 And welcome back to Think Tech Hawaii in my sixth episode of Movement Matters. Movement Matters covers topics dealing with health and wellness of your body. If this is your first time joining us, I'm Christine Linders. I've been a licensed physical therapist for over 23 years in California, New York, Connecticut, now Hawaii in a variety of settings, including sports, orthopedics, neuro, and on-site corporate wellness platforms. I'm a board-certified orthopedic clinical specialist. I'm certified in applied functional science, and I have my manual therapy certification. This show is designed to bring you the most cutting-edge and effective treatment strategies so you can help your body perform better, decrease pain, and get back to doing the things that you love. Today, I'll focus on scoliosis, a simple and effective approach to learning to treat your curve. I began teaching to the community and physical therapists on my treatment approach to scoliosis in 2012. I presented successful case studies using my approach at physician rounds in New York City and prepared community education talks in Connecticut and New York, and then in 2016, I had the pleasure of instructing a two-hour educational seminar on my approach at the National Physical Therapy Association's annual special section conference. So what does scoliosis look like? Scoliosis can take on several different shapes. And here's one image of a person with scoliosis. So you can see a curve that's looking at the person from behind. And so when someone like that comes into physical therapy that has that curve, it can be from many reasons. But for the purpose of my show today, I want to explain to people that do have a curve a little bit about where they can start and what you could get from physical therapy. So what we're trying to accomplish in physical therapy is to address the signs and symptoms that you're experiencing which are related to your curve and could be a result of some of the postural collapse and the compensations that your body has made over time. You could experience shoulder pain or shoulder blade pain, back pain, neck pain, hip pain or more. So in image number two, we're going to show an X-ray of Rachel. And so Rachel and I met in August and she came to my house after her first physical therapy session and we were looking at her back, she had some gluteal pain or sciatica and we noticed that she wasn't standing quite straight. And so about a week later she got the results of her X-ray and it showed this slight curve to the right that you can see here in the X-ray. And so in image number three, Rachel and I met up this Sunday, in image number three I imposed a line so that you could see the curve that's in her upper back there, it extends down to the top of her lower back and that is something that matched her X-ray, something that we found. And if you go into image number four, you'll see in the upper photo how if you drew a line across the grass, how Rachel's left shoulder is higher than her right shoulder, that's something that we'll talk to Rachel about in a minute and something that she noticed and in the image below, a minute later, Rachel had learned how to correct her curve. So the point is showing those photos is that there's some simple exercises that you can do if you do have scoliosis that can correct your posture and activate and turn on all those muscles that may be inhibited because of your curve. Now hers is mild and some people might have more severe curves, but the point is there's very simple things that you can do and I wanted to teach you all about that today. So now let's meet Rachel. Rachel's a volleyball coach, a beach volleyball player and fitness enthusiast who recently sought medical attention for the pain that she was experiencing in her buttock and more it was concerning her about playing volleyball. She was nervous to play, she didn't want to make it worse because it was preventing her from sleeping at night. So Rachel, thank you so much for coming on to Move It Matters. You're having me, Christine. I'm so excited to be here and share this and hopefully help others who have similar issues. I know you will, so I want you to tell me a little bit about your history with your buttock pain, back pain, anything that you were complaining of. Yeah, so what brought me to seek medical attention in the first place was this reoccurring, pinching deep inside my glute and from having it before and going to some like massage therapists and friends kind of describing it that they were saying it was my piriformis muscle tightening around my sciatic nerve and in the last seven years since I lived in Hawaii I've had that pain three times. This was the third episode and so the first two times it was painful when I would bend over the pinching but I think that kept me from doing everything that I would do, play volleyball, coach volleyball, all my activities, yoga. But this third time it really affected all those things I love to do. Was there something different, did you have an injury or was it just a different presentation? It wasn't a different presentation but the thing that was different this third time around was that I couldn't sleep at night and usually before I could lay flat and it would relax and I'd feel better in the morning. This time I'd go to sleep and I'd wake up in pain. I knew something was different and it was something I had to seek help for. That's when you have to get help too I mean because sleep is when we're supposed to restore when our muscles and our bodies get to replenish themselves and so that's usually the time when people that do have pain are able to rest the most. So what did you see, what did you do? So I went to my general doctor and I just mentioned it to her I was actually there for another reason and I said hey I'm having this pain I can't sleep at night I've had it before and I said could you please you know prescribe me physical therapy and she did a quick check and she's like yeah it looks sounds like sciatica I can refer you and so that's how I got started and went to eight weeks of physical therapy and they had some great insights and told me a lot of great things however by the end of physical therapy eight weeks I was in more pain I had numbness going down to my toes that's not okay not okay and so it just progressed and got worse. So did they did they see that you had a scoliosis or is it something they were addressing and the treatments? No they kind of went off of verbally what I was saying about my piriformis and just previous information I had been told and I thought was my issue not really thinking that I had spine issues so I think that might have been part of the issue. Yeah just addressing so one of the things that Rachel and I have talked about that for the audience sciatica is a term that has been globalized to call pain usually that's coming out of your one side of your rear end running down your leg and nerve irritation and back in the day the true sciatica was where the sciatic nerve could pierce the bottom of the piriformis muscle which is a deep hip rotator and it would aggravate the nerve and people would get pain down their legs someone like who was a runner that had a weak gluteus medius which is a bigger hip muscle that's something that could cause a sciatica but another thing that could cause this global term of sciatica which is tending now to just mean pain that's running down your leg which we call a radiculopathy often more often than not comes from your spine where the nerves are exiting the vertebrae like L4 L5 to the S1 which is the top of your sacrum where the nerves are coming out where that nerves getting pinched in the L5 S1 distribution is causing your piriformis muscle or the deep gluteal muscles to tighten up because the nerve is aggravating and misfiring its messages and then you get pain down your leg so I know it's something Rachel I talked about with the when I first saw her a week after your PT assessment I had looked and saw like a little rotation in the lumbar and was concerned and at that time you didn't have back pain you just had butt pain right and so we were trying to I think I corrected the little rotation and then you went off and did your PT I think until I saw you again in last weekend which is crazy many weeks later many weeks two months later I guess the time right yeah a little bit more than two months later but you are doing much better now right much better now so yeah what between the first time I saw you and this last weekend I saw you I had progressed from no lower back pain or numbness in my toes to radiating lower back pain from the pinching in my butt yeah and then the numbness that went down into my toes horrible pain when I would sit I couldn't sit for more than 10 minutes at a time and then finally I after eight weeks of PT that's where I was with the worst pain I've ever had I couldn't sit for 10 minutes and then I PT ended my prescription it ended so I took everything I learned from everybody I've talked to you physical therapists my massage therapist everybody and I just put together my own routine that's fantastic where I just was like okay I feel like this is what my body needs and I would do some really deep piriformis glute stretches and then I would do some strengthening and then I would do some real core strengthening and then stretching yeah so so from then on it's taken weeks but I feel tremendous I only get the pinching when I bend over now I don't have the back pain you could sleep I don't have I can sleep I I don't have the nerve I don't have the numbness in my toes right now that's terrific however I did go to another doctor and they did a nerve test and they said I from this I have residual nerve damage on my leg so I'm now going to PT for for that which is yeah that's that's a good overall I feel so much better and it's it's because of all the information I've received and I've just taken it and I've tried to you know it's a lot of work you know it's a daily daily effort to try and get back into health it is and I'm thanks for saying that I think that's great and I think one of the things for people listening to show that you said is so huge that our job as physical therapists and health professionals doctors chiropractors massage therapists is to give you extend our knowledge to you because every body is every body is different and so it's good that you you're so aware of your body and I know you've done some Pilates training and things like that that it's great that you were able to extrapolate of all the things that you were given some great things to do for yourself and you also mentioned too that it's a kind of a daily practice so what in that second picture that I had shown or the third or fourth I can't remember but the picture where you had straightened out your shoulders mm-hmm how long have you been working on that how easy is that how often do you have to do that is it normal now so Sunday yeah so I've noticed that I was leaning with my left shoulder up it was probably about nine months ago now and I was when I was in practicing Pilates and you're looking at your alignment exactly Pilates is all about alignment realigning and redistributing your strength right and so I noticed that back then and we're like that's weird and I never noticed it before and I was like huh and so I just noticed and I and I tilt the shoulder down I engage my lat here absolutely and I just try and stay come back into realignment even though it feels unaligned right but I look at myself in a mirror or you know and here I am but it's a constant reminder because it doesn't feel normal and so I have to remember or realize when I get comfortable again am I aligned you know but it's starting it's starting to feel normal I think I've been doing this for three months yeah it's been three months three months just early August right or before yeah so I think that's that's important for everyone to know too is the I love it when I'm helping someone that has a scoliosis or that is sitting poorly even if they're just flouching forward in this plane it's great when I correct them and they say well that doesn't feel normal or what that feels weird because I'm thinking oh that's great because your nervous system if you tend to sit like this or if you have a scoliosis it's something that the one we're talking about that happened during your growth spurt so sitting like this to you feels normal but when we correct you and we level you out I like that it feels weird because your nervous system has the normal within your curve as this when you move straight your nervous system feels abnormal and now it needs to adjust to that as it being your new normal it needs to learn a new habit like we do when we brush our teeth every morning or I had shoulder surgery I had to you know scratch my back and brush my hair and damage my gums brushing my teeth in my left hand that was a habit that even to this day I'm not as good at but I was able to do it and so you're developing a new habit and your nervous system is now saying that straight and you do think about it daily and probably multiple times I think it's a good point that you made is some of a lot of us are hunched over every day and it was more of an awareness of everything about my alignment and it wasn't just the scoliosis or just the tilt I did have you know tendency to do this as well so just bringing awareness to my overall body alignment to bring everything up tall and straight and holding in with my anatomic girl you know my abdominal girl you know and just it's but it's a daily thing I have to remind myself sitting in the car don't lean back in the car right don't lean back up straight and engage and that's a really good time for me to practice my my posture that's fantastic so we're going to go to a very brief break this is movement matters Think Tech Hawaii we'll be right back stay tuned thanks to our Think Tech underwriters and grand tours The Atherton Family Foundation Carol Mun Lee and the Friends of Think Tech The Center for Microbial Oceanography Research and Education Collateral Analytics The Cook Foundation Dwayne Kurisu The Hawaii Community Foundation The Hawaii Council of Associations of Apartment Owners Hawaii Energy The Hawaii Energy Policy Forum Hawaiian Electric Company Integrated Security Technologies Galen Ho of BAE Systems Kamehameha Schools MW Group The Shidler Family Foundation The Sydney Stern Memorial Trust Volo Foundation Yuriko J. Sugimura Thanks so much to you all we're live this is movement matters and I'm speaking with Rachel Sherman who is a volleyball coach and beach volleyball player who happens to have scoliosis and we were just talking about how Rachel has been practicing on her own how she sits in her car to realign her curve and fire the proper muscle so she can feel better so Rachel tell us a little bit more about you realigning your body coming out of your curve is there other times of the day besides sitting or standing that you notice that you're off that you have to now think about to fix yeah so so I now know when I'm sitting I can re-correct when I'm standing I re-correct but what's kind of funny is sometimes I go salsa dancing with my sister it's so much fun and it relaxes you it's such a good time it's a core workout right it's a core workout yes but it's funny I go with my sister and we talk about you know this stuff and she says oh my gosh Rachel when you dance it's so prominent that your shoulder drops and that you look she says you look so crooked and it makes sense though because you know when you're dancing you're thinking about the the dance moves and the feet you know uh steps I'm not thinking about re-correcting so maybe that's like the next step is to try and bring that correction but I want it to be natural and I think it's getting there but it's getting natural like that just reminded me now too because we were at the park on Sunday and you had mentioned now how you when you do sit-ups you you change your position too even before doing sit-ups and I think that's awesome and I mentioned how I have a mild scoliosis it's uh I don't know if it's undiagnosed or or whatever I have it in my family and I don't think I really noticed it until after I had had a couple surgeries on my left shoulder and I thought that's why my shoulder blade was weak because that happens sometimes after a major reconstruction but my mom said I think I remember you always one of my problems is my shoulder blade sticks in the chair and she goes I think you always did that you always fidgeted and like you're always moving them one arm around because your shoulder blade kind of stuck out and that's something that can happen on the side that the spine rotates towards because it pushes the ribs out of the way yeah and so I think I mentioned to you how look at my ribs like when I was laying down I was noticing that I was off so I would correct my ribs and then do sit-ups and it felt so much better on the back problem that I had had immediately I felt like it loosened up so I was pretty psyched when you mentioned all in your own hey let me fix it when I'm laying down and exercise and strengthening my body alignment pilates biomechanical I'm super big into aligning things getting this close to normal that you can because I think things work better there right and it was when I started practicing pilates that really paying attention to my alignment came into full play like in a daily life my lifestyle and it was interesting though because I sort of kind of when you found the scoliosis I was like I thought I had that because way back in the day you know when you're a kid in in school they do the scoliosis test where they make you bend over and I thought I remembered way back then that someone once said that I had it and yeah but we never did anything and it's small because it was slight like it was not a big deal however now you know how active I am and just the repetitive motions that we get into in habits it's definitely come out in this lean and now that I have to be aware of incorrect so I hope that like people can become aware earlier and understand earlier that that's why we're here today yeah it's it's great it's uh my friend Marissa she teaches a stroth method in New Jersey and we did a talk together I forgot to mention that in my credentials but we did a talk together troth and then my biomechanical approach to scoliosis which mine is very similar since researching now there's a Italian technique s e a s which is like scoliosis exercise specific things that's having good results we did a talk together to show how a stroth would treat someone and then how I treated someone and then what the person looked like afterward which was fantastic yeah you gave me some great exercises that I did on my own at home like the strengthening twist and oh yeah yeah that's great and so in image five I show a picture of someone doing exercises that we gave to Rachel back in August when I first saw her this is opposite of her curve so if you're trying to look at her x-ray and rewind and see this is opposite because this was uh I took this from my PowerPoint presentation but one of the things that you want to do is the scoliosis takes on a three-dimensional curve so you have rotation which is left to right you have side bending which is left to right but leaning left to right and then you have bending forward backward like slouching forward and bending backward and so one of the things I do with my patient is I start to break down okay we need to get you derotating so in this slide on the left you'll see the model rotating back and that's to get the ribs out of the way to stretch it out of the curve to help the body rotate away from the curve it's important to do a lot of breathing when you're doing the rotation like that to open up the ribcage because on that inside of the curve they call it the concavity the ribs are closer together so you want to expand those intercostal muscles that live between the ribs and breathe you can do it as a stretch and hold in a position and breathe or you can go backward and forward like a bow and arrow while you breathe that gets a little bit more of muscle activation into it and then in the picture on the right where you see the model leaning over that's a spine corrector apparatus you can use a foam roll you can roll a pillow you put it at the the peak of the upper back curve the thoracic curve usually it's the upper upper curve in most people you put it right at the peak of that open up your ribcage put your arm over the side and breathe and really expand now that takes care of the side bending component so when i'm first working with my patients with scoliosis i will break it down in the rotation the side bend once they learn that once they're getting stretched out then i say okay now let's do rotation and side bend okay now let's do rotation side bend and flexion and extension so we get the three-dimensional nature of the curve and so i think i gave you the bow and arrow and the stretch so we got the rotation the side bend and you are already working on your flexion extension your posture getting that third component so i'm leaning forward to just sitting straight i love i love that you're doing all these things and even more so of course that you're feeling better getting better because i can't wait to play beach volleyball with you in image six i've been waiting image six six shows rachel bending forward and so this is why probably nothing was done with her when she was younger because i drew a little arrow there that's where you could see a little bit of a rib hump but it's so small and mine looks exactly the same as hers because no one even noticed when i was in high school because it's so small and usually under 10 degrees it's very hard to see it with the naked eye and i have seen curves like rachel and mine that is maybe eight degrees like then they people have had x-rays and said oh that's an eight degree curve they measure that a specific way but it's very hard to see and i think in a kid it's probably almost impossible to see but in an adult we've compensated a little bit and probably leaned into our curve a little bit not knowing and so now it's it we're able to see it yeah with the naked eye even though the curve angle may be eight to ten degrees and so in image seven another thing i want to call out to people that may be difficult unless you're seeing a physical therapist or someone that you know is dealing with scoliosis or very good in alignment is you need to identify your curve so there's lots of ways to do it there's scoliometers there's apps on your phone but the forward bend test is very good to see so in the leftmost image you'll see i put little stickers right up and down the center of the spine and you can see a slight fullness on the right she has a lower curve it's like the sort right at the bottom of her thoracic spine or middle back that extends down into her lower back and in the middle picture you can see another way to identify the curve because the curves will bend one way and turn the other if you look at the center position you can see the skin fold on the left her waist is more defined on the left indicating that the curve is bending to the left and then you see the fullness in her right lower back in the middle picture it's indicating that she has that rotation her spine is turning to the right and so now in the drawing on the right that's her curve it's so small it's so slight that you almost would never notice it unless you were really looking but she came to me we met before i did my talk she'd had back pain for such a long period of time i think she was maybe 40 42 at the time and was riding in a bus and it was noticing that her back hurt all the time and so in the next picture image number eight we did that same day i loosened up the muscles on her concave side the side that it's bending towards and then i gave her some stretches where i had her get down lean to the right that's the side bending component the picture on the left where she's leaning to the right to stretch out the left side doing some breathing opening up that side and then i also gave her on the picture on the right a more functional lunge stretch where she can lunge and lean to the right and lunging and leaning to the right created a little bit of the rotation component but that was our first session so i wanted to be able to show her what she could do right now to feel better and two days later she sent me a message and said i woke up without my back hurting and i've never felt so good i i couldn't believe how quickly it happened but her curve is so small and her only complaint was back pain i hadn't progressed because sometimes they don't that stretch worked really great for her and so some of your things like the things that you're inherently doing straightening your body out is is great and i'm glad that everyone can see that it's something so small that can make such a difference and it's awesome that she all she had to do was a couple exercises i think for me it's progressed quite a bit because of my level of activity and it's just you know really pounded it into that muscle memory in the in the wrong way and so it's taking a lot of effort a daily effort and energy and thought process to get back to normal but i think once you do it still is a daily effort but just to remember stay aligned stay aligned stay tall stay you know keep your scaffolding intact you know i like that the scaffolding yeah you know your shoulders stack on your hips and and while you're keeping your scaffolding aligned to point out from last show about mindfulness meditation how important it is to calm your mind to get the best sleep calm your mind when you are in pain so that you're not overfiring that do your deep breathing clear your mind before sleep so if you didn't get to see two weeks ago check out the mindfulness meditation and in image 10 everybody take a look at that and just relax and enjoy just unwinding your brain this is movement matters i have Rachel Sherman who spoke with me today about scoliosis i want to thank thank tecawaii and all of our donors for having us on today and thank you for joining us tune in next week for part two two weeks for part two on scoliosis aloha