Read this fascinating exchange between Tom and one of our followers on Facebook about working with Scheuermann’s kyphosis.
I’m a personal trainer and I love your work! Any advice for an athlete with Scheuermann’s kyphosis?
I’ve been attempting lots of different thoracic rotations/extensions. Strengthening and lengthening the hamstrings seems to mitigate pain. One issue is the corresponding rib hyper-mobility that many Scheuermann’s people have. I’ve found the rhomboidal muscles of most kyphosis patients are long and very weak. I’ve done work with ‘face pull’ style movements to strengthen them, and it improved my curvature.
Scheuermann’s kyphosis gets set in childhood and involves a literal shape change in the vertebrae, wedging shorter in front and thus creating the kyphosis in the back. It would be helpful have a picture from the side in gym shorts – I could be more exacting since treatment specificity depends on where the apex of the curve is.
You are on the right track with the hamstrings; keep that up – they are in the Superficial Back Line with the back muscles and do a lot of compensating. You want the center of gravity of his trunk to be over his knees – he may be behind or in front.
OK, then there’s age: How old is your client? – the younger the more change you can expect. With the younger client, going into backbends with different-sized physioballs can be challenging but ultimately rewarding. The client has to take it on as homework, as the best results come from the longer stints in extension, but you have to do some instruction to make sure he is fulcruming around the right area. Stretch the Front Line to ease the Back Line. All those erectors are in eccentric contraction all day – that’s what probably hurts, but the shortness – fascial and muscular, is in front.
But of course it is not only the front front but the deep front – the Anterior Longitudinal Ligament, diaphragm, psoas, and other organ-supporting tissue that runs up the front of the spine. Hard to reach, even for the experienced manual therapist, and using the physioballs will take some deeply relaxing but significant commitment of time.
In a client over 40 (-ish, people are different), going into hyperextension will be an exercise in frustration with fewer results – everything’s just too set into all the tissues for the time investment to be worth much improvement.
Finally, your work with various types of ‘rows’: dead rows, vertical rows, face pulls – all good, keep going and vary the menu (meaning the angle as well as the duration and weight) to be sure to get not only the rhomboids toned but the middle trapezius and serratus anterior too.
Depending on the angle and location of the kyphosis, you can also experiment with bench flies or presses while on a Bosu ball or the like – but we’re getting into territory where specificity is key, and without being there with you it’s hard to write it out.
That was awesome. Solidified a lot of what I was doing. I’ll add more time on the ball and different pull angles. Also, to clear up confusion, I am both the patient and the trainer here. Have you heard of the ‘neck tilt’ maneuver? I’ve been doing this regularly and its made my neck more flexible, but cervical lordosis is still making my shoulders crawl to my ears during sleep.
Last thing- a half roller instead of a bosu ball for chest flies- is the bosu ball more preferable because it’s more forgiving?
The cervical lordosis is the concomitant to your excess kyphosis, so will be a problem until you can help the kyphosis – I would add exercises like this one depicted in image 7.9 in Anatomy Trains 3rd Edition while you see how far you can beat back this Scheuermann’s.
While a half roller will do in a pinch, I prefer the Bosu ball because a) it opens the chest laterally as well as the extension, part of what you need, b) it is more forgiving on the spinous processes that the half roller, and c) as you open your spine, you will need to keep re-establishing your stability ability, and the Bosu ball is good for that because it requires more stability out of you.
Hope this helps.
-Tom Myers, June 2016
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