2nd opinion on scoliosis "diagnosis"

[Konstantinos Kavos]

Coach, I know scoliosis has been dealt with many times on this board, but I would appreciate your thoughts on the following (and TravisRussellDC's too if he can).

Background info first (bear with me):

I have been having very annoying pain and difficulty of movement in my lower back for about a month, so I got in touch with a friend of mine who is a physiotherapist for one of the two biggest football (soccer) teams in the country. As he deals with professional athletes I think I can have more faith in him than someone who works with 90 year olds who have broken their hip (useful though those PTs are and I hope I never need one).

A couple of vicious massages have made me feel much better. He says that it appears that I have mild scoliosis, and that one leg as a result is "shorter" than the other. He stated that as a PT he shouldn't and can't really make a diagnosis and wants me to see the soccer team's orthopedic doctor. He thinks that I might need one of those support things (shims?) in my left shoe.

Actual questions:

1. My PT thinks that I should see the doctor in September, as throughout the summer I will be alternately in sandals/barefoot and in closed shoes, and he thinks that this would interfere with my body learning a new posture with the shoe support (as I won't be wearing it consistently). He says I would be better of starting that in the autumn. Does this sound logical?

2. Until September he would like me to work out once, maybe twice a week with lower weights, about 50% of my 5RMs as they stand now, to maintain my motor skills (such as they are), occasionally hitting some heavier weights if I feel strong. He wants me to concentrate on swimming instead. He says that once I have seen the doctor and we know if I need a shoe support, or whatever else, then I can hit the weights with a vengeance. Again, does this sound logical?

Looking forward to your answers. I hope your shoulder is feeling better Coach.

[Mark Rippetoe]

It has always been my understanding that short legs cause back problems, and not vice versa. I mean, how can a crooked spine shorten the bones of the leg? A "functional" short leg due to a pelvic tilt is something that Travis will have to comment on, and I hope he does. But, instead of completely de-training to satisfy your physical therapist, I would suggest that you begin immediately to train your squat, press, deadlift, and all pulling movements with an appropriate shim under the sole of your training shoe. I'm less concerned with the unloaded portion of the day than I am of the effects of the load on the spine.

[Konstantinos Kavos]

Thanks Coach. I think my physiotherapist did mean that my leg has been sort of pulled upwards, as it were, but considering he is a Dutch speaker communicating in Greek with an English speaker, I can only guess at the level of miscommunication that might have occured between us ;-) He did stress that he was only making a slightly educated guess and that he is only a PT and not a doctor.

That said, it has just occured to me (I'm a bit slow) that as he isn't a doctor, where did he get off telling me not to train for 2 months?! Based on what? Experience? I know it's extensive but still.... his logic of detraining for up to 2 and a half months in order to "protect" an already weak area is slightly dubious.

I am going to press him to introduce me to the team's ortho asap as I am already feeling down after just 10 days of reduced training. Until I see the doc I have subbed box jumps for squats, handstands for the press (trying for handstand pushups) and hamstring/glute raise for deads, and I feel like a dork.

[TravisRussellDC]

First of all, why wait a few months to get it properly diagnosed? It's not going to fix itself in the meantime. As far as alternating footwear, I have my patients who need them wear their heel lifts in all types of shoes (sneakers, dress shoes, sandals, etc.) There are some of my patients who have such a dramatic short leg that I tell them never to go barefoot. One patient in particular experienced sever lower back pain after 20 minutes of housecleaning while barefoot. After putting her shoes on with the lift in her left side, she was much better 20 minutes later.

If there's a problem, get it checked out so you don't have to waste your summer training light.

As far as the "functional" short leg, it's possible. When lying in the prone position, a leg can draw up superiorly due to an oblique pelvis caused by many possible factors. The trick is finding out what is causing the pelvic obliquity. Chances are, it's not primarily the pelvis. The SI joints are among the most stable joints in the body as the ligaments that cross the joint are incredibly strong. More often than not, a torqued pelvis is a compensation for another long standing dysfunction. Many things can cause this, including fallen arches, anterior and inferior tilting of the sacrum, lumbar disc wedging, loss of cervical lordosis, etc. The trick is to find what the actual cause of it is. But, one thing to keep in mind that I think a lot of docs don't think about is this: humans are upright creatures. Look to the foundation first to determine the cause of abnormal curvature. Namely, the sacrum and lower extremities.

When dealing with a scoliosis, it's been very rare that the short leg is "functional" only. Unless there is abnormal anatomy in the lower spine which has caused a compensatory pelvic obliquity in turn drawing a femur head more superior than the opposite side, I would be willing to bet that the leg is not "functionally" short.

I'll be interested to hear about your diagnosis.