We have many clients coming into our clinic wondering if their spine is slightly rotated or asymmetrical. What we would like our clients to understand is that this is often normal and not necessarily problematic. Gone are the days that we think that everyone should be 100% symmetrical and being slightly “wonky” does not necessarily mean you’ll be in pain. Many healthcare professionals place intense emphasis on leg differences/perfectly aligned spines, but what they should be saying is that spinal curves and leg length differences can sometimes be normal and are ok. It’s how our bodies move and adapt to these differences that matter.
Of course there are instances where having asymmetries could be problematic, but luckily there are exercises that we can do to either help us “straighten out” our curves or strengthen our muscles surrounding the spine to support all the small joints effected by the curve.
Firstly, let’s start by explaining that we mainly have two types of curves in the spine; the first type we refer to as “structural” curves which means that you were probably born with that type of curve. In this instance, the spinal boney segments have been formed this way and trying to “straighten” you out can often lead to more problems. This type of curve is often referred to as a scoliosis which we will be talking more about later. The second type of curve we refer to as a “functional” curve and this is often due to ineffective/weak or tight muscles around the spine that pull us into these curved positions. They often occur due to faulty postural work positions or perhaps playing a type of sport regularly which will overdevelop one side of the body more than the other side and “pull” our spine into a different position. In this instance, we would definitely support the effort to straighten the spine as much as possible with manual therapy techniques, manipulations and very importantly, exercises.
When referring to scoliosis, there are mainly two sub-types of curves – a S-type curve and a C-type curve, and they are treated differently with rehabilitation exercises.
Scoliosis, normally starts to show signs once a child starts puberty and it’s quite important that the child receives early exercise and manual treatment before they have stopped growing. For girls this can start as early as 9 or 10 years old and she will be finished growing by 15 or 16. For boys it’s a bit later. We would recommend the child sees a spinal orthopaedic specialist who specialises in scoliosis and have the child undergo a full standing spinal X-ray. An X-ray of the hand is also often taken to determine how much the child has grown and when he/she has finished growing. For physiotherapists this is the most important time to be treating the individual in order to lessen the development of the scoliosis if possible. Healthcare professionals cannot fix scoliosis curves but can help lessen the severity and help the client’s muscles and joints adapt around the curve.
In adults we cannot minimise the structural scoliosis curves but if that curve is causing symptoms such as headaches, neck pain and or back pain, a physiotherapist can assess the underlying cause and decrease the excess force that the scoliosis is producing. Where I see most patients get hurt is when healthcare professionals or massage therapists try to “straighten” these curves instead of providing high-quality functional exercises to minimise the force produced. In children however, our chances of influencing the development of the curve is possible and it is very important for them to regularly see a physiotherapist who can improve by stretch and manual therapy combined with specific rehabilitation exercises.
Understanding scoliosis curves is extremely important as they are not one dimensional at all but have rotations and translations in all three planes. Explaining this in detail is complex and easier with the help of a flexible spine model. For this reason only doing standard based exercises such as lunges and squats are not enough to influence the curve in all the planes. It is important that the exercises are not only lying down but in upright positions to try and make it as functional as possible.
At Joint Dynamics we have a team of physiotherapists, rehabilitation specialists and massage therapists who really understand the three dimensionality of spinal curves and who work together to provide an excellent service in helping the client get stronger and feel more aligned.