Scoliosis and Dance

Dancing with scoliosis, a curvature of the spine, can pose challenges for growing artists. It does not, however, mean the end of a dancing career.

Elina Wisung in conversation with Dr. Mayura Kudva, founder and lead physiotherapist and scoliosis/spinal disorder specialist of Physio4You, a specialist spinal disorder treatment centre in South Bangalore. Dr Mayura is also the mother of Smriti, a Grade 6 student and a dancer with the National Youth Ballet.

Tell us about yourself – what is your background in physiotherapy? What made you interested in physiotherapy? Where did you study? 

Dr. Mayura Kudva

I have 20 years of experience as a physiotherapist and I was fortunate to graduate at Fr. Muller’s College of Physiotherapy from Mangalore.

When I was in Grade 11 at school, I had a teacher who became paralysed in both his legs after a tree fell on him. Within 6 months to a year, I saw how he managed to pull himself to work and drive a car too, with a wheel chair and a modified car. While medicine and surgery helped him survive, it was a physiotherapist who stood behind him and brought him back to lead a near to normal life in the span of one year.  I was amazed by this. This was my inspiration to take up physiotherapy, and to this day it gives me the same joy when I see people who I am able to serve overcome their hurdles, big or small.

What is your specialty within physiotherapy?

I have over the years specialised in physiotherapy for spinal deformities like scoliosis and kyphosis, and have trained in the Schroth Method from Germany, SEAS method of Italy, Dobomed method of Poland, Lyon method of France, Side shift method of UK, and Yoga for Asymmetries and Scoliosis.

What is scoliosis?

Scoliosis is a three-dimensional deformity/ abnormal curvature of the spine. It often affects the whole trunk. 

What are the causes of scoliosis?

80% of scoliosis is idiopathic, meaning it is of unknown cause. 20% occurs secondary to other underlying conditions such as neurological conditions, or some connective tissue syndromes. 

Who does scoliosis affect?

Scoliosis occurs in children, and it is either congenital (present from birth), or develops later as they enter different growth spurts in their adolescence. The cause is unknown and may occur in any child. Because of this, it is a good idea to keep checking the spine during your child’s growth period, especially from the age of 9 to 16, or sometimes even beginning earlier. The earlier scoliosis is detected, the more correctable it can be.

If unattended, scoliosis may lead to a big curve in the spine, and in the worst case, may eventually need a fusion of the whole spine by surgery.

Scoliosis can also occur in ageing adults as a part of the degenerative process.

How is scoliosis diagnosed? Can I see it myself?  What are the methods of early detection?

There are two simple tests to check for some classical signs that indicate if one has scoliosis and they are very easy to perform. If you detect any one or more of these signs in your growing child, you should consult a scoliosis clinician for a full assessment.

Posture Assessment in Standing

Stand with Feet aligned and check for these signs from the back: 

1. Shoulder Level – One shoulder is higher than the other
2. Shoulder blade – One shoulder blade is more noticeable than the other
3. Side to side deviation in spine – a slightly curved C or S spine may be visible
4. Waist asymmetry – Unevenness of the waist
5. Hips asymmetry – One hip is higher than the other
6. Head aligned over pelvis – Head is not centred over bottom.

Forward Bend Test

Keep the feet parallel and aligned when you check this and do not bend your knees. Join your hands in front of you and bend down towards the floor. Put your head down.

Upon bending please check for a hump in the upper back; and or a hump in the lower back. 

What are the different types / stages of scoliosis? 

Scoliosis can be diagnosed as congenital (from birth), infantile (developed in infancy), juvenile (developed at a young age), adolescent or adult scoliosis, depending on the age of diagnosis. According to the severity of the curvature it is diagnosed as mild, moderate or severe scoliosis.

The severity of scoliosis is based on the Cobb angle which is seen through an x-ray. 

• Mild to Moderate — 16-24 degrees
• Moderate — 25-34 degrees
• Moderate to Severe — 35-44 degrees
• Severe — 45-59 degrees
• Very Severe — 60 degrees or more  

Ideally, if the curve is within 30 degrees of Cobb angle at the end of growth the phase, there would not be much risk of progression or pain later in life.

When the curve is severe there is a possibility of progression of the curvature, affecting breathing, equilibrium (balance) and gait, as well as the possibility of a limited functional life with episodes of acute pain and major health implications. 

If detected early during the growth spurt age, scoliosis can be handled well with physiotherapy, specific exercises and bracing.

Does everyone who has scoliosis need treatment? 

A girl with scoliosis, before (L) and after (R) Schroth treatment

During the growth spurt age when the chances of progression of the curve is most, everyone from a mild to severe scoliosis should be under supervision or undergo treatment until they reach the end of their growth phase.

What treatments are available? 

Treatment options can be a mix of scoliosis specific exercises like Schroth, SEAS, Dobomed, and SideShift methods along with soft tissue release techniques, manual therapy by a physiotherapist, and bracing from an orthotist. In very severe cases, there is the option of a spinal fusion surgery.

Does scoliosis get worse over time? 

During the growth spurt age, scoliosis is often, but not always, seen to progress. This is why it is important to keep the curvature of the spine under supervision and frequent checks. During adulthood, moderate to severe curves can worsen slowly over the years, depending on exercise regimes and other lifestyle factors. As we age and degenerative changes occur, there may once again be a progression. This can be handled well with an active and fit lifestyle.

If I suspect my child has scoliosis, what should I do?

If you suspect that your child has scoliosis, you should visit a spine specialist or scoliosis specialist who will examine your child’s spine. They may refer you for an x-ray for diagnosis. You will be referred to a physiotherapist, who will likely use the Schroth therapy (scoliosis physiotherapy) or other methods of therapy and bracing while waiting for the bones to mature. This will prevent any progression during growth and allow for maximum early correction. 

Please share a step by step guide to do an initial check if my child has scoliosis

Does scoliosis affect dance training? How?

The asymmetry in the body may bring in a little difficulty with dance training. One may not be able to do equal movement on both sides, such as lifting both legs at equal height. Since the spine tends to collapse on one side, it may also take more effort for someone with scoliosis to hold oneself symmetrical as compared to someone with a relatively normal spine curvature.  

Is it a good idea to keep dancing if scoliosis is diagnosed?

Yes, any kind of physical activity is very good for growing children and there is no restriction. With ballet, there is a lot of elongation and stability involved with movement. This can only help in scoliosis. The aim of physiotherapy, too, is to bring in correction in three dimensions including elongation, while learning to maintain stability in the spine. Ballet will certainly aid in this. 

Are there any styles of dance which should be avoided? 

No. Extreme backbending activities should be avoided, especially without proper supervision. 

What other areas of life can scoliosis affect?

Scoliosis has effects upon posture and the symmetrical appearance of the body. As scoliosis worsens, it can cause more noticeable changes — including uneven hips and shoulders, prominent ribs, and a shift of the waist and trunk to the side. Individuals with scoliosis often become self-conscious about their appearance.

Scoliosis can cause limitations and difficulties with daily activities, such as walking, lifting, and exercising. It can create problems with balance, but these problems tend to show up later in life, particularly with more severe cases.

Due to the deformation of the spine, scoliosis patients can develop breathing and heart disorders as the rib cage presses into the lungs. Potentially life-threatening complications like these are extremely uncommon, but they can happen.

The physiotherapy scoliosis specific exercises work to strengthen the muscles surrounding the spine, bringing the person into a more central upright position. This prevents progression, improves cosmetic appearance, decreases pain and gives the best possible chance of avoiding spinal fusion surgery.

Are there any other activity restrictions with scoliosis?

With stability, a strong core and very good scoliosis specific exercises program, any activity can be pursued.

There are studies which suggest that some sports or dance styles may be more prone to developing or exaggerating scoliosis in an individual, such as competitive gymnastics, football and other high contact sports.  But it is not that one should not pursue these activities;  rather one needs to keep a check on the spine to detect any trunk asymmetries early and work on them. If these activities were completely avoided, it does not mean that there is no chance of developing scoliosis.

Any physical activity is good and beneficial when undertaken under the supervision of a professional.

Are there any alternative therapies/forms of exercise specifically for dancers that can help with keeping scoliosis under control? 

Yes. The Schroth method from Germany, and many other scoliosis exercise methods that help to work specifically on the curves of the spine, can help dancers to keep scoliosis under control. Alternatively, Iyengar Yoga has helped adults with scoliosis to manage their symptoms. The Iyengar system of Yoga is known for its specific focus on alignment and the innovative use of props that makes the postures therapeutic and accessible for an asymmetric body.

What are some exercises that my child can do if he/she has mild scoliosis? 

These exercises are curve specific and needs to be learnt from a scoliosis specialist physiotherapist. However, lying on the concave (the side that curves inwards) side of the major curve for resting can help to open up that particular side. Also certain exercises like plank, side plank, bridging and mountain climber can keep the spine strong.  But again these are symmetrical exercises and one needs to learn 3- dimensional curve specific exercises to treat scoliosis.

What are some exercises that my child can do if he/she has severe scoliosis?

These exercises are curve specific and needs to be learnt from a scoliosis specialist physiotherapist.

What is your general advice to parents with children who have scoliosis or are worried about it? 

My suggestion would be to keep checking on your child’s spine in their growing age. Unfortunately, a spine check is not done in schools here in India. We as parents need to take that responsibility, just like you think about vaccinating your child, or even bracing your child’s teeth. The spine is the most important part of your body.  

Incase your child has scoliosis, please work towards managing it well until they are mature and have stopped growing. 

With a disciplined, active and healthy lifestyle, there is nothing to fear about scoliosis management.  It is not a fatal condition. 

Are there any good daily habits you can recommend to keep the spine strong and lengthened, especially at this very screen-concentrated time. 

If you or your child are sitting for long hours in front of a desk, a good ergonomic chair will help to prevent slouching. In general, avoid long fixed sitting. If possible, stand up to stretch even while attending online lessons. 

Here are a few exercises one can do while at the desk. 

Dr. Mayura can be reached on Physio4you

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