By Dr. Aatif Siddiqui DC and Dr. Clayton J. Stitzel DC

 The word scoliosis is derived from a Greek word meaning “twists and turns.”  While the most obvious characteristic of scoliosis tends to be the lateral movement of the spine, these “turns,” are often accompanied by a rotation or “twisting” in the vertebrae as well.  Together these twists and turns not only unbalance the muscles that support the spine, but also create challenges in the functioning of the ribcage, lungs, and pelvis.  Although the exercises for scoliosis patients mapped out below, it must be noted that Re-training the automatic postural control centers of the hind brain is the only way to alter the natural course of the scoliosis condition.  With that being said, these Exercises for scoliosis patients may help reduce the symptoms and pain associated with some scoliosis cases.

Exercises for scoliosis patients #1

 Rediscovering Your Balance.  Over the years, your body has developed an intricate balancing system to compensate for your spine’s curves.   We now need to relearn how to stand properly.  Start by standing with your feet hip-distance apart.  (While it’s most important to feel what’s happening in your body, the first few times you try this you may benefit from standing in front of a mirror.)   Check that your toes are all pointing straight ahead.  Allow your arms to relax by your sides.  Begin breathing, and notice if one foot is pressing deeper into the floor than the other.  Try to press evenly through both feet while you continue to breathe.  Notice if one hip is pulling out to the side and gently guide it to back to stack over its’ corresponding foot.   Feel your collarbones widening as you breathe deeper.  Bring your awareness to your head.  If it is tilting to one side, allow it to float easily at the top of your spine.  Focus your eyes on something specific directly ahead of you and breathe.

 Exercises for scoliosis patients #2

“Filling the gap”....Increasing your breathing capasity.  The rotating of the ribcage in the scoliosis patient can cause constrictions in the lungs and limit your breath capacity.   The convex  (overstretched) area of your back receives breath very easily, while the concave (more hollow) side needs your focused attention to breathe fully.  Practice moving your breath deeply into your concavity and feel your ribs stretching open.  You can do this anytime throughout your day.  It is especially effective to engage this practice while you are exercising (in whichever form of exercise you choose).   If it is difficult for you to access this point on your own, you might ask a partner to warm up their hands and place one very lightly on the most concave area of your back.  You can then breathe deeply into the heat of their palm. 

Exercises for scoliosis patients #3

 Lengthening Your Spine.  This is a very simple exercise that can be done anywhere.   Find something solid you can grab onto and pull (a dance bar, a porch railing, a sink etc.).  Grab onto the bar with your arms shoulder-distance apart and walk your feet back until your feet are directly under your hips and your spine is parallel to the floor.   Now walk your feet just one step forward and pull your hips away from the bar.  (Make sure you keep your neck in line with the spine).  Your spine will receive a wonderful, long stretch.  Stay in that stretch for at least three breaths then take a break before beginning again.    

Exercises for scoliosis patients #4

De-rotating the Spine.  Find a sturdy chair with a hard surface.  Sit sideways on the chair with the right side of your body toward the back of the chair and your feet firmly planted on the floor.   If you have a yoga block, place one between your thighs (this helps keep your knees pointed straight ahead).  Place one hand on each side of the chair back.  Press your hands down and feel yourself growing tall through the spine as you breathe in, then twist to the right as you breathe out.   Allow your ribs and head to follow.   Do this several times on the right before turning around and repeating the process to the left.  Depending on your particular scoliosis, you’ll notice it’s much “easier” to twist in one direction than the other, as your ribcage may be compromised and already turned in that direction.  Resist the temptation to under-do-it, if this was meant to be easy they wouldn’t call it work.   In fact, you’ll want to spend a few extra breaths on the more difficult side to start de-rotating your spine and coaxing your ribs back into healthier alignment.     

Exercises for scoliosis patients #5

 Strengthening Your Spine.  This exercise is aimed at properly aligning your scapulas and strengthening your spine’s postural muscles.  Lie down on your belly (preferably on a yoga mat or blanket).  Stretch your arms in front of you shoulder-width apart and turns your thumbs up.  Keeping your legs long and the tops of your feet pressed into the floor, lift your shoulders and arms up a few inches from the ground.  While you are there, encourage your shoulders to slide down away from your ears, and be sure to keep your neck in line with your spine.  Breathe there for a full minute, then rest.  

Exercises for scoliosis patients - cool down

After doing this focused work on your spine, it is a wonderful idea to end by lying comfortably, face-up on a yoga mat or carpet for up to 20 minutes with a rolled up towel at the back of your neck and at the base of your ribcage.  Be sure you’ve lined your body up as symmetrically as possible, close your eyes and breathe consciously.  This is an excellent way to re-mold your spinal discs/ligaments and allow your body the opportunity to integrate the work you’ve done.

The story is the same regardless of who you talk to, They all say the same thing..

 “You’re an adult and there is nothing that can change my scoliosis at this point.”

Well… I am here to assure you they are wrong. Adult scoliosis does have more soft and hard tissue adaptation that is fact. So how does a clinician deal with all of that change, years of soft tissue changes and potentially even bony malformation. The answer is simple proper measurements need to be analyzed to determine if the bone malformation is creating permanency to the scoliosis and to what degree. Generally speaking the bony malformation typically appears in the later stages of aging around 50 years or older depending on the location of the curve and the percentage of bone wedging is fairly minimal in most cases. The majority of the structural problem in adult scoliosis is soft tissue adaptation.

The soft tissue adaptation occurs in the muscle, ligaments, and discs and is secondary to the scoliosis not the cause of it. The more soft tissue adaptation that takes place over time the more rigid the spinal column becomes and therefore  there exists less potential for changing it. Fortunately we know a lot about the physiological properties of muscle, ligament, and disc. As with many discoveries in healthcare and other fields certain pieces of technology trickle into other areas in which they were not originally intended for. The concept of continuous passive motion was originally intended for post operative joint replacement patients in order to prevent the new joint from stiffness during the repair phase.

This concept of placing soft tissue under load in a cyclical fashion has been incorporated into the treatment of scoliosis. Since the tissue surrounding the spine is very dense and loaded with collagen it was a natural transition to utilize cyclical motion and pressure, to induce a change in the physical properties of this tissue that surrounds the spine. By applying continuous passive motion in combination with belts that are positioned to reduce the scoliosis we have been able to significantly alter the flexibility of the scoliotic spine allowing the neuromuscular rehabilitation and scoliosis exercise to the stabilize the spine in a straighter position.

Scoliosis Continuous Passive Motion Table –

The use of continuous passive motion (CPM) to assist in removing adhesive qualities contributing to joint stiffness following the repair phase in post operative joint replacement has been well documented. The results of these published studies suggest as well  a potential therapeutic effect of short bouts of cyclical, passive manipulation on otherwise inactive skeletal muscles.

Scoliosis exercise can often produce limited results due to the spinal rigidity inherent to apical regions as demonstrated on scoliosis motion studies. In order to effectively rehabilitate muscle proper range of motion is needed to activate muscle firing in order to rebuild the proper contractile properties needed for spinal stability to be achieved. The use of continuous passive motion on the apical regions of scoliosis patient is applied in order to unlock the spinal rigidity and allow for substantial gains in range of motion. This gain then allows for muscle activation to occur through proper application of scoliosis neuromuscular training.

The scoliosis CPM table uses motorized flexion distraction in combination with de-rotation brackets which influence where the forces are applied during motion. By challenging the inside of the spinal curvature during continuous motion biochemical changes occur within the collagenous regions allowing for expansion of wedged discs and shortened ligamentous bands specific to apical regions of the scoliosis. Patients utilize the scoliosis CPM table on average for 20 minutes depending on the severity of spinal rigidity.

Clin Orthop Relat Res. 1989 May;(242):12-25.

The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Salter RB.

Continuous passive motion (CPM): Theory and principles of clinical application

Shawn W. O'Driscoll, MD, PhD and Nicholas J. Giori, MD, PhD

Mayo Clinic, Rochester MN 55905

Seems like there should be pretty obvious answer to this question doesn’t it? However, this question between scoliosis exercises and scoliosis brace treatment has plagued the scoliosis treatment community for the past 463 years (Ambrose Pare created the first metal scoliosis brace in 1575!). 

Throughout the past several decades scoliosis brace treatment have become the preferred choice among the orthopedic scoliosis specialist community, aided in part to “designed-to-fail” research studies in the 1960’s-1970’s on the effects of scoliosis exercise, in which participants were asked to do exercises for scoliosis in a very general, non-specific manner (think sit-ups and push-ups).  This gave the justification to state that exercise for scoliosis was worthless and all the time, money, and energy should be invested into passive scoliosis treatment methods like scoliosis bracing.

Recent long-term studies published in major scoliosis research journals now call the effectiveness of scoliosis brace treatment into serious question in terms bracing’s ability to halt scoliosis spine progression, prevent the patient from reaching the scoliosis surgery threshold, or even alter the natural course of the condition in any statistically significant manner.  In fact, one of the oral presentations at the 2010 SOSORT meeting in Montreal even presented research on how simulated scoliosis bracing/long-term immobilization in rat tails (which simulate the human spine structurally) rapidly increased the rate of scoliosis disc deformity and thus increased the likelihood of scoliosis spine progression (as opposed to the intended slowing or halting of progression).  It is clear now that the path scoliosis brace treatment has lead the scoliosis community down should have remained “the path less travelled”.

Shifting the focus from the failure of scoliosis bracing efforts back towards exercise of scoliosis efforts, it is very clear that scoliosis exercises applied in a generalized and non-scoliosis specific manner will have little to no effect on idiopathic scoliosis.  The reason is because scoliosis primarily results from a problem in the automatic postural control centers of the brain (and potentially linked to melatonin signaling dysfunction as well) in which the brain doesn’t “recognize” the scoliosis spine is out of alignment and therefore, simply doesn’t trigger the spinal auto-correction mechanisms to kick in and fix the scoliosis curvature.  For whatever reason, the alarm bells just aren’t going off in the brain stem, so the brain just doesn’t know there is even a scoliosis problem to solve.

With this in mind, it becomes self-evident that the scoliosis exercise treatment needs to focus on creating a “stimulus” that triggers the brain to recognize that “something is going wrong down there” and make the necessary auto-correction to the spinal posture.  This means any type of voluntary movement exercises for scoliosis simply are over-ridding the subconscious automatic postural control centers in the brain and not allowing them to truly “learn” how to auto-correct the scoliosis spine (so much for all of the scoliosis exercise and scoliosis brace combinations!) and the only truly effective scoliosis exercises occur when the automatic postural control centers in the brain are stimulate subconsciously. 

Please click on one of the embedded links in this article for more information on how these new and exciting exercises for scoliosis treatment program can work for you.

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Many theories exist as to the potential etiology of scoliosis. The recent genetic testing and research from axial biotech has isolated DNA that contributes to scoliosis and most likely cause and progressive nature of the disease. The majority of theory that describes possible mechanisms of producing scoliosis in children often include a brain- body scheme dysfunction where input (information from the environment) via the spinal cord and output (motor control of spinal muscle balance) also via the spinal cord are confused causing a lack of balance between the two communicating systems.

The research study attached describes the involvement of both systems in the production of scoliosis in rabbits. Granted the translation of animal studies to humans is always a source of probable validity issues I feel in this case the information is most likely applicable to humans. The study discusses how when the afferent system, the sensory mechanism of our body is damaged by itself will not produce scoliosis. This is important because it allows important information regarding probable spinal cord or central nervous system pathology must include both input and output control in order to produce scoliosis. Deafferentation, the removal of just input, is not sufficient enough to cause the scoliosis deformity. The deformity involves both sensory and motor control pathways.

This information can then be utilized to design a system of rehabilitation (scoliosis exercises) that involves both the afferent and efferent system to stimulate a reconnection and strengthening of this communication mechanism. The continual advancement of the neuromuscular retraining techniques where spinal cantilever weighting systems create changes to input and sensory afferent input causing a direct response of the body’s righting reflexes to adjust its motor control to achieve balance will inevitably become the standard of care for children and adults with scoliosis. The fact that we can alter spinal alignment utilizing sensory and motor control at a subconscious level is a major breakthrough in how we approach scoliosis exercise.nmrdeafferentation_and_scoliosis.pdf

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It has been known that the "deep" core muscles of the spine are primarily controlled automatically by a constantly monitored group of censors in the hind brain (brain stem), but the effect of discoordinated function between local and global spinal muscles and back pain is just now coming into focus. 

Similarly idiopathic scoliosis is suspected to be primarily a discoordination between the "deep" core muscles of the spine and is coorelated with increased incidence of back pain as well.

Since most the traditional therapeutic exercise programs for back pain have focus on strength, endurance, fitness, and functional capasity only, the connection between idipathic scoliosis and therapeutic exercise for back pain seemed remote.  However, a new understanding of neuro-muscular discoordination syndromes is starting to provide new insight into the relationship between back pain and scoliosis pain.

This study is very well written and captures the essence of why "one size fits all" type therapeutic exercises for back pain is inappropriate and the cross-over knowledge for back pain and scoliosis exercises could be very closely related to this new approach to therapeutic exercise for back pain.

Here is the full study:

A_new_direction_for_therapeutic_exercise.pdf

"There is considerable variability in the nature and degree of the motor control problems presenting in patients with low back pain. In the future, links may be found between certain variables in the patterns of

motor control exhibited by patients with low back pain and the tendency for severity or persistence of the condition.

 In the short term, this variability between patients highlights the need for an individual problem-solving approach to the neuromuscular dysfunction in patients with low back pain in the clinical situation."

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One of the most common mis-conceptions I find among the general pubic in regards to understanding idiopathic scoliosis is they feel the condition is some how due to weak spinal muscles or curve progression can be halted by strengthening spinal muscles through general scoliosis exercises.  Both of these concepts couldn't be any further from the truth.

While it is true that spinal muscle strength does become unbalanced in moderate to severe scoliosis spines, this is a secondary adaptation to the structural curve in the spine, and not the cause of idiopathic scoliosis.  This is confirmed by normal EMG studies in early stage scoliosis patients that later show hyper-tonic muscles on the convexity of the curvature a substantial amount of time after the curve as already progressed.  Therefore, it is a secondary adaptation and not the cause of, nor the reason for scoliosis curve progression.

The muscles aren't weak, they are dis-coordinated.

Idiopathic scoliosis is primarily a neurological condition that has it primary effects on the spinal column.  Essentially the brain's postural feedback mechanisms aren't working correctly and they don't set off any "red flags" in the brain's automatic postural control centers.  No alarms going off in the brain's automatic postural control centers means the muscles aren't directed to self correct the abnormal posture and the spinal curve (scoliosis) is the result.

Environmental influences as scoliosis curve drivers....especially bio-mechanical.

While early stage scoliosis appears to be the result of a genetic under-development of the automatic postural control centers in the brain, the reason some curves progress to a severe degree appears to be largely dependent on both genetic and environmental influences...especially bio-mechanical influences like head position, hip rotation, and certain activities (ballet, gymnastics, ect).  This would explain the significant increase in likelihood of curve progression in scoliosis spines with a cobb angle larger than 20 degrees vs scoliosis spines with a cobb angle less than 20 degrees.

No one is arguing the value of good core strength and stability, but it probably plays little to no role in the development of, nor the progression of idiopathic scoliosis curve progression.  The only scoliosis exercise based rehab program that will have any true affect on the spinal curvature is one that is specifically designed to "re-train" the automatic postural control centers in the brain.

Early Stage Scoliosis Intervention is the best opportunity for a scoliosis patient to overcome and successfully manage their condition. This will require a completely new treatment schedule and system of treatment process.

“The treatment goals for an early stage scoliosis intervention program should be to hold the curvature under 20 degrees during the growing years and have the curvature measure no more than 25 degrees by the time the patient reaches skeletal maturity”

While there is still no cure for adolescent idiopathic scoliosis, theories abstracted from current research suggests the natural course of the condition can be altered with an active rehabilitation program that targets the involuntary postural control centers in the patient’s brain.

For many early stage scoliosis patients, treatment will be a necessary and ongoing process until they reach skeletal maturity (16-17 for females and 18-20 for males), and some patients will require ongoing treatment throughout life. However, the risk of progression significant curve progression in skeletally immature patients and skeletally mature patients can greatly reduced by developing a “20/25 vision” ongoing treatment plan during their “growing years” and before skeletal maturity.

Current research has found that younger patients with spinal curvatures that measure 0-19 degrees have a 14%-22% risk of further progression while they are growing, but the risk increases more than 3 fold (68%) for the same patients if their increases to the 20-29 degree range (1). Therefore, it is vitally important to halt or reduce the curvature below the 20 degree mark in order to reduce the adolescent patient’s risk of progression by up to 46%.

Long-term research has discovered that idiopathic adolescent scoliosis patients whom have spinal curvatures that measure greater than 25 degrees have a 68% risk of continued progression in their scoliotic curvature throughout adulthood that will cause severe pain and disability, however scoliosis patients who whose curvatures measured 25 degrees or less only experienced further curve progression 8% of the time throughout adulthood.(2)

(1) Lonstein et el, The prediction of curve progression in untreated idiopathic scoliosis. J Bone Joint Surg AM.1984,661061-1071

(2) Curve Progression in Idiopathic Scoliosis – Follow up study to skeletal maturity
Ken-Jin Tan, et al.
SPINE.2009.vol34(7).697-700

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I am not Schroth certified, but I can offer some distinct treatment advantages that are unique only to the CLEAR Institute scoliosis exercises treatment system......

It has been well-documented that patients with scoliosis demonstrate a significant increase in neuroanatomical abnormalities of the corticospinal tract, as well as neurophysiological abnormalities, especially in the areas of vestibular function, proprioception, vibratory sensation, postural reflex mechanisms, abnormal reflex processing, and disordered postural equilibrium.50-60 Lateralization of neurophysiology also occurs more frequently in patients with idiopathic scoliosis (IS), and this can be correlated to the convexity of curvature.61-63 However, it has been suggested that this laterality is a result, rather than a cause, of scoliosis.64 While many authors have suggested that brain asymmetry may play a role in the etiology of scoliosis, one recent study did “not support the concept of a generalized brain asymmetry in idiopathic scoliosis,” but noted instead that the trend towards asymmetrical neurophysiology was “probably representing subclinical involvement of the corticospinal tracts secondary to mechanical compression.”65 The goal of the chiropractic manipulative therapy provided by CLEAR Institute doctors is to reduce this mechanical compression and thus restore normality.
Neurophysiological compensations may develop as a mal-adaptation to disordered spinal structure; similarly, disordered spinal structure may create muscle imbalances & exacerbate existing neuromuscular imbalances.66
Scoliosis has been induced in an animal model following unilateral vestibular compromise (when one part of the balance system of the body was disrupted).67 However, scoliosis only developed when the animals were subjected to gravity, thus lending further credence to the statement made by Stokes, Burwell & Dangerfield that, “independent of whether a scoliosis is congenital, neuromuscular, or idiopathic, mechanical factors become predominant relative to initiating factors during rapid adolescent growth, when the risk of curve progression is greatest” or, as expressed succinctly by Hawes & O’Brien, “no matter what you believe to be the cause of AIS, ultimately the problem can be reduced to the production of an imbalance of forces along the spine.”31,68 The simplest explanation for the cause of scoliosis is a biophysical adaptation to gravity. Understanding why this adaptation occurs is paramount to designing an effective treatment regimen.

Using innovative concepts such as whole-body vibration and advanced spinal weighting techniques to improve the body’s posture & balance and re-train how the brain activates different muscles in response to gravity, we are able to address the neuromuscular compensations that occur in scoliosis.69-72

References:

50) Mihaila D, Calancie B: Is corticospinal tract organization different in idiopathic scoliosis? Stud Health Technol Inform. 2008;140:350.
51) Woods LA et al: Decreased incidence of scoliosis in hearing-impaired children: implications for a neurological basis for idiopathic scoliosis. Spine, 1995;20:776.
52) Goldberg C J et al: Adolescent idiopathic scoliosis and cerebral asymmetry. An examination of a non spinal perceptual system. Spine, 1995;20:1685-1691.
53) Geiselle A E et al: Magnetic resonance imaging of the brain stem in adolescent idiopathic scoliosis. Spine, 1991;16:761-763.
54) Stevens et al: MRI of the posterior fossa and evoked potential analysis in adolescent idiopathic scoliosis. In: Proceedings of the Scoliosis Research Society, 27th Annual Meeting, Kansas City, Missouri, USA, September 23-26, 1992, p. 89-90
55) Maguire J: Intraoperative long-latency reflex activity in idiopathic scoliosis demonstrates abnormal central processing. A possible cause of idiopathic scoliosis. Spine, 1993;18:1621-1626.
56) McGovern A et al: Reflexes induced by vibration in the superficial paraspinal muscles of girls with adolescent idiopathic scoliosis. In: Proceedings of the British Scoliosis Society, 21st Annual Meeting, London 20-22 March 1996. Journal of Bone and Joint Surgery Orthopaedic Proceedings, British Volume, In Press.
57) Arai S et al: Scoliosis associated with syringomyelia. In: Proceedings of the Scoliosis Research Society, 27th Annual Meeting, Kansas City, Missouri, USA, September 23-26, 1992, p. 139.
58) Barnes PD et al: Atypical idiopathic scoliosis: MR imaging evaluation. Radiology, 1993;186:247-253.
59) Evans SC et al: MRI of ‘idiopathic’ Juvenile scoliosis. A prospective study. Journal of Bone and Joint Surgery, 1996;78B:314-317.
60) Lewonowski K et al: Routine use of magnetic resonance imaging in idiopathic scoliosis patients less than eleven years of age. Spine, 1992;17:S109-116.
61) Sahlstrand T: An analysis of lateral predominance in adolescent idiopathic scoliosis with special reference to the convexity of the curve. Spine, 1980;5(6):512-8.
62) Grivas TB, Vasiliadis ES, Polyzois VD, Mouzakis V: Trunk asymmetry and handedness in 8,245 school children. Developmental Neurorehabilitation, 2006;9(3):259-266.
63) Goldberg C, Dowling FE: Handedness and scoliosis convexity: a reappraisal. Spine 1990;15(2):61-4.
64) Goldberg CJ, Moore DP, Fogarty EE, Dowling FE: Handedness and spinal deformity. Stud Health Technol Inform. 2006;123:442-8.
65) Kimiskidis VK, Potoupnis M, Papagiannopoulos SK, Dimopoulos G, Kazis DA, Markou K, Zara F, Kapetanos G, Kazis AD: Idiopathic scoliosis: a transcranial magnetic stimulation study. J Musculoskelet Neuronal Interact. 2007;7(2):155-60.
66) Chu W, Lam W, Ng B, Tze-Ping L, Lee K, Guo X, Cheng J, Burwell R, Dangerfield P, Jaspan T: Relative shortening and functional tethering of spinal cord in adolescent scoliosis - Result of asynchronous neuro-osseous growth, summary of an electronic focus group debate of the IBSE. Scoliosis, 2008;3:8.
67) Lambert FM, Malinvaud D, Glaunès J, Bergot C, Straka H, Vidal PP: Vestibular asymmetry as the cause of idiopathic scoliosis: a possible answer from Xenopus. J Neurosci 2009 Oct 7;29(40):12477-83.
68) Hawes MC, O’Brien JP: The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment. Scoliosis, 2006;1(1):3.
69) Tjernström F, Fransson P, Hafström A, Magnusson M: Adaptation of postural control to perturbations – a process that initiates long-term motor memory. Gait & Posture 2002;15(1):75-82.
70) Fontana T, Richardson C, Stanton W: The effect of weight-bearing exercise with low frequency, whole body vibration on lumbosacral proprioception: a pilot study on normal subjects. Aust J Physiother., 2005;51(4):259-63.
71) Issurin V: Vibrations and their applications in sport: a review. J Sports Med Phys Fitness, 2005;45(3):324-336.
72) Kluzik J, Peterka R, Horak F: Adaptation of postural orientation to changes in surface inclination. Exp Brain Res. 2007;178:1-17.

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The Article entitled “Exercise Can Reduce Scoliosis Symptoms” does a relatively accurate job of profiling the spinal condition and Dr. Edwards discusses various methodologies of managing and treating scoliosis. As the title implies, active rehabilitation of the spine can and will reduce symptoms of scoliosis, but the article omits is that active rehabilitation of the spine can reduce the scoliosis curvature itself. I have seen and read many of the studies showing how exercise protocols that include core strengthening exercises like sit-ups, chin-ups, and pelvic tilts have no effect on scoliotic curvatures, but those studies have over-looked a critical aspect of the spinal condition. Scoliosis is primarily a spinal condition of neurological control of the spine in response to gravity. In short, the brain is incorrectly perceiving gravity and therefore mis-orienting the spine accordingly. This is why scoliosis is 5 times more common in the blind population, but only 25% as likely in the hearing impaired population. However, neurological control doesn’t seem to be the only factor involved in the progression of the disease. Spinal curvatures under 20 degrees have an approximately 22% risk of progression, but the risk of progression jumps to 68% for curvatures 20-29 degrees. This dramatic jump in progression rates can probably be contributed to the increased “coil down” effect seen at this stage of the disease. No one seems to know why the “coil down” effect occurs, but it appears to be connected to adverse mechanical tension on the spinal cord. This also explains why the bending and rotation patterns appear to become “uncoupled” when the curvature reaches or surpasses the 30 degree angle mark. The normal coupled bending and rotation pattern normally forces the spinal cord over the outside of the curvature which increase tension on the spinal cord, but maintains a relatively low amount of torque in the spinal curvature; however, when the spinal curvature reaches 30 degrees or larger, the bending and rotation pattern become uncoupled and the rotation component begins turning towards the inside part of the curvature. While this has the effect of reducing the tension on the spinal cord by allowing the cord to travel through the inside part of the curvature, but has the negative effect of creating a massive amounts torque in the spinal curvature. This has a tremendously negative effect on the curvature and dramatically increases the “coil down” effect and curve progression.

So is the cause of scoliosis neurological or biomechanical? It seems early stage scoliosis (0-19 degrees) is rooted in a neurological mis-interpretation of gravity, however biomechanical factors involving spine torque (driven by a need to relieve adverse mechanical tension on the spinal cord) seem to be the driving force behind curve progression in spinal curvatures 20 degrees or greater.
“Exercises” in the form of neurological re-education and biomechanically specific exercise can have an positive effect on the signs and symptoms of scoliosis, but it must be applied in a very specific manner, by a trained and skilled physician.