 and welcome back to Movement Matters. I'm your host, Christine Linders, physical therapist and board certified orthopedic clinical specialist. Today I have a special episode for you on scoliosis. It's a subject that is very near and dear to my heart as it has been in my family for generations. And so I'm gonna welcome my mom, Joan Linders, to the show and we're gonna tell you from a patient, a person and a physical therapist standpoint, everything you need to know to identify your curve so you can get to pain-free. Welcome, mom. Hi, Chris. It's great to have you. So I'm gonna be showing everyone today different varieties of curves that we can have. And I know that as a teen, I never knew I had it and you really never knew you had it and we probably both had been screened but tell us a little bit about your back and your scoliosis. I know grandma had scoliosis and my cousin had to have her spine fused when she was 14 or 15 for scoliosis. And then my cousin I found out about 10 years ago when I was doing a talk on how I treat scoliosis, she has scoliosis as well. And so I know it is a very genetic and familial influence and I see that in my patients when I find scoliosis and they're not aware, similar to you and I finding ours and having not really been aware because we didn't notice it until we started getting older. So how did you notice, mom? Well, I would reach back and I could feel the bumps in my spine and I thought that doesn't feel very straight. It wasn't in alignment. And then when you checked me, you said, you confirmed that there's that curvature you could see it and feel the curve. Whereas I couldn't really, you know, to feel the, you know, high up on the back. Yeah, and I was surprised because I had worked on your back before because you had pulled it gardening or something. And I remember just laying you down on the sofa when I was visiting and massaging your back muscles and thinking they were very tight but I never saw anything abnormal from side to side. It was just like, wow, mom, your back muscles are really, really tight and really hard, but a few years ago, I think I'd moved to Hawaii as one of my first trips back, you had back soreness and I looked at it and thought, oh my gosh, mom, do you have scoliosis? And it was obvious and I could see it. And that was into your 70s when it became visible to the eye. Now, were you having some pain before certain sides that you would notice got tight over the years? Yes, well, in nursing, you know, you're always straining and lifting and so I had a few back injuries and I think I was just relating it to that rather than, you know, I thought I got a pass on the scoliosis between grandma and your cousin Jodi. So I didn't. You were telling me the other day how you were feeling like, I think you said gardening and you noticed one side of your back just got. So tight and so hard, which kind of that? Tell us about that. It was the right side and I was, you know, feeling the back and I said, oh my goodness, it's just as hard as a rock and the other side to the left of my spine was loose, you know, and I could, you know, grab some skin but the other side, the right side was so tight. It was so hard. So what did you do? What did you do after gardening to loosen that up? Well, I have the, you know, the hydrocolator moist teeth. Well, this is small when I have into the microwave and then I rested into that and it really helped. And then of course you were telling me how to do the stretch to also improve that, you know, stretch and the breathing and just to expand that area. So, you know, all that, you know, it was so helpful. Yeah. And it works. Yeah, no, that's great. It's great to share what worked for you. And one of the things that I like to talk about with my patients is the first thing I need to do is I need to draw you and I need to show you what I see from the back of your body so you can see the nature of this curve. And so scoliosis, the kind that happens in your adolescent, adolescent growth spurt, they don't know really why it happens. They do know that there is a familial or genetic influence. It happens in three dimensions. So the curve will bend one way, like let's say to the left, it will turn the other way, let's say to the right and there's a variety of bending forward or bending backwards within the curve. And that happens as we grow. Now, you can't really see a curve that's under 10 degrees with the naked eye. And I think that's where you and I made it so far into our lives before, as we aged in one side of the curve got a little tighter, the other side of the curve got a little weaker and gravity took its toll on us. Over the years, plus back injuries with you as a nurse, back injuries with me as a physical therapist and an athlete, now all of a sudden we can see our curves, we can feel our curves, but we didn't even know they were there, we thought we had to buy a pass. So I tell people, we need to draw you because you need to see your back so that you know which side to stretch, which side to strengthen and positions to put your body into relief. Like you said, you're doing some stretches and some heat. So this was just a quick little drawing and to give everybody an idea of what you'll see when you come into the clinic, if whether you know you have scoliosis or not, if I find one, this is what I will give you is I will show you from the back what you look like. And you can see the little notes on there. I write the in, that's a C curve. There's C curve and there's S curves, there's double S curves, and there's all different kinds of curves that you can have, everybody's individual, but those are the two most common is the variation of the C, which is basically like one curve going one way, bending to the right, rotating to the left. And then the S curve is, there's two different parts of the curve, you can have a triple S curve, there's all different kinds, but this is showing that on the inside of the curve here, those muscles tend to be held in the shortened position. So we tend to say they're short and tight because over time, they stay in a short position similar to if you had your arm in a sling and your elbow was bent and then you can't straighten your elbow because that bicep muscle gets held in the shortened position and now it's more difficult to straighten it out, right? And so now on this other side, the outside of the curve over here, those muscles are constantly under load because the spine is bending away from that side. So the brain is getting a message to fire those muscles. And those are the muscles that you were saying in your back were getting really hard because you're bending and gardening and doing all the things that you love to do, but those muscles even at rest, get an input to your brain to fire because they're getting a stretch reflex and now you're bending and you're working and they're lengthened and tired. And so there's a lot of different ways to call it, does that kind of make sense with your curve? Yeah, I look cute from the back. Yeah, don't we all, right? This is great. And I like to make it simple. These years drawing you can do and there's programs you can use with the curve but this is you from the back. And so some of the other that you can see would be like an S curve. And so this is just another drawing that I did of someone you can see the pelvis being off and I try to show the relationships of the little line indicates where the curve changes from one C to the other C making it more into an S. And I try to explain to people, okay, these muscles we need to strengthen because they've been weak and we also need to stretch these guys to make your spine more straight because when you start stretching these out that's when the pain goes away because all of the pain that you experience here or here or in your neck or in your shoulder or in your back, the front of your hip, there's so many different kinds of pains that you can get from having the curve where certain muscles get shorter and others get more strain. So as we stretch out these muscles and start to reactivate or strengthen the other side you not only look straighter because now you have the muscle support more symmetrical on your spine but the pain goes away because there's no abnormal collapse of the curve happening from the muscle compensations. Yeah, yeah. That's a good illustration, both of them. Yeah, it's helpful to see what you are like from the back because none of us can see. So let's go to image number one. It was just a picture of me. I have a very subtle curve and so my thoracic area that middle back between my shoulder blades it is bending to the right and rotating to the left. And if you can see my left shoulder blade is a little bit more prominent on my rib cage and that's kind of been like that all my life my mom said I was always like was always digging into the chairs and I thought it was just because I had shoulder surgery when I was in college and my muscle was weak. But no, she said, no, you're always fidgeting with that shoulder blade and it's because I guess my rib cage got pushed back with my scoliosis but again, it was under 10 degrees. Nobody saw it. I didn't even see it until 10 years ago when I was teaching a class and I was having my mom and dad take pictures of me because I said, yeah, I know there's a problem back there let's see what it looks like. And I thought, wow, yeah, there it is. It's been kicking my shoulder blade out for years. And so image number one shows that image number two is a nice drawing that my dad did of that same curve. So it shows that little blip where the spine is bending to the right but it's also rotating to the left kicking my ribs back and making my shoulder blade kick off of my back and bother me and dig into the chair. Now where that can be symptomatic and I've had this problem for years I don't anymore, I know better but I used to get this terrible pain right here on my shoulder blade and it would run up to the base of my head and give me a pain right here in my eye all the time. One of my patients in Connecticut called it eye grains and I was stretching, stretching, stretching, stretching stretching, stretching, stretching, stretching, stretching and I remember my brother said in college why don't you stop stretching? Maybe that will help. And I wasn't a PT at the time and I thought, okay, I'll try it. And what I was doing was I was stretching a muscle that was already so lengthened that it was crying out in pain. As soon as I stopped stretching it and to strengthen just not even knowing anything about physical therapy that neck pain went away and I no longer get eye grains but I didn't understand it back then. I do now. Yes, yes. I do now. And I know that you've complained of shoulder pain. Yeah. And some of the problems with the rotation in the shoulder is that the ribcage, the way it rotates can push the humorous forward and then your bicep tenderness is really getting an input from your brain to fire and stabilize the ball on your socket. And so now you get super spinatus impingement, rotator cuff impingement or bicep tendonitis and it hurts when you reach and it hurts when you're raised. So you need to go out of the curve to get rid of that pain. Right, and it's that same side. It's the same side. It's the same right side. Yeah. So it's good. It's good for you to, you know, your pain and symptoms and some of mine is good because I want everyone that's watching that scoliosis to learn like, wow, your shoulder pain can be as a result of your curve and all you need to do is reset the balance between those muscles. Your bones will still be curved. So are mine. They may be curved less closer to when you were like, you know, 18 years old and you stretch and strengthen them to get back to your original curve. Unless it's collapsed too much you can get yourself more upright. I've had it happen again and again and again but I want people to get that concept that, oh my gosh, wow, my shoulder could be hurting because of my curve and then I just need to learn these simple techniques and now I can get all this relief and enjoy my life. Yes, more than balance. Everything in balance and it all works better together. Yeah, so are you doing your exercise? I know when I saw you a few weeks ago I gave you some new instructions. Yes. Kind of on and off to tell you the truth but, you know, the W, I find that also helps with this, the back to stretch those muscles. I like that exercise a lot, whether it was intended, you know, for the scoliosis muscles but it does help a lot to help with posture and anything you can do to help your posture is going to be beneficial. I like hearing that, the patient favorites. That W is one that people tell me over and over and over again, I give people a million exercises and you can choose, I say, would you find one that works for you? Do that. Here's a few different ways because everybody's body is different but that W is great because I remember I said, wow, you're starting to round and it's really pushing your shoulders and your neck forward and I didn't, and it could see what was going to happen. It was. Right, and I could see it. So the W is a great one to do. It doesn't ask you to put your arms overhead. So if you have shoulder pain, you're low. It's great for people that have shoulder pain. This is another one, but again, if you have shoulder pain that might not work where you push your elbows back and this is a favorite that I have folks do the ones that get out of bed in their first 15 minutes of the day, they have terrible pain in their back or pain down their legs. It's usually from stenosis, but this one and the ones by your side and this one are the ones that they all say, you know what, when I do those exercise, sitting at the edge of my bed, I feel better when I get up and it's because it fixes their posture. Right, right. Everything gets better back in line and we're good. We're good. So let's go to image C where we look at an x-ray and what happens with these muscles. So you can see in the x-ray, that's a multiple part curve, but I tried to line up the one part that is bending to the left. It will be rotating to the right. So those are the multifidus muscles, the spinal rotators. They're the stabilizers of the spine at each segment. And you can see on the left side where the arrow is pointing, those muscles are relatively shorter in a shortened position. And then ones on the outside are reaching to hold the spine. So that's just a little bit more about understanding what's happening with your curve and which muscles you need to stretch or lengthen, which muscles you need to strengthen. And that would be the shorter side on the inside of the curve will need to be stretched and the other sides will need to be strengthened. So if we go to image D, we can take a look at, I can't even see that picture. Oh yeah, we could take a look at what's happening where there's an arrow pointing to the bump. Now that's a really small curve, but that is the curve pushing the ribs back on the left. So that's the bump that people get their shoulder blades stuck into the chair with. The bump that gives you that headache that goes up here or that pushes your shoulder forward and gives you that terrible bicep pain. Now if we go to image E, we can see a little bit more about someone that has a lumbar spine curve. So this is a S curve where you'll see I do, this is a quick sketch I did for someone so that they can see. It's not coming through here. Okay, I can see it. I can see it though. I think the audience can see it. So it's bending on the lumbar spine, the lower curve, it's bending to the right, you can see it and it's rotating to the left. And the most common place that people get symptoms is on the left side, usually it's on the side where the muscles are strained. But also I tell people, you can get as you age the nerve compression on the right side as the spine is bending toward and there's less space for those lumbar nerves to come out of the spine and go down your leg. So people can get but a pain, sciatica pain. It can happen on the other side and someone younger as the disc get pushed towards the left compromising the nerves on that side. So that's also showing if you start stretching the muscles on the inside of the curve and strengthening the muscles on the outside of the curve, pretty soon all that nerve compression that's held from that positional collapse is no longer there and you can be pain free. Okay. So in that last example where we're looking at the low back and it's bending to the right and rotating to the left, let's go to video F where we have a quick fix of what to do at home. So if your lower spine, your lumbar spine is rotated to the left as in the previous example, you're gonna need to go opposite your curve to reset everything. So when it's rotated to the left with scoliosis, it's bent to the right. So what that means is your low back would be more prominent on this side which indicates that it's rotated to the left and you would have more of a like skin fold on this side which indicates that it's side bent to the right. So all you have to do is get a pillow for your head to support your head and you roll a pillow or a fleece jacket or something. It doesn't even have to be this big. You can be like on the side this way to start off and you put it right in the bend where you are rotated to the left and side bent to the right. This will help bend you to the left. So you lie on your side over a pillow. So now in this position, you are bent to the left opposite of your curve because your curve is bent to the right. And now your curve is turned to the left. You're going to bend your knees up to 90 degrees and now you are going to turn your upper body back to the right. That's a two dimensional correction. So your low spine is turned to the left and bent to the right. Now we are bent to the left and turned to the right. So from that position, you can breathe and stretch. You can open your arm back and really open up the ribcage and take the vertebrae out of the curve and stretch all those side mental muscles. Take deep inhales and relax. You can also, that's a stretch, make it an exercise. You can pretend like you're pulling a bow and arrow and let your ribs come back. Make those spinal rotators work outside of your curve so that you're stabilizing your spine outside of the curve instead of continuing to collapse inside of the curve. This is working on that rotational dimension this way with the bow and arrow. Now if you take your arm up over your head and you raise it up over your head and breathe in. Now you're taking it into that left side bend. Breathe in and open up. If you want, if your knees are okay, you can put your leg down and create more of that bending over the pillow and breathe. Now you can hold that for a stretch and breathe, inhale, exhale five times or you can do it active motion and make it an exercise bending to the left. Enjoy. I remember doing that stretch with you a few years back, mom, do you remember that? Yes, yes, I'm trying to remember. I would put the pillow though on my right side. That's right. Yes, okay. Where's my picture? Here's your right, wait, is that right? Yeah. Yes, here's your right side. Can we see that? Yeah, here's your right side. You would put the pillow on your right side so you open up that side of the curve. Okay, that's what I was remembering. Yeah, that looks like such a great stretch. It's a great stretch. Yeah, yeah. And it's all about maintaining your curve. That's the thing is as we age, some people make it to their late 80s or 90s and they have a severe scoliosis and they don't really have pain. Just like some people have severe degenerative spinal conditions and the doctor will take an extra of their spine because they have like a back ache and they see it so collapse that most people with a quarter of that x-ray would have pain and they don't have pain. And so that's what's great about scoliosis is you don't have to have pain if you have scoliosis, but if you do, these are the things to do to keep your body functioning as close to normal as possible so that you can enjoy your life and not have the pain slowing you down. Sure, oh yeah, I'm gonna try that. Wait, say that again. I will try that. Yeah. I could do it on the bed. Yeah. Okay. I prefer to do it on the bed because it's softer on your shoulders than your hips. If you do it on the floor, it's very abrupt on those bony promises. And so I don't want people to feel discomfort in one way to help another way. Okay. So if we go back to image number A, we're gonna look at the picture where the curve is a thoracic curve is bending to the right and rotating to the left. And let's go to video number G where we'll talk about a very simple sitting correction that you can do at your desk and your chair anywhere. So if you have an upper thoracic curve that's rotated to the left as you'll see here, by this bump where the spine kicks the ribs over to the left, that means you are rotated to the left and you were bent to the right. So an excellent sitting correction if you're having neck pain, shoulder pain from that kicking your spine up like this, you just go the opposite way. So how you wanna start that is your turn to the left and bent to the right. So to go outside of your curve to get your brain to fire those muscles symmetrically on your spine and get out of pain, you are gonna need to shift your rib cage over to the right or drop the left shoulder down to get the side bend first. So what I tell people to do is to hug yourself. You can use your right hand and put it on your left shoulder and you could just let your left hand rest on your arm and you take your right hand, push that left shoulder down and then take your left hand and pull the left shoulder through. So now you are bent to the left, turn to the right, you're out of the curve. You can hear me tighten up because it's my curve and now you wanna inhale, lift your chest, exhale, release, inhale, lift your chest, exhale, release. This is a great stretch to get rid of pain in the neck and the shoulder even in the back and you can also do it as a movement. Bend to the left, shift your ribs, turn and go back and forth. Bend, shift, turn and enjoy. That's excellent. So let's go right to video eight where we talk about what to do if you have a C curve. Okay, so if you have a C curve, which means your spine is basically all one curve bending one way, you would look more like this all in one direction. You wouldn't have the S as I was showing. You would have more of this one direction. So you do the same thing as you did before. You need to, when you're this way, your shoulders will be lifted. You'll be bent to the left and you'll have more of the rib hump on this side of your back. So to undo it, you need to bend to the right and turn to the left. So you're gonna put a pillow here and instead of putting the pillow low like you did in the earlier videos for your low back, you put the pillow more in the middle because you're just one curve. So you don't need to put it too low. You put it kinda right mid-flank between your shoulders and your hips right at the bottom part of your rib cage. And then you just open up your C. Now, if you want more of a stretch, you can actually let your head go down. But if you wanna keep your neck supported, keep your head here. You're bending yourself opposite over the C. Now that's one dimension. That's a side bend dimension. And you can do the breathing. Open up the rib cage that's getting tight on the inside of your curve. Breathe in, let those ribs come up. But also that's one dimension. Now let's get two dimensions. So you're gonna rotate back and inhale. You won't go this far because your ribs are rotated the other direction. You have thoracic spine. It's rotated, take a deep breath in. So now you are side bent to the right and you are rotating to the left and breathing. You're back and forth when you inhale. Breathe. Ah, enjoy. That is depicting a curve like this, a C curve. So if you have the one curve, all you have to do is have someone take a picture of you from behind or bend forward and see the prominences. It's great to really get to know your curve. You can send me some images if you like at my email ClandersRun at gmail.com and I can help you. Anything you need to do to identify which side is tight, which side is weaker and what you need to do. What did you think of those stretches, mom? Oh, it was great. It was great. I could see how that straightened you right in line. Yeah. Wonderful. The visual is very helpful, I think, when you can see it. And I'm very visual. And so that's why I, you know, even though these are simple drawings and you could do much nicer on programs, I've actually done it in the past, it's really nice just in the clinic to say, okay, let's look at this. This is where you're bending in. These are tight. Your nerves, canals are compressed. That's why you're having pain down your leg. Here's the other side. These muscles are weak and long, but when you're bending this way, by anatomy and biomechanics, the discs are shifting this way and now they're crowding the nerve space so you can get pain down here. How do you fix it? Open this to get rid of the compression. Strengthen this to get the disc to sit more centrally within the curve. So now you don't have pain on whichever side you're having pain in. And then what that does to your neck when you're tilted, if you're tilted here and your head's like this to keep your eye level, this is getting really tight, even though there's no curve in your neck. And so you're starting to get all these other pains within the shoulder and it makes sense if you can see the drawing of yourself and how things are shifting. Oh, that's right. When I do this, people will do that sitting stretch and say, something is just like releasing when I take myself out of that curve. They feel it right away and I love that. I love that. I think most of us need that visual. So between your drawings and the demonstration of the exercise, it makes it so plain to what you can do, what you have and what you can do about it. That's great. So I got one more video for you. Let's go right to it. Cause this stretch is money for everybody that wants to loosen up their back. Let's go to video I. Let's say that you're having low back pain on this side because you're in the C curve like this. That's the demonstration that we're going to do right now or you have low back pain on this side but your curve is looking like this. You are side bend to the right and the lower back. A great way to open that up. All my patients love this, including me, is to stand sideways to a wall, put one hand there for balance your left hand. You're going to reach your other hand up over your head. If your shoulder hurts, you can do this. So you don't strain your shoulder. You're going to cross your left, your right foot behind your left and you're going to use this hand and you're going to push your hips away from the wall and then walk your top hand up and then bend your knees and breathe into this part of your rib cage. Open up those connecting muscles that are connecting your rib cage to your pelvis and go opposite your curve. Now that's one dimension. You are bending to the left to open up your curve. You can also take that left hand and now reach it through to the right and turn to the right and breathe. That's going opposite your curve. You don't want to have any pain. You just want to feel stretch. So push your pelvis out, breathe. Bend your knees to stretch or really reach that right arm up and enjoy the stretch. Wow. Yeah. And so you're bending both your knees slightly. I am bending both my knees slightly. And again, like I know with your arm you might not be able to put it overhead. Sometimes I have people put it in front. Sometimes I have people put it on the shoulder because we don't want to, I love this thing, Rob, Peter to pay Paul. You don't want to hurt one thing to solve a problem somewhere else. And I realized myself included, I use myself as a demonstration so often because I've been injured in so many parts of my body. It's almost hard to believe, but I am the one to know, like I can't hurt my shoulder to do this exercise. I have to find a better way. So there's lots of varieties, but you're bending both your knees to elongate your spine this way. And then you're rounding that pelvis out and turning to open up the space between the rib cage, the part that's on the inside of the curb or the ribs are closer and the lungs aren't expanding much to really free that. Yeah, good. I was doing that a little while ago or trying to do exactly what you just showed, but I was in the doorway, but I was able to use my weaker arm to hang onto the molding in a way. Oh, great. Yeah, so it was a point to grasp and the breathing that really it does, it helps to expand that whole area. Thank you for bringing us the breathing. I know I didn't talk about that much today, so everybody stay tuned for next week. We'll do scoliosis 101 part two. We'll talk about more specific exercises to do. So thank you so much, mom, for coming out again and sharing your story with us and your inspiration for the exercises. You're welcome, my pleasure. Thank you. And thanks everyone for joining us today and to thinktechhawaii.com for allowing us to be here with you. Life is better when you'll see your physical therapist. Hello, everyone. Yeah.