I’d been studying scoliosis medical research for about a decade by the time I started working with Alicia, and had just published my book Analyzing Scoliosis, The Pilates Instructor’s Guide to Scoliosis. I knew the research stated about muscle discrepancy in those with scoliosis and that Alicia was fitting the bill perfectly, despite being fused and having a hefty listhesis sitting on top of her fusion.
All past practitioners who worked with Alicia had strengthened the muscles on the convex part of Alicia’s spine, but they were in constant spam and huge in comparison to the muscles on the other side. The muscles in the concave areas were so atrophied that they were about the thickness of dental floss—they were so weak. This was the low hanging fruit and where I decided to start strengthening her.
I found that when Alicia did little leg lifts and tiny side shift oblique work when seated sideways in the Arc with her concave side up, that those muscles were really easily able to fire. Just that exercise alone started giving her the support she needed to have hope that she could manage her spine without surgery. She bought an Arc for her house, plopped it in her living room so she’d get on it multiple times a day, and went to town strengthening these muscles. Her pain slowly went down a notch.
She had nerve pain going down both legs, but she told me it was different. After some muscle testing, I found that the nerve pain going down one leg was caused from an overly tight piriformis. She learned to roll it out with a ball and stretch it. The nerve pain went away. Her pain slowly went down another notch.
We also found that the glutes on the other side barely fired. She was so unbelievably muscularly unbalanced in her pelvis. I gave her some one-sided glute work to start to balance that out. Her pain continued to slowly go down.
Her legs and pelvis acted as though she had a leg length discrepancy, but after much testing and lots of trial and error, we concluded that we didn’t know. In the beginning I’d have her wear a shoe lift or wear one flip flop at home to level her pelvis out. We’d even make one strap longer when doing feet in straps on the Reformer. We couldn’t tell if the pelvic and leg unevenness was her listhesis throwing things off, her soft tissue coming into play, her past fusions not being properly aligned, or her actual legs. Alicia now wears no shoe lift nor just one flip flop around the house and keeps both straps the same length in feet in straps.
We continue to do lots of side lying work where she can lengthen her legs out one at a time. When she is on her back working both legs or kneeling or standing on both legs, you’ll often hear me say in class, “lift your head off your ribcage and lift your ribcage off your pelvis”, and “feel even pressure of both sides of your body”, always being directed at Alicia.
Then came figuring out the big neuro listhesis pain. Honestly, when looking at her X-ray, I didn’t know how she was still standing because it looked so bad. Some days I didn’t know if I was just delaying the inevitable for her needing surgery or if I could truly figure this out. I’d never read research or case studies about anyone stopping neuro pain for someone in as bad of a condition as hers through movement, so I really didn’t even have a guide.
Throughout our continued private lessons, I started toying around with her psoas. Because she was fused, I couldn’t have her do lunges on the Reformer since it would tilt her pelvis into an anterior pelvic tilt and put her lumbar spine into extension forcing the fusion to bend. So, one day I had her lay on a hard 5cm ball on her stomach, right where her psoas is on the side where her listhesis is—just to see what would happen. An explosion of pain erupted in Alicia as screams came out of her mouth. Searing nerve pain went down her leg and I knew I’d found another key to getting her out of pain.
I told her to go see a skilled and trusted massage therapist I trust to start manually figuring out what was happening with her psoas. After weekly massages, the nerve pain down her other leg had totally disappeared. One leg’s nerve pain was due to bound psoas, and the other leg’s was due to a tight piriformis. Through the massage and Pilates lessons she was able to decipher not only the root of nerve pain when it would arise, but more importantly, what she needed to do to get out of the pain.