Keep it Simple
This always helps you get started, no matter your goal
My suggestions on approaching scoliosis:
While working with a client with scoliosis it is important to remember that everyone is different. What will communicate best to each client will be very individually based on their curves, spine spiral, and muscle reactivity. And of course personality, just like you do with all your clients. But there are specifics you should adhere to for safety and to achieve progress in their body.
I would caution you to consider carefully if you should teach side bending, twisting, or heavy springs on the equipment. Most scoliosis clients do not tolerate these movements well in their bodies. That said, with beginning students especially take it slow and ask lots of questions before embarking on the bending, twisting, or heavier spring use.
Be sure to check in and keep track of clients movement history as you build a repertoire together. To create that repertoire you need to learn their individual muscle imbalance patterns.
These imbalances will show up as tightnesses and lack of mobility throughout their body, mainly the legs and feet as well as shoulder girdle. The human body seeking balance will create the “proper imbalances” to makes sure that a person can be upright and walking and upright, therefore, be mindful of tightness that should not be released!!!
These patterns you discover will dictate their exercise protocol. These tightnesses are a map. They will show a client how to gradually unwind their patterns.
Avoid typical Pilates pitfalls:
Many instructors, without knowing it, have caused more harm rather than good by increasing tightnesses in the body with the understanding they were strengthening that area of the body. Starting systematically and gently teaching clients to breathe, sense the sense their body, contract their TA and spinal erector muscles, then they are able with their breath to create ease in the body when needed. To emphasize my point on the tightness patterns I’ll share that the spasms and over-tightening that can occur as a result of this lack of anatomical strategy can send a person with scoliosis into horrific spasms. I have had this happen to my body when I was first learning pilates and recovering from an injury and also from overstretching. So be calculated and seek balance. My goal is to train bodies from the inside out to discover their true spine and be able to transition to it and from it. If you are dealing with idiopathic scoliosis the goal of fitness is never to straighten the curves, merely to not induced unnecessary stress and provide new skills for comfort and enjoyment of movement.
Being mindful, gentle, and aware will help get the client past the first phase of training and make sure they are ready to begin strengthening.
**Do not ask them to lay on their back with a foam roller! It is not safe for unstable vertebrae, not to mention the twisted vertebrae and vulnerable spinous and traverse processes in such a position.
Focusing on what makes the body feel good as a whole, like proper stretching, proprioceptive focused movements for knowing their spine, good scapular glide, proper bone rhythms through the hip knee and foot, will set the stage for proper spinal relief for your client.
As an instructor, the best goals would be
Good postural analysis and creating a muscular assessment of what tightnesses are and discovering the why behind this based on the rest of the body’s movements abilities in response to the structural rotations in the body.
Considering why patterns are occurring, and perhaps if they are necessary and shouldn’t be released
Focusing for a long period of time on a client’s core connections (as defined by Marie Jose Blom-Lawrence) and helping your client breath their way of finding them. Help your client notice the mindfulness that’s involved in pilates, not just the impressive positions or movements.
The Mind is Best Teacher for the Spine :
The mind-body connection is so powerful in pilates. The feeling of having your body perfectly balanced and being hyper-focused is what builds new neuropathways for scoliosis clients. This is the best skill you can offer a client.
This is achieved by asking the multitasking of your client in reasonable ways. For example, cuing their core connections and their self-corrections while doing movements with lighter springs, pressing in and out slowly on the reformer, using the push-through bar to begin to learn to articulate their spine forward, bridging, using an over the ball at the mid-back for an ab curl….the list goes on…
Simply do movements that allow balanced sitting bone alignment all the way to their head and slowly, gently, helping them find their spine.
HOW TO PROP: You want to prop until the body looks neutral, that keeps things simple. You will know right away when they can’t layin prone or supine comfortably. Or if they sit too heavily on one side of the pelvis… it should cross your mind like this. ( hm, if I prop them on this side then…. or if I cue them to find my touch on their spine here and length up, and let the other sit bone release, then…. ) And go from there. —> Odds are you are an anatomy nerd & training enthusiast if you are reading this and I have hope that you know your anatomy and you can help a client get into neutral with props ;)! — But all the same, I will share a video soon.
what you prop will either even out the body or make the unevenness worse…. and there you have it, seek out neutral 😉 Just like your training taught you.
I teach propping of various kinds depending on if I am using heated props, round props, and depending on what muscles you want to see effort or release.
When using SmartSpines I place the heated sacral wedge into the concavity side to encourage a “dropping” of ribs on that side… to encourage grounded toward the correct direction for derotation. It’s as if they want to find the heat. I will sometimes have to use another wedge to balance the pelvis or shoulders after doing this.
IF a person doesn’t respond to this ( most people do, its amazing to see) then yes, conventional science that comes from bracing techniques says you should prop the convexity. — consider though that you are not dealing entirely with the rotation… you are impacting the side shift or translation. This is considered forceful, however, and should most likely be left to preassessment from a Schroth Therapist for the client.
WHICH PROPS TO USE
I highly highly recommend SmartSpine Wedges! They can be heated and used to prop (and they produce great results for teaching proprioception!)
My other favorite tools are yoga blankets, yoga blocks, over ball brand exercise ball, and Spike balls for foot massages( I use them everywhere).
Or get creative and cut up a yoga mat into triangles, or rolled up “sticky pads” that look like cabinet liners, or folded wash clothes. Experiment and try out different props on yourself.
Above all, keep your scoliosis client relaxed, take breaks, focus, and be sure you factor in feeling and sensing. You just might find that you love working with people looking to learn more about their bodies and live with scoliosis! Because typically they are so interested in learning more 🙂