Can an individual with mild to moderate scoliosis and no back pain safely perform a clean and press?

Can Individuals with Scoliosis Safely Perform Clean and Press Exercises?

Yes, individuals with mild to moderate scoliosis and no back pain can generally perform clean and press exercises, but this requires careful assessment of curve severity, skeletal maturity, and proper exercise technique with emphasis on symmetrical loading patterns.

Key Considerations for Exercise Safety in Scoliosis

Curve Severity Assessment

• Curves under 20 degrees are generally stable and have less than 30% risk of progression in skeletally immature patients, making them lower risk for exercise participation 1
• Curves between 20-50 degrees require closer monitoring, particularly in skeletally immature individuals where progression likelihood may exceed 70% 1, 2
• Curves exceeding 50 degrees warrant surgical consideration due to continued progression risk of approximately 1 degree per year even after skeletal maturity, and these individuals require more cautious exercise prescription 1, 2

Exercise-Specific Biomechanical Concerns

The clean and press involves significant axial loading, rotational forces, and asymmetric positioning during the catch phase. For individuals with scoliosis:

• Asymmetric loading can theoretically accelerate curve progression through increased mechanical stress on already-compromised spinal segments 3
• Proper technique emphasizing symmetrical bar path and balanced muscle activation is critical to avoid exacerbating existing spinal asymmetry 3
• The overhead press component creates significant compressive forces that may be problematic in curves with reduced vertebral integrity or osteoporosis 3

Evidence-Based Exercise Recommendations

• Scoliosis-specific exercises (PSSE-Schroth) have demonstrated 87.1% success rate in preventing progression in curves 15-25 degrees during the high-risk growth period, suggesting that properly designed exercise can be protective rather than harmful 4
• These protective exercises emphasize 3D self-correction and pattern-specific movements, which differs fundamentally from the bilateral symmetrical loading of clean and press 4
• General exercises without scoliosis-specific modifications showed 74.1% worsening rate compared to 12.9% with specialized exercises, highlighting the importance of exercise selection 4

Clinical Decision Algorithm

For Mild Scoliosis (Curves <20 degrees, No Pain)

• Clean and press can be performed with proper technique supervision focusing on symmetrical bar path and balanced muscle recruitment
• Monitor for any pain, asymmetric fatigue, or postural changes that might indicate exercise-induced progression
• Consider incorporating scoliosis-specific exercises as complementary training to maintain spinal stability 4

For Moderate Scoliosis (Curves 20-40 degrees)

• Proceed with caution and obtain baseline radiographs to establish current curve magnitude before beginning heavy overhead lifting 1
• Limit loading to weights that allow perfect symmetrical technique without compensatory movements
• Schedule follow-up radiographs every 6-12 months depending on skeletal maturity (Risser stage) to monitor for progression 1
• If curve progresses >5 degrees, discontinue overhead loading exercises and transition to scoliosis-specific rehabilitation 4

For Severe Scoliosis (Curves >40 degrees)

• Avoid clean and press exercises due to high axial loading and rotational demands on already-compromised spinal architecture 2, 3
• Focus on scoliosis-specific exercises and core stabilization without heavy axial loading 4
• Consider surgical consultation as curves exceeding 40-50 degrees with remaining growth potential warrant intervention 2

Critical Red Flags Requiring Exercise Restriction

• Any back pain during or after exercise suggests mechanical overload and requires immediate cessation 3
• Neurological symptoms including radiculopathy or myelopathy are absolute contraindications to heavy loading, as severe scoliosis can rarely cause spinal cord ischemia 5
• Rapid curve progression (>1 degree per month) indicates high-risk status requiring conservative management only 1
• Skeletally immature patients (Risser 0-2) with curves >20 degrees have >70% progression risk and should avoid exercises that may accelerate deformity 1, 2

Common Pitfalls to Avoid

• Assuming no symptoms means no risk - curves can progress silently, particularly during growth spurts 1
• Ignoring technique breakdown under fatigue - asymmetric loading patterns emerge when proper form cannot be maintained 3
• Failing to obtain baseline imaging - without documented curve magnitude, progression cannot be monitored 1
• Overlooking skeletal maturity status - Risser staging determines progression risk and should guide exercise intensity 1

Alternative Exercise Strategies

For individuals with moderate to severe curves or those at high progression risk:

• Substitute with exercises emphasizing spinal stabilization rather than heavy axial loading
• Implement scoliosis-specific exercise protocols which have demonstrated superior outcomes compared to general exercise 4
• Focus on symmetrical strength development through unilateral exercises that allow independent limb loading
• Prioritize exercises in supported positions (seated, prone) that reduce compressive forces on the spine