
Improved core stability and strength
Easier breathing
Less pain
Improved overall movement pattern and function
Improved self-management and understanding of the spine
Better pelvis alignment
However, a long-term commitment to the Schroth guidelines is necessary to make this treatment successful. Read more about the Schroth method here (x).
Cure for Scoliosis? Is it Possible to Prevent Scoliosis?
At this time, there is no cure for scoliosis. Still, there are good treatment options as previously discussed. Researchers are trying to find the causes of the different types of idiopathic scoliosis. This hopefully leads to better treatments or a cure. Since the cause of idiopathic scoliosis is not known, there is no known way to prevent the problem to date. Doctors speculate and warn that certain exercises performed in Pilates and Yoga, for example, poses that torque or twist the spine may worsen the condition. Also, gymnastic-type activities (like doing backbends), carrying weight on one side of the body (like a backpack on one shoulder), and using a trampoline are examples of ways to potentially make scoliosis worse.
Can Scoliosis Affect Menstruation?
Many girls in puberty and women of all ages are experiencing menstrual cramping and a lengthy menarche (can last up to seven days). Around 80% of women are estimated to experience period pains at some stage in their lifetime, and numerous suffer from early teens to menopause. Most experience some discomfort during their menstrual cycle, especially on the first day, while 5 to 10% endure pain severely enough to disrupt their daily life.
This may also become an issue for female athletes. It is a medical fact that females can experience a weight gain of three to five pounds (fluid) during each monthly period that tends to fade after a few days of bleeding. It is a physical symptom of pre-menstrual syndrome (PMS) and includes a wide range of physical, emotional, and behavioural symptoms affecting women from several days to two weeks prior to their period. If menstrual pain is added female athletes may be reacting differently in training and performance can consequently be affected. My question as a female coach: many males are coaching women's sports? How many are really knowledgeable enough about the female body, and/or have the tools to deal with such aspects? I dare to venture…very few!
The female body can be confusing at the best of times. There has been very little formal scientific research how or why scoliosis affects menstruation, although plenty of anecdotal accounts exists from girls, who claim to have experienced irregular periods. It has been suggested though that the condition can intensify the amount of period pain women experience. Research seems to indicate that girls with idiopathic scoliosis may (on average) start having periods slightly later than girls without scoliosis.
The Brooklyn Abortion Clinic (NYC) lists scoliosis among a number of skeletal conditions that may increase menstrual pain. The reasons are not especially clear, but it may have something to do with the amount of pressure placed on the spine as the uterus contracts and swells during menstruation. In addition, hormonal changes can cause back pain even for girls with healthy spines when they are menstruating. So it stands to reason that it could be even worse for girls, who already experience back pain as a result of scoliosis. If the condition is interfering with life quality, causing pain, and making the female feel insecure. Click here and here for further resources.
More exercises to come in the following parts of the Impacts of Scoliosis series!
References:
https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-014-0027-2
https://www.medicalnewstoday.com/articles/325385
https://www.mayoclinic.org/diseases-conditions/scoliosis/diagnosis-treatment/drc-20350721
https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716
https://www.irvinespine.com/blog/7-stretches-and-exercises-for-scoliosis-17389.html
https://www.medicinenet.com/scoliosis/article.htm
****Recommended Internet Pages for Treatment and Yoga Exercise Information
https://www.amazon.ca/Schroth-Therapy-Advancements-Conservative-Scoliosis/dp/3659667951
https://www.amazon.ca/Scoliosis-Yoga-Therapy-Art-Letting/dp/184819272X
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