January 31 marks the end of the “early bird” registration period for summer 2011 Pilates Therapeutics Specialization Programs in Scoliosis Management and Breast Cancer Rehabilitation.
The courses, to be led by Suzanne Martin, PT, DPT, a doctor of physical therapy and Pilates expert, are designed for certified Pilates teachers. Each course has been awarded 26 continuing education credits (CECs) for PMA-certified Pilates teachers by the Pilates Method Alliance.
Martin is an ACE-certified fitness instructor and cancer specialist and is certified by the American College of Sports Medicine, the Pilates Method Alliance, and St. Francis Memorial Hospital Center for Sports Medicine. She has been presenting scoliosis and breast cancer workshops since 2001 for professional associations and education providers such as the Pilates Method Alliance, California Education Connection, and Balanced Body University, and has written articles on both subjects for Pilates Pro magazine and other publications. She is also the author of the “A Better You” column in Dance Studio Life magazine.
Both four-day courses will be held at Pilates Therapeutics, Martin’s private physical therapy practice, in Alameda, California. Scoliosis Management will run June 23 to 26, and Breast Cancer Rehabilitation will run July 21 to 24. Both include two months of mentoring and follow-up.
Detecting, treating, and dancing with scoliosis
By Maureen Janson
More than 30 years ago, while scrutinizing myself in ballet class, I noticed a small hump on one side of my back. Nothing felt odd, but I didn’t look symmetrical. I couldn’t seem to stand straight and I suddenly felt different from everyone else in the class. A doctor diagnosed scoliosis, and it wasn’t comforting news. But for me, fully grown and with a curvature just shy of 40 degrees, my doctor advised no intervention as long as I kept on dancing. So I did. And 30 years later, I’m still dancing.
Scoliosis is an abnormal curve in the spinal column. Though the spine has natural curves, none should be in a lateral direction. The curvature of scoliosis, viewed from behind, can appear as an S or C shape and is sometimes accompanied by a rotated rib cage (one side rotates forward and the other back) or by an uneven pelvis (one side sits higher than the other).
Having scoliosis has heightened my awareness of the condition in my dance students. When I was a student, none of my dance teachers realized that I had scoliosis. Today, as a teacher, I find that recognizing it can boost affected students’ self-esteem and help them increase body awareness, possibly staving off complications.
Scoliosis remains a mystery. According to Dr. Bonnie Weigert, associate professor of rehabilitation medicine and a spine specialist at the University of Wisconsin Hospital and Clinics, “most of the time we don’t know why scoliosis happens. There is some speculation that people who have lax or loose ligaments may have more risk for it.”
That could be why the diagnosis shows up often in dancers, gymnasts, and swimmers. Others speculate that it is hereditary or the result of a sudden growth spurt, as my doctor suspected was the case for me. I had grown five inches during the previous year.
Unless screening is done, the imbalance can go undetected in many teenagers. (Eleven is often recommended as the age to begin screening.) Suspect scoliosis if you see any of the following in a dancer who is standing straight:
- One shoulder sits higher or one shoulder blade is more prominent. (The shoulder blade discrepancy can be seen more clearly when the dancer bends forward, rounding the spine.)
- One side of the ribcage protrudes more than the other.
- The dancer seems to be leaning slightly sideways.
The presence of asymmetry does not always indicate scoliosis, but it might be grounds for seeking a medical opinion.
Early detection reduces the possibility of complications. A progressing curvature can lead to back pain or arthritis in the spine, negative body image, and in severe cases, increased pressure on the lungs and heart. But, Weigert adds, “more severe curves are fortunately less common.”
Options for treatment 30 years ago were limited: surgically install an immovable titanium rod into the spinal column and/or fuse the vertebrae, thus limiting much of the spine’s mobility; wear a cumbersome brace for 23 hours a day for up to five years; or do nothing and see what happens.
Weigert, who studied dance most of her life, has incorporated her understanding of the art form into her medical practice. She agrees with the treatment options I was given at age 17. “In general, curves of less than 30 degrees can be watched; curves that are between 30 and 40 degrees should probably be braced until the person has stopped growing,” she says. “And sometimes curves of greater than 50 degrees can worsen with age.” When considering the surgical option, she is quick to state that the procedure might stop the curve from getting worse, but it won’t straighten the spine completely. And after surgery, the person’s ability to dance could be quite limited.
Recognizing scoliosis can boost affected students’ self-esteem and help them increase body awareness.
The severity of a spinal curve, measured in degrees, is called a Cobb angle, formed by drawing intersecting lines through the vertebrae as pictured on an X-ray. The higher the Cobb angle number, the more severe the curve; at 40 degrees or greater, bracing or surgical action is typically considered. Once the skeletal system has finished growing, bracing is often not effective.
Medical treatment options for scoliosis haven’t changed much in the 30 years since my diagnosis. However, rigid plastic braces have been replaced by a more pliable bracing option that allows more freedom of movement while training the spine into a straighter position. Some of the new braces can even be worn during dance class.
The Schroth method of physical therapy, first developed in the 1920s in Germany, has made a recent appearance in the United States but remains relatively obscure. The method, a series of breathing, strengthening, and stretching activities that must be performed daily for life, is designed for each individual. In some cases, the method has been effective in reducing the degree of spinal curves.
Many dancers find relief from yoga, Pilates, and trigger point massage, all of which improve strength, flexibility, breathing, postural awareness, and motor control.
Dancing with scoliosis
Continuing to dance can be the best way to prevent scoliosis from worsening. Weigert says, “The strength and flexibility that dancers develop and maintain is probably of benefit with scoliosis.”
And in her book Getting Started in Ballet: A Parent’s Guide to Dance Education, Anna Paskevska states, “The very nature of ballet training—working both sides of the body equally and in harmony—helps to correct the misalignment that scoliosis creates.”
Dancers’ experiences in coping with the limitations of scoliosis vary, often according to how severe the curvature is. One of them, Afro-Caribbean/break dancer Danez Smith, didn’t let surgery stand in his way. “Surgery was really my only option because of the severity of my curve, which was 65 degrees,” he says. Diagnosed at age 14, he had surgery two years later. “I knew after surgery my dancing wouldn’t be the same.”
Smith explains his ordeal with an upbeat attitude, claiming that it was simple. “They opened up my back, braced the spine with some nuts and bolts and a metal rod, and took a little of my hipbone to help keep things in place.” He laughs. “OK, maybe it wasn’t that simple. I was left with two big scars, five months’ worth of rehab, and a 25-degree curve, which is still pretty up there. I was a rebel to the rehab process though, and one month after the surgery I was back in the studio break dancing.”
Olivia Templin, an undergraduate dance major at the University of Wisconsin–Madison, does feel that her mild scoliosis affects her dancing. Before she discovered that she had a curvature, she knew that something was off, especially in ballet class. The muscle imbalances and spinal stiffness that accompany scoliosis can cause some pain and occasionally some motor control issues, and Templin experienced both. “When I switch between right and left sides, there are times when it feels like I’m not even doing the same movement,” she says.
After her diagnosis a few years ago, she was referred to physical therapy. Finding no relief from her chronic pain, she gave up the physical therapy and began scouring the Internet for information. “There seem to be only two ends of the spectrum that are addressed with scoliosis: either you don’t have it, which is wonderful, or you have it bad enough to receive medical attention,” Templin says. “If you don’t fall into either of those, you just have it and that’s it.” Dance students who have scoliosis often experience considerably more back pain than accompanies most dance training, and Templin feels that it’s important for teachers to understand that.
Former Pacific Northwest Ballet dancer Kerry Parker, 39, now a principal dancer with Kanopy Dance Company, continues to dance and perform full force with scoliosis. When she was a child, her family doctor recommended putting her in a brace, but her mother felt she’d be better off in ballet class. “Personally, I always thought that ballet was good for my scoliosis,” Parker says. “My right leg goes higher into arabesque, and my left leg goes higher to the side, but I’ve always worked to counterbalance my body, so the scoliosis doesn’t affect my dancing at all.”
Dealing with imperfection
Dancers try hard to hide imperfection, but in the case of scoliosis, it may be best to acknowledge it. “I have seen dancers who have developed enough strength and maintained enough flexibility in their curve that they can minimize its appearance, but that is not an easy thing to do,” says Weigert. The most important thing dance teachers should understand, she says, “is that they may not be able to correct the posture and placement of a dancer with scoliosis. The dancers may have to compensate elsewhere, which may allow them to dance with a better cosmetic appearance but could put additional strain on other areas.”
In my own teaching, I strive to work as symmetrically as possible, trying not to demonstrate combinations only on one side. And I’ve developed a pre-class ritual series of back stretches for myself, to release specific areas of tension. These methods are appropriate for any dancer. With scoliosis, one side of the spine is almost constantly in muscle spasm, so my theory is that targeting that area with stretching can help balance the spine. Still, what brings me relief might not work for others. Since each case is different, if a teacher provides a range of ideas that might bring relief, it can allow students to learn what is most beneficial to them.
I’ve also recognized that students who have scoliosis need encouragement and understanding. Scoliosis has an emotional as well as a physical effect. And when young dancers learn that their teacher has it, they realize there’s no reason they cannot pursue a career in dance.
Smith does feel that scoliosis has changed his life. “Every time I see some amazing dancer,” he says, “I get a little emotional and think about how life would be without scoliosis.” But, almost five years after his surgery, he can do much more than he ever thought would be possible.