I’ve written before about research looking for associations between back pain and posture. There are few associations to be found, which calls into question the common belief that we should spend a lot of time worrying about alleged postural dysfunctions like forward head posture, slumping, or anterior pelvic tilt.
I may have built up this false belief over time that if my body isn't perfectly balanced and symmetrical then it will cause issues for me down the line.
Much better to think about how to work within the variances in each of our bodies.
This speaks to the mystery of back pain which is covered a lot in the TMS John Sarno mind-body dysfunction world where I look for information to treat chronic pain after Covid. Essentially their belief is a high majority of back surgeries are unnecessary as the problem stems from the brain and not the actual curvature or degeneration of the spine. Your study seem to support it as well given that the groups followed in the study didn't differ that much from the control group. Do you also believe that back pain results from physiological condition rather than anything in the back
Hi Rebecca, I think that structure is generally overrated as a cause of pain, but that it matters, and probably plays some role in pain related to scoliosis.
Hi there! Thank you for this post that included a lot of thought and research. Much appreciated. I am a physio with a passion for helping folks with scoliosis. A few thoughts if I can share-
1) As you stated, we should not be demonizing asymmetry nor striving for symmetry. I completely agree. Nickpicking little asymmetries can do more harm than good. I think the key is movement variability. From my own clinical experience, one factor I've seen quite a bit in folks with mod/severe curves is that they tend to "live" in their curve patterns. Meaning, the scoliotic alignment becomes the default alignment 90% of the time, with a lack of awareness or inability to move into other positions. I think a lot can contribute to this but I've found it helpful to raise patient/client awareness in this regard and to help folks find other movements and positions to experience.
2) From a research standpoint, scoliosis-specific exercise has a long way to go in terms of proving effectiveness. However, I'd like to offer this perspective that's hard to grasp from a look at evidence alone. Coming out of PT school in 2006, I had 1 hour of scoliosis education under my belt. Since 2012, I've gone after scoliosis education with determination and now I've had hundreds of hours of scoliosis education between various scoliosis-specific approaches and attending spine conferences. Do I think I'm the best therapist ever? No. But I know that I've thought deeply about scoliosis in a way to better help adolescents and adults who live their lives with scoliosis. I think that scoliosis-specific EDUCATION is really valuable, even from the standpoint of offering a non-specific effect. I have found that parents of an adolescents with recently discovered (hypothetically) 35 degree Cobb angle scoliosis with plenty of growth remaining and recommendations to wear a brace 20 hours per day value coming to a provider who's really done a lot of work to understand scoliosis. I feel myself to be more effective than the old PT Kelly from pre-2012 with just one hour of education in my brain. I feel myself to be a valuable asset to the team even vs doing nothing at all. Honestly, most parents don't want to do nothing at all for their child. Being told there's a significant asymmetry in the spine that could worsen can feel scary and alarming. Being offered exercise options that are safe, in consideration of the individual curve pattern, I think can help alleviate a lot of fear. From the perspective of an adult with scoliosis, perhaps a woman who wore a huge metal brace for years as a teen, was subject to xray after xray, who chooses her clothes based on how they affect how her back looks, same thing, I find folks feel relieved in the hands of a provider with an extensive knowledge base in the area. I'm not sure how to articulate this in a way that can be proven in the research.
I think ultimately, I take issue with the concept that we should tell folks not to worry about scoliosis at all. Yes, mild Cobb angles and small asymmetries and even mod/large asymmetries don't predict function and quality of life. However, for many, particularly girls who had to deal with bracing and surgery and the effect of a different aesthetic on self-image, the experience can be influential on a person's life experience.
Thank you for giving me space to offer my two cents and cheers if folks have read all the way to the end of this looooong comment! Appreciate the work you do :)
Many people with headaches are treated with lengthy exercise "therapy" for scoliosis, head forward, loss of cervical lordosis.
A physiatrist whom I consulted with for leg and deltoid weakness, poked my back in 2 places and said I had moderate scoliosis and prescribed 18 PT sessions of corrective exercises. No imaging or measurements were taken. I couldn't afford it but having read enough of the literature didn't do it.
Do you have any experience working with severe scoliosis, 2 rods along the spine from T3-L3 and 16 small rods, surgically placed at age 12, now 36yo. Suffering from back pain,
Hi Inbar, No I don't have much experience with severe scoliosis or surgical corrections. I like Feldenkrais style movement for anyone who (1) is interested in Feldenkrais or mind/body therapies like meditation and (2) has gotten some results from either.
You say "the heart is on the right", but no. It's essentially right in the center behind the sternum, but sort of peeking out from behind it, on the left. Center-left, like Bernie Sanders. I tried to paste in a picture, but the software doesn't allow that. Google "location of human heart". The basic point that we're not PERFECTLY symmetrical is correct; only one liver, two lobes on the left lung and three on the right (I'm pretty sure, without checking), but our basic body plan is bilateral symmetry--left mirroring right, back different from front, top different from bottom. It's basically two of everything, with one digestive tube in the center, and some other quite minor modifications in the internal organs. I would argue that we're much more symmetrical than asymmetrical.
Hi Jerry. Thanks for pointing out the mistake, which I've now corrected! I meant to say heart on left, liver on right. And yes we are more symmetrical than not, but some asymmetry is part of the plan.
Loved this! Thanks Todd
I may have built up this false belief over time that if my body isn't perfectly balanced and symmetrical then it will cause issues for me down the line.
Much better to think about how to work within the variances in each of our bodies.
This speaks to the mystery of back pain which is covered a lot in the TMS John Sarno mind-body dysfunction world where I look for information to treat chronic pain after Covid. Essentially their belief is a high majority of back surgeries are unnecessary as the problem stems from the brain and not the actual curvature or degeneration of the spine. Your study seem to support it as well given that the groups followed in the study didn't differ that much from the control group. Do you also believe that back pain results from physiological condition rather than anything in the back
Hi Rebecca, I think that structure is generally overrated as a cause of pain, but that it matters, and probably plays some role in pain related to scoliosis.
Hi there! Thank you for this post that included a lot of thought and research. Much appreciated. I am a physio with a passion for helping folks with scoliosis. A few thoughts if I can share-
1) As you stated, we should not be demonizing asymmetry nor striving for symmetry. I completely agree. Nickpicking little asymmetries can do more harm than good. I think the key is movement variability. From my own clinical experience, one factor I've seen quite a bit in folks with mod/severe curves is that they tend to "live" in their curve patterns. Meaning, the scoliotic alignment becomes the default alignment 90% of the time, with a lack of awareness or inability to move into other positions. I think a lot can contribute to this but I've found it helpful to raise patient/client awareness in this regard and to help folks find other movements and positions to experience.
2) From a research standpoint, scoliosis-specific exercise has a long way to go in terms of proving effectiveness. However, I'd like to offer this perspective that's hard to grasp from a look at evidence alone. Coming out of PT school in 2006, I had 1 hour of scoliosis education under my belt. Since 2012, I've gone after scoliosis education with determination and now I've had hundreds of hours of scoliosis education between various scoliosis-specific approaches and attending spine conferences. Do I think I'm the best therapist ever? No. But I know that I've thought deeply about scoliosis in a way to better help adolescents and adults who live their lives with scoliosis. I think that scoliosis-specific EDUCATION is really valuable, even from the standpoint of offering a non-specific effect. I have found that parents of an adolescents with recently discovered (hypothetically) 35 degree Cobb angle scoliosis with plenty of growth remaining and recommendations to wear a brace 20 hours per day value coming to a provider who's really done a lot of work to understand scoliosis. I feel myself to be more effective than the old PT Kelly from pre-2012 with just one hour of education in my brain. I feel myself to be a valuable asset to the team even vs doing nothing at all. Honestly, most parents don't want to do nothing at all for their child. Being told there's a significant asymmetry in the spine that could worsen can feel scary and alarming. Being offered exercise options that are safe, in consideration of the individual curve pattern, I think can help alleviate a lot of fear. From the perspective of an adult with scoliosis, perhaps a woman who wore a huge metal brace for years as a teen, was subject to xray after xray, who chooses her clothes based on how they affect how her back looks, same thing, I find folks feel relieved in the hands of a provider with an extensive knowledge base in the area. I'm not sure how to articulate this in a way that can be proven in the research.
I think ultimately, I take issue with the concept that we should tell folks not to worry about scoliosis at all. Yes, mild Cobb angles and small asymmetries and even mod/large asymmetries don't predict function and quality of life. However, for many, particularly girls who had to deal with bracing and surgery and the effect of a different aesthetic on self-image, the experience can be influential on a person's life experience.
Thank you for giving me space to offer my two cents and cheers if folks have read all the way to the end of this looooong comment! Appreciate the work you do :)
Thanks for sharing your knowledge Kelly, much appreciated.
Many people with headaches are treated with lengthy exercise "therapy" for scoliosis, head forward, loss of cervical lordosis.
A physiatrist whom I consulted with for leg and deltoid weakness, poked my back in 2 places and said I had moderate scoliosis and prescribed 18 PT sessions of corrective exercises. No imaging or measurements were taken. I couldn't afford it but having read enough of the literature didn't do it.
Tod,
Do you have any experience working with severe scoliosis, 2 rods along the spine from T3-L3 and 16 small rods, surgically placed at age 12, now 36yo. Suffering from back pain,
by working I'm Thinking Feldenkrais lessons.
Thanks! for any input!
Hi Inbar, No I don't have much experience with severe scoliosis or surgical corrections. I like Feldenkrais style movement for anyone who (1) is interested in Feldenkrais or mind/body therapies like meditation and (2) has gotten some results from either.
Nice, well explained article
You say "the heart is on the right", but no. It's essentially right in the center behind the sternum, but sort of peeking out from behind it, on the left. Center-left, like Bernie Sanders. I tried to paste in a picture, but the software doesn't allow that. Google "location of human heart". The basic point that we're not PERFECTLY symmetrical is correct; only one liver, two lobes on the left lung and three on the right (I'm pretty sure, without checking), but our basic body plan is bilateral symmetry--left mirroring right, back different from front, top different from bottom. It's basically two of everything, with one digestive tube in the center, and some other quite minor modifications in the internal organs. I would argue that we're much more symmetrical than asymmetrical.
Hi Jerry. Thanks for pointing out the mistake, which I've now corrected! I meant to say heart on left, liver on right. And yes we are more symmetrical than not, but some asymmetry is part of the plan.