Scoliosis is a condition in which the spine, when viewed from the back, has one or more curves. The vertebrae are abnormally rotated, which creates twisting and more prominent visibility of the rib cage on one side, and it is most commonly seen in adolescents ages 10 and older. Most cases cannot be reversed, but they can be controlled, for example dancer Paige Fraser who despite suffering from severe scoliosis, has thrived as a dancer. Dance teachers can play an essential role in spotting the condition at an early stage.
“Teachers can help to notice that scoliosis is there in the first place," says Sophia Fatouros, a New York City–based dance teacher and and former professional ballet dancer who has struggled with scoliosis since she was 12. “Parents do not always see their children in tight clothes, like leotards."
So what should you keep an eye out for during class? In addition to a curved spine, other warning signs are: head not centered directly above the pelvis; uneven shoulders; one raised hip; rib cage sides at different heights; uneven waist; changes in color or texture of skin overlying the spine (like dimples or hairy patches); entire body leans to one side; fatigue; difficulty breathing.
Once you notice that a dancer may have scoliosis, the next step is to alert the student and her parents. But, “encourage the student to continue with her dance career," recommends Fatouros, who is the former director of dance at The Harlem School of the Arts. “Let her know it's not over." Wendy Whelan, Deanna McBrearty, Alexandra Ansanelli and Katie Bergstrom, for instance, all had successful careers with New York City Ballet after being diagnosed with scoliosis in varying degrees.
Every case is unique, says Rebecca Dietzel, an anatomist who works with The Ailey School. “Dancers need to find a physical therapist to pinpoint where the curves are happening and to get personalized exercises." And while scoliosis is not usually painful, if a dancer does develop pain, it is important to see a doctor. “She should be encouraged to see her health care provider and bring back recommendations for movement modifications to the teacher," says Karen Clippinger, a dance professor at California State University at Long Beach and author of Dance Anatomy and Kinesiology, who was diagnosed with mild scoliosis as a teen.
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If a dancer has a curve of 10 to 15 degrees, her doctor may suggest exercises that will strengthen the muscles around her spine (see below for a spine-strengthening exercise). Fatouros recommends trying Hanna Somatics, a system of neuromuscular mind-body training that helps improve spinal strength and symmetry. While there is still debate about the effectiveness of back braces, some doctors suggest that patients with a curve between 20 and 40 degrees wear one, and they can be removed during class. If a curve is greater than 40 degrees, the dancer may need surgical treatment.
When a dancer undergoes surgery for scoliosis, parts of the spine are fused together or may be held in place by a rod, which immobilizes those joints. “She can no longer move that part of the spine," Dietzel says. “Movement will come from above or below those joints, and the movement will look different. Teachers should not compare the student to how she moved before surgery or to other dancers in class." After surgery, Clippinger advises, teachers should promote the use of abs to support the spine. “Because the fused segment moves as a unit, the vertebrae adjacent tend to bear extra stress," she says. “Students should use the abdominals to support and distribute the arch of the spine throughout the area that is moveable."
But don't fret: There's no need to overhaul or create special combinations for students with scoliosis. Most can do all movements, unless advised otherwise by their doctor. Simply using certain imagery in class instruction can help these students work on maintaining a straight posture. “Use images that are strong and balanced," Fatouros advises, “like a fountain that comes straight through the body and goes out in all directions."
Another helpful technique is to think about pulling up with the front of the body and down with the back of the body. “You can use a physical or verbal cue to help a student bring the shoulder forward or hip bone back so that it is even with the other side," Clippinger says. “Encouraging the student to feel the weight evenly placed on the feet and to keep the hips and shoulders square with the rib cage directly above the pelvis can help the dancer develop a sense of how much symmetry their body will allow." Clippinger adds that students with scoliosis should alternate the use of their right and left sides during class exercises and barre work for better balance.
But the most important thing a teacher can do for a student with this condition is to encourage them in every way. “Be sensitive to students with scoliosis," Fatouros says. “Understand that they may not always look like the other students. Check in on a regular basis to make sure she is doing her exercises, and keep her moving and motivated." Fatouros recalls one particular success story: “I once had a student who would do an exercise, and then she would slump on the barre. It wasn't helping her scoliosis." Once she fully dedicated herself, it affected her posture positively. “By junior year, her doctor said the degrees of curvature had lessened," she says. “I saw evidence of a dancer holding herself well, and it helped."
Straighten Up Scoliosis!
Dance professor Karen Clippinger breaks down a simple spine-strengthening exercise from her book Dance Anatomy and Kinesiology for dancers with a 15-degree or less spinal curve. (Dancers with curvatures going in the opposite direction will need to adjust accordingly, and those with greater degree curves should seek medical recommendation first.)
Curl-Up with a Twist:
1. Begin by lying on your back with knees bent and feet flat on the floor. Curl the torso up vertebra by vertebra until the shoulder blades are off the floor. Then, use hands to curl the torso slightly higher off the ground, emphasizing rounding the spine and pulling the abdominal wall inward toward the spine.
In this position check for symmetry, and if needed, shift your upper rib cage (generally to the left) so that its center is aligned as close as possible with the center of your pelvis. Let go with the hands and hold this position for four counts before lowering to starting position.
2. As strength develops, when letting go with the hands bring the left arm overhead and think of reaching out with the fingertips and lengthening the spine as if curving around a large exercise ball. Hold for four counts before bringing the left arm forward and lowering to the starting position. Perform six repetitions with the left arm going overhead and then four repetitions with the right arm going overhead.
3. As skill improves, rotate the upper torso to the left when the left arm is overhead. Be sure to isolate the rotation to the upper torso and think of keeping the right hip bone back so that the pelvis and lower back are not allowed to rotate. Reverse the pattern when the right arm is overhead.