What exercises and interventions are recommended for a patient with thoracolumbar strain due to mild levoscoliosis, and how should they be performed?

Exercise and Intervention Program for Thoracolumbar Strain with Mild Levoscoliosis

For thoracolumbar strain with mild levoscoliosis, initiate a core stabilization exercise program combined with gentle range-of-motion activities while strictly avoiding trunk flexion, twisting movements, and high-impact activities that increase axial spinal loading. 1

Activities to Strictly Avoid

Immediately eliminate these high-risk movements that can worsen thoracolumbar strain and scoliosis:

• Avoid all bending and twisting movements of the spine, particularly dynamic abdominal exercises with excessive trunk flexion, as these exacerbate symptoms and delay recovery 1
• Eliminate high-impact activities including jumping, jogging, and explosive movements that increase axial loading on the spine 1
• Prohibit heavy lifting, especially with improper form or involving twisting movements 1
• Limit prolonged sitting, which increases disc pressure and can worsen symptoms 1
• Stop any activity that produces significant pain increase during or after performance 2

Core Stabilization Exercise Protocol

Core stabilization exercises show effectiveness for mild scoliosis and should form the foundation of your rehabilitation program 3:

Starting Position and Frequency

• Begin with bed-based or chair-based exercises if standing tolerance is limited 4
• Perform exercises 2-3 days per week initially, progressing to daily as tolerance improves 4
• Start with 10-15 repetitions for frail or previously sedentary patients 4

Specific Core Exercises (Perform in Order)

1. Abdominal Isometric Contractions (Supine Position):

• Lie flat on your back with knees bent, feet flat on surface
• Tighten abdominal muscles by pulling belly button toward spine
• Hold contraction for 10 seconds without holding breath
• Perform 10 repetitions, rest 30-60 seconds between sets 2, 4

2. Modified Back Extensions (Supine Position):

• Lie flat on your back
• Gently press lower back into the surface while maintaining neutral spine
• Hold for 10 seconds
• Start with one set of 10 repetitions every other day 4

3. Pelvic Tilts:

• Lie supine with knees bent
• Flatten lower back against surface by tilting pelvis
• Hold 5-10 seconds
• Perform 10-15 repetitions 4

Upper Extremity Strengthening

Begin range-of-motion exercises for bilateral upper extremities within the first days to prevent joint contractures 4:

• Shoulder flexion: Raise arms forward and overhead through pain-free range only
• Shoulder abduction: Raise arms out to sides through pain-free range
• Elbow flexion/extension: Bend and straighten elbows
• Start with 2-3 repetitions, progress to 10-15 repetitions as tolerated 4
• Use minimal resistance initially, progressing only when 15 repetitions feel "somewhat difficult" on Borg scale (12-14) 4

Stretching Protocol

Perform all stretching through pain-free range of motion only 1:

• Hold static stretches for 10-30 seconds 1
• Rest 30-60 seconds between stretches 1
• Focus on hamstrings, hip flexors, and lateral trunk muscles
• Never force movement into painful ranges 2

Progression Guidelines

Week 1-2: Establishment Phase

• Perform exercises every other day 4
• Focus on proper form with minimal repetitions (10 reps) 4
• Monitor pain response—stop if pain increases significantly 2

Week 3-4: Building Phase

• Increase to daily exercise if well-tolerated 4
• Progress to 15 repetitions per exercise 4
• Add gentle walking for 10-minute intervals if pain allows 4

Week 5-8: Strengthening Phase

• Increase resistance when 15 repetitions at current level feel "somewhat difficult" (Borg 12-14) 4
• Progress walking to 20-30 minutes continuous if medically cleared 4
• Maintain intensity at Borg RPE 13-15 for moderate work 4

Low-Impact Aerobic Options

Once core stability improves, add these low-impact activities 2:

• Fast walking: Well-tolerated, low-impact exercise providing excellent results 2
• Swimming: Appropriate for thoracolumbar conditions 2
• Stationary cycling: Maintains upright posture without impact 2
• Stair climbing: Progress only after pain-free walking achieved 2

Critical Monitoring Parameters

Stop exercising immediately and seek medical evaluation if any of these occur 2:

• Discomfort in upper body, chest, arm, neck, or jaw during exercise 2
• Faintness during exercise (not just brief light-headedness after) 2
• Shortness of breath where conversation becomes difficult or wheezing develops 2
• Back or joint pain during or after exercise 2
• Unusual or persistent fatigue lasting more than one hour after exercise 4
• Increased weakness 4

Environmental Considerations

Optimize exercise environment to prevent complications 2:

• If air temperature exceeds 80°F, exercise in early morning or late afternoon 2
• Watch for heat stress symptoms: headache, dizziness, faintness, nausea, coolness, cramps, palpitations 2
• Ensure adequate fluid intake before, during, and after each session 2
• Wear loose-fitting, comfortable, porous clothing 2

Common Pitfalls to Avoid

These mistakes frequently compromise recovery:

• Do not delay exercise initiation—early mobilization results in earlier functional recovery 4
• Do not focus solely on the scoliosis—whole-body conditioning is necessary given the thoracolumbar strain 4
• Do not ignore cardiovascular fitness—improving cardiorespiratory fitness increases ability to execute daily activities 4
• Do not perform exercises that significantly increase pain—pain response should guide activity levels 1

Reassessment Schedule

Reevaluate and adjust the prescription every 2-4 weeks to maintain therapeutic effect and progress intensity appropriately 4. Medical clearance is essential before beginning this program, particularly if you are over 55 years old or beginning a new exercise program 1.