Barbell resistance training is the most effective type of exercise training to accomplish nearly all goals. From achieving a muscular and lean physique to maintaining health and function as you age, and rehabilitating from surgery and returning to your sport of choice. But often, doctors, physical therapists, and chiropractors shy away from “lifting weights” because they lack an understanding of safe and effective programming and technique implementation across the life and healthspan.
Classically, doctors, physical therapists, and chiropractors become even more resistant to barbell training when their patients have diagnoses such as “arthritis,” “degenerative disc disease,” and “scoliosis,” often warning them against lifting heavy weights and doing squats and deadlifts.
But here’s the thing: if you have any of these, and in particular, if you’ve been diagnosed with juvenile, or adult-onset scoliosis, in any part of your spine, and to any degree, barbell strength training is one of the best possible things you can do to improve your overall health, pain, and progression of scoliosis with time.
Before we dive into WHY you should be doing it and why it’s SAFE to barbell strength train with scoliosis, let’s talk about the facts! Everyone, and we mean EVERYONE, is asymmetrical to some degree, and it’s all about learning how to use your body and how you move best. Scoliosis, from the very mildest to severe forms, doesn’t have to be a limiting factor in your life, and it doesn’t mean that you can’t do the things that you love.
Some Facts About Scoliosis:
It is a lateral curvature in the spine of greater than 10 degrees
Requires testing and measurement to diagnose it
Is more prevalent in females than in males
Many people who have scoliosis don’t have any pain or other symptoms.
Types Of Scoliosis:
Structural scoliosis is when the spine bones aligned in a curved fashion and stay in that alignment no matter what position you’re in.
Functional scoliosis is when the spine appears curved, but the curvature is caused by something else such as a muscular asymmetry or leg length discrepancy.
Causes Of Scoliosis:
Juvenile Scoliosis is a form of scoliosis diagnosed between 4-10 years of age. At younger ages, it’s diagnosed more in boys with a left-sided curve, and at older ages, it’s seen more in females with a right-sided curve. Depending on how large or small the curve is when first diagnosed will determine how to treat it.
Adult-Onset Scoliosis is a 10 degree or greater curvature in a skeletally mature person. In adults, the scoliotic curve is accompanied by arthritic changes in the spine, and the curve is relatively rigid. It can arise from unidentified idiopathic adolescent scoliosis or other boney changes in adulthood.
Idiopathic Scoliosis is a type of scoliosis that develops with no underlying disease or cause identified. This is the most common type of scoliosis, and there is a higher prevalence in males than in females, and it tends to run in families.
Having scoliosis does not mean you are disabled, will have pain, something is wrong with you, or that you shouldn’t do particular activities. People with scoliosis have anywhere from mild to significant asymmetries, pain or no pain, movement limitations, or no limitations, and some people are not even aware that they have scoliosis. In all cases, it’s possible to safely barbell train and lift heavy weights to be strong or also participate in competitive powerlifting.
What we're saying might be confusing, especially if doctors and other medical professionals have told you that it’s not safe to lift heavy with scoliosis. But as we mentioned before, most medical professionals don’t lift weights, and if they do, they don’t lift heavy or understand proper program progression and technique. They often hear about the barbell squat, bench press, deadlift, overhead press, and powerlifting when someone walks into their office injured, so it’s not surprising they feel this way if they are uninformed and only see “injured” lifters. We’re here to tell you that barbell strength training and powerlifting aren’t dangerous and can improve your symptoms and decrease your pain if implemented correctly.
Let’s look at two highly successful powerlifters with significant Juvenile Scoliosis. Heather Connor and Lamar Gant are two very well known powerlifters who hold, or held, world records. Neither of their powerlifting careers has been limited by their moderate to severe scoliosis diagnosis. They do not have a higher rate of experienced injuries than people without the diagnosis.
A 2011 retrospective study published in the SPINE journal studied 3185 individuals who were 40 years of age or older referred for DEXA of the lower back. What they found was that:
8.85% of the scanned individuals presented with lumbar spine scoliosis (defined by a Cobb angle of greater than 11 degrees)
80.6% of people identified as having scoliosis presented with a mild curve.
This study found that the prevalence of scoliosis did increase linearly with age (but not in severity), which suggests that scoliosis naturally progresses over time.
A 2014 cross-sectional study published in the Spine Journal looked at the prevalence of thoracic spine scoliosis in 760 asymptomatic people referred for standing chest radiographs for non-back pain-related conditions. This study found that the prevalence of thoracic spine scoliosis to be 24.2% in the asymptomatic population over the age of 50 and more prevalent in females versus males.
If you have a slight curve in your spine that someone happens to notice and tells you about, that doesn’t necessarily mean that you have “scoliosis.” And if you’re pain-free and move normally on a day to day basis, you probably shouldn’t worry about it any further. We’re all asymmetrical, and our bodies and spines will never be perfectly straight or symmetrical, and that’s okay!
Maybe you were told you had scoliosis by a doctor, chiropractor, or physical therapist when you didn’t even have any symptoms. Yes, this can happen. You go into your doctor for a routine checkup, and they happen to notice a slight curve in your spine and tell you about it. You weren’t asking, and you weren’t in pain, but now you have a new diagnosis to be concerned about. Maybe you went to see a physical therapist for newly occurring foot pain associated with increased cardio before a competition. They evaluate you from head to toe and tell you that it could be coming from the slight lumbar scoliosis you weren’t aware of...So you ask google and start worrying that you might need treatment or that it could be dangerous for you to start or continue lifting heavy.
You may have asymmetries and no associated symptoms.
This is when you don’t have any pain, but your posture and/or movement appears uneven. You might see this when you’re standing still and also when you’re under a barbell. You may see this as:
Wind-milling of the bar
Bar tilt while moving or standing still
Hip shift or knee cave throughout the movement
One shoulder or hip is higher than the other
Maybe you’ve spent countless hours trying to correct this, or perhaps someone told you that you need to work on it. But here’s the thing…this might just be how you move and what your posture looks like, and that’s okay! If you see these “deviations” on every set and every rep and you just can’t seem to do anything about it, it’s likely your body structure, and you could be barking up the wrong tree. If you have significant asymmetries in your body and movement that are always there and don’t cause you pain, these movements are adapted, are fine, and we suggest leaving them alone.
You see, other lifters who are continually trying to correct deviations and minimize form breakdown, so why is it okay if you have them? Because yours isn’t a breakdown in technique.
Here’s The Difference:
Technique breakdown appears at more substantial loads and when you’re more fatigued, like at the end of a set when intensity is very high, or when you’ve done numerous sets in a row. These technical deviations aren’t always there, we don’t see them at lighter weights, and they can be corrected.
Adapted movements posturally associated with scoliosis, don’t fit this description because they’re there all the time regardless of the weight on the bar. In this case, we should be more focused on keeping this motion consistent as the weight gets heavier to not see a significant technical deviation in form from how you were moving with lighter weight.
But Can You Train If Your Scoliosis Causes You Pain?
It’s possible to barbell train when you have scoliosis associated with varying levels of pain and symptoms. We first need to determine whether your pain is related to training or everyday life. If you have a moderate to high level of pain outside of training, you should start by addressing those symptoms before getting under the bar. There are various ways to improve your symptoms if you experience them throughout daily life outside of training, and we recommend speaking to a physical therapist who can help you do this [to set up a free consultation with PRS Physical Therapists, CLICK HERE].
Let’s look at PRS client, Gina, for a moment. Gina has two different length legs, a knee that doesn’t straighten, thoracic kyphosis and lumbar and thoracic scoliosis...that does not HURT her or cause her any pain regularly. In 2015 she started barbell training with PRS Clinical Coach Rori and had never had an injury in training associated with any of these asymmetries. Does her bar tilt? Does her right knee cave? Does she windmill? Yes. But with close monitoring, working with moderate intensities, and limiting high intensities, as well as frequent adjustments to her unique program, Gina has remained injury-free under the barbell.
Once your symptoms outside of training have reduced, you can begin a barbell strength training program. Yes, you can start even if you have a mild amount of pain (4 or less on a scale of 0-10). Beginning a conservative barbell resistance training program can help you reduce your symptoms while also preparing you to maintain strength and improve function long term.
Monitor your pain level and understand that some mild pain is okay and maybe expected as you start to train if you’re already having pain. We recommend that training begins when pain levels are at a four or less out of 10 and should be limited to no more than 1 point on the 1-10 pain scale while lifting. Check out THIS Instagram post for details on how to move through barbell training sessions with mild to moderate levels of pain. Improving your movement and getting stronger can ultimately help to decrease your pain and improve your ability to manage any symptoms that might arise in the future.
Regardless of your level of asymmetry, the severity of symptoms, or where you start, it’s possible to safely barbell train, lift heavy weight and even competitively powerlift. It’s essential to closely monitor your technique and symptoms as you progress conservatively. This means that you should slowly increase your training intensity and monitor any form breakdown above and beyond what YOUR “normal” is. Your technique doesn’t need to be perfectly symmetrical, but it should be consistent. Identify any deviation from your usual technique and/or pain that occurs and address these issues as they arise. Identifying and addressing any problems that you’re having will help you continue to get stronger while reducing your risk of injury.
The Truth About Barbell Training & Powerlifting Injuries:
Most resistance training-related injuries aren’t because of structural issues in your bones and joints. Instead, they are related to more specific training factors, including frequency of training, load, and fatigue.
We can reduce the risk of injury of any kind (scoliosis/asymmetry related or not) by designing a barbell training program that specifically:
Manages significant increases in load when we haven’t had enough time to recover.
Monitors and accounts for fatigue associated with higher rep sets that can often lead to form breakdown
Has built in appropriate amounts of recovery within and between training sessions
These are not only concerns for barbell strength athletes and powerlifters with scoliosis, but for anyone who trains with a barbell. Recovery, rate of weight progression, and technique breakdown associated with fatigue can all negatively impact performance and increase the risk of injury. If you have scoliosis, you’ll need to monitor these factors to identify and address any issues that arise just like any other athlete would. For a detailed article on the keys to injury risk reduction in barbell training and powerlifting, CLICK HERE.
Barbell training isn’t dangerous when implemented safely and effectively. Doing a more intense sport can help you to feel more resilient and decrease any fear that you associate with movement. The severity of scoliosis that you have doesn’t correlate to your level of pain or disability. Everyone is unique, and having a diagnosis of scoliosis, a mild to moderate asymmetrical posture, or movement is not an indicator that you’ll have other problems related to this.
A diagnosis can be scary and cause you to decrease your movement in fear of getting hurt. But limiting your movement or changing the way you move out of fear could result in having pain that wasn’t there before. Moving and strengthening your body can keep you feeling good and give you control over your movement and the way you feel.
In a case report published in the British Journal of Sports Medicine, an adult powerlifter with idiopathic scoliosis talks about his experience with his diagnosis, treatment, and involvement in powerlifting. He was diagnosed at 17 years old when he saw his family doctor for an unrelated wrist injury. As in the case for many people, his doctor happened to notice some postural asymmetries and sent him for an x-ray even though he did not report any symptoms during his appointment. Soon after the x-ray, he was told that he had scoliosis with two curves, was at risk of his curves progressing, and he should begin physical therapy. This led him to become more sedentary, fearful of movement, and he started to have pain and difficulty breathing even though he never had symptoms before being diagnosed.
Despite his feelings of fragility and fear, he developed an interest in resistance training and started to go to the gym. After some time, despite his “scoliosis,” he started powerlifting, and at 145lbs bodyweight, he squatted over 300lbs and deadlifted over 400lbs. Not too long after he began powerlifting, he noticed that he was no longer having back pain or difficulty breathing. At his follow-up x-ray, he discovered that the curves in his spine hadn’t worsened! Though his doctor said that she typically wouldn’t recommend lifting heavy with scoliosis, she was happy to hear about the positive benefits powerlifting training had had on his back pain and scoliosis. At the end of the article, he mentioned how important it was to have medical professionals support and not discourage him from doing more intense resistance training with barbells. To check out the article CLICK HERE!
Remember: everyone is unique, what you read online, or your friend tells you about their scoliosis, or what a doctor tells you isn’t the end-all-be-all when it comes to a diagnosis. You’re not your scoliosis. You’re not even your friend’s scoliosis. And you’re almost certainly not what the doctor thinks your scoliosis is.
How often have you heard of a medical miracle where the person was told they never walk again and then run a marathon? Right...You may happen to be more asymmetrical than other people or defy what the doctor thinks the prognosis is. A medical diagnosis is not an indicator of your physical potential or your feeling of well-being. It can be challenging or scary to face this alone if you’re looking to address your symptoms and begin barbell training. There are people out there that can help and give you guidance who understand both your scoliosis and how to safely barbell train or competitively powerlift. Don’t let your scoliosis keep you from doing what you want, even if you’re looking to start barbell training.
Remember, everyone starts somewhere, and there are ways to safely accomplish your goals regardless of what your body looks like, feels like, and is limited by. Barbell training isn’t a threat to your safety and health, but instead, it could be the answer to resolving your pain long term and improving your movement altogether!
Need some help understanding your body and a barbell training program that’s right for you, your goals, and your structure? Set up a free consultation with a PRS Clinical Coach HERE. Also, join our Facebook group, The Secret Society of Barbell Mastery, for FREE form checks and help weekly!
If you're interested in learning how to optimize barbell technique, maximize strength and muscular development, and reduce injury risk (and peeing) for you, your clients or patients, then join the waitlist to get insider information on all the PRS online courses when they're ready for enrollment!
Citations:
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky RL. Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender. Spine (Phila Pa 1976). 2011;36(9):731-736. doi:10.1097/BRS.0b013e3181e9f120
Urrutia J, Zamora T, Klaber I. Thoracic scoliosis prevalence in patients 50 years or older and its relationship with age, sex, and thoracic kyphosis. Spine (Phila Pa 1976). 2014;39(2):149-152. doi:10.1097/BRS.0000000000000095
Malyala R. Balancing confidence and conservatism: idiopathic scoliosis in an adult powerlifter [published online ahead of print, 2019 Sep 18]. Br J Sports Med. 2019;bjsports-2019-100925. doi:10.1136/bjsports-2019-100925