What is Scoliosis?
This image on the right shows a "normal" spinal curvature.
When I was a kid, we used to have these scoliosis tests in which the school nurse called you out of class, had you bend over, and then karate chop checked your spine for irregular curves. I always remember wondering what would happen if you were found guilty of scoliosis-just being called out of class in groups was stressful enough, especially when your classmates were waiting in the same room with you. But I digress.
What is scoliosis? Simply put, it's an irregular curve of the spine to the side. We look at the human body through anatomical planes of movement (sagittal, horizontal, frontal), and the spine naturals orients its curves in the sagittal plane, but scoliosis will create curves in the frontal plane (i.e. sideways curves). While scoliosis can correspond with certain diagnoses (sometimes called nonstructural scoliosis, correlated with cerebral palsy, muscular dystrophy), most causes are unknown, and may be a combination of genetics, injuries, habits, or other causes. Scoliosis is defined as an abnormal spinal curvature that deviates in the sideways plane, or frontal plane. Kyphosis and lordosis are exaggerations of the existing spinal curves (front to back- sagittal plane) either from habit (high heels, asymmetrical instruments.), genetics, aging (osteoporosis and bone degeneration) or other diagnosis.
Notice that scoliosis is a lateral curve deviation , whereas the other two examples exaggerate the native curves of the spine.
So why care about scoliosis? Well, many musicians have scoliosis but don't do much about it until the pain it causes is quite severe. Doctors haven't agreed whether the muscles and soft tissues caused the misalignment or whether the bones pulled the muscles out of alignment, but the result can be discomfort, particularly on the side where the spine is pulled (in the images, the spine is pulled to the right side). When applied to musicians, one has to take into consideration any asymmetrical postures or movement habits, whether it's playing the violin which might exaggerate a curve to the left or playing the flute. Some musicians were diagnosed with scoliosis as a child and have adapted accordingly, whereas others have found that their body adopted a non structural scoliosis as they've aged. (Side note: medical professionals divide scoliosis into structural, meaning the spinal curvature is difficult to reverse, and nonstructural, meaning that the spine works semi-normally, but with a curvature. I would add that even in severe scoliosis, change is possible with medical treatment/physical therapy, because of the body's ability to adapt) What also makes scoliosis more difficult to address is that the curve deviation is to the side, but it usually alters the curves in the sagittal plane, meaning that a lateral deviation could exaggerate a kyphosis in the upper back, or limit the natural lumbar curve. Although scoliosis is often defined as a simple lateral deviation of the spine, the dynamic curvature of the spine makes scoliosis a more complex spinal deviation.
In the image above, the woman with scoliosis might have serious right sided pain due to the tension of the tissues on the right side, but will also have certain movement restrictions, whether in daily life or athletic endeavors. In the old days, those with severe scoliosis got a steel rod implanted, which not only hurt immensely but also restricted all normal movement of the spine. The steel rod is less common, though many older individuals still have it from their youth. No one has fully "cured" scoliosis, meaning that few people return to a fully "normal" spinal curvature, but there are many ways of allaying pain, discomfort, and the effects of scoliosis. As always, seek the insights of a medical professional if you're working with scoliosis, and make sure that any movement professional, bodyworker, or instructor understands scoliosis and how to best assist you.
1. Therapeutic movement: work with someone who can see your patterns and help to balance out the musculature strength and weaknesses. Going to a traditional yoga or pilates class might not help until you know your own tendencies-certain postures will be easy because they're on the good side, others less so, and to exaggerate the "good side" postures is not helpful in the long term. Looking to balance out the sides, strengthen weak and unbalanced muscles, and decrease the discomfort is key.
here's my model skeleton with some right sided scoliosis.
2. Ditch the high heels (and probably the spanx too). I played a concert with an operatic soloist whose scoliosis was apparent through her gowns, and when she wore her 5 inch heels, the curve was definitely exaggerated, and probably painful. (It was difficult to watch and wonder how that affected things.) Remember that high heels cause spinal misalignment in the sagittal plane and can increase neck pain, low back pain, etc.
3. Bodywork: Seeing a rolfer, a deep tissue manual therapist, and NKT practitioner...all can be really valuable. These folks will hopefully work a bit more on the restricted side (if the spine deviates to the right, the tissues on the right may be weaker, painful and less forgiving), and help to restore a feeling of balance in the long run.
4. Self-massage: Using therapy balls to work on your own misalignment can be empowering and pain killing, which is terrific. Combining self massage with therapeutic movement and bodywork would be a great way to work with pain and restriction.
5. Take a moment to look at how you sleep, especially if you're a side sleeper. There has been some involved research about long term changes from sleep patterns, and if you always sleep on the good side (or bad side), you might be increasing your pain and discomfort unknowingly.
6. Know your curve. Figure out where in the spine your deviation is, what movements hurt (or don't hurt), where you have pain, and what you need to work on. Taking agency for your own body aids other practitioners in helping you more effectively.
*Oh, and quick point, if you teach very young children, watch to see how they stand and sit. Try to gently guide them to upright positions so as to avoid spinal misalignments down the line. Scoliosis is technically idiopathic (don't know the cause), but when instruments like violin/viola and brass instruments favor one side and children start early, there's a possibility of long term adaptation, especially given how malleable bones and soft tissues are in our youth.*