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Getting It Straight

Posted on: Friday, 4 February 2005, 03:00 CST

How to recognize and teach dancers with scoliosis

Figure A

A normal spine viewed from the side and back

Figure B

Front views of spines with scoliosis; for curves greater than 45 degrees (see the double curve at far right), spinal surgery may be necessary.

Your 11-year-old Student is having difficulty performing an arabesque. As you help her with the movement, you recall that she often has difficulty performing dance moves on one side. Since she's going through her growth spurt, you begin to wonder: Are her difficulties coming from simple muscle imbalances, or could she have scoliosis? While scoliosis can sometimes present a physical challenge for dancers, it's not a career-ending diagnosis. Understanding the basics of scoliosis will help you identify this condition, its challenges and how to maximize your role as a dance teacher.

Understanding Scoliosis

In a normal spine, there are three natural curves visible from the side. From behind, however, the spine should look straight (see Figure A). Scoliosis is a lateral curvature of the spine that makes it look like an S or a C from behind. The curve patterns are identified by their location in the spine (see Figure B). The severity of the curve can be measured in degrees on an X-ray.

The curves are further classified as either functional or structural. In functional scoliosis, the spinal curve can be normalized by having a health care professional correct a problem such as a leg-length discrepancy or muscle spasms. In structural scoliosis, however, the curves are irreversible and include spinal rotation as well as lateral curvature. Structural scoliosis can be caused by injury or disease, or be of unknown origin. This type of structural scoliosis is referred to as idiopathic, meaning it has no known cause.

Idiopathic scoliosis, comprising 80 to 85 percent of cases diagnosed, affects children during their growth spurt after age 10. Three to five adolescents out of 1,000 have curves that require treatment. While mild scoliosis affects boys and girls equally, the moderate and severe forms most often affect girls. Curve progression generally stabilizes once growth has stopped, but curves beyond 50 degrees run the risk of progressing into adulthood.

Identifying the Problem

In dance class, there are common postural asymmetries exhibited by children with scoliosis that may tip you off to their condition. One shoulder may be higher or one shoulder blade more prominent. The young dancer could have an unequal space between the arm and waist on one side as compared to the other, or have a hip protruding to the side. The child may even appear to be leaning sideways when asked to stand up straight. From the front, one side of the rib cage may protrude. Dancers with scoliosis often have difficulty balancing on one side and performing movements such as arabesque, due to muscle imbalances and associated motor-control problems.

Early recognition of scoliosis can lead to early treatment, which can slow or stop the abnormal growth of the spinal curves. Although screening programs for scoliosis usually take place at public elementary schools starting at age 10 or 11, you may observe signs of scoliosis before the child has been screened. The forward-bend test is an easy screening procedure that you can perform. Ask the child to bend forward with his or her feet together, knees straight and arms dangling. If the rib cage and spinal muscles bulge on one side, alert the parents so that the child can be evaluated by a physician.

Scoliosis should have a minimal impact on a person's physical well-being. Still, the condition can predispose individuals to muscle imbalances, spinal stiffness and motor control issues, which increase stress on the neck, shoulders, back and hips. These accompanying problems can lead to pain and arthritis, and dance teachers must be aware that students with scoliosis can experience pain beyond the ordinary muscle aches associated with dance training.

Recommended Treatments

Treatment for structural scoliosis is dependent on the child's age, the degree and pattern of the curve and how much growth is left. Curves less than 15 to 20 degrees are considered to be a postural asymmetry and respond well to exercise. Close observation is recommended for those with a 20- to 25-degree curve to monitor curve progression. With curves ranging from 25 to 45 degrees, a specialized brace may be worn 18 to 23 hours per day, with breaks for sports and bathing, until the child stops growing. The brace can only prevent or slow curve progression, but cannot reverse the process. Most braces are made of rigid plastic that restricts movement, but research is being done on the long-term effectiveness of non-rigid braces, which may be a viable alternative for the adolescent dancer who desires more freedom of movement. Unfortunately, for growing children with curves greater than 45 to 50 degrees, spinal surgery is recommended to fuse the curving segments, balancing the curves and preventing curve progression.

Exercise is helpful to maximize spinal function over time, but alone it has not been found to stop or reverse curve progression. Pilates is particularly beneficial for dancers with scoliosis, to improve core strength, balance, flexibility, postural awareness and motor control. These exercises should be guided by a physical therapist or a certified Pilates instructor who has experience working with individuals with scoliosis. If the child requires a brace, a physical therapist will develop exercises that can be performed both in and out of the brace.

The Role of the Dance Instructor

Dance allows children with scoliosis to stay active while improving posture, balance and confidence. As the dance teacher, it is important for you to encourage symmetry of movement as much as possible. Dancers tend to be strong but not necessarily balanced, and they will often reinforce movements on their "easier" side because they enjoy success. It's your job to take them outside of their comfort zone. For example, if your warm-up always begins on the right leg, try starting on the left once in a while. This will benefit your other students as much as your dancer with scoliosis. Take time to focus on the side most affected by the spinal curvature, if not during class then before or after. Give verbal and tactile feedback while students work on their more difficult side to encourage correct movement patterns.

You may have additional challenges if the student is wearing a brace, as hip movements may be limited. Wearing a brace also contributes to a stiff upper back, making it difficult for the dancer to maintain a relationship between the spine, rib cage and pelvis, especially during jumps. Stretching the hip flexor muscles will help decrease stress on the lower back, as will developing adequate motor control in the hips and pelvis. Many Pilates exercises are ideal for encouraging control since complex movements can be broken down into simpler components to aid muscle memory. Imagery is also a great way to improve control through the trunk. Cues such as "imagine that your rib cage is connected to your pelvis by rubber bands" can help encourage the connection between the pelvis and trunk.

Communication with all members of a child's medical team will maximize results. Consult with the physical therapist and physician for additional recommendations or restrictions that the child may have. Also, talk with parents about how to reinforce at home what their child learns in the studio, from postural reminders to assisting with stretches. Finally, give plenty of encouragement to your student during class without drawing undue attention to his or her condition. No child wants to be singled out for being different, so be aware of how you address scoliosis with other students.

Scoliosis does not spell the end of a young dancer's career, and in fact should have relatively little impact if the dancer and instructor are aware of the accompanying physical challenges. As a dance teacher, you are invaluable in helping with the recognition and management of your student's scoliosis. By giving and receiving input from the child, parent, physical therapist and/or physician, your student will have a more positive experience and enjoy a lifetime of dance.

The Dance Connection

Q: Are young dancers and gymnasts really more susceptible to scoliosis?

A: It has been observed that scoliosis has a higher incidence among gymnasts, figure skaters and dancers. A Bulgarian study in 2000 looked at 100 girls between ages 11 and 15 participating in rhythmic gymnastics, a sport which combines elements of dance and gymnastics. The study found a five-fold increased incidence of idiopathic scoliosis in rhythmic gymnasts as compared to non- gymnast adolescents. Participants of this sport were found to have genetically "loose" joints, predisposing them to be selected for dance and rhythmic gymnastics at a young age. This population also generally had delayed puberty onset, which can contribute to weakened bones, influenced by the physical, dietary and psychological stresses of the sport. Finally, these gymnasts experienced repetitive asymmetric overloading on their growing spines. These factors in combination could account for the larger incidence of scoliosis in this population. Nonetheless, it should be noted that scoliosis in dancers is usually mild and that exercise and dance promote \good posture and an active lifestyle.

"TALK WITH PARENTS ABOUT HOW TO REINFORCE AT HOME WHAT THEIR CHILD LEARNS IN CLASS, FROM POSTURAL REMINDERS TO ASSISTING WITH STRETCHES."

By Ada Wells, MPT

Ada Wells, MPT, is a physical therapist, a Polestar-certified Pilates instructor specializing in sports injuries and the owner of ProBalance Physical Therapy in Alameda, California.

Copyright Lifestyle Ventures Feb 2005

Source: Dance Teacher

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