The primary goal of any scoliosis treatment is to stop the development of and, if possible reduce the cobb angle – that is to say, the degree of scoliosis ie the “curve” in the spine. To date, there are only two non-surgical options that have been shown to be effective in scientific studies – these are bracing and exercise-based physiotherapy approaches.
When treating scoliosis, however, it’s critical to remember that every case is different – the same degree of curve may affect two people in a totally different way on a day-to-day level. Either bracing, or exercise will always be the core of effective scoliosis treatment, but with this in mind, we can also make use of numerous complementary therapies to form part of an overall treatment plan. Let’s look at some of the approaches which may be of benefit.
Massage
Massage therapy is a substantial field in and of itself, with many different approaches that practitioners may use based on the needs of a specific case. Broadly speaking, however, we can say that message can play a valuable role in supporting the rehabilitation of functional issues in scoliosis patients and is also beneficial for improving overall health factors such as sleep patterns.[1]
One of the main ways in which massage can assist in scoliosis treatment is by relieving muscular pain which may result from imbalances arising from the Scoliosis. Due to the elongated musculature on one side and the shortened musculature on the opposite side, back pain, shallow breathing, sciatica, headaches and insomnia are frequent issues that a person with scoliosis may experience. Various massage approaches are effective in helping to manage these symptoms and some approaches used in sports therapy may be valuable in helping to relax and stretch muscles that are too tight.
Massage, like many complementary approaches, may also help in increasing body awareness, which in turn can help patients to work to change movement habits that contribute to functional scoliosis.
The level of research on massage specifically for scoliosis is currently limited – studies do confirm that scoliosis suffers have shown an improvement in pain levels, trunk rotation, posture, quality of life, and pulmonary function through massage therapy.[2] More research is needed to establish the effectiveness of massage specifically since most of the current studies available consider the treatment of scoliosis with massage as part of a broader variety of manual therapies.[3]
Yoga
In truth, Yoga is more of a system of being than a specific treatment – there’s no doubt that countless people around the world find peace and tranquillity through yoga which is of course a huge benefit to scoliosis sufferers (and just about anyone else too!)
On a more practical level though, there are also some specific characteristics of Yoga that are helpful in Scoliosis treatment. Firstly many yoga positions are symmetrical and therefore are, in essence, aiming to achieve the same kind of body symmetry taught through scoliosis specific exercise. Further, Yoga can be especially effective in helping patients to discover a way of being sensitive to the asymmetries of the body and detecting them more readily without external input. This in turn could improve patient engagement with scoliosis specific exercise.
Secondly, Yoga practice can exercise each dimension of the body —the vertical plane through lateral flexions that create side bends, the sagittal plane through flexion and extension patterns that create forward and backward motion, and the horizontal plane through rotations. While scoliosis specific exercise goes beyond simply balancing the body in order to try to correct scoliosis, the ability to consciously maintain balance and flexibility in the body throughout a range of movements can be highly valuable in terms of controlling scoliosis.
Some small scale studies (mostly case studies) have suggested that yoga may have a positive role to play in reducing cobb angle[4] and at least one case study has demonstrated a reduction in Cobb angle from 49 to 31 degrees, although in this instance progress was achieved over a very long period of 35 years.[5] At this time there is not sufficient evidence to suggest that yoga can effectively reduce cobb angle however the complimentary benefits provided are often enough to cause scoliosis practitioners to recommend yoga alongside more traditional treatment.
Pilates
Pilates is similar to the more physical disciplines within yoga, in that it is a system of exercise focusing upon controlled movement, stretching and breathing. Pilates is popular today not only for physical fitness but also for rehabilitation programs for many conditions.
Currently, Pilates is not recommended as a standalone treatment for scoliosis, but like yoga, there are some excellent reasons to consider it as a complementary aspect to an overall program.
A 2018 review of 23 papers that considered Pilates as a potential treatment for scoliosis showed that in 19 of the studies, Pilates was more effective than a placebo at improving outcomes – most notably including pain and disability levels.[6]
There is some limited evidence that indicates that Pilates may have a role to play in reducing cobb angle, although more research is required. It is also worth noting that when Pilates is compared with a specialised exercise methodology such as Schroth, it has been shown that Schroth therapy is more effective over the same time span[7] – what has not yet been studied (so far as we are aware) is whether combining Pilates with a more traditional exercise approach could yield better results still.
Whereas some aspects of Yoga can be tricky, and many disciplines do also recommend a focus on meditation as a complement to physical work, Pilates is more focused on being active and is arguably simpler to pick up and start enjoying. This might make it a better selection for those who prefer more active muscle strengthening approaches or those who would like to perform several short workouts throughout the day.
The Alexander Technique
The Alexander Technique is a system that aims to retrain a person to be more aware of their posture. It helps you to notice the bad habits you have picked up during your lifetime and helps you correct them. The idea is that by adjusting our movement and posture, we can reduce pain and discomfort associated with sub-optimal movement.
While a simple concept, the technique does have some objective research to back up this claim – a large randomised controlled trial was published in December 2008, which showed that NHS patients with chronic or recurring back pain who took part in Alexander technique lessons reported a long-term (measured up to 1 year) reduction of days with pain, a measurable increase in the number of daily tasks they could do, and benefits in quality of life, compared with patients who received usual care from their doctor.[8]
Perhaps one of the biggest advantages of the Alexander Technique is that many patients report really enjoying learning and using the technique. Unlike the other options discussed here, the Alexander Technique can be practised at any time during the day, even while undertaking everyday activities or relaxing.
There is no evidence to show that the technique has any particular impact on scoliosis – however, some practitioners do suggest that it can be an excellent approach to help children, in particular, manage some of the discomfort from wearing a scoliosis brace, in particular by helping them learn how to move “with” the brace, rather than against it. More research into this approach is certainly needed, however.
[1] M Hamm, Impact of massage therapy in the treatment of linked pathologies: scoliosis, costovertebral dysfunction, and thoracic outlet syndrome. Journal of Bodywork & Movement Therapies (J BODYWORK MOVEMENT THER), Jan2006; 10(1): 12-20.
[2] A LeBauer, The effect of myofascial release (MFR) on an adult with idiopathic scoliosis. Journal Of Bodywork And Movement Therapies [J Bodyw Mov Ther] 2008 Oct; Vol. 12 (4), pp. 356-63
[3] Michele Romano and Stefano Negrini, Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review. Scoliosis 2008 3:2
[4] Yoga for scoliosis: new findings. University of California at Berkeley Wellness Letter (UNIV CALIF BERKELEY WELLNESS LETT), Jul2018; 6-6. (2/3p)
[5] Elise B Miller Yoga therapy for scoliosis: an adult case approach Scoliosis 2007:2 (Suppl 1) :P6
[6] Keira Byrnes et al. Is Pilates an effective rehabilitation tool? A systematic review. Journal of Bodywork & Movement Therapies Jan2018, Vol. 22 Issue 1, p192
[7] Gichul Kim, Effects of Schroth and Pilates exercises on the Cobb angle and weight distribution of patients with scoliosis J. Phys. Ther. Sci. 28: 1012–1015, 2016
[8] Paul Little et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain Br J Sports Med. 2008 Dec;42(12):965-8.
