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CAN STRETCHING MAKE SCOLIOSIS WORSE? · Scoliosis with Dr. Chris Gubbels

• 0:00
  SPEAKER_00: Can stretching actually make your scoliosis worse?
• 0:03
  SPEAKER_00: The exact same stretch may help one person with scoliosis while making another person with scoliosis worse.
• 0:10
  SPEAKER_00: And when you're stretching, simply feeling good is not enough to tell you if it's the right stretch for you.
• 0:15
  SPEAKER_00: So before I ever tell someone with scoliosis to stretch, there's one thing I always need to understand.
• 0:20
  SPEAKER_00: Hi, I'm Dr.
• 0:21
  SPEAKER_00: Chris Goobel's leading specialist with the non-surgical treatment is scolosis and hyperkyphosis.
• 0:26
  SPEAKER_00: And in this video, we're going to look at how stretching can actually help or potentially hurt your scoliosis.
• 0:33
  SPEAKER_00: And the one thing you need to know before you ever start any stretching routine for scoliosis.
• 0:38
  SPEAKER_00: Now, the first thing you have to understand is what are you actually trying to stretch?
• 0:43
  SPEAKER_00: Now, when somebody tells me that a stretch feels good, that does give me some useful information.
• 0:48
  SPEAKER_00: It tells me that that stretch may have reduced tension in the muscles or possibly improve movement throughout the joint.
• 0:55
  SPEAKER_00: And there's definitely nothing wrong with wanting to feel less stiff.
• 0:58
  SPEAKER_00: Now, a lot of people with scoliosis carry quite a bit of muscle tension because the muscles on both sides of the spine are constantly trying to stabilize the body that is not evenly balanced.
• 1:09
  SPEAKER_00: But just because somebody feels tight in a certain area, that doesn't automatically tell us which direction the spine needs to be stretched or potentially moved.
• 1:18
  SPEAKER_00: That may make sense if we're dealing with a single isolated and tight muscle, but with scoliosis, we're dealing with a spine that both bends and rotates in three dimensions.
• 1:29
  SPEAKER_00: So before I ever recommend a stretch for someone, I have to fully understand the full curve pattern or patterns.
• 1:37
  SPEAKER_00: I need to know where the spine is bending, where it is rotating, which areas are compressed, and most importantly, how many curves are there and where are they located?
• 1:46
  SPEAKER_00: Because what makes one curve better will make another curve worse.
• 1:50
  SPEAKER_00: Here's what I mean by that.
• 1:51
  SPEAKER_00: If you look at this simple image, this shows how the muscles are affected when someone has scoliosis.
• 1:57
  SPEAKER_00: Now, when you're looking at the image, you can see there's a big thoracic scoliosis.
• 2:01
  SPEAKER_00: And on the outside or the convex side of the curve, those muscles are constantly being stretched and they're always contracted.
• 2:08
  SPEAKER_00: The muscles on the inside of the curve are being shortened.
• 2:11
  SPEAKER_00: Now, if we look at the lower spine, in the lumbar spine, it's doing the exact opposite.
• 2:16
  SPEAKER_00: So in the lumbar spine, on the outside where the red is, those muscles are being stretched.
• 2:20
  SPEAKER_00: And on the inside, those muscles are being shortened or contracted.
• 2:24
  SPEAKER_00: So when you look at the scoliosis, the stretches that actually help, the thoracic spine, will do the opposite to the lumbar spine and vice versa.
• 2:33
  SPEAKER_00: So without that information on the scoliosis and what's going on with someone's individual scoliosis and how many curves and the location, we're just guessing if we're giving someone random scoliosis stretches.
• 2:45
  SPEAKER_00: And that's why one of the biggest problems with general stretching programs is they usually treat the body as though the right and left sides are doing the exact same.
• 2:53
  SPEAKER_00: But as I previously mentioned, with scoliosis, they're not.
• 2:57
  SPEAKER_00: One side of the curve is being compressed and the other side of the curve is being stretched or elongated where it's completely open.
• 3:03
  SPEAKER_00: The spine will be rotating one direction through the rib cage and the completely opposite direction in the lumbar spine.
• 3:10
  SPEAKER_00: The pelvis may shift to the one side and the midbody or thoracic spine could be compensating and shifting to the opposite side.
• 3:17
  SPEAKER_00: So if you take a general stretch and you perform it equally on both sides, you may be stretching one side in a way that's actually beneficial in stretching the spine, but it may be doing the opposite and reinforcing the scoliosis on the other side or other area of the spine.
• 3:32
  SPEAKER_00: Now, that doesn't mean every movement needs to be completely different on both sides, but it does mean symmetry cannot be simply assumed.
• 3:41
  SPEAKER_00: This is why I'm always very cautious and it creates red flags when I hear someone say, I found the five best stretches for scoliosis.
• 3:51
  SPEAKER_00: And then they demonstrate the exact same routine on every single person and every part of the body.
• 3:57
  SPEAKER_00: You see, there's no single scoliosis curve.
• 4:00
  SPEAKER_00: The thoracic curve is different from the lumbar curve.
• 4:02
  SPEAKER_00: A double curve is different from a single curve.
• 4:04
  SPEAKER_00: A double curve with equal size curves is different than a double curve with different size curve, or one is larger and one is smaller.
• 4:12
  SPEAKER_00: A flexible adolescent curve is completely different from an adult degenerated curve that has become very rich and possibly even unstable.
• 4:20
  SPEAKER_00: Being diagnosed with scoliosis just tells us that you have a curve.
• 4:23
  SPEAKER_00: It doesn't tell me what that particular curve is doing.
• 4:26
  SPEAKER_00: And that particular movement pattern is what determines whether a stretch makes sense or not.
• 4:31
  SPEAKER_00: So what about things like yoga and Pilates?
• 4:34
  SPEAKER_00: Patients come in all the time.
• 4:36
  SPEAKER_00: A lot of times people with scoliosis really enjoy doing things like yoga and Pilates.
• 4:41
  SPEAKER_00: And the truth is both of those can be very helpful for strength, mobility, breathing, and body awareness.
• 4:47
  SPEAKER_00: But most of those classes are not designed around your specific scoliotic curves.
• 4:52
  SPEAKER_00: You see, if you go to those gender classes, you may be asked to bend or rotate or stretch equally in both directions, even though your spine is not moving the same on both sides.
• 5:02
  SPEAKER_00: So I'm not saying that people with scoliosis should not be doing yoga or Pilates.
• 5:07
  SPEAKER_00: But what I am saying, each movement you do with those has to make sense for your specific curve.
• 5:13
  SPEAKER_00: You see, a good instructor may be excellent at teaching yoga or Pilates and still have no idea how your particular spine bends, rotates, or compensates.
• 5:22
  SPEAKER_00: And that's where general exercises can feel good and still move you in a direction that is not helpful.
• 5:28
  SPEAKER_00: And this is why a general stretch can feel good, even though it may not actually be helping.
• 5:33
  SPEAKER_00: And this is the part that really tends to confuse people.
• 5:36
  SPEAKER_00: Let's say you repeatedly tend to bend and rotate in one direction, and it feels really good when you do that.
• 5:42
  SPEAKER_00: The muscle tension drops, you're breathing a little easier, and for the next hour your back feels looser.
• 5:47
  SPEAKER_00: Naturally, you're gonna assume that movement is good for your scoliosis.
• 5:51
  SPEAKER_00: Those are two separate questions.
• 5:53
  SPEAKER_00: Did the stretching reduce tension?
• 5:55
  SPEAKER_00: And did the movement actually help place your spine in a more corrected position?
• 5:59
  SPEAKER_00: You see, the answer to the first question may be yes, while the answer to the second question may be no.
• 6:04
  SPEAKER_00: And the reason this happens is the body often becomes very comfortable moving in the direction that it already prefers.
• 6:11
  SPEAKER_00: You see, if the spine has spent years bending and rotating a certain way, moving in further that direction is typically easier, may even feel better.
• 6:19
  SPEAKER_00: Moving against that pattern tends to feel awkward and restricted and stiff.
• 6:23
  SPEAKER_00: I mean if you have a big curve in your spine like this, it's generally easier to bend like this and more difficult, more challenging to bend like this or against that curve.
• 6:33
  SPEAKER_00: And so it doesn't automatically mean the easier direction is the direction you need more of.
• 6:39
  SPEAKER_00: A lot of times it's the opposite.
• 6:41
  SPEAKER_00: Sometimes the corrective movement feels less natural precisely because the body is not used to putting itself in correction, it's used to being out of correction.
• 6:50
  SPEAKER_00: Now, I'm not saying that you should force your spine into painful positions and just keep pushing through a movement that doesn't feel good.
• 6:57
  SPEAKER_00: Pain is still very useful information, but comfort by itself is not enough to tell us that the stretch is actually correcting anything.
• 7:06
  SPEAKER_00: So one thing you absolutely have to understand first before doing any stretching routine is what direction does your curve move, or what direction is your curve in?
• 7:15
  SPEAKER_00: Which way does your spine bend?
• 7:16
  SPEAKER_00: Which way does your spine rotate?
• 7:18
  SPEAKER_00: And where is the main or primary curve?
• 7:21
  SPEAKER_00: Also, is there a secondary compensatory curve?
• 7:24
  SPEAKER_00: Is the pelvis shifted from midline towards one side?
• 7:28
  SPEAKER_00: Is your spine flexible or has it become stiff and rigid over time?
• 7:32
  SPEAKER_00: And those details will help us determine what areas of spine need to be open, what needs to be stabilized, and which movements may need to be limited or potentially changed.
• 7:41
  SPEAKER_00: And this is why an exercise cannot be truly scoliosa-specific unless it's built around the person's actual individual curve pattern.
• 7:49
  SPEAKER_00: There's no one fits all approach, there's no canned approach.
• 7:52
  SPEAKER_00: Everything has to be custom for each individual.
• 7:55
  SPEAKER_00: And the other thing is you cannot determine that from symptoms alone.
• 7:58
  SPEAKER_00: Generally, you need a proper full spine standing x-ray because that allows us to see the spine under gravity and how each of those curves relates to the other.
• 8:07
  SPEAKER_00: We also need to have an actual picture of someone's posture with their shirt on.
• 8:12
  SPEAKER_00: Because we have to look at the spine on the inside and the outside.
• 8:16
  SPEAKER_00: One of the things I always remember when one of my mentors who is teaching me school-specific rehab is to look at the patient in front of you.
• 8:24
  SPEAKER_00: You can't just look at an X-ray.
• 8:27
  SPEAKER_00: You have to also look at the X-ray and pay attention to the person in front of you.
• 8:32
  SPEAKER_00: Because sometimes what you see on the outside doesn't show you what you would expect to see on the outside.
• 8:37
  SPEAKER_00: You got to look at both of those pieces of information.
• 8:39
  SPEAKER_00: And the third thing you have to do, you have to see what actually happens to the body or what happens to the person when you start to introduce specific stretches or exercises.
• 8:50
  SPEAKER_00: Because sometimes you look at their x-rays and their posture and you think you know exactly what you should do with that person.
• 8:56
  SPEAKER_00: And then when you try and have the patient do it, they may not be able to do it like you envisioned.
• 9:02
  SPEAKER_00: So you have to be able to adapt and customize your approach to each patient in real time as you work with them.
• 9:09
  SPEAKER_00: So once we have all that information and we know each individual patient's curve pattern, the stretching and exercise and approach can be much more purposeful.
• 9:18
  SPEAKER_00: So instead of simply saying, you know, your back is tight, so stretch everything, we can ask why is that airtight?
• 9:23
  SPEAKER_00: What movement would actually help the body become more balanced?
• 9:27
  SPEAKER_00: And then when we apply it, we can see and adapt how the patient responds.
• 9:31
  SPEAKER_00: That's a completely different approach from a one-size-fits-all can scoliosis exercise approach.
• 9:36
  SPEAKER_00: Now, another thing we have to consider age can change everything.
• 9:41
  SPEAKER_00: So age absolutely matters when it comes to scoliospecific exercises and stretches.
• 9:46
  SPEAKER_00: You see, a child or teenager with scoliosis may have a very flexible spine, but they also have a curve that is actively progressing during growth spurts.
• 9:56
  SPEAKER_00: So with a patient like that, I'm thinking about how the movements actually affect the developing spine and whether the exercises are helping the child find and stabilize the most corrected position.
• 10:05
  SPEAKER_00: Also, if we're looking at an adolescent, we're probably doing bracing with them too.
• 10:10
  SPEAKER_00: And I have to think about how is the brace designed and what is the brace designed for?
• 10:15
  SPEAKER_00: Is the brace designed to actually put their body in a correct position?
• 10:19
  SPEAKER_00: And are we trying to actually reduce the size of the curve with the brace?
• 10:23
  SPEAKER_00: In those cases, I'm going to think about the exercises and stretches.
• 10:26
  SPEAKER_00: And when I'm deciding what I want to do with the patient, how those individual exercises and stretches are going to work with the brace and help the brace be more effective, also.
• 10:36
  SPEAKER_00: Now, an adult who has had scoliosis for decades may have a much more rigid curve.
• 10:41
  SPEAKER_00: There may be severe disc degeneration, arthritis, and stiffness throughout the whole rib cage and spine.
• 10:47
  SPEAKER_00: And there's probably some pretty big compensation patterns that have developed over years.
• 10:52
  SPEAKER_00: Also, that patient may be wearing a brace, but the brace may have a completely different goal.
• 10:57
  SPEAKER_00: The brace is likely to stabilize and reduce pain and not necessarily focused on correcting.
• 11:02
  SPEAKER_00: So I have to think about my exercises and stretches and how those are going to influence and work with the brace that's likely designed different than a brace that was designed for an adolescent.
• 11:13
  SPEAKER_00: So an adult with degenerative scoliosis, that patient may still benefit from stretching, but we have to be realistic about what the stretches are actually doing.
• 11:21
  SPEAKER_00: You see, maybe the goal is to improve mobility, maybe it's to reduce pain, maybe it's to be able to breathe more comfortably and using the diaphragm better, or possibly being able just to help the person stand up straight and more erect.
• 11:33
  SPEAKER_00: Now, those are all really worthwhile and important goals to know.
• 11:36
  SPEAKER_00: But again, this is completely different from saying a general stretch is correcting the scoliosis.
• 11:40
  SPEAKER_00: And as I mentioned, then we have adults with degenerative de novoscoliosis where the curve develops later on in life and the disc and joints are starting to break down and decay.
• 11:50
  SPEAKER_00: And patients like this generally or most often have areas of instability as well as stiffness.
• 11:56
  SPEAKER_00: So stretching everything more and more is likely not what the patient needs with a degenerative, unstable scoliosis.
• 12:03
  SPEAKER_00: A lot of times, in those cases, the body needs better control and stability compared to just mobility and flexibility.
• 12:09
  SPEAKER_00: This is why age, curve type, and the condition of the spine all change or potentially influence by recommendations.
• 12:17
  SPEAKER_00: Now, are there times when stretching may become a problem on its own?
• 12:21
  SPEAKER_00: You see, there are a few situations with scoliosis where I'm going to be more cautious with stretching.
• 12:25
  SPEAKER_00: First, when you are repeatedly pushing into the direction of your curve without understanding the rotation that goes along with it.
• 12:32
  SPEAKER_00: Here's what people don't understand.
• 12:33
  SPEAKER_00: I know this is a little high-level concept.
• 12:34
  SPEAKER_00: I'm going to try to make it as simple as possible.
• 12:37
  SPEAKER_00: When you start to twist and rotate your spine, and they are no longer in the normal alignment, the bones and joints simply do not move how they normally would move.
• 12:47
  SPEAKER_00: It's called a coupling pattern.
• 12:49
  SPEAKER_00: So when we start to move the spine, when the spine is already fixated in an unnatural position, the joints don't move like they would normally move when they're in proper alignment.
• 13:00
  SPEAKER_00: And that has to be considered when we're looking at stretches and exercise and how we approach those and in what sequence we give them.
• 13:08
  SPEAKER_00: Also, when we're looking at a displacement of the scoliosis, the spine moves in three dimensions.
• 13:14
  SPEAKER_00: It shifts, it bends, and it rotates.
• 13:18
  SPEAKER_00: When we look at that, we have to look at what's the biggest thing.
• 13:21
  SPEAKER_00: Is the biggest thing the amount of rotation?
• 13:23
  SPEAKER_00: Like is it in proportionally have more rotation than we would expect compared to the size of the curb?
• 13:29
  SPEAKER_00: Is the spine bending more than it's rotating, or potentially the spine is lateral shifting out of normal coronal alignment more than we thought it would?
• 13:38
  SPEAKER_00: So we have to look at all of those things when we're deciding what movement patterns we want to put the patient in, what stretches we want to use, how we want to approach those exercises.
• 13:47
  SPEAKER_00: So we have to look at all of that when we're deciding what's the most important for that patient.
• 13:51
  SPEAKER_00: If we're going to use stretches or exercises, is there an exact sequence we want to use this in based on their curve and what the priority is?
• 13:59
  SPEAKER_00: The second thing we have to consider is when the stretch creates more pain after doing it, especially when that pain lasts longer than temporary relief we would expect during the movement.
• 14:09
  SPEAKER_00: And the third thing we have to think about is when you become more flexible but not also more stable.
• 14:14
  SPEAKER_00: See, whenever we increase mobility, you have to also increase stability.
• 14:18
  SPEAKER_00: Increasing mobility helps us to potentially reduce the scoliosis.
• 14:23
  SPEAKER_00: But if we don't also add stability, that improvement may look better short term, but because the spine is more unstable, it collapses faster and gets worse long term.
• 14:34
  SPEAKER_00: So if you move further and further into a position, but you don't have the ability to control the spine there, you are likely just increasing mobility without improving how the body actually carries itself, which is one of the most important things when we're dealing with scoliosis.
• 14:48
  SPEAKER_00: And the fourth thing that gets my concern is when a stretching routine is being presented as a complete treatment for progressive scoliosis.
• 14:55
  SPEAKER_00: It's one of the adjunctive tools we use, but it's not the entire solution.
• 15:00
  SPEAKER_00: You see, stretching is generally part of scoliospecific exercise routine, but it's not on its own scoliospecific exercise or rehabilitation.
• 15:09
  SPEAKER_00: It can help improve mobility in an area that's restricted to make it easier for that person to find a correct posture.
• 15:15
  SPEAKER_00: But stretching alone does not address everything that needs to happen.
• 15:19
  SPEAKER_00: You see, each patient also has to learn how to actively correct their spinal alignment and posture, how to stabilize it in that position, how to breathe in the restricted or collapsed areas, and how to carry that corrected posture while they're doing normal everyday activities.
• 15:35
  SPEAKER_00: So if all you're doing is stretching and becoming looser, you're missing a major or the majority of the overall treatment plan.
• 15:42
  SPEAKER_00: Now, if you or your child have scoliosis and you're not sure whether the exercise you are doing are making sense for your curve or what you should be doing, I'm going to encourage you to request a free discovery call by clicking the link in our description and our team will reach out to you and set up a time where you can talk to me one-on-one about you or your child's scoliosis and what's most appropriate for you or your individual spine.
• 16:05
  SPEAKER_00: Now, let's talk about how you can tell whether a stretch may actually help.
• 16:09
  SPEAKER_00: Now, the first thing to look at is what direction the stretch is actually moving your spine.
• 16:14
  SPEAKER_00: Generally speaking, we may want to create more space through a shortened or compressed area and move the spine towards a more corrected position.
• 16:22
  SPEAKER_00: But that exact direction depends on the full scoliosis pattern, because correcting things in one area can actually worsen it in another area.
• 16:30
  SPEAKER_00: So we don't just simply stretch wherever the spine feels tight.
• 16:33
  SPEAKER_00: And we absolutely do not automatically perform the exact same stretch on both sides of the spine in both directions.
• 16:41
  SPEAKER_00: Because what's happening on one side of the scoliosis curve is often very different than what's happening on the other side.
• 16:47
  SPEAKER_00: So when you look at a stretch, you have to ask yourself, is it opening the compressed side of my curve?
• 16:53
  SPEAKER_00: Or am I moving further into the direction my spine is already bending?
• 16:57
  SPEAKER_00: Now, most people are not gonna know that just by looking in the mirror.
• 17:01
  SPEAKER_00: In fact, when I talk to patients every day that have had scoliosis their whole life, many of them struggle to just point out or show me where their scoliotic curves are.
• 17:09
  SPEAKER_00: And it makes sense because you generally can't look at your spine from behind in a mirror and people don't walk around memorizing x-rays and how that correlates to what's going on the inside of their spine.
• 17:19
  SPEAKER_00: But you need to understand where the main curve is, which direction it bends and rotates, and whether there are curves above and below it.
• 17:26
  SPEAKER_00: But in general, when you're looking at scoliosis, rehab or exercise routines, there are a few red flags that you absolutely want to recognize whenever someone's giving you some advice.
• 17:36
  SPEAKER_00: First of all, if the routine gives every single person with scoliosis the exact same stretches, it's probably not scoliosis specific.
• 17:45
  SPEAKER_00: If the only reason for the stretch is that side feels tight, that's probably not enough information.
• 17:52
  SPEAKER_00: And if you're getting more pain, numbness, tingling, or symptoms that remain worse afterward, you should stop and have the movement evaluated by a trained specialist.
• 18:02
  SPEAKER_00: The other important piece of information is what happens after doing the stretch.
• 18:07
  SPEAKER_00: As I mentioned before, creating mobility is only useful if you can also control the spine in a better position.
• 18:14
  SPEAKER_00: And this is why stretching is generally one piece of scoliospecific rehab.
• 18:19
  SPEAKER_00: We may use it in restricted areas, but then a person has to learn how to actively correct their spine, possibly breathe into collapsed areas, and most importantly, stabilize the spine in a more corrected position.
• 18:31
  SPEAKER_00: Otherwise, we've just created more movement without also teaching the body what to do with it and how to use it.
• 18:37
  SPEAKER_00: So at a high level, each stretch should have a very clear purpose.
• 18:41
  SPEAKER_00: It should move your particular curve towards a correct position, and it should also work to strengthen and stabilize it in that correct position.
• 18:49
  SPEAKER_00: So let's say you're already doing some scoliosis stretches.
• 18:53
  SPEAKER_00: What should you do with your current routine?
• 18:54
  SPEAKER_00: Now I don't want to tell everyone that's watching this video to just simply stop doing stretches.
• 18:58
  SPEAKER_00: If a stretch consistently reduces discomfort, doesn't create any other symptoms afterwards, helps you move and function better, it likely still will be useful.
• 19:08
  SPEAKER_00: But I would stop assuming that every stretch that feels good is automatically good for your scoliosis.
• 19:14
  SPEAKER_00: And I'd be very or extremely cautious of following general online routines that claim to work on every curve.
• 19:21
  SPEAKER_00: So before you continue with anything you're currently doing, find out what type of scoliosis you have and what direction the spine is actually moving.
• 19:30
  SPEAKER_00: And then ask if each stretch has a purpose that fits your specific curve pattern.
• 19:34
  SPEAKER_00: Now, if nobody can explain why you're doing that movement, which area it's supposed to affect, and what you should do after you gain that mobility, you probably don't have a scoliospecific exercise program.
• 19:46
  SPEAKER_00: You have a general stretching routine.
• 19:48
  SPEAKER_00: And those are absolutely not the same thing, and they're not appropriate for every patient.
• 19:53
  SPEAKER_00: Stretching can absolutely be helpful for scoliosis, but the stretch has to match the direction of your curve.
• 19:58
  SPEAKER_00: It has to be connected with what you do after you gain that mobility.
• 20:02
  SPEAKER_00: And it has to be tied to what you do with that after you gain the increase in mobility.
• 20:06
  SPEAKER_00: Otherwise, you may be getting looser without getting any more corrected or stable.
• 20:11
  SPEAKER_00: This is why an exact stretch may make sense for one person, but be completely wrong for another person.
• 20:17
  SPEAKER_00: And so if you're wondering whether your scoliosis is something that you can safely monitor or maybe require very specific treatment right now, watch my video.
• 20:40
  SPEAKER_00: I'll see you there.