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Is Life Turning You Kyphotic? Here’s How to Prevent It

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The spine supports the torso and allows the head to stay upright, keeping the gaze towards the horizon. Proper alignment in the sagittal plane helps maintain the torso in the correct position with minimal energy expenditure and optimal load distribution along the spine.

Over time, particularly in older adults, a forward imbalance tends to develop, causing the torso to lean forward. Researchers have identified the age range of 50 to 60 as the period when this imbalance typically begins to manifest, progressively worsening with age. Compensatory mechanisms then come into play, creating a vicious cycle involving the pelvis and the entire spine, leading to specific degenerative changes.
The pelvis tilts backward, lumbar lordosis decreases, and the upper torso bends forward. In some cases, these changes in sagittal alignment occur rapidly and progressively, developing into pathological conditions.
Certain factors may exacerbate this, such as the presence of scoliosis, disc disorders leading to reduced lordosis, or stiffness in the spine. Severe kyphosis or kyphosis resulting from vertebral fractures also contribute to forward collapse, as does weakness in the spinal extensor muscles, leading to forward lean.

Now, let’s consider our daily activities.
Most of what we do involves looking downward or at least keeping the head tilted forward. For example, how much strain is placed on the cervical vertebrae when the head is tilted forward at 30 degrees? (Keep in mind that when we look at our phones, we usually tilt our heads much more than 30 degrees.)

At this angle, the discs experience 400% more stress compared to when the head is upright and looking forward. The natural tendency towards forward collapse, combined with daily activities that increasingly involve static, flexed postures and potential degenerative spinal conditions, accelerates the forward tilt of the torso. This forward imbalance results in pain, reduced spinal functionality, fatigue, aesthetic concerns, and, most importantly, a decline in quality of life.

What Can We Do?

  1. Resist Gravity: Throughout the day, whether standing or sitting, make an effort to sit or stand up straight and hold this position for a few seconds.
  2. Engage in Regular Physical Activity: Any type of exercise is beneficial, but activities that engage the trunk extensor muscles are especially helpful. Don’t stop moving! It’s also a good idea to vary your exercises over time, which will benefit your back as well.
  3. Seek Medical Advice: If you notice yourself leaning forward when tired, especially in the evening, or if those around you point out that you’re becoming more stooped, it’s time to seek a medical evaluation.

…And if life pushes us forward? Let’s straighten it out!

Gym workouts and scoliosis: can the two go hand in hand?

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In recent years, fitness has become a booming industry, driven by a growing interest among young people and on social media. This trend has resulted in the emergence of better-qualified fitness professionals, triggering a virtuous circle in terms of improving the quality and safety of training.

From our perspective, it is worth remembering that physical activity, if performed correctly, can have a protective role in the management of scoliosis.
We are often asked whether patients with scoliosis, particularly those undergoing bracing treatment, can work out in the gym.
Before answering this question, let’s make two things clear:

● the literature contains nothing specific on this topic;

● “working out in the gym” means more than one thing (i.e., not all training is the same).

The importance of goals
Before embarking on a training programme, it is crucial to establish your personal goals. Among adolescents, the main reasons for working out are often the desire to build muscle (boys) or tone up (girls). However, in adolescence, learning the correct training techniques and improving your physical abilities, such as coordination, balance, strength, and resistance, are more important than immediately seeking to bulk up your muscles.
Young people will find that efforts to gain muscle mass give more gratifying results once they have finished growing (i.e. after reaching 16-18 years of age).
The best approach, then, is to try to focus on what you actually do in the gym, striving to do it better and more effectively and thinking less about what you see in the mirror.

The benefits of training in the gym

Training in the gym offers you the chance to monitor your body and safely regulate training stimuli, unlike when practising many competitive sports, during which you are more likely to sustain an injury. Several studies show that the gym is associated with a lower injury rate than other sports.

Advice for those with scoliosis

We should first point out that young people with scoliosis (boys and girls) are, in most cases, no different from their peers who do not have scoliosis. Having said this, we do have some advice.

  1. Find a professional. A properly qualified trainer can help you do the exercises correctly and adapt the training programme to your individual requirements. It might also be a good idea to put your doctor/physiotherapist and trainer in contact with each other, so that the training programme can be refined and any doubts addressed.
  2. Don’t be in a hurry. Targeted warm-up exercises can improve flexibility and reduce stiffness in the spine.
  3. Choose your exercises. It is important to start with simple and controlled exercises, then gradually increase the difficulty level.
  4. Take care with axial loads. Axial loading exercises must be performed carefully to avoid sudden or compensatory movements. When it comes to the squat, for example, the goblet squat may be the best option as it is performed with the weight (dumbbell/plate/kettlebell) held in your hands, at chest height, in front of you. By facilitating load management, this version guarantees greater stability and makes it easier to control the movement.
  5. Learn to “dose” self-correction. When you are working out in the gym, the amount of self-correction you apply (i.e., the extent to which you adopt the position designed to counteract the scoliotic curves and therefore keep your spine more aligned) will depend on the type of exercise you are doing and the level of fatigue you are experiencing. The objective of exercises done in the gym differs from that of the specific exercises taught you by your physiotherapist, where self-correction is the key element, and determines how the exercises are performed. When you are using weights, the priority is to focus on the specific training stimulus, while at the same time trying to keep your spine properly supported.

Should a brace be worn in the gym?

Individuals who are being treated with a brace can consider doing their physical activity during their brace-on hours, so as to take full advantage of the support provided by the brace itself. However, if they prefer to train during their brace-off window, they should make sure they do a longer warm up, so as to prepare their back for the training session.

So, finally

Working out in the gym is possible for those with scoliosis and can indeed be beneficial if the necessary precautions are taken. Be sure to find a professional trainer, keep your doctor in the loop, and listen to your body because these are the keys to safe and effective training.

Returning to physical activity after surgery for adolescent idiopathic scoliosis

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Sport and physical activity are essential for psychosocial and physical well-being in children and adolescents, and youngsters with scoliosis are not subject to any limitations in this regard: they can do sports and other physical activities just like their peers can.

In severe scoliosis, i.e., in individuals with curves measuring more than 50° and presenting significant aesthetic and developmental deformities despite undergoing orthotic/bracing treatment properly administered according to the SOSORT criteria, surgery is indicated. 

“In some cases, patients who undergo corrective surgery for scoliosis may reduce their level of physical activity postoperatively due to a loss of spinal flexibility and pain. This inevitably impacts negatively on their quality of life – says dr Carmelo Pulici, physiatrist – No guidelines have yet been published on the resumption of physical activity after surgery for adolescent idiopathic scoliosis, and “expert opinion” is therefore all we have to rely on. Consequently, different surgeons may give different indications, depending on their experience and the particular type of approach”.

There are also individual factors at play, and the decision to resume physical activity may therefore depend on: the type of surgery performed, how the body responds and adapts to the metal rods inserted to correct the spine, the extent of the fusion, how recently the surgery was carried out, the characteristics of the patient, and also the type of sport practised (non-contact, contact or collision).  

For example, while some surgeons allow contact sports to be resumed six months after surgery, others recommend waiting a year, and some even rule out the resumption of collision sports altogether (https://pubmed.ncbi.nlm.nih.gov/26920125/). 

“In one study, return to sport/physical activities after surgery was examined using a specially created questionnaire (https://pubmed.ncbi.nlm.nih.gov/28604495/). By six months, most patients had returned to the activities they did before the surgery” – explains Dr Pulici. “The authors found that patients returned to athletics much earlier than expected. Despite this, there were no cases of loss of correction, implant failure or complications among the 95 patients included in the study”. 

A new surgical technique

In recent years, there has been a growing interest in vertebral body tethering (VBT), a new surgical technique used only in children and in early adolescence and, even then, only in carefully selected patients, given that the method is still experimental. VBT is proposed as a possible alternative to spinal fusion (currently the most widely used technique for the surgical treatment of scoliosis). Unlike spinal fusion, it does not reduce the mobility of the spine. 

“According to a recent study, VBT allows daily activities and sports to be resumed within three months of the surgery” Dr Pulici goes on. “Furthermore, most of the patients examined in the study reported an improvement in their athletic performance, and some were found to be doing more sports than before undergoing VBT”.

Even though surgeons today tend to allow patients to return to sports (even high-intensity ones) earlier than in the past (https://pubmed.ncbi.nlm.nih.gov/34267153/), we are still a long way from seeing a common approach to the management of postoperative resumption of physical activity in this patient population.

In the absence of guidelines, we at Isico recommend that patients turn to an experienced therapist in the post-operative period to ensure a gradual and safe return to physical activity, obviously following the instructions received from their surgeon.

It is important to avoid falling into the vicious cycle of a sedentary lifestyle. The less active you are, the less you feel inclined to do physical activity and the greater the risks to your health due to your lack of movement.

Physical activity in adults with scoliosis: what and how much?

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Before we start talking about scoliosis and physical activity in adults, a few background considerations are called for.

It is important to remember that every patient has a unique history. Even though different patients can present similar scoliosis features, it should not be assumed that the same kind of physical exercise will suit all of them.  

It is also necessary to bear in mind certain thresholds of curvature: scoliosis curves measuring less than 25°-30°, especially if treated in adolescence, are extremely unlikely to worsen over time. Conversely, curves that exceed 45°-50° must be monitored, through specialist check-ups, throughout adulthood.

Then there is the “pain” factor. Scoliosis is not necessarily associated with pain. Nevertheless, pain is a factor that needs to be taken into account when choosing what physical activity or sport to do. As a rule, any kind of movement that does not worsen pain, or that alleviates it, can be considered a great help.

Exercise, in a general sense, helps to relieve pain, improve functionality and improve quality of life: and these are the real objectives. A healthy back, which does not necessarily mean a straight back, is one that is capable of withstanding the stresses of everyday life.
Furthermore, when you have scoliosis, it is especially important to train the muscles that support the spine, so as to stabilise it.

It is important that we distinguish clearly between sport and self-correction exercises i.e. active movements designed to lead to better positioning of the spine in the three planes of space, which the patient performs independently.
These exercises, prescribed specifically for scoliosis, with the aim of stabilising the condition, serve a therapeutic purpose. On the other hand, there is no sport or general physical activity of any kind that can be said to “treat” scoliosis.

It is also necessary to beware of certain old “beliefs” regarding scoliosis and sport. In the past, it has been claimed that certain sporting activities can “treat” or vice versa exacerbate scoliosis.

In reality, however, the literature contains no reliable data showing that certain sports activities might be harmful for adults with scoliosis.
The only question mark concerns activities (e.g. belly dancing) that demand considerable flexibility and mobility of the spine, since these could destabilise it and lead to a worsening of the condition.
To date, there are no sports that are specifically prohibited or recommended. Indeed, contrary to what some believe, swimming and Pilates cannot be guaranteed to be beneficial, while running and tennis do not need to be considered risky activities.
In adulthood, any sport, providing it is started gradually, practiced regularly, enjoyed and performed within your own limits, can only be good for you.

In conclusion, it is worth underlining that adults with scoliosis can and MUST do some form of physical activity, at least 2-3 times a week, choosing from the various disciplines. Those whose scoliosis causes them pain must make sure their chosen activity respects this limitation.