The Vestibular System and Scoliosis
Most of our new patients that walk through our doors for the first time are standing and sitting crooked and asymmetrically. And They. Have. No. Idea. This astonishes me.
These are photos of one of my most hard working teenage patients. When we first started Schroth, he had no idea that he was standing in the position you see on the left. He can get into a very symmetrical posture, which you see on the right, but needed to be taught how to do that.
At Rest v.s. Corrected
How is it possible to not realize that you are leaning to the left, that your weight is mostly on your left foot when you’re standing, or that your neck is tilted to one side?
Answer: That big old adaptable brain of ours. Specifically, the vestibular system.
Most know the vestibular system as being responsible for balance. (And maybe some unlucky ones know that the vestibular system is responsible for vertigo – oy vey!) But this little system in our inner ears does so much more. It’s role in providing the brain with information about body position and spatial orientation is what we will focus on today.
Let’s touch base on the genesis of scoliosis. In both adolescent and adult scoliosis, the spine changes gradually, over a period of months (adolescents) or years (adults). As this gradual twisting and curving of the vertebrae happens, our vestibular system and therefore brain is constantly adapting to the change. The brain begins to register the curved spine as normal, or straight. The vestibular system profoundly shifts perceived verticality.¹. This is why so many with scoliosis are walking around crooked, unknowingly.
It's also important to note here that we cannot see our backs. What may be obvious to parents or spouses is not to those living in the scoliotic body. This is why pictures are part of every Schroth evaluation. We want our patients to see their backs, and to see what we are seeing. If we don’t know that we are crooked, how would we ever know to fix it?
So step 1, a thorough Schroth evaluation with pictures of the back = knowledge of postural deviations. Step 2; we teach our patients how to sit and stand in a symmetrical, “non-crooked” position.
This is when the vestibular system freaks out a bit.
The first time a person with scoliosis is taught how to sit and/or stand properly, their brain is telling them they are leaning over in the opposite direction that they started in.
Let’s break that down. If one’s dominant scoliotic curve is on the left side of the spine, that curve will literally pull their torso to the left. Remember, this happened slowly over time, so this person’s brain tells them that their leftward-leaning torso is “straight”. If we ask this person to bring their torso to center, which means shifting their torso to the right, their brain now perceives that they are “leaning” to the right. It’s all relative according to their perception.
This is the number one reason that Schroth therapy always involves mirrors. Lots of them. Our clinic space has mirrors covering 2 of our 4 walls. AND we have a rolling mirror that we literally follow patients around with. The mirrors don’t lie about body position. Oddly enough, the vestibular system (in those with scoliosis) does. Weird, right?
The fact that our brains are so adaptable (also called neural plasticity) means that those with scoliosis can eventually dig themselves out of this warped-perception hole. With lots and lots of practice with re-posturing, done in front of a mirror for feedback, we can change the vestibular system in a positive way. We can more easily catch ourselves when we are leaning to one side, standing more dominantly on one foot, and make our healthy postural corrections to get us centered again. Done repetitively, symmetrical posture becomes second nature, and we no longer have to think in order to be symmetrical. Our brains have been re-trained.
An orthotist I met once compared his “crooked” scoliotic patients to a painting hanging on a wall that’s crooked. His comment was, “If a painting in your house was 3 degrees off center, wouldn’t it drive you nuts?” Although I do appreciate the analogy, humans are much different than paintings! This orthotist is assuming that patients with scoliosis know they are crooked. As we discussed, most don’t, and even once they do know, it takes time and effort to change the brain and therefore the posture.
If you have scoliosis, try this at home. Sit in any chair. Relax. Allow your body to be in its most natural position. Close your eyes. Are you sitting heavier on your left hip? On your right hip? Symmetrically? Is it hard to tell? Any of those options are possible. Some folks’ awareness is better than others. If you identify that you are sitting heavier on one side, it is likely the side of your dominant curve. Right away you can start Schroth seated correction: even out the weight on your hips. Elongate your torso upward. Bring the shoulders down and back. Breathe.
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