A little while back, I received this email from a teacher concerned for her student with scoliosis:
“I have a student that has scoliosis. She has been told by her doctor that she is going to have to stop playing flute due to the severity. I know that if she is sitting correctly, and using complete correct posture this really shouldn’t be a problem. I need expert advice from a professional to make sure she is doing all that she can in terms of posture to keep her playing. She loves playing is upset about the report from the doctor. What advice or strategies do you have?”
As chair of the Performance Health Committee for the National Flute Association, I sent this query out to my committee members and the advisory panel. Our advisory panel is made up of licensed medical professionals and the committee is made up of flutists with an interst and/or specialized background in health/wellness/fitness. These are their answers and hope they give some insight for those who may wonder about this question.
Disclaimer: this is not medical advice or a prescription, merely optionion and speculation based on the fact that none of those polled have actually seen, treated, tested, etc. the child in question. We are going on the limited knowledge we have at face value and this is not in any way to disregard the treating clinician.
Dr. Steve Mitchell, ENT
I am confused why this child’s
doctor feels she has to stop flute playing. Granted deep breathing and tidal
volume would likely be less than her peers, but so what? Just add more breath
marks. Quite frankly, anything that helps the child with deep breathing
exercises is usually encouraged. A flute is much more fun than a respiratory
Dr. Michael Treister,
MD: during my
orthopaedic career I treated lots of people with scoliosis. I cannot
specifically relate scoliosis directly to flute playing in terms of specific
recommendations. Pulmonary function is probably the main overall issue: breath
capacity is often reduced in individuals with scoliosis. Taking additional
breaths in the right place is appropriate in this case. Additionally, if
standing causes back pain, you just have to perform sitting. As long as their
upper extremity function is not affected they should be able to play the flute
My suggestions: avoid
marching band (perhaps) and if there is back pain, perform sitting. If
anything, flute playing should be therapeutic and not harmful in scoliotic
patients as I see it. If there are therapeutic recommendations they should come
from an orthopaedic expert who primarily treats children
with scoliosis. Scoliosis is not a contra-indication to
playing the flute.
Dr. Michael Weinstein,
Here is a link to the Mayo Clinic’s page on scoliosis:
I agree with the other
MDs that it is a curiosity that this person was told not to play flute.
A variety of interventions, from breathing technique modification, to improved
seating, use of a flute stand, etc…Could be useful.
Dr. Chip Shelton, DDS: The
treating doctor would likely endorse a practice regimen consisting of 60% end
blown flute and 40% transverse flute, ergonomically-postured as suggested. I
presented at NFA Orlando on end-blown flutes (article on NFA committee page). Ergonomically re-designed flutes seem to all
have significant learning curves, particularly the one I write about in my
synopsis. However the limitations are surmountable and well worth the resultant
benefits. Here is a link to an audio example:
Susan Mayer and Kristen Gygi
In addition to the MD
comments, there is support for people with scoliosis in yoga therapy,
massage therapy, personal training and Alexander Technique.
My guess would be that scoliosis, which already creates some imbalance due to misalignment, could exacerbate the assymetry required to play the flute for extended periods of time. I agree with Michael that it would be impossible to give a “one size fits all” prescription since each individual’s case of scoliosis would be unique.
As a yoga teacher I’ve had
numerous clients who come to yoga as a part of their therapuetic plan to
alleviate pain due to scoliosis. I’m guessing that flute student might
benefit from something similar? In all honesty, some of my best yoga students
are the ones with scoliosis.
I’m sure there are also
strength training activities that might support a diagnosis of scoliosis.
McCuiston, NASM-CPT, CES
My first thought, having trained several people with scoliosis, is that while strength training cannot fix the problem, we can at least strengthen the muscles in the opposite direction of the rotations while incorporating more overall core strength, as well as bilaterally and unilaterally. I wonder if 1) the student is in marching band, which, we know, can contribute to poor posture choices due to the straight nature of the instrument, rotational compensations must be made and if in the opposite direction of her scoliosis could contribute to pain or if in the same direction as her scoliosis could make the problem worse or 2) the student rotates her upper body due to being cramped in the section, or just naturally over rotates causing the above concerns?
In either case, body awareness of posture would go a long way in addition to strength training and the all the other suggestions made. Additionally, making sure you have adequate sleep can go a long way towards alleviating pain.
In summary, the overwhelming response is confusion as to why this doctor would
tell the child to stop playing. A suspicion is that this doctor has no idea
about playing a musical instrument and is giving a standard “stop
playing” answer. This is all said without knowing any particulars about
the student or her situation, which leaves out a lot. But overall, we see
no reason scoliosis should hinder her from playing.
- If playing is affected by not being able to breathe well,
add more breath marks, but continuing to play should actually help this
- Playing the flute is actually beneficial to increasing
volume of breath and tidal volume
- if due to postural distortion, is it because of unreasonable
demands in marching band, natural over rotation in her posture, cramping in the
flute section, etc? If so, those are easy modifications to be made.
- If it is more of a postural distortion problem, body
awareness techniques, Alexander Technique, yoga and strength training in the
opposite direction of the rotation, improving overall core strength, etc. could
be VERY beneficial.
Have you had experience with this? We would love to hear your thoughts and experiences! You can find the official page for the PHC Here and the unofficial Facebook page here. Love to hear if you have more questions!