Clinical Conversation: Working With Scoliosis (June 2022)

This transcript includes highlights from the live, interactive session of our Clinical Conversation: Working With Scoliosis. 

If you missed the live webinar, you can read about how to use clinical Pilates to work with scoliosis below. 

Please join our next live event, where you can participate in our Case Study discussion and Q&A session. 

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  • Scoliosis is a side to side, three dimensional curve of the spine, involving curves in the sagittal, coronal, and transverse planes.
  • In addition to the spinal curves, scoliosis also presents with a concave and  convex hemithorax.
  •  Despite the fact that scoliosis exists in three dimensions, it is defined an measured by curves in the coronal plane.
    • for a diagnosis of Scoliosis, a patient needs to have a Cobb angle of more than ten degrees.
  • Scoliosis affects the bones, joints, ligaments and muscles of the spine, as well as the lungs and other internal organs of the thorax.


  • Congenital.
    • Occurs when a patient is born with a bony abnormality that causes the spine grows into a curve.
  • Neuromuscular.
    • Generally develops when patients have a neuromuscular condition where the muscles of the spine are unable to hold a "normal" spinal alignment.
    • Scoliosis in these patients is secondary to the other neuromuscular conditions.
    • Muscular dystrophy, Marfan syndrome, and cerebral palsy are all examples of conditions where people might develop a neuromuscular scoliosis.
  • Idiopathic.
    • Generally develops in adolescents between the ages 10-18, and there is no known cause.
    • As adolescents, children are experiencing big growth spurts, thus the risk of curve progression through this stage is fairly high.
    • Female-bodied individuals tend to develop idiopathic scoliosis at a rate of about seven to one, compared with male-bodied persons.
  • Adult de Novo.
    • Occurs in adults who are experiencing degenerative changes in their spine, who have not had a previous diagnosis of scoliosis.



  • Bracing.
  • Breathing exercises.
  • Strength and mobility exercises.
  • Manual therapy.
  • Respiratory therapy.
  • Surgery.



  • The Pelvis as the Foundation.
    • There is generally not a true leg length discrepancy, with asymmetries of the pelvis most often presenting as a result of spinal curves.
    • Therefore helping patients to build symmetry in their pelvis will give them a stable base from which to work towards more efficient spinal alignment.
    • Hip and lower limb dissociation with gravity eliminated builds strength for equal weightbearing through the legs. 
    • Supine and prone can be great positions for patients to feel the rotations of their pelvis.
    • E.g. Reformer footwork is excellent for patients to feel lateral flexion through the spine/hiking of the pelvis while driving the movement equally through both legs. 
    • Progression to side lying leg press on the Reformer challenges the alignment and stability of the thorax, pelvis, and spine in space, but doesn't require the spine to be held upright against gravity.
    • From here, progress to sitting, and then to standing to challenge the spine against gravity.
  • Unwind Curves in Three Dimensions.
    • For movement to occur around a joint, there needs to first be space for movement: traction, hanging, stretching, and breath can all be used to decompress shortened sides of the spine, before then moving the joints through a decompressed range of movement. 
    • We can build to balance the curves of the body by working asymmetrically: If a patient already has asymmetries, then working each side equally will only reinforce those asymmetries. 
    • E.g. If a patient's thorax is rotated to the right and laterally shifted to the left, help them to align to centre before working their left rotation and left side flexion. 
    • Build postural strength in optimal alignment: Decompress the spine, move the spine and thorax into its optimal alignment over the pelvis, and hold this position while working the upper of lower body.
    • E.g. Seated Chariots on the Reformer will work the shoulder girdle to spine connections, and the patient will build postural strength through holding their optimal spinal alignment ("unwound" curve). 
  • Use Breath.
    • The muscles of respiration are directly connected to the spine and ribcage, and thus can be engaged to support optimal spinal alignment.
    • Directing breath to certain areas of the spine and thorax can also facilitate decompression and thus movement into these areas. 


  • Lie on the floor, with your knees bent and feet flat on the floor.
  • Notice your breath, and where it settles in your body.
  • Bring your attention to your ribcage, noting the weight of your thorax on the floor, and feeling the expansion of your breath into this area.
  • Using the floor as feedback, see if you can direct your breath into your right lung only, noticing how the right side of your thorax expands toward the floor.
  • Try the same on the left side.
    • Do you notice a difference side to side?
  • After a few quiet, normal breaths, return your focus to your right lung. 
  • See if you can direct your breath into the bottom third of your right lung.
    • How does that feel?
  • Can you direct your breath into the middle third of your right lung? And the upper third of your right lung?
  • Repeat this on your left side.
    • What differences do you notice side to side?  



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