Joseph Pilates

What Are The Best Exercises for Scoliosis?

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 Polestar Educator, Physical Therapist, and certified C2 Schroth therapist Lise Stolze offers further insight to Scoliosis and working with Scoliosis clients.  For all upcoming continuing education courses with Polestar visit: Polestar Continuing Education

Most asked questions scoliosis clients ask me about exercise:

  • Should I perform some exercises just on one side?
  • Should I choose exercises that rotate me to the opposite direction of the curve?
  • Should I do an extra set of movements to one side?
  • I just saw research that side plank exercises can reduce curve degrees…should I be doing these?
To answer these questions we must understand how scoliosis affects movement.

What is the Pathomechanism of Idiopathic Scoliosis? (the short version!)

I will be brief since this is a whole course in itself! We know that Idiopathic (no known cause) Scoliosis (IS) is a 3 dimensional spinal disorder that begins with anterior vertebral wedging due to RASO (relative anterior spinal overgrowth) during bone development. We also know that the rotational component of scoliosis exists as both inter-vertebral torsion (rotation of one vertebra relative to another) and intravertebral torsion (an internal rotational distortion within each vertebra), most notably at the apical vertebra (the vertebra most deviated laterally from the vertical axis that passes through the sacrum).1 This distortion contributes to less joint motion at the apex of the curve and more at the transition points of the curve. We see this to a greater degree in adults and to a lesser degree in adolescents who have a more flexible curve before bone maturity. This is apparent in a supine lateral flexion X-ray that assesses curve flexibility.

Three Goals for our Clients with Scoliosis

Movement educators can keep 3 goals in mind when choosing exercises for clients with IS:
  1. Achieve better postural alignment along the central axis
  2. Provide a safe fitness option to increase flexibility, strength and fluid movement
  3. Support sports, recreation and functional activities that enhance quality of life

We Can Improve Posture Through Exercise!

Better posture can be achieved by emphasizing the most fundamental principles of all intelligent movement disciplines:  axial elongation and breathing.  Scoliosis curve concavities are constantly under compression by gravity.  Axial elongation encourages a natural re-alignment of the spine by using neuromuscular activity to reduce multi-plane compression and collapse of the concave side of the scoliosis curves. Once the concavities (which include the ribs) are expanded, then breath can be used to further open the collapse through:
  1. Tactile cueing of the concavities
  2. Unilateral nostril breathing
  3. Guided imagery
The most effective position to learn decompression of the concavities is in a spinal neutral position, out of gravity. Once there is neuromuscular re-patterning, movement can then be transferred to functional positions against gravity like standing, sitting, walking, squatting and lifting where it is more difficult to maintain axial decompression. There are many neutral spine exercises in the Pilates and yoga environment that can be used in this initial phase of re-patterning.

The Side Plank Research Controversy

A research article was published in 2014 claiming that scoliosis curves can be reduced by doing side planks on the convex side of the curve, and was sensationalized in a WSJ article.2  But the research had many flaws3 and while interesting, it cannot make that claim.  Muscular activity on both the concave and convex side of a scoliosis curve is inefficient and exercises that address each side are optimal for IS, including the Side Plank. Consider benefits of the Side Plank based on curve type:
  1. Single Major Thoracic Curve: performing side plank on the convex thoracic side (concavity up) can help strengthen elongated muscles on this side by placing them in a relatively shortened position, and helps to open the concave side, working these muscles eccentrically.
  2. Double Curve, Primary Thoracic: the same can be true for the thoracic curve but now the lumbar curve may be more compressed and specific cueing and/or modification of the exercise must be considered.
  3. Double Curve, Primary Lumbar: performing side plank on the convex lumbar side may be beneficial, but the thoracic curve may be more compressed, and will require special cueing or modification.
  4. Single Curve – Lumbar or Thoraco-lumbar: performing side plank on the lumbar or thoraco-lumbar convex side may strengthen elongated muscles on this side by placing them in a relatively shortened position and helps to open the concave side, working these muscles eccentrically.
  5. Adult with Degenerative Scoliosis (Lumbar): receive the same benefits as Single Lumbar curve but if there is a lateral instability (listhesis), then this exercise may not be indicated.
In all curve types, performing the Side Plank on the concave side of the primary curve is much more challenging but also beneficial.  This brings us to the importance of performing a scoliosis assessment to determine the curve type.  In the case of adult degenerative scoliosis, an X-ray must be obtained and collaboration established with a health care practitioner who has a deep working knowledge of scoliosis evaluation and management.

Safe Exercises for Spine Mobility

Life takes us out of neutral spine…shouldn’t we train our scoliosis clients how to move their spine effectively out of neutral?  The answer is of course yes…. but which movements and how much?   This depends on your assessment of the client:  Are they in pain?  How much movement does the apex of each curve have?  What is the curve type?  What other muscle imbalances or injuries exist? What are their goals?  Considering that the scoliosis spine tends to move more at the transition points and less at the apices, we may want to limit end range movements and emphasize elongation in postural shapes that minimize compression of the curve concavities.  This will be more difficult for those with a double curve. So it is important to make critical decisions with your client based on your evaluation and their goals.

Recreation and Sports: Can it Be Done with Scoliosis?

Everyone with scoliosis should be free to enjoy activities that increase quality of life! What does you client love to do?  Sports activities such as dance and gymnastics involve many compressive spine positions for scoliosis….as do golf and tennis.  Each person must be evaluated for the risk that their chosen activity may have on their scoliosis.  Considerations for age, curve type, activity frequency, and muscle imbalances must be made. Clients should be educated about scoliosis spine mechanics and progressions to help them make an informed decision about the activity they choose.  A fitness or movement session with your client could focus on training to maintain axial elongation and openness of the concavities during sport. Just as likely and equally important, a session could simply focus your client back to their center line!

Education and the Need for Individualized Programs

Polestar founder Brent Anderson, PT, PhD, OCS reminds us of the importance of working within our own scope of practice. It is crucial to invest in your education to increase your effectiveness and level of safety with your scoliosis clients. Find a professional you can partner with, join a network of practitioners with like interests, and take courses to keep yourself current with scoliosis research. If you are the client, make sure that your Pilates teacher or therapist has the training to create safe and effective exercise programs for you and your needs.

For all Upcoming Continuing Education Courses: Continuing Education with Polestar

References: 1Dickson RA, Lawton JO, et al. The pathogenesis of idiopathic scoliosis. Biplanar spinal asymmetry. J Bone Joint Surg Br. 1984;66(1):8–15. 2 Fishman LM, Groessl EJ et al.  Serial case reporting yoga for idiopathic and degenerative scoliosis.  Global Advances in Health and Medicine.  2014;3(5):16-21.   3 Salvatore M, Zaina F, et al.  Letter to the editor: Serial case reporting yoga for idiopathic and degenerative scoliosis. Global Adv Health Med.2015;4(1):79-80.

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Lise Stolze, MPT, DSc PMA®-CPT, is a certified C2 Schroth therapist, Polestar Educator, and owner of Stolze Therapies in Denver, CO. She has co-created Pilates Adaptations for people with Scoliosis with Schroth Scoliosis Therapist and BSPTS educator Hagit Berdishevsky, PT, MSPT, DPT, Cert. MDT. Lise has been published with her research on Pilates and Low Back Pain. 

Be Your Own Architect!

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Becky Phares, PMA®-CPT is a Polestar Pilates Graduate, Practitioner and contributor to the Polestar Life Weekly Blog.  With more than 10 years of teaching Becky teaches at her studio The Body Initiative Pilates Studio in Lafayette, Louisiana.  Find Becky and her Studio on Facebook: The Body Initiative Pilates Studio and Instagram @the_body_initiative_ .

Being Your Own Architect

“Everyone is the architect of his own happiness.”

-Joseph Pilates

If you are a Pilates instructor you have probably heard the quote from Joe in Your Health: “Everyone is the architect of his own happiness.” This to me means that we as humans have the control to make the necessary changes in our lives to create fulfillment.  When teaching class, I find myself referring to my clients as their own personal architects to help inspire the point; take control of your own joy, mental well being, and physical health. Hearing the word architecture in Pilates also makes me think of other characteristics this profession provides. In exercises like long stretch, I ask my clients to imagine that their body is like a house. When you are in the plank position your house is small and needs only a few supportive beams. When you are stretched out long you must add in more support so the roof doesn’t cave in. These cues make me think of one of Polestar’s favorite philosophies: as little as possible, as much as necessary. What better way to validate this connection than to interview an architect. So I sat down with my friend Kally to see if our ideologies mesh. BP: Describe your job in 1 sentence: Kally: I design custom homes from scratch. BP: What type of supportive systems are used in a home that you design? K: They are all wood framed houses so normally wooden beams, columns or structural walls. Sometimes when we want a long span of open space we use steel beams. BP: How do you determine how many beams to put up in your house to keep the roof from caving in? K: So over 20 feet and under normally requires some sort of wooden beam. Over 20 will require a bigger/stronger beam. BP: What would happen if you have to little support? K: Well the structure would fall, obviously. BP: What would happen if you have too much support? K: Too much… nothing would happen to the structure, but it would be a waste of resources. BP: What other things make your job fun but challenging? K: It’s fun because it’s creative and each family I design for is unique. It’s challenging for 2 reasons: 1. When the lots are small but people still want to build a big house on limited space. 2. Trying to accommodate everything they want but sometimes those things conflict with each other physically. For instance, you want a window in the bathroom, but the desired location of the bathroom is not on an exterior wall. So we either have to move the room, or not have windows. BP: Based on this interview I have supported the reasoning for why the quote, “as little as possible, as much as necessary” is important not only in Pilates and architecture but in life in general. Using too much stuff during a job wastes resources; using too little doesn’t create enough support. I have also realized that my job and Kally’s have more similarities than I once imagined. We both have to figure out what is best for our clients through creative and critical thinking. She describes her process of designing a house like putting together a jigsaw puzzle. Kally knows what they want, but it is not always a quick fix. Similarly, when a new client walks into my door, they may have a goal for their body, but I know it will take multiple sessions to make that goal a reality. Becky Phares, PMA®-CPT is a Polestar Pilates Graduate, Practitioner and contributor to the Polestar Life Weekly Blog.  With more than 10 years of teaching Becky teaches at her studio The Body Initiative Pilates Studio in Lafayette, Louisiana.  Find Becky and her Studio on Facebook: The body Initiative Pilates Studio and Instagram @the_body_initiative_ . Link our Blog? Subscribe to the Newsletter Polestar Life Weekly!

Working with Clients with Scoliosis

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A teaser by Polestar Pilates International on the topic of our course: Scoliosis and Spinal Conditions, Pilates Master Course with Scroth educator Hagit Berdishevsky and Polestar educator Lise Stolze (Stolze Therapies)

WORKING WITH CLIENTS WITH SCOLIOSIS

Scoliosis is one of the most stubborn, abundant disorders in growing children and teens. The good news is that Pilates professionals can help ease the pain scoliosis sufferers experience through movement. The question is, how does one go about helping someone find peace with this condition?

WHAT IS SCOLIOSIS?

Scoliosis is a skeletal deformation, usually the result of growth spurts during adolescence, congenital spinal abnormalities, and other defects. 65 – 80% of scoliosis cases are idiopathic or of unknown origin. In sufferers, the spine is bent out of shape (no pun intended). Sometimes minimally or sometimes dramatically, the spine contorts into a C or an S shape. The Cobb angle is widely used to test for scoliosis, which is a measure done by locating distorted vertebrae and marking their paths on the back.

Early onset or early childhood scoliosis appears before 5 years of age and makes up 2% of all reported cases. It is sometimes associated with severe respiratory failure and, by affecting lung growth, may lead to decreased respiratory capacity even before puberty. Late-onset idiopathic scoliosis appears after 5 years through adolescence and usually occurs at puberty, around age 10. In such cases, complications with breath and healthy lung function have been reported. When left untreated, these conditions are exaggerated and the spine can be very distorted, to the point where the backbones can only be fixed through surgery. Most cases of scoliosis, however, resolve themselves with age, moderate exercise, and physical therapy.

HOW TO TREAT SCOLIOSIS

Lise Stolze and Hagit Berdishevsky discuss working with scoliosis clients on Pilates Hour.

ALTERNATIVES FOR SCOLIOSIS TREATMENT

  • Observation: where the deviation does not exceed 20º.
  • Use of corset: Used to slow the progression of the curve during the growth stage in people whose curvature is between 20º and 45º.
  • Surgery: Stop the evolution of the curve and, if possible, to correct it. It is indicated for the minors of growing age whose curve is greater than 45º and for adults with curves higher than 50º.
  • Physiotherapy and active rehabilitation: These treatments seek to slow the progression of curvature, improve respiratory function and reduce pain.

These types of treatments can be combined with different techniques. These include electro-stimulation through medium-frequency currents, heat treatments with IR to increase tissue elasticity and circulation, and lumbar traction to reduce compression in the spine. Kinesiotherapy uses movement-based exercises that include stretching, exercises to strengthen weakened muscles, and those that seek to invert the curves of the spine by position.

Therapeutic exercises for scoliosis treatment are based on principles that we manage day by day in Pilates such as postural reeducation, flexibility and muscular strength. The Schroth Method is a good example of a regimen that targets scoliosis to reduce pain and the rapid growth of scoliosis. The method focuses on postural and breathing exercises, spine flexibility, and convex-side stretching. It has been praised for being effective in minimizing symptoms.

These tips will not cure scoliosis, as most forms will resolve themselves naturally. However, these techniques will greatly reduce the discomfort that usually comes with this disorder. This is also true for recovery from extreme scoliosis. The key is to continue positive movement experiences and expanding our knowledge of this disorder to gain insight on how best to stop it.

What are the best Exercises for people with Scoliosis? Click here.

To learn more about the online course, click here: Scoliosis and Spinal Conditions, Pilates Master Course

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Polestar Pilates Founder Highlight: Brent Anderson PT, PhD, OCS, NCPT

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We sat down with Brent Anderson PT, PhD, OCS, NCPT founder of Polestar Pilates, to ask him a few questions.  Brent has been teaching for over 30 years and incorporates movement science, mindfulness, and human behavior in his work.  A fun fact about Brent is that he is a retired extracurricular pole vaulter!

Polestar: What do you love about teaching?

BA: Being in the moment with students and observing them experience the material and giving me that look like “I get it.”

Polestar: What is your current inspiration?

BA: I love everything about movement science and spontaneous movement facilitation… the science of PLAY.  I am also inspired by behavioral science: What motivates us?  How does what we believe affect who we are?  Lastly, I am super inspired by humanitarians, really making a difference in the world by touching one person at a time. SERVICE!

Polestar: Why Pilates?

BA: I am fascinated with the simple and yet profound philosophy of Joseph Pilates.  The formula is simple and accessible to every human being.  Exercise, eat well, sleep well, keep your mind clean, connect with nature, and foster a balance between work, rest and recreation.

Polestar: What do you hope to convey in your teaching?

BA: Movement and health are available for everyone.  Identify the uniqueness of the individual and design a successful whole body experience for them that exceeds their expectation.

Polestar: Where would you love to vacation?

BA: Home.

Polestar: What is your favorite quote?

BA: “Love one another as I have loved you.” JC,  “As much as necessary, as little as possible.” Alan Lee MD

Polestar: Describe your movement style:

BA: Sometimes I feel like a train, but I’m told that I am a nimble train with some soulful rhythms.

Polestar: What is your favorite apparatus:

BA: I love all the apparatus, just like I love all my kids.  NO FAVORITES.  Early in my training, I would try to conduct an entire exercise program just on one piece of equipment.  You will be amazed at how creative you can be on each piece of equipment.

Polestar: What are you reading?

BA: The Book of Mormon in Italian and a new book called Sapiens.

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Graduate Highlight: Mara Sievers

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“What really matters is that we feel good and that we can live our lives to the fullest. If we apply it correctly, Pilates is the tool to get there.

It’s the best tool I know.” – Mara Sievers

Mara Sievers is a Polestar Graduate, Practitioner and the creator of the Pilates Encyclopedia.  Read our interview with Mara and discover her thoughts on the body’s kinesthetic intelligence and what led her to Pilates.

Polestar: What do you love about teaching?

MS: I love that I get to know the whole person. Pilates gives me permission to take all aspects of a person into consideration… their body of course but also their emotions and thoughts. Feelings influence breathing and breathing influences movement. I love that my students leave the studio feeling better than when they came in. Often that’s my only goal for a session, especially for my clients with movement restrictions, limitations or pain. I work with a lot of people who’ve never experienced individualized Pilates on equipment before, and I love seeing their excitement when they realize that they CAN do this. That they don’t have to hurt and suffer to get stronger and move better with more ease.

Polestar: What is your current inspiration?

MS: My students’ activities outside the studio inspire me. I usually ask them what they’d like to be able to do outside the studio, in the real world. Often it’s hiking, skiing, tennis, gardening or playing with and lifting up their grand children. Once we have a goal that excites them we build the skills to get there and we find ways to mimic the movement in the studio in preparation for real world application.

If my energy gets drained from teaching a lot I make sure to take lessons from other teachers. Getting out of my head is important. Having another teacher look at my body and help me find better movement patterns is invaluable and incredibly inspirational. When my own body feels great I want to share this feeling with my students. Ultimately, Pilates teachers are practitioners first.

I live in New Hampshire, and we’re pretty outdoorsy. Moving in nature is the best meditation and inspiration for me. It helps me put things into perspective, clears my mind from clutter, and helps me focus on the essentials.

Polestar: Why Pilates?

MS: I used to be a dancer. Then I got injured and Pilates helped me get back on stage. I later started to teach all sorts of group fitness, aerobics, step aerobics and yoga. Eventually, I decided to fully focus on Pilates because it was the only modality that gave me the skill to work with everyone, no matter their limitations. You can’t be too inflexible, too weak or too out of shape to do Pilates. You’re out of excuses to feel better, stronger and happier.

Polestar: What do you hope to convey in your teaching?

MS: That Pilates doesn’t matter. What? Did I just say that? What I mean is that it’s not important to do Pilates perfectly. What’s the point in practicing a gazillion Roll Ups to “perfect” them if I end up with neck pain. What really matters is that we feel good and that we can live our lives to the fullest. If we apply it correctly, Pilates is the tool to get there. It’s the best tool I know. So in that regard Pilates matters. A lot.

Polestar: Where would you love to vacation?

MS: Any of the National Parks in the western US. I’m an avid hiker, and I’ve never been to Yosemite, Zion, Yellowstone, etc. I’m also getting more and more intrigued with Alaska.

Polestar: What is your favorite quote?

MS: “Everyone is the architect of their own happiness.”

It reminds me that it’s all about personal responsibility. I sometimes get the feeling that my desire for my students to get better is stronger than their own. Probably because I have more faith in Pilates than they do. I’ve seen with my own eyes and felt in my own body the power of the method. But ultimately, I can’t do it for them. The student has to believe in it, too. If you can’t believe it, then you can’t achieve it, right?

Polestar: Describe your movement style?

MS: Slow, precise, soft, gentle, and with intention. I came to Pilates through an injury due to hyper-mobility.  This set the stage for me to focus on exercising within my abilities and not pushing outside of my comfort zone until I’m able to fully control the movement. I focus on building a strong foundation first for each of my students. They want to see me do the most difficult exercises in the repertoire. But I know exactly what I can and can’t do (correctly). I know which exercises will help me and which ones I’d be cheating (compensating) my way through. I don’t care about showing off. Unfortunately most of us are very impressionable by the “shiny things,” the flashy exercises, the upside down ones. The subtle work that happens inside the body is often not visible to the outside (especially not to the untrained eye). But it changes everything. It makes all the difference.

Polestar: What is your favorite apparatus?

MS: At the moment the Ladder Barrel. Pilates can get a bit linear and rigid. The curves of the Barrel remind me and my students to keep the spine supple (as a cat’s).

The Oov has been tremendously helpful with this same goal. It provides a shortcut by helping the student feel a neutral spine position without having to explain so much. It’s a direct line to the body’s kinesthetic intelligence.

Polestar: What are you reading?

MS: I recently read Critical Hours: Search and Rescue in the White Mountains by Sandy Stott. As a hiker and outdoor enthusiast, I was humbled by how much effort goes into rescuing hikers who get into trouble. I learned a ton about how to stay safe.

I also highly recommend Essentialism: The Disciplined Pursuit of Less by Greg McKeown for anyone who, like me, tends to have too many ideas and wants to do too much. Its philosophy of dropping all non-essential activities resonates with the “less is more” Pilates mindset. He calls it “less but better.” I remind my students that fewer repetitions but performed with more focus are worth more than 20 sloppy repetitions.  One of Joe’s quotes comes to mind:  “A few well-designed movements, properly performed in a balanced sequence, are worth hours of sloppy calisthenics or forced contortion.”

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From Pilates to Neuroscience

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We interviewed Polestar Educator Kate Strozak MSc, LMT, NCPT of Chicago,  Illinois.  Not only is Kate a leader in Pilates education in Chicago and the Mid-West she is also a Runity coach, Oov educator and JB-MFR trained.  Kate is a contributor for Polestar Life Weekly (check out her blogs on Neuroplasticity, Fascia, Healthcare and Pilates Chairs).  Watch Kate as a special guest on the #PilatesHour episode “Neuro-Concepts in Pilates”. 
Polestar: What do you love about teaching? KS: I love the challenge of helping anybody surpass their movement expectations and goals. It’s one thing to meet goals and another to exceed them. I also love the uniqueness of each individual and how there are beautiful similarities that we all share. We are complex systems of gliding tissues with this incredible spark of life. This keeps me in constant awe and amazement and makes me feel like it’s an honor and privilege to be able to collaborate with my clients and students. Polestar: What are your current inspirations? KS: Nature is my perpetual inspiration. Whenever I start to feel in need of inspiration or if I feel in need of balance or grounding, I head outside as fast as I can. Polestar: Why Pilates? KS: Pilates made movement accessible and fascinating to me. It’s my foundation to start from and return to for my personal movement inquiries or for my clients’ movement exploration. Polestar: What do you hope to convey in your teaching? KS: I hope to empower my clients to revel in their movement, health, and fitness. I aim to be a resource and a collaborator, not a teacher or practitioner. Polestar: Where would you love to vacation? KS: I love to hike and would love an extended trip to visit a few countries in Africa. But I would go anywhere…I love to travel. Polestar: Do you have a favorite quote? KS: “The definition of insanity is doing the same thing over and over again and expecting different results.” Polestar: Describe your movement style? KS: Explorative, Playful, and Varied. Polestar: Do you have a favorite apparatus? KS: The mat. I think of that apparatus being there as a tool to help me better access my own body’s capabilities. But if I had to choose an apparatus I’d go with the cadillac for purposes of hanging and flips . Polestar: What are you currently reading? KS: H is for Hawk by Helen Macdonald, and Fascia: The Tensional Network of the Human Body by Leon Chaitow.