Top 10 Stretching Exercises for Scoliosis

Human body functions more efficiently and effortlessly when it is in a better alignment, we cannot move properly if we do not start from a proper position. This alignment is compromised in a spinal deformity known as, Scoliosis, Scoliosis refers to the presence of an abnormal lateral curvature or side bending in the Thoracic and/or Lumbar spine. It is a highly variable condition as each patient experiences different severity levels, curvature locations, and condition-related symptoms. Not every patient with scoliosis experiences mobility limitations, but it is important to maintain flexibility in the spine and its surrounding muscles as much as possible. Therefore the focus is laid on building strength and resilience in the body and this can be achieved with the help of trained and experienced physiotherapists. The physiotherapist designs an exercise-based approach to reduce the abnormal spinal curvature, helps to strengthen the spine and its surrounding muscles, improves posture, and the brain-body connection. Today in this blog we have discussed scoliosis and various stretching exercises that can be done by the patients having scoliosis.

 

What is Scoliosis?

Scoliosis is characterized by a tilted head, winged scapula, uneven shoulders, uneven nipple height, rotating torso, a rib hump, uneven arm gap, uneven muscle bulk, asymmetrical abdominals, hip hike and leg length discrepancy. Scoliosis occurs due to two main reasons, Structural and functional reasons.

 

1: Structural Scoliosis occurs due to genetics or as a result of fused joints.

 

2: Functional Scoliosis is determined by how the body habitually the person holds him/herself up as he/she attempts to maintain an upright posture against gravity. The spine gets used to using certain muscles in a certain position, which over time makes the person habitual to hold this abnormal posture. For example, asymmetrical sitting posture, playing sport with the dominant arm only, always carrying the bag on one side, always sleeping on one side, etc.

The spine's surrounding muscles play an important role in providing it with optimal support and stabilization Scoliosis in the spine can limit the amount of flexibility and mobility in the spine which may negatively influence posture and movement.

 

Exercises for Scoliosis

In case of scoliosis 2 or more curves might be present in the spine, one is primary and the others are compensatory curves. The compensatory curve is formed to maintain an upright posture as a response to the primary curve.

The position of the pelvis has a significant influence on the orientation of the entire spine, the pelvis must be in a neutral position while addressing scoliosis. It is important to know where the concave curve is located. Stretching exercises should be given to the muscles which fall within the area of the concavity as these muscles will tend to be tight and/or overactive.

 

Stretching Exercises:

Apex is where the spine bends the most, this area needs to be targeted, and stretching should be felt in the region of concavity at the level of the apex.

 

Stretching exercises for Thoracic area:

Side stretch on the floor:

• The area to be targeted is the side of the rib cage, side of the thoracic spine.
• The patient is asked to lie down with the side of concavity towards the ground.
• While keeping the waist pinned down to the ground, push the torso upright.
• The patient should feel a stretch on the side of the rib cage and the thoracic spine.
• Take a deep breath into the area while the patient feels the stretch also push the ribs and belly out as much as possible.

 

Side Stretch with Flexion:

• The area to be targeted is the side of the spine.
• The patient is asked to sit in a chair.
• Bring the upper back region forwards by making a curve.
• Aim to curve the spine at the level of the apex.
• Bend the spine away from the side of concavity.
• Pull the head towards the armpit that is on the opposite side of the concavity
• The patient should feel a stretch on the side of the spine.
• Take a deep breath into the area and feel the stretch.

 

Stretching exercises for Lumbar area:

Side tilt:

• The patient is asked to stand with feet wide apart with left foot turned out to the side.
• With arms outstretched, the patient starts to bend to the left side.
• The patient should reach the upper arm as far to the left as possible.
• Keep the body in line with the left leg, but do not rotate the body and keep the legs straight.

 

Stretching exercises for Spine area:

• Hanging from a bar is a good and easy way to give traction to the tight joints in the spine.

Traction or Hanging:

• The patient is asked to hold onto a horizontal bar.
• Dropdown, attain a squat position and allow the bodyweight to completely hang off the arms.
• Make sure that the feet are gently resting on the floor for support.
• Lean slightly backward.
• Round the upper torso forwards.
• Tuck in the chin while looking downwards.
• The patient should feel a stretch in the upper back region.
• While doing so take a deep breath in between the shoulder blades to increase the stretch and hold this position for 30 seconds.

 

Step down and one-arm reach:

• With whichever leg appears longer place it on a stepper.
• Lower the opposite leg down to the floor while bending the knee.
• The patient is asked to lower the leg and raise the arm on the same side as high as possible. For example, if the right foot is lowering to the floor, raise the right arm.
• Perform 3 sets and repeat 10 times. Don't perform the exercise on the other side.

 

Upward and downward stretch:

• The patient is in a prone plank position with arms stretched out straight, push the hips back and up as far as possible.
• Hold this position for 2 seconds, and then lower the hips back down toward the floor.
• Try to go as low as possible without discomfort or pain.
• Perform 3 sets and repeat 10 times.

 

Split stance with arm reach:

• Step forward with the longer leg in front in a slightly hyper-flexed stride length.
• Keep the torso as upright as possible.
• Begin to shift the weight back and forth, allowing the knee in front to bend and feel the weight shift onto it.
• While shifting the weight forward, raise the arm that is opposite to the front leg as high as possible.
• While the arm is reaching upward, reach the other arm back as much as possible with the palm up. This movement causes the torso and spine to turn toward the side of the front leg.
• Perform 2 to 3 sets and repeat 10 times.

 

Torso Rotation:

Cat and cow position:

• The patient is asked to attain 4 points kneel sitting position.
• Round up the upper back as much as possible
• Rotate the torso to one side.
• The patient should feel a gentle stretch at the back.
• Make sure that the pelvis does not move.
• Repeat 20 times.

 

Plank:

• The patient is instructed to get into the plank position such that the face is towards the floor and the bodyweight is taken on the elbows and toes keeping the head, back, and legs straight in one line.
• Place the pelvis in a neutral position and the lower back should not sink in.
• Hold this position for 30 seconds.

 

Segmentation

• The patient is in a standing position with arms wrapped around a Swiss ball, trying to touch the fingertips.
• Emphasize rounding over the areas where Scoliosis is located.
• Round the spine, one vertebra at a time as the patient proceeds down.
• Then reverse the movements back to the beginning.
• Repeat 20 times.

There are varying degrees of Scoliosis, it is advised that as these exercises are specifically designed and prescribed for the individual, therefore should be done under the guidance of a physiotherapist.

 

Physiotherapy Walking Aids and their use to gain Mobility after an Injury

If you suffer from a stroke or any injury in your leg or foot, then you need to use a walking aid during the process of healing or recovery. These essential walking aids are recommended by your physiotherapist, they include crutches, a cane, a walker, etc. The walking aid helps to keep the bodyweight off the injured or weak leg and helps in balancing and enables to perform the daily activities more safely. In this blog, we'll discuss the different walking aids and how to use them safely.

 

Crutches

After injury or surgery, non-weight bearing on the leg or foot is required if you are unable to bear any weight on your leg or foot, you may have to use crutches.

 

Positioning

• While standing straight, the top of the crutches should be about 1-2 inches below the armpits.
• Handgrips of the crutches should be at the level of the top of the hip line.
• Elbows should be slightly bent while holding the handgrips.
• The weight should rest on the hands and not on the underarm supports, to avoid damage to the nerves and blood vessels in the armpits.

Walking

• Slightly lean forward and put the crutches about one foot in front.
• Begin the step as if you were going to use the injured leg or foot but, instead, shift the weight to the crutches.
• Slowly bring the body forward between the crutches.
•  And finish the step with a good leg.
• While the good leg is on the ground, move the crutches ahead to prepare for the next step.
• Always look forward, not down at the feet.

Sitting

To sit:

• To sit on a sturdy chair.
• Put the injured foot in front of you and hold both crutches in one hand.
• Use the other hand to feel for the seat of the chair behind you.
• Slowly lower yourself into the chair.
• While being seated, lean the crutches upside down as crutches tend to fall when they are leaned on their tips.

To stand up:

• Bring the body to the front of the chair.
• Both the crutches are held in the hand on the injured side.
• Bring the body up and stand on the good leg.

 

Stairs

To go up and come downstairs with crutches:

• Face the stairway, hold the handrail with one hand, and tuck both crutches under the armpit on the other side.
•  While going up, lead with the good foot, keep the injured foot raised behind you.
• While going down, hold the injured foot up in front and hop down each step on the good foot.
• Take only one step at a time.

 

Canes

•  A cane can be used in case of minor problems like pain, weakness, injury in the leg or trunk, or problems with stability or balance.
• In elderly people, a single-point cane is used to walk more comfortably and safely. For more stability, a quad cane, which has 4 points, can be useful.

 

Positioning

• While standing straight, the top of the cane should reach the crease in the wrist.
• Elbow should be slightly bent to hold the cane.
• Hold the cane in the hand opposite to the affected side. For example, if the left leg is injured, hold the cane in the right hand.

 

Walking

• To walk with the cane take about one small stride ahead and step off on the injured leg.
• Finish the step with the good leg.

 

Stairs

To climb stairs:

• Place the cane in the hand opposite to the injured leg.
• With the free hand, grasp the handrail.
• First, step up on the good leg, and then step up on the injured leg.

To come downstairs:

• Place the cane on the step first
• Then, put the injured leg on the step.
• Finally, put the good leg, which carries the body weight, on the step.

 

Walking

• Position the walker about one step ahead, making sure that all four legs of the walker are on even ground.
• With both hands, grip the walker for support and move the injured leg into the middle area of the walker, don't stop at the front.
• Push straight down on the handgrips of the walker to bring the good leg up so it is even with the injured leg. While turning take small steps and move slowly.

 

Sitting

To sit:

• Back up until the legs touch the chair.
• Use the hands to feel for the seat of the chair behind.
• Slowly lower yourself into the chair.

To stand up:

• Push yourself up using the strength of the arms and grasp the walker's handgrips.
• Do not pull on or tilt the walker to help to stand.

 

Stairs

• Never climb stairs or use an escalator with a walker.

 While using walking aid for the first time, have a family member or a friend nearby to give you support. Initially, it may seem difficult but after taking a few tips and a little practice, most people can gain confidence and learn to use a walking aid safely.

 

Hemiparesis | Training, and Re-education of Muscle Weakness by Physiotherapy

Hemiparesis is a condition, in which there is weakness on one side of the body that can occur due to the secondary effect of injury to the central nervous system. Because of this, the treatment of this condition involves engaging the central nervous system's natural ability to heal itself. For this process, the neural pathways are created, reorganized, and strengthened. This blog helps to explain how this technique works through physiotherapy. The physiotherapist helps individuals with hemiparesis to improve their movements by doing repetitive and consistent exercises on their weakened sides. We have discussed below, the effect of physiotherapy exercises on the central nervous system.

 

Hemiparesis

Hemiparesis is most commonly caused by a stroke, in which, the supply of blood in the brain becomes disrupted, which causes brain cells to die. This process can affect the areas of the brain responsible for movement, it can cause issues with motor control such as hemiparesis (weakness on one side of the body) or hemiplegia (paralysis on one side of the body).

Each hemisphere of the brain controls the movement of the body on the opposite. Therefore, hemiparesis typically affects the side of the body opposite to the side of the stroke, whereas some strokes or brain injuries can cause muscle weakness on the same side as the injury, which is called ipsilateral hemiparesis. Movement is not only controlled by the motor cortex but other areas of the brain, such as the cerebellum, that play a role in the ability to move. As a result, there is an increased risk of a stroke or brain injury affecting an area of the brain that contributes to the movement. Other conditions that can cause hemiparesis are cerebral palsy, brain injury, or other diseases that affect the nervous system or brain such as cancers or tumors. Though these causes are less common but still are prevalent.

 

Effect of Physical Therapy Exercises on Neuroplasticity

The central nervous system has the capability to heal itself through the phenomenon of neuroplasticity.

Neuroplasticity occurs based on demand ie the task that is practiced most frequently are the neural pathways that will be the strongest. This is why everyday tasks like combing, eating, tying shoes eventually become thoughtless. Because of practicing the task a thousand times, the neural pathways for that skill become very strong.

Hemiparesis involves neuroplasticity which helps the brain to create and strengthen new pathways that control movement. The stronger these pathways become, the more strengthened and coordinated movement the individual will have with their affected side.

Physiotherapy is such therapy that focuses on neuroplasticity and is crucial for helping survivors regain movement. This is important to regain independence and therefore helps to accomplish the daily activities.

 

Physiotherapy for Hemiparesis

Physiotherapy aims to rehabilitate the nervous system, though hemiparesis recovery is a long process. Neuroplasticity does not occur overnight, it requires repetitive training and a consistent rehabilitation program to keep the recovery going. Physiotherapy helps to restore optimal functioning. The physiotherapist understands how to design exercises with an optimum challenge for patients with hemiparesis to target their affected limbs.

Physiotherapy helps to retrain the affected limbs by repetitive exercises. The more the individual moves their affected side, the more neuroplasticity occurs in response.

As a result the individual gains independence for daily activities like eating, dressing, bathing, etc. Functional training is given such as lifting a spoon, holding things, and placing them back down. Compensation techniques are also taught to the individual to accomplish difficult tasks by using shortcuts and to help him/her navigate their new life. If the individual continues to exercise their affected side regularly, only then they can continue to maximize their chances of motor recovery.

 

Repetitive Practice

Neuroplasticity occurs based on frequency and consistency. For engaging neuroplasticity repeating skilled movements with the weakened side is essential.  The more the task is being practiced, the better the movement becomes. This is referred to as massed practice and it's essential for hemiparesis recovery.

 

Home Exercise Programs

Home exercise programs become important, as they can help individuals to improve by practicing exercises with massed practice at home.

Depending on the frequency of the physiotherapy sessions, physiotherapists suggest practicing home exercise programs to build upon the skills that have been learned in physiotherapy sessions. To optimize neuroplasticity and functional recovery, it is essential to continue practicing outside of therapy sessions.

 

Constraint-Induced Movement Therapy

Constraint-Induced Movement Therapy (CIMT) is a treatment that involves restraining the unaffected side while exercising the affected side for10-15 consecutive weekdays each day the exercises are done for several hours. CIMT is most commonly used for affected arms/hands and involves the affected lower extremities as well. Being more aggressive therapy in the volume, it shows great improvement.

 

Mirror Therapy

This therapy uses a mirror that is placed over the hemiparetic arm or leg. Then, the individual performs exercises with the stronger arm or leg while watching the moving image in the mirror. This image in the mirror tricks the brain into thinking both arms or legs are moving, which helps spark neuroplasticity.

 

Electrical Stimulation

Electrical stimulations are applied to the muscles through pads on the skin, this stimulates movement on the weakened muscles. For example, if an individual has a weak hand or wrist movement, the physiotherapist can apply electrical stimulation, which helps flex and extend the wrist, depending on the placement. For maximum results, these stimulations can be combined with task-related training.

 

Mental Practice

Mental practice is a cognitive treatment that requires no movement at all it helps activate neuroplasticity. It involves mentally rehearsing specific activities to improve the performance of those activities. An individual with hemiparesis is asked to spend time mentally rehearsing their exercises before actually performing them.

 

There is no specific time period for recovery, it can be challenging to predict neurological recovery time, as each person's brain is wired differently, which makes recovery after every neurological injury unique.