the lats get all the fun

This is another of the exercises I was given as part of my prescribed treatment at London, UK. Scoliosis SOS clinic.  Of course not everyone received this exercise and those that did were given various modifications according to their curves, but what was common was a good ol' lateral muscle workout on an unstable foundation.

First, a wee primer on the whys and wherefores of that particular muscle group.

The latin name latissimi dorsi is commonly known to its friends as the "lats".  Favoured by body builders, the name can be translated as "the biggest muscle in the back" (or, when it is sore, as "the biggest pain in the back", but I digress)

Here is a description of what the lats do by Wikipedia:
The latissimus dorsi is responsible for extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and (medial) internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine.

And here is a description of its function by www.bodybuilding.com:
The Latissimus Dorsi is a large "fan-like" muscle that covers those dozens of muscle that I mentioned earlier, it is therefore called, superficial. Its place of origin, or where it starts, begins at the middle of the back at the vertebrae T5-T7, the lower three ribs of the rib cage, the iliac crest (the hip), and the inferior angle of the scapula. That's a big muscle! And the whole thing runs to one single spot.

And yet another description by NYU's Langone Spine Center:
Flexion of the spine is defined as movement that produces forward bending, such as bringing the chin toward the chest or bending forward at the waist as if to pick up an object....Trunk muscles (latissimus dorsi) also participate in flexion of the vertebral column, shoulder or head movements, or arm movement. (These) trunk muscles, unlike the abdominals, attach to the spine.

Did you find that the explanations got clearer and easier to understand? Me too!  For once, Wikipedia confused the heck out of me.  But all three descriptions (and thousands more) were backed up with consistent visuals (even if artistically skewed towards specific demographics):

The Scoliosis SOS clinic talked a lot about lats, but so does my pilates teacher who says they need one of the largest percentages of work given the tasks they are expected to do, and for those with scoliosis their work is that much harder.

So the exercise I was given was all about the lats. In fact, nothing else much moves, except what is generated by the lats.

The work is more valuable when carried out on an unstable foundation (no, I do not mean my deranged childhood years!), as they have to work that much harder. In this case, that unstable surface takes the form of a large exercise ball, on which I sit.  In my case, I also have a beanbag placed under my left butt cheek (see that cute little thing in the photo?), so that my two hips are more even in elevation off the floor. I must also, of course, sit in my corrected position, with my rib cage lifted up and to the right. My knees are also bent at a 90 degree angle, with my heels directly under my knees, which means I end up with my shins pressed against the bars.  It took me a few days and many shin bruises (I am a slow learner!) to figure out that a small mat over the bars might not be such a bad idea!

In front, I hold the ends of two therabands that have been fastened to the gym bars at roughly waist height. My arms are held at a 90 degree angle, my chin is tucked, and the back of my head is stretched up as if someone was pulling a string attached to it.  Then I squeeze my lats together, trying to draw my should blades together. In so doing my arms move back and I hold the position for a slow count of 6 before releasing them back to the start point.  By the end of a set of 12 I can sure feel my back!  (A good counter stretch in between sets is the cat.)  Then I repeat for a total of 3 sets.  After which I am so aware of my lats that I feel I must go out and have a latte!

scoliosis and pregnacy

I love reading the New Yorker magazine. There's always at least one article of interest each edition, and the writing is so good.  The only thing I do not like about it is its published frequency.  Every week!  Way too much pressure to finish one before another arrives on the doorstep!  I get my mother's cast offs and that way do not feel rushed.  The negative of this is that sometimes it takes me so long to get to them that I am reading a February edition in October.  Small price to pay I say.

Just this afternoon I was catching up and reading an old copy (only 6 weeks old - practically up to date!) that included an article by and about a woman who never really wanted to be a mother and wrestled with that.  Some of what she said resonated with me and it made me quite sad.  Not drink an entire bottle of merlot sad, but pensive. 

When my scoliosis was first detected I was 19 and it was deemed either too late or too early to do anything about it.  The specialist who confirmed it had just two things to say to me: be active, and you might have a hard time giving birth as it is unlikely you will be able to receive an epidural.

At 19 and a dancer I was already on board with advice #1 and advice #2 just seemed so far into the future to worry about.

As it turned out I married at 33: "late in life", and becoming a mother, which I had always assumed would take place several times, became high on the "to do" list.  But it didn't happen.  Two years later I went through a barrage of tests, and the only thing that came of it was "you have scoliosis" (duh), "you have a lot of endometrial scarring" and "your uterus is heart-shaped".  Whaaat?  There it was, drawn on a scratty piece of paper by the doctor just after a laparoscopy, drawn for me as I came out of unconsciousness and was trying very hard to look like I had all my senses.

What do I make of that?  There is some evidence that endometriosis impacts the ability to become pregnant.  But it's not absolutely prohibitive.  Same thing with a heart shaped uterus, which is rarer, but not impossible.  And despite what many people who do not have scoliosis say, it in no way impacts conception.  I know quite a few people who have both scoliosis and children, although they did confirm the fact that giving birth is not always so easy.  Many have had caesarians, and it's not because they are "too posh to push".

We determined to do everything modern science allows, at least once, as most things cost many thousands of dollars.  In vitro fertilization, where multiple eggs are induced, harvested, allowed to mingle with husband's sperm in a petrie dish, and then re-introduced into the maternal body.  Nope.  Intra-cytoplasmic sperm injection (ICSI), a brand new procedure that did all of the above except that one specific sperm was chosen per egg (strong swimmers with everything intact).  Uh-uh.  Donor insemination, whereby someone else's sperm is injected.  We had quite a bit of fun going through the anonymous but descriptive file and eventually chose someone who liked to dance and to cook and who shared our basic colouring.  Nada.  6 times nada. 

There were other things, but the bottom line is I will never find out if I can or cannot take an epidural.  Why am I telling you all of this?  As I had been told delivery is really the only major concern with pregnancy and scoliosis, I wasn't really prepared for the emotional roller coaster of just trying to get pregnant.  No one was able to figure it out as none of the separate ingredients were detrimental, but collectively they seemed to be.  So I am a happy aunt and godmother and mentor and influence.  My marriage is rock solid.  I have been able to do things I wouldn't otherwise have been able to do and anytime someone complains of motherhood and expenses envy for my life I say "Snap!"

But what was pregnancy like for those others with curves who could conceive children?  What did they experience?

I asked around and ended up getting about as many answers as curves.  Medically speaking, there is little information in the literature on the impact of scoliosis on male or female fertility. There is also no correlation between the progression of one's curves and her age at first pregnancy. Pain was cited as a limitation on sexual practice, which produced some negative effects on relationships. With a bit of education on different sexual positions that lessen pain, and some empathy to ease embarrassment during unclothed intimacy, there really should be no problem with conception.

There are a few issues around pregnancy. A few of the women I talked to had much more back pain in pregnancy, but then some did not notice any more pain than usual. One woman said her curve grew noticeably worse during pregnancy and she is quite worried about the idea of having a second child. For those who had rods in their backs, it was difficult to push at the birth, because getting into a sit-up position was particularly hard to do.  Two of these had to be given oxygen as their lungs were compressed with the curvature and the baby pressing on them.  Several of the women were recommended to stop at two children, given the toll taken on the back.  The one I spoke to who had more than two children regretted it as her curvature is considerably worse as is the pain.

One young woman was recommended to have the fusion surgery but was so keen to have babies that she got pregnant and had major sciatica, spasms, and was almost bed-ridden with pain before having a premature baby. She then had the surgery (worse than giving birth was her comment) but has since had baby #2 with no real complications.

I was intrigued to hear the (second hand) thoughts of a chiropractor who adjusts infants and newborns.  She said that being pulled from the birth canal can cause the babies to experience subluxations in their flexible spines, and scoliosis further down the road.  !!!  That theory might have to be a separate blog post!

A read a research paper finding that scoliosis can increase pregnancy risk as the uterus expands, further impeding the natural upward displacement of the diaphragm and reducing vital capacity and residual volumes. It's difficult for these women's bodies to find room at the inn due to skeletal narrowing, particularly in the thoracic cavity. Breathing is often harder and may require ventilatory support.

A genetic disorder called EDS (Ehlers–Danlos syndrome) cropped up in the paper as relevant.  EDS is a defect in the production of collagen, or of those protein that interact with collagen. The collagen in connective tissue (arteries, skin, intestines and the uterus) helps tissues resist deformation, and so is important for physical strength of skin, joints, muscles, ligaments, blood vessels and visceral organs; abnormal collagen renders these structures more elastic.  Pregnant women with both scoliosis and EDS (severe) might find risks related to uterine hemorrhages/rupture, miscarriage, and premature deliveries due to cervical incompetence.  Depending on the degree of scoliosis (referred in the paper as "spinal deformity" - thank you for making me feel even worse), c-sections are generally prescribed to avoid shifting the body's centre of gravity during birth, and increased joint discomfort.

For those who have EDS-associated scoliosis, it was recommended to take combined oral contraceptives for their added estrogen benefit for EDS-related osteoporosis. Severe EDS and limited mobility due to scoliosis runs the risk of thromboembosis. Caution was give to the teen female population with this as they are establishing bone mass.

Actually the thing that came up with each mother without exception was that the back pain and deepening curvatures of their scoliosis became worse with the early years of motherhood: bending down awkwardly, picking up young children, twisting and carrying things beyond comfort.  Needed refusions are not unusual, and neither are considerable amounts of medication.  One of them said that quite frankly she wished she had adopted a puppy!

Breathing is harder than you think

Breathing is important for those with Scoliosis.  That's not to say it isn't without merit for anyone else, of course.  But breathing in a conscious, specific manner may add years to scoliosic lives.

I spent a bit of time of this subject in an earlier post, outlining "rotational breathing".  But since then I have been given some different images to try out, and have also had a year or so of practising.

Every activity I do it seems requires me to breathe in a conscious, specific manner that's different from all the other conscious, specific manners.  It's not just as simple as 'in out and forget it'.  In my singing classes I am told to breathe in so that my diaphragm extends down into my belly.  In choir (especially for the high notes!)  I add extra air to expand my lungs, which then are kept firm on the slow exhale until after the diaphragm is back under my lungs.  In yoga it is all about breathing into the belly, making a "Buddha belly".  In pilates it's about expanding the rib cage, back and sides too (i.e., lateral breathing), on each inhale through the nose, then exhaling out through the mouth with the effort of whatever exercise I happen to be doing.  For running and race walking and cycling, it's about keeping the chest fairly upright and open and breathing regularly. And for swimming it's about regulating the exhalation so that I don't run out of air. For me it is anyway.  I am the first to admit I am not a competitive swimmer!

But breathing for scoliosis requires another mental image, one that is very specific to each individual curve.  The best way to do this is in "puppy pose":

Get on your hands and knees.  Stretch your hands forward so that your torso is on a long angle, with your butt up over your heels at a 90 degree angle.

Start by squeezing out all the air in your lungs as if you are wringing a wet towel dry.  As you take a long, slow breath in, focus that breath into your concavity, the collapsed part of your back or side.  Feel the breath push that part of your body out as far as you can push it.

As you exhale the image becomes that of a spiral. Imagine the air leaving your concavity, then swirling across to the other side of your back, spiraling from your "hump" down and around to the front of your chest and out your mouth. 

As you breathe in in this way you are stretching the muscles that are not stretched enough on your concave side.  Then you are sending your breathe forward and out, depressing the overstretched high side of your back, the "hump" down and forward.

The best thing to have is a strong good friend who will stand over or behind you as you sit in puppy pose, tap or touch you on your collapsed side as you breathe into it. then as you breathe out they press hard down and forward on your other side.  This helps with the imagery, making the desired breath direction really felt. But it also helps on the exhalation to help those muscles that are overstretched to work differently.  It might look easy, but it's really not - you need to work hard to isolate specific muscles and then press down with your arms as you breathe the spiral of air out.

puppy pose from above

As habitual activity continues to promote its effects on the muscles being worked, doing 10-15 minutes of breath work every day will eventually work some muscles differently and make a positive difference to your body shape.  And this can actually make a life or death difference!

As you age your collapsed side becomes more collapsed and the twisted side becomes more humpy and twisted.  Depending on your individual curve that means that your ribcage might twist around so much that your ribs squeeze your heart, resulting in a heart attack, or your ribs might puncture a lung. 

Regular breathing exercises will work to prevent that from happening by keeping the lungs free and open, and the muscles around them strong enough to resist the pull of gravity.  And who can resist sitting in puppy pose for a quarter of an hour!

scoliosis en pointe

I recently read of last month's announced retirement of prima ballerina Wendy Whelan from the New York City Ballet Company.  Not that she will retire from dancing.  After all, she's only 47. 

this is what 47 looks like - to only one woman on this earth!

In July of this year 2014, a very good friend of mine in London got tickets for us to see La Wendy at Covent Garden, dancing in a series of pas de deux with four different choreographers.  At one point, I remember her bending forward for a nano-second and was struck by the sight of one shoulder bone raised higher than the other.  This registered to me and I thought "I wonder.....nah! It's just me being hyper-sensitive."  That's because it's something that I have, and other scoliosis sufferers as well.  When we bend forward one side of our backs is higher than the other. 

However, upon reading the program afterwards I found out that Wendy Whelan does indeed have scoliosis.  How did I not know this???

Apparently she found out at 12 years old that she had severe scoliosis, and at that age thought she now had a name for a disease that was causing the leg pain she had been feeling.  She was put into a heavy body brace, but oddly enough was told to continue with her ballet classes as a way to strengthen her muscles. Having already having had several years of ballet lessons was a plus, as she already had learned how to carry an uneven body, to adapt, to develop keen balance, even shoulders, strong leg muscles, stable pelvises (or is it pelvi?).  To give the appearance of a long, straight back. 

it is oh so faint but you can see a slight curve to Wendy's back here

I wonder if this is one of the reasons my own scoliosis wasn't detected until I was 19.  All those ballet and modern jazz classes - 13 years worth by then!  Maybe I had just learned how to compensate, how to intrinsically know when my head was off centre or one shoulder or hip was too high, and had become too good at hiding my imbalance. It was only when I bent forward in front of my mother that it was noticed.

Wendy Whelan has referred to the scoliosis treatment she went through as a teen as "the medieval torture chamber", with stretching machines as well as her rigid brace and a series of demanding exercises in a ballet regimen that was her only escape from the brace itself, as well as massage, acupuncture, and hot baths.  One week a month, she had to go to the hospital and spend 20 hours a day in traction. Then she'd get plastered up in her body cast again and sent back home to live a "normal" life.

Lots of ballet mad young girls are now being taught the single most important lesson all we twisted sisters and brothers need to learn - how to do simple, deep breathing exercises that get our diaphragms moving up and down and our ribcages expanding with a full inhale through the nose and exhale out the mouth. Preferably at the beginning of each day, when the spine can find centre more easily. Breathing for scoliosis is now second nature to me and my body definitely feels looser than the days when I forget or can't make the time.

Let me reiterate: The best thing in the world to do each am is to rise, brush your teeth, wash your face, drink a glass of water and do breathing exercises - about 10-15 minutes should do it.

Marika Molnar, founder of New York's Westside Dance Physical Therapy and director of physical therapy at the New York City Ballet says she knows loads of professional dancers with scoliosis and doesn't see it per se as a problem. Of course having a twisted spine means a dancer has to have an acute body awareness and a good eye (in the mirror) and sense (when not in a mirror) to correct problems that arise when one seeks the bodily perfection of a ballerina.
La belle Wendy is refreshingly open about her scoliosis and has become a bit of a leader to those of us who always thought things like professional dancing was out of the question.  She gives credit for her current strength to all those years of training and going to class in that horrid heavy plaster cast.  Braces are much softer now of course.  It's still an archaic and dubiously successful form of treatment, but at least its stigmatized and helpless sufferers are slightly more comfortable. (I am saying this with a acidic drip of irony by the way)

Huge kudos to Wendy for sticking it out.  Having a positive attitude of course is huge. When she was student at the School of American Ballet, she was encouraged to look up to the then principal dancer at the New York City Ballet, Heather Watts, who also had scoliosis patient.  Oh how lucky it is to find a real live hero or heroine at the right time and place!  It must have been a enormous lift to the spirits to see someone with the same body issue go on and succeed in such a demanding and public profession. Wendy knows that she has certain strengths on certain sides that are particularly visible to her because of her scoliosis. "I'm always having to pull my right shoulder back, for example, especially when I'm turning. It curves to the front and I have to really open it up."

When asked about her body's eccentricities she replied, "I think my scoliosis gives me character--it adds something to the way I move. And even when I do feel the crookedness in my spine at my age, I don't let it bother me--it's just part of who I am."  And who she is is a 47 year old dancer with the body of a 20 year old - and a 20 year old professional dancer at that - who both deals with and embraces her scoliosis. What she is is a hugely successful ballerina and an inspiration to young dancers and would-be dancers who also have scoliosis.

Brava!