Active Versus Passive Scoliosis Treatments

One of the most frequently asked questions we get from new and potential patients is, “Are the tables that flip me upside down good for my scoliosis?” What they are referring to is called an inversion table; in which you lie down, secure your ankles, and proceed to invert yourself. This reverses the effect of gravity on the spine: instead of gravity pushing from the top down, gravity now pushes from the bottom up. This often feels great to those suffering from compressive types of low back pain, as gravity’s pressure is shifted to the upper back and neck. But for scoliosis specifically? Let’s dive into this important topic today.

Devices like inversion tables fall into the category of a passive treatment. No muscle activation is required on the user’s part. Although this may temporarily “straighten” the scoliosis while the patient is inverted, as soon as they come back into an upright position and resume normal gravitational positioning, the scoliosis will go right back to where it started. Same goes for devices like traction machines for the neck and for the low back. Maybe some temporary “straightening”, but right back to baseline when the person resumes upright positioning. Sigh. So much for a silver bullet.

Devices like the ones mentioned above, and so many more, have flooded the market in recent years as our appetite for both consumerism and quick fixes in the U.S. has soared. With so many of our patients asking about these various devices, we think it’s important to address them as a unit to help you all make the distinction between passive and active treatments for scoliosis.

As a recap, scoliosis is a “bone problem”: the bones of the spine – the vertebrae – are twisting and bending. Scoliosis, so far as we know, is not a muscular problem, although the muscles absolutely react to the bony malformation - but the muscles are not the genesis of scoliosis. 

All of our spinal muscles are under our voluntary control. We can and we should be using the voluntary muscular system to our advantage in treating scoliosis. Do nothing, and you’re allowing the muscles to shorten on the inside of the curve and become overly-stretched on the outside of the curve. Participate in an exercise-based scoliosis program, and you can teach your muscles to stretch out on the inside of the curve, and to contract on the side of the curve, therefore re-balancing the incredible muscle imbalance that scoliosis creates.

Scoliosis-specific exercise is an active treatment: you are activating muscles to reduce the curvature (in kids and teens) and re-balance the muscles (in everyone with scoliosis). The result of participating in an active form of scoliosis treatment is torso-reshaping which has been detailed in previous blogs for both teens and adults.

We at SchrothDC are trained in the Barcelona School of Schroth, now referred to as Rigo Concept. But it’s important to know that there are several other “schools” of scoliosis-specific exercise, including but not limited to the German Method of Schroth called ISST, The Lyon Method hailing from France, and SEAS which originated in Italy. All of these methods fall into the category as Physiotherapeutic Scoliosis-Specific Exercise, or PSSE. They are all active treatments for scoliosis and we’d be thrilled if every person with scoliosis practiced one of these methods. 

If it hasn’t come through loud and clear yet, we are HUGE advocates of active methods of treating scoliosis. Yes, this means you have to get off the inversion table and start exercising my friends!

For your reference, here’s a quick list of ACTIVE scoliosis treatments, or PSSE:

• Rigo Concept (Formerly known as Schroth Barcelona Institute)

• SSOL Schroth (formed by a former instructor of Schroth Barcelona Institute)

• ISST Schroth (Germany)

• SEAS (Italy)

• FITS (Poland)

• Side Shift (United Kingdom)

• Lyon Method (France)

 Also for your reference, a list of PASSIVE scoliosis treatments:

• Inversion Tables

• Traction machines

• Denny Rolls

• Foam wedges placed under one buttock in sitting

• Foam wedges placed under one side of the spine while resting on your side

• “Postural t-shirts”

• Postural devices that pull the shoulders back

• Soft Braces for Scoliosis

• Hard Braces*

Ok, we must elaborate on that last one, hence the asterik. A well-made hard plastic three-dimensional brace for a skeletally-immature kid or teen, although technically passive, can reduce or at least prevent worsening of scoliosis, and we 100% advocate for this piece of passive treatment. Read more about bracing for pediatric scoliosis here.

In an ideal world, every kid or teen that wears a brace like the one mentioned above would be actively working with their brace, rather than “hanging” on their brace like one recent teen who admitted to me that his hands were falling asleep when he was super-slouching in his brace: without any muscle activation on his part, the hard plastic was cutting off his circulation in his armpits (!)

Also in an ideal world, every kiddo in said brace would be participating in a scoliosis-specific exercise program, or at the very least, be regularly doing core strengthening exercises, as a known side effect of wearing a rigid brace is core muscle weakening.

As we wrap up this topic, we think it’s important to note that we are not trying to demonize passive scoliosis treatments. We realize there’s value in some of these treatments, like the above example with a rigid brace. We’d just like patients to be able to know the difference, and to ALWAYS incorporate some type of active treatment alongside their chosen passive treatments – a classic “best-of-both-worlds” scenario.

 If you’re craving more guidance on how to best take care of your scoliosis over the lifespan, come get active with us! We’d love to be your guides.