Positive Health Online

Scoliosis is not just a teenage issue.  Menopause can also play havoc with our spines.  Caroline Freedman, a Personal Trainer and author of The Scoliosis Handbook discusses how scoliosis can be a very common problem for women too.  Caroline has had three spinal fusion surgeries.  She has extensive knowledge and feels the combination of load bearing weight exercises together yoga practice is ideal to manage the condition.

Scoliosis is a curvature of the spine in an S shaped form

https://www.scoliosishandbook.com/

What is Scoliosis?

Scoliosis is a curvature of the spine in an S shaped form.  It is a side to side curve of over ten degrees. It can affect any age from before birth (congenital), in young children (early onset), teenagers (adolescent idiopathic) where the scoliosis has developed through puberty/growth and onto adulthood. The curve can change dramatically around the ages of 10-20 years old.  Adolescent scoliosis comprises 80% of cases.  We also see it in women going through menopause.

What Links Scoliosis and Menopause?

The effects of menopause affect the quality, strength, and resistance of women’s bones and joints. ‘Menopause significantly speeds bone loss and increases the risk of osteoporosis.  Research indicates that up to 20% of bone loss can happen during these stages and approximately 1 in 10 women over the age of 60 are affected by osteoporosis worldwide’ [Menopause and Bone Loss. endocrine.org. Jan 24 2022.

https://www.endocrine.org/patient-engagement/endocrine-library/menopause-and-bone-loss]

With age the joints and discs in the spine start to collapse in the lumbar (lower part of the spine), discs can then protrude and eventually slip which can cause a scoliosis. Women in menopause can suffer from degenerative scoliosis in two ways. Menopause therefore, can either be a trigger to begin degenerative scoliosis from those who are diagnosed at an earlier age, or cause it to develop in later life.

Caroline says

“I have seen a number of new personal training clients and also friends complaining of backache where they have not had any previous issues.  This is due to in many cases a lack of bone density causing osteoporosis.

“Physically the first thing they may notice is pain on one side of their bodies.  This is due to the spine twisting and a pulling feeling which is the lateral muscles being pulled across the ribcage which over time as the curve progresses can lead to neck ache, headaches and then central and lower back ache.  Pain, as we know causes tiredness and coupled with all our hormonal changes, just adds to the feeling of exhaustion.  They may also notice that they do not look as symmetrical and one shoulder may protrude forward lifting the shoulder blade.  This causes clothes to hang differently and often my clients/friends cannot work out why”

Christine Jaureguiberry, a yoga teacher who runs Yogaberry and has moderate scoliosis herself https://www.movewithscoliosis.com and specialises in yoga for scoliosis adds

“from my experience working with yoga students with scoliosis I can say that a big part of my clients that come to me with problems of pain due to their scoliosis are women that have recently gone through menopause.

“They usually fall into two categories: women who knew they had scoliosis for a long time and where the scoliosis got worse during menopause and women who never knew they had scoliosis and were recently diagnosed.

“We can of course not say for sure if they had scoliosis before (called Adolescent Idiopathic Scoliosis if it developed during teenage years) and it has never been detected or if they developed it later on which is called De Novo Scoliosis or Degenerative Scoliosis”.

“Scoliosis can be a debilitating condition, and maximising bone mineral density is important in helping to reduce the risk of scoliosis developing and deteriorating. After the menopause, bones mineral density (BMD) reduces, taking HRT is an important option to prevent BMD reduction which has been confirmed in several large research studies. Other lifestyle options like regular weight-bearing exercise and diet are also important ways to maintain bone health"

Ellis Downes FRCOG
Consultant Obstetrician & Gynaecologist,

“This is an important underappreciated condition that warrants wider discussion and awareness of the psychological impacts that can be associated with it. I have several menopausal patients who have a history of Adolescent Scoliosis, which is an abnormal curvature of the spine. As these women approach perimenopause depending on the extent of the curve, asymmetric loading in conjunction with declining oestrogen levels and lower bone density may impact on intervertebral disc degenerative changes. This could present with symptoms of chronic back pain, reduced mobility, poor sleep quality, feelings of negative body image, affecting self-esteem and confidence, sometimes causing social withdrawal, anxiety and depression.”

Dr Suzanne Saideman MBChB MRCGP DFSRH
GP and Menopause

“I’m seeing menopausal women with various bone and muscle problems.  The hormonal changes affect blood and bone chemistry.”

“A degenerative curve in adults is caused by progressive joint damage to the spinal segments, falling bone density and weakening of muscle. It presents as a C-shaped curve. It usually affects those above the age of 50. Falling hormone levels (i.e. oestrogen in women), and nutritional deficiencies, contribute to lower bone density. A number of people lose the ability to absorb and maintain adequate vitamin B12 and folate levels. Flat feet, decreased levels of exercise and less effective body balance contribute to curve formation.”

John Rutherford. Caroline Freedman.
The Scoliosis Handbook of Safe and Effective Exercises Pre and Post Surgery

John Rutherford adds

“Postural deficits and falling exercise levels contribute, as well as hormone deficits and mineral and vitamin deficiencies from reduced stomach absorption.  Existing idiopathic scoliosis affects 2% of population.”

“Degenerative scoliosis can be up to 30%

“Also degenerative mainly affects the lumbar spine with minimal curve in the thoracic spine and further, menopause can make an existing idiopathic scoli worse.”

John Rutherford MCSP DC HCPC
www.backpainspecialistslondon.co.uk/p>

Resistance training with weights or any load bearing exercise is proven to increase bone density. Here are three of Caroline’s favourite exercises from The Scoliosis Handbook

Upright Row
The Scoliosis Handbook

Upright Row

The upright row works the traps – the triangular muscle at top of the spine that connects to the deltoids.  It’s so important to keep the trapezius muscle toned. It helps to hold your head upright.

Clients have reported improved posture, reduced neck aches and headaches.

• Stand with legs hip-width apart, knees soft, slightly bent, shoulders relaxed;
• Start with arms down, relaxed, holding the bar with hands thumb-width apart. Leading with elbows, slowly raise the bar, hands brushing your body until at upper chest level and elbows are higher than hands, elevated above shoulders, making the shape of a V;
• Do not raise your shoulders;
• Slowly return to start;
• Introduce a weight slowly, starting with 0.5 kg.

Bent-Arm Pullover
The Scoliosis Handbook

Bent-Arm Pullover

This is my favourite exercise of all time! It works your back, rear shoulder muscle, chest and triceps while supporting your back, neck and head

• On your back, feet a little wider than hip width, check leg alignment;
• Chin tucked in, relaxed;
• Suck in abs and push back into the floor with pelvis tilted upwards;
• Start by clasping hands together into a fist. Progress by adding weights up to max 5 kg;
• Elbows slightly bent. Start with arms at eye line, over your chest, then extend them above your head, as far as is comfortable. Feel a slight stretch. Do not attempt to bring your arms further back to touch the floor behind you as this will make you arch your back;
• Start with five repetitions with no weight and increase to 5 kg and 20 repetitions x 3 sets.

High Plank and Bear Squats
The Scoliosis Handbook

High Plank and Bear Squats

This combination works your quad and glute muscles, as well as your lats and abs and arms so it's a great load bearing exercise to build up the muscles and bone density.

Get yourself into the High Plank position.

• Start on your hands and knees and with straight arms, shoulder-width apart. Lift your knees off the floor, pushing your toes into the floor;
• Tip: If you find standing on your hands in this position a strain on your wrists you can use small push-up hand bars for support. Your neck and head should continue along the same line as your spine so that your body is aligned. Lifting your head up will shorten your neck muscles; dropping your head will pull on your neck muscles, possibly resulting in neck strain and muscle pain;
• Make sure your pelvis and hips are elevated slightly (so not in a total straight line) to take the pressure off your lower spine. Do not dip your hips, nor arch your back. Do suck in your abs;
• Bend knees and sit/squat horizontally, bringing your glutes back, gently stretching your arms. Keep your abs drawn in towards your navel, your back straight and your head in line with your body. Again, do not look down or upwards. Hold for a few seconds;
• Return to the High Plank position. Build up from 6 repetitions to 15 X 3 sets;
• The Bear Squat is often performed pushing the glutes towards the ceiling and straightening the legs, I prefer this technique if you have any spinal issues as less strain on the spine.

The Scoliosis Handbook of Safe and Effective Exercises Pre and Post Surgery

by Caroline Freedman

Published by: Hammersmith Books. 2020. £12.65 / $15.96   ISBN-13: 978-1781611661.    

Available from Amazon.co.uk  and  Amazon.com and Hammersmith Books.

Picture Credits

Caroline Freedman Headshot image: Sam Pearce - www.square-image.co.uk – Image courtesy of Scoliosis Association UK

Exercise images: Andy Taylor andy@moondancephotographt.co.uk