No two cases of scoliosis are the same; the complex nature of the condition necessitates the customization of effective treatment plans. When it comes to squatting with scoliosis, in mild cases, a treatment-provider can clear the exercise, but in more-severe cases, and/or if squats cause pain, avoiding squats can be recommended as it’s a back-focused exercise.
There are certain exercises that should be approached with caution by people with scoliosis, others that should be avoided completely, and some that help augment corrective treatment results. Whether or not squats are safe for those with scoliosis will depend on the individual case in question.
Before addressing the specific question of whether or not squatting with scoliosis is safe, let’s talk about how condition severity is determined.
How Bad Can Scoliosis Get?
Scoliosis is a highly-prevalent spinal condition; not only does the Scoliosis Research Society have current estimates of close to seven million people living with the condition in the United States alone, it’s the leading spinal condition amongst school-aged children.
Scoliosis causes the spine to bend unnaturally to the side and rotate, and the rotational component makes scoliosis a complex 3-dimensional spinal condition.
Scoliosis is progressive, meaning it has it in its nature to worsen over time, so where a scoliosis is at the time of diagnosis doesn’t mean that’s where it will stay; scoliosis isn’t a static condition.
Scoliosis can range in severity from mild to moderate and severe to very severe, and activity/exercise restrictions and recommendations will depend largely on how severe a condition is.
If left untreated, or not treated proactively, scoliosis can progress from mild to moderate and severe to very severe; only proactive treatment can work towards counteracting the condition’s progressive nature.
In addition to the different severity levels of scoliosis, there are also multiple different types a person can develop, each with its own characteristics, effects, and treatment needs: another reason exercise recommendations are so case-specific.
Condition severity is determined during X-ray by taking a patient’s Cobb angle measurement, and this involves drawing lines from the tops and bottoms of the curve’s most-tilted vertebrae, at its apex, and the resulting angle is expressed in degrees.
The higher a patient’s Cobb angle, the more severe the condition, and the more likely it is that certain exercises, like squats, should be avoided:
- Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
- Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
- Severe scoliosis: Cobb angle measurement of 40+ degrees
- Very-severe scoliosis: Cobb angle measurement of 80+ degrees
When it comes to exercise/activity restrictions, these would have to come from a patient’s treatment provider as only they can determine whether or not doing squats would be too strenuous for the spine and/or interfere with treatment.
Should I Squat with Scoliosis?
Before addressing the topic of squatting with scoliosis, let’s first take a look at the movement itself.
A squat is performed by:
- Standing upright with feet shoulder-width apart
- While being mindful of keeping the chest out, engage the core, and shift the body’s weight into the heels and push the hips out and back
- Lower the body into a squat position
- While shifting weight to stand upright again, ensure the chest is out, the core is engaged, and the feet are applying even pressure to the ground
Performing squats can help increase core, hip, leg, and joint strength. In addition, having a strong core means better posture and can make the spine less vulnerable to injury.
Having strong abdominal muscles means the spine is stronger and more flexible, and it’s going to be better able to handle stress from twisting, bending, and lifting movements.
Now, part of treating scoliosis proactively involves increasing core strength through physical therapy and certain exercises, but these exercises have to be designed by a scoliosis-specific physical therapist, and no form of exercise should be attempted before it’s first cleared by a patient’s treatment provider.
The reason some patients shouldn’t be squatting with scoliosis is that it’s a back-focused exercise, and in severe cases, that movement can cause pain, and as the movement uses the body’s weight as resistance, this can mean adding extra weight/pressure to the lower back.
So if a condition is mild, the movement doesn’t cause pain, and/or it was cleared by a patient’s treatment provider, scoliosis patients can benefit from the core-strengthening potential of squatting, but if severe, painful, and/or it hasn’t been deemed safe, it can add extra pressure and weight to the lower back: something that scoliosis patients don’t need.
Additional Exercises to Avoid with Scoliosis
When it comes to exercises and activities to avoid with scoliosis, again, recommendations will be case specific, but in general, the following exercises are deemed unsafe for people with scoliosis, or at the very least, should be approached with caution:
- Exercises that overuse one side of the body
- Exercises that involve hyperextending the spine
- Exercises that involve repeated jarring shocks from impact
- Exercises that involve the back bearing extra weight
- Exercises that cause pain and/or place the spine in an unnatural position
As scoliosis introduces a lot of uneven forces to the body, its main visual effect is disrupting the body’s overall symmetry; in children, this will look like uneven shoulders, shoulder blades, the development of a rib arch, and uneven hips.
One of the related effects of scoliosis is developing a muscle imbalance; the unnatural spinal curve pulls its surrounding muscles in different directions, causing muscles on one side to become stretched and weak from overuse, and the muscles on the opposite side to become weak from underuse.
Exercises that overuse one side of the body can exacerbate the asymmetrical effect of scoliosis and contribute to a developing muscle imbalance; this can include exercises/activities such as bowling, tennis, and golf.
Hyperextending the spine is not good for people with scoliosis because as a 3-dimensional condition, the spine also twists, and hyperextension means the spine is over-extended, and vertebral bodies can rotate further into the unnatural spinal curve; for this reason, gymnastics and diving are generally not deemed safe for people with scoliosis.
When skeletal maturity has been reached, scoliosis becomes a compressive condition, and this means the spine and its surrounding muscles and nerves are vulnerable to compression (uneven pressure).
Exercises and activities that involve repeated shocks from jarring motions are compressive forces, and the last thing scoliosis patients need is to expose their spines to additional compression.
Sports and exercises that involve repeated shocks include squats with jumps, football, and horseback riding.
Dead-lifting is generally not considered safe for people with scoliosis because adding extra weight to the upper body means adding extra weight to the spine, and this can strain it and increase its chance of injury, and a scoliotic spine is already vulnerable to injury.
Basically, any exercise that causes pain, puts the spine in an unnatural position, overuses one side of the body, and/or increases potential compression should be avoided by people with scoliosis.
Conclusion
So should I squat with scoliosis? The answer will be case-specific, but in general, mild cases of scoliosis can benefit from core strengthening, but only if cleared by a patient’s treatment provider.
Even if a patient is told squatting is safe for their curvature type, but finds it painful, squatting should be stopped; scoliotic spines are already facing a number of challenges, and anything that causes pain is likely straining it.
When performed properly, squats can help increase core strength, and this helps support the spine and facilitates its ability to maintain its natural curves and alignment, which is why physical therapy and scoliosis-specific exercises are a key facet of treatment.
Exercises and/or activities that introduce more uneven forces to the spine and body should be avoided, while those that work the body’s muscles symmetrically and help increase spinal strength and flexibility can make the spine more responsive to treatment.
There was once a time when the place of exercise in scoliosis treatment was questioned, but we’ve since learned that when scoliosis-specific, designed by a scoliosis specialist, and combined with other corrective treatment disciplines, certain exercises can help in a number of ways.
Scoliosis-specific exercises can increase core strength, spinal flexibility, address any related muscle imbalances, improve posture, and augment corrective treatment results.
Here at the Scoliosis Reduction Center®, I customize each and every treatment plan, and a large part of that is lifestyle guidance; helping patients find that balance of healthy activity levels/exercise that facilitate a scoliosis- and spine-friendly lifestyle is key.
