How to treat lumbar scoliosis: exercise therapy, exercise, gymnastics

Conservative treatment is considered the most effective if carried out in childhood, in patients under 15 years of age. It is during this period that the vertebrae still have a cartilaginous layer, which makes it possible to correct the curvature to the natural position of the spinal column. In adulthood, in most cases, it is only possible to slow down the further development of deformity.

In children under 8 years of age, the vertebrae have a cartilaginous structure, so they can be easily corrected. Approximately in the period from 8 to 14 years, the process of replacement of cartilage tissue with bone tissue occurs. In children over 15 years of age, the spine acquires an integral structure, which remains for life.

Conservative therapy for lumbar scoliosis includes the following techniques:

• manual therapy, with improving the condition of the muscular system, relaxing the muscles, eliminating spasms;
• corsetting to keep the spine in its natural position;
• the use of medicines - externally and internally - to relieve the inflammatory process and eliminate pain;
• therapeutic physical effects (exercise therapy, gymnastics).

However, the main point in treatment is the elimination of the cause of the curvature. So, an orthopedist helps in correcting flat feet or clubfoot, and a sedentary lifestyle is corrected by providing additional physical activity.

The help of surgeons may be required only when the curvature cannot be corrected by other methods, and the very presence of scoliosis negatively affects the work of internal organs. [1]

Corset for scoliosis of the lumbar spine

One of the solutions to the problem of scoliotic curvature of the lumbar spine can be the use of posture correctors, lumbar orthoses or corsets.

What is such a corrector for? It should be understood that such devices are recommended not only for obvious manifestations of scoliotic curvature. The sooner the correction begins, the sooner a cure will be achieved. Depending on the degree of pathology, the corrector is used from several hours daily to constant wearing.

Currently, the use of corsets is part of the complex treatment of vertebrogenic pain syndrome, along with medications, exercise therapy, manual therapy and physiotherapy. The range of posture correctors and lumbar corsets is extremely diverse, which allows you to find an individual solution and determine the optimal device for each individual patient. [2]

Exercise therapy for lumbar scoliosis

Therapeutic gymnastics classes last for 40-45 minutes daily or every other day. The lesson is conventionally divided into three stages:

• The preparatory stage lasts up to 10 minutes and includes preparing the body for the upcoming load. Most often, they practice walking, warming up the main muscle groups, building, rebuilding, breathing exercises, exercises for posture.
• The main stage lasts about 25 minutes. Exercises are performed to form a muscle corset, correct and stabilize the deformation process. Classes are performed in accordance with a special individually compiled program, which is determined by a doctor or exercise therapy instructor (rehabilitation therapist), taking into account the location of the curvature, its degree and development dynamics. As a rule, the complex consists of exercises that improve the general and strength endurance of the back and abdominal press, strengthen the muscles of the lateral surface of the trunk, and correct the position of the spine.
• The final stage involves relaxation of the muscles, and may include breathing exercises.

Gymnastics for lumbar scoliosis

Gymnastics classes for the correction of lumbar scoliosis are always special, selected by the doctor on an individual basis. [3]The  [4]  following exercises are often preferred:

1. The patient lies on his stomach, bends his arms at the elbows, hands hold the gymnastic stick. Performs active traction by straightening the arms. Repetitions: 5-6 times.
2. The patient lies on his back, arms straighten along the body. Performs a swing of the press with a deep forward bend, trying not to deflect the body to the side.
3. The patient stands with his back to the gymnastic wall. Performs a half-hang with abduction to the side of the leg corresponding to the side of the curve of curvature. Frequency of execution: 5-6 times for 10 seconds. The back should be pressed against the gymnastic wall.
4. The patient stands facing the gymnastic wall. Performs a half-hang with the leg laid back, opposite to the arch of curvature. Frequency of execution: 5-6 times for 10 seconds. It is important not to tilt your torso to the side.
5. The patient takes a knee-wrist position. Periodically pulls back the leg opposite to the side of the curvature of the arch. Performs 5-6 repetitions without deviating the trunk to the side.
6. The patient lies on the affected side, lifts the opposite leg at a right angle to the body and takes it back 5-6 times with the toe touching the extreme points of support.
7. The patient lies on the side opposite to the side of the curvature. Pulls to the side the leg that is at the top. Repeats 5-6 times.
8. Fits on the back, holds the arms along the body. Bends the right or left leg (opposite to the curve of the curve) to a right angle. It is preferable to do the exercise with weights.
9. The patient lies with his stomach on a stool or bench, fixes his legs, bends his arms at the elbows. Performs breaststroke movements with his hands, trying to adhere to the greatest possible amplitude.
10. The patient sits on a gymnastic bench, the feet are placed on a special massager. Performs movements on the massager with simultaneous retraction of the arms forward and downward. The brushes are held in a "lock". It is important during the exercise to control and maintain the correct posture.

Exercises for scoliosis of the lumbar spine

• Exercise to support the curved spine:
  • starting position - the patient sits on a stool, holds his hands behind his head;
  • turns the shoulder girdle to the side 90 degrees, the legs remain in place;
  • lies on the bench so that its edge is located in the lumbar region;
  • bends over the edge of the bench, makes a sag down with relaxation;
  • performs swinging movements up and down - about 20 times.
• Exercise to strengthen the paravertebral muscles:
  • starting position - the patient lies on a bench on his stomach, hands behind his head;
  • the edge of the bench should be located in the belt area, the legs are fixed;
  • bends down, after which it unbends as much as possible, while the face looks forward;
  • performs 20 repetitions (if necessary, weights from 1 to 3 kg can be used).
• Exercise to strengthen the latissimus dorsi:
  • the patient performs pull-ups on the bar with a gradual increase in the number of pull-ups up to 10 times;
  • if necessary, you may need third-party help (for example, a child).

Lumbar scoliosis massage

Depending on the severity of the curvature and the patient's age, the specialist will be able to choose the necessary massage technique. [5]The treatment has a number of contraindications:

• cardiac ischemia;
• hypertensive crisis;
• allergic reaction;
• attacks of nausea and vomiting;
• lymphangitis and lymphadenitis;
• dermatological problems in the field of massage;
• high likelihood of hemorrhage.

Correct massage gives scoliosis patients a feeling of relief and relaxation after the first sessions. Therapy is also recommended for prophylactic purposes - for example, for people who are engaged in sedentary work and cannot always control the level position of the spine. After all, lumbar scoliosis can appear not only in children, but also in adulthood. [6]

Among the massage techniques used, kneading, rubbing, stretching, and sometimes shock movements prevail. The strength of the impact is determined by the masseur in each case. [7]

Yoga for lumbar scoliosis

Physical influences, including yoga, are the most effective way to create a strong muscular corset, relax tight muscles, and improve joint mobility in lumbar scoliosis. Yoga asanas allow you to gradually correct the curvature and significantly improve the patient's well-being - however, this applies mainly to the 1-2 degree of pathology. The third or fourth degree requires a more thorough approach and regular consultation with a doctor, classes with exercise therapy and yoga specialists.

Most often, the following exercises (asanas) are recommended for the defeat of the lumbar spine:

• The person stands against the wall, stretches out his arms in front of him and rests his palms against the wall. Leans back a little, stretching the back, while keeping the legs hip-width apart. He tries to move further and further so that his arms are at the level of the hips, and the body is bent at a right angle.
• The patient is taken with his hands on the table or bars (approximately at the level of the hips). Moves back, holding on to the object. The lower limbs and back remain straight: the tension of the back muscles should be felt. In this position, the person squats, continuing to be held with his hands, is fixed and returns to its original position.
• Becomes on all fours, hands rests on the floor. Bends the back in the chest area, fixes, bends in the opposite direction and again fixes the position. Deflections should be performed not abruptly and carefully.
• Becomes on all fours, hands rest on the floor. He takes several steps with his hands forward, lowers the abdomen, straightens his arms. Touches the floor with the forehead, relaxes the neck. The back should be straight. To stretch the back, stretch the arms forward along the floor. With right-sided scoliosis, the arms can be shifted to the right.
• Performs a right-side forward lunge. The toes of the hands are lowered to the floor on the sides of the right foot. Keeps your back straight and your chest straight. It is important to feel the muscle tension in the thighs and groin of the "back" leg. The pose is fixed for half a minute, then the lunge leg should be changed.
• The patient sits on the floor, puts one leg forward and bends at the knee, and the other starts back, trying to straighten it. The hips should be directed forward, the back should be straight. You can focus on straight arms, or bend your elbows and lower yourself on your forearms. The pose is fixed for half a minute, after which the leg should be changed.
• The person lies on his back, tears off the upper body and legs from the floor. The loin remains flat on the floor. Hands are straight, pressed to the body. The toes are held at eye level. The pose is held for half a minute.
• He lies on his back, puts a towel or clothes roller under the knee joints. Closes his eyes and tries to relax as much as possible. Breathing is even and calm. The exercise should be continued for at least five minutes. After that, you can get up: gradually and carefully.

Exercises should be performed 3-4 times a week (optimally every other day). This will greatly improve both flexibility and posture.

Physiotherapy treatment

Electrotherapy involves muscle electrical stimulation and electrophoresis. Electrical stimulation is used to strengthen muscles, in 10 or 15-day courses with an interval between them of about 3 months. Electrophoresis prevents the development of osteoporosis.

To stimulate blood and lymph circulation in lumbar scoliosis, heat therapy is prescribed - in particular, hot wraps, paraffin applications.

To activate the immune system, water procedures, sodium chloride baths, mud therapy are suitable. At the same time, the greatest effect is observed with a combination of physiotherapeutic methods, as well as when supplemented with manual therapy and exercise therapy.

Physiotherapy procedures alone will not help in correcting scoliotic curvature. They should be used in combination with other possible treatments. This is the only way to create the most favorable conditions for eliminating the blockage of motor segments in the spinal column, getting rid of pain syndrome, and improving the functioning of internal organs.

Surgery

An operation to eliminate lumbar scoliosis is prescribed only in the most advanced situations, when the deformity angle exceeds 50 degrees, and conservative treatment is recognized as ineffective. The essence of the intervention is to correct the curved arch of the spine by introducing special plates, grips or screws into it. After such manipulations, the straightened segment of the spinal column is immobile. [8]

Contraindications to surgical intervention can be uncompensated pathologies of the respiratory and cardiovascular systems, general depletion of the body.

The operation for lumbar scoliosis is performed mainly through the posterior (dorsal) approach. An implant is installed - a metal rod with fixing elements that can move along the axis: they are fixed in the vertebrae. The implant plays the role of a kind of splint that supports the spine until the bones are completely fused. However, even after this, the "splint" is not removed, due to the complexity of the intervention. The process of fusion of the vertebrae can take 3-12 months. During this period, the patient is not allowed to load the spine.[9]

Surgical treatment is not used so often, since any operation brings not only benefits, but can negatively affect the state of the whole organism. [10]