How to treat lumbar scoliosis: LFK, exercises, gymnastics

Conservative treatment is considered most effective if it is 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 allows the curvature to be corrected to the natural position of the spinal column. In adulthood, in most cases, it is only possible to slow down the further development of the deformation.

In children under 8 years of age, the vertebrae have a cartilaginous structure, so they are easily corrected. Approximately between 8 and 14 years of age, the process of replacing cartilaginous tissue with bone tissue occurs. In children over 15 years of age, the spine acquires a solid structure, which is preserved for life.

Conservative therapy for lumbar scoliosis includes the following methods:

• manual therapy, with improvement of the muscular system condition, muscle relaxation, elimination of spasms;
• corsetry, which allows the spine to be held in its natural position;
• the use of medications - externally and internally - to relieve inflammation and eliminate pain;
• therapeutic physical interventions (physical therapy, gymnastics).

However, the main point in treatment is considered to be the elimination of the cause of curvature. Thus, an orthopedist helps in the correction of 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 functioning of internal organs. [ 1 ]

Corset for lumbar scoliosis

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

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

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 decide on the optimal device for each specific patient. [ 2 ]

Exercise therapy for lumbar scoliosis

Therapeutic gymnastics sessions last 40-45 minutes daily or every other day. The session is divided into three stages:

• The preparatory stage lasts up to 10 minutes and includes preparing the body for the upcoming load. Most often, walking, warming up the main muscle groups, building, rebuilding, breathing exercises, and posture exercises are practiced.
• The main stage lasts about 25 minutes. Exercises are performed to form a muscular 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 specialist), taking into account the location of the curvature, its degree and dynamics of development. 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 body, and correct the position of the spine.
• The final stage involves relaxing the muscles and may include breathing exercises.

Gymnastics for lumbar scoliosis

Gymnastics exercises for the correction of lumbar scoliosis are always special and are selected by a doctor on an individual basis. [ 3 ], [ 4 ] Preference is often given to the following exercises:

1. The patient lies on his stomach, arms bent at the elbows, hands holding a gymnastic stick. Performs active stretching by straightening the arms. Repetitions: 5-6 times.
2. The patient lies on his back, arms straight along the body. Performs abdominal crunches with a deep forward bend, trying not to tilt the body to the side.
3. The patient stands with his back to the gymnastic wall. Performs a half-hang with the leg abducted to the side, corresponding to the side of the curvature arc. 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 opposite the curvature arc extended back. Frequency of execution: 5-6 times for 10 seconds. It is important not to tilt the body to the side.
5. The patient assumes a knee-wrist position. Periodically moves the leg opposite to the side of the arch curvature back. Performs 5-6 repetitions without deviating the body to the side.
6. The patient lies on the affected side, raises the opposite leg at a right angle to the body and moves it back 5-6 times, touching the extreme points of support with the toe.
7. The patient lies on the side opposite to the side of the curvature. Moves the leg that is on top to the side. Repeats 5-6 times.
8. Lies on your back, holds your arms along your body. Bends your right or left leg (opposite to the arc of curvature) to a right angle. It is preferable to perform the exercise with weights.
9. The patient lies down on a stool or bench with his stomach, fixes his legs, bends his arms at the elbows. Performs breaststroke movements with his arms, trying to maintain the greatest possible amplitude.
10. The patient sits on a gymnastic bench, places his feet on a special massager. Performs movements on the massager while simultaneously moving his arms forward and down. The hands are held in a "lock". It is important to control and maintain correct posture during the exercise.

Exercises for scoliosis of the lumbar spine

• Exercise to support a curved spine:
  • starting position – the patient sits on a stool, holding his hands behind his head;
  • turns the shoulder girdle to the side by 90 degrees, the legs remain in place;
  • lies down on the bench so that its edge is located in the lumbar region;
  • bends over the edge of the bench, sags down with relaxation;
  • performs rocking movements up and down – approximately 20 times.
• Exercise to strengthen the paravertebral muscles:
  • starting position: the patient lies on the bench on his stomach, with his hands behind his head;
  • the edge of the bench should be located in the waist area, the legs are fixed;
  • bends down, then straightens up as much as possible, while the face looks forward;
  • performs 20 repetitions (if necessary, you can use weights from 1 to 3 kg).
• Exercise to strengthen the latissimus dorsi:
  • the patient performs pull-ups on a horizontal bar with a gradual increase in the number of pull-ups up to 10 times;
  • If necessary, outside assistance (for example, a child) may be required.

Massage for lumbar scoliosis

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

• ischemic heart disease;
• hypertensive crisis;
• allergic reaction;
• attacks of nausea and vomiting;
• lymphangitis and lymphadenitis;
• dermatological problems in the area of massage;
• high risk of bleeding.

Proper massage gives patients with scoliosis a feeling of relief and relaxation after the first sessions. Therapy is also recommended for preventive purposes - for example, for people who have sedentary work and cannot always control the straight 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 percussion movements predominate. The force of impact is determined by the massage therapist in each specific case. [ 7 ]

Yoga for Lumbar Scoliosis

Physical effects, including yoga, are the most effective way to create a strong muscular corset, relax tense 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 stages 1-2 of the pathology. Stages 3 and 4 require 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 lumbar spine lesions:

• The person stands in front of the wall, stretches his arms out in front of him and rests his palms on the wall. He moves back a little, stretching his back, while keeping his legs at hip width. He tries to move further and further so that his arms are at hip level and his torso is bent at a right angle.
• The patient grasps the table or bars with his hands (approximately at the level of the hips). He steps back, holding onto 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 hold on with his hands, fixes himself and returns to the starting position.
• Gets on all fours, rests his hands on the floor. Arches his back in the chest area, fixes it, bends in the opposite direction and fixes the position again. The bends should be done gently and carefully.
• Gets on all fours, hands resting on the floor. Takes a few steps forward with hands, lowers the abdominal area, straightens arms. Touches the floor with forehead, relaxes neck. Back should be straight. To stretch the back, stretch arms forward on the floor. With right-sided scoliosis, arms can be shifted to the right.
• Makes a right-side lunge with the leg forward. Places the fingers on the floor on either side of the right foot. Keeps the back straight and the chest open. It is important to feel the muscle tension in the hips and groin of the "back" leg. Hold the pose for half a minute, then change the lunge leg.
• The patient sits on the floor, moves one leg forward and bends it at the knee, and moves the other back, trying to straighten it. The hips should be directed forward, the back straight. You can lean on straight arms, or bend your elbows and lower yourself onto your forearms. The pose is fixed for half a minute, after which you should change legs.
• The person lies on his back, lifts the upper part of the body and legs off the floor. The lower back remains pressed to the floor. The arms are straight, pressed to the body. The toes are kept at eye level. The pose is held for half a minute.
• Lie down on your back, place a towel or clothing cushion under your knee joints. Close your eyes and try to relax as much as possible. Breathe evenly and calmly. 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 significantly improve both flexibility and posture.

Physiotherapy treatment

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

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

Water treatments, sodium chloride baths, and mud therapy are suitable for activating the immune system. The greatest effect is observed with a combination of physiotherapeutic methods, as well as with their addition of manual therapy and exercise therapy.

Physiotherapy procedures alone will not help correct scoliosis curvature. They should be used in combination with other possible types of treatment. This is the only way to create the most favorable conditions for eliminating blockages in the motor segments of the spinal column, eliminating pain syndrome, and improving the functioning of internal organs.

Surgical treatment

Surgery to eliminate lumbar scoliosis is prescribed only in the most advanced situations, when the angle of deformation exceeds 50 degrees, and conservative treatment is considered ineffective. The essence of the intervention is to correct the curved arc of the spine by inserting special plates, grips or screws into it. After such manipulations, the straightened segment of the spinal column becomes immobile. [ 8 ]

Contraindications to surgical intervention may include uncompensated pathologies of the respiratory and cardiovascular systems, and general exhaustion of the body.

Lumbar scoliosis surgery is performed primarily 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 acts as a kind of splint that supports the spine until the bones are completely fused. However, even after this, the “splint” is not removed, which is due to the complexity of the intervention. The process of fusion of the vertebrae can last 3-12 months. During this period, the patient is prohibited from putting any load on the spine. [ 9 ]

Surgical treatment is not used very often, since any operation not only brings benefits, but can also have a negative impact on the condition of the entire body. [ 10 ]