How I discovered a potential link between deep squat toileting and scoliosis prevention
I read an article by
chiropractor William Levaditis entitled
pelvis leveling manouvre: clinical impressions. From here I reasoned that if the deep squat can
temporarily level the pelvis and improve the posture then regular toilet squatting (one or more times per day) should
aid in prevention of scoliosis. This theory predicts a reduced prevalence of scoliosis in the toilet squatting nations (India and China, and to a
lesser extent Japan and Singapore/Malaysia).
Is there in fact reduced prevalence of scoliosis in the toilet squatting nations?
I performed a scientific article search for worldwide prevalence of
scoliosis which included scoliosis prevalence in the toilet squatting nations.
Table: Prevalence of persons with scoliosis compared with prevalence of households deep squatting
Prevalence of Households deep squatting
Prevalence of persons with a positive Adams
Prevalence of persons with X-ray evidence of Scoliosis
3-5 per 1,000(7)
0.64 per 1,000(8)
0.65 per 1,000(6)*
(*) excluding cases due to nerve damage (mostly poliomyelitis)
(1) In countries where children squat to toilet (India and China), the prevalence
of scoliosis is approximately one seventh of that found in countries where children sit to toilet.
(2) In Japan in 1995, perhaps one quarter of the children may still have been routinely
toilet squatting at home and almost all of them would still have been toilet squatting
in schools and public places. This amount of squatting correlates with a level of
scoliosis in teenagers in Japan of just 39% of that observed in America (i.e incidence is less than half).
(3) In the older Japanese population (who grew up at a time when squat toileting was
more common), the prevalence is lower than in the teenage population (2, 3).
(4) In Singapore, the Asian female adolescents have the highest prevalence of scoliosis, followed by the less well off
Indian and Malaysian ethnic groups. The Indian and Malaysian ethnic groups probably have poorer diet(16), and likely will tend to
squat toilet more than their more well off Asian counterparts.
We can't! - Short of a mass intervention squatting trial performed on perhaps 10,000 girls through their formative years.
I suggest you look at it another way. It's not hard to encourage your kids to do a heels down squat to
read the newspaper on the lounge floor. And the postural and muscular rebalancing is going to be good for them
even if they were never going to get a case of scoliosis. The downside(???) - you have to do it yourself to set a good example.
A compromise approach would be to do your own Adams forward bend testing at home and get some deep squatting in place at the earliest opportunity.
The deep squat may be the reason that scoliosis (curvature of the spine) is far
less prevalent in Asian countries (where they regularly squat to go to the toilet).
Regular deep squatting seems likely to reduce the risk of development of scoliosis,
and if performed regularly enough, risk reduction may be up to seven fold!
Take home message for scoliosis prevention and control
If you want to reduce the incidence of scoliosis (and very probably other imbalances)
in your children, get them to deep squat on a regular basis - preferably every day.
As an adult you should deep squat too, because the deep squat is observed to balance
the body, and (from my reading and observations) has other therapeutic advantages as well.
How to squat
It is rare indeed for a western person to be able to squat with the heels down but
it is therapeutic for both hip joints and spine, and you can develop the skill over time.
Start with chair assisted and door jamb squats (see below).
Left - door jamb assisted squat, Right - chair assisted squat. Both of these modified squats provide a lead into full squatting.
Expect it to take up to a year to achieve the actual "latrine style" deep squat.
Probable link with lower blood levels of vitamin D and higher than normal requirements for vitamin D
Higher latitudes (higher than 25 degrees) are associated with higher prevalence of idiopathic
scoliosis in adolescent girls(9).
Also, of sisters where one is scoliotic and the other not scoliotic, the scoliosis sufferer
will have osteoporosis (low bone density)(10).
Of 382 healthy Philadelphia children examined during winter(age range, 6-21 years, latitude, 40° north),
the overall prevalence of low blood vitamin D (30 ng/mL) was 51% among whites and 94% among blacks.
This figure is alarming when you consider that other authorities state that blood levels should be
monitored and maintained at 60 ng/ml.
Unfortunately, no researcher has yet looked for a link between vitamin D and idiopathic scoliosis.
Vitamin D deficiency is a huge subject, and (sadly) I do not believe that your average doctor - or even your
orthopaedic specialist - is equipped to advise you on it.
You need to do your own research, and take control of your own blood test monitoring and
supplementation program. Try this link: Dr. Mercola Vitamin D Resource Page
Intense athletic training, gymnastics and dance are associated with higher rates of scoliosis and
this may be due to exercise depression of estrogen levels and also due to stress on joints and bone growth plates
Increased bleeding tendency
Vitamin K deficiency (related to bleeding into immature bones that subsequently become misshapen)
It may be that scoliosis is associated with inability to absorb fat soluble vitamins
Tall and slender girls are more likely to have scoliosis
See reference 11
Girls with scoliosis tend to have later onset of puberty
See reference 9 - interestingly, onset of puberty is delayed at higher latitudes - another link with low vitamin D?
Wikipedia: Toilets in Japan
[There are two styles of toilets commonly found in Japan. The oldest type is a simple squat toilet, which is still somewhat common in public conveniences. After World War II, modern Western-type flush toilets and urinals became common. The current state of the art for Western-style toilets is the bidet toilet, which, as of 2009, are installed in 69% of Japanese households].
Research for the prevalence of scoliosis
Nippon Seikeigeka Gakkai Zasshi. 1985 Nov;59(11):895-906.
[Article in Japanese]
SUGITA KIYOSHI: Epidemiological study on idiopathic scoliosis in high school students
prevalence and relation to physique, physical strength and motor ability. Japanese
journal of public health. vol: 47 issue: 4 page: 320-325 year: 2000
OLIVIA D CARTER and SUZANNE G HAYNES
Prevalence Rates for Scoliosis in US Adults: Results from the First National Health and Nutrition Examination Survey
International Journal of Epidemiology, Volume 16, Number 4, Pp. 537-544
R. L. Mittal; R. Aggerwal; A. K. Sarwal: School screening for scoliosis in India:
The evaluation of a scoliometer, International Orthopaedics (SICOT) (1987) 11:335-338
Statistics by Country for Scoliosis
Liu SL, Huang DS: Scoliosis in China. A general review.
Clin Orthop Relat Res. 1996 Feb;(323):113-8.
Theodoros B Grivas, Elias Vasiliadis, Vasilios Mouzakis, Constantinos Mihas, and Georgios Koufopoulos:
Association between adolescent idiopathic scoliosis prevalence and age at menarche in different geographic
Mir Sadat-Ali, Abdallah Al-Othman, Dalal Bubshait, and Dakheel Al-Dakheel:
Does scoliosis causes low bone mass? A comparative study between siblings
Mordechai Shohat, Tami Shohat, Menachem Nitzan, Marc Mimouni, Ron Kedem
and Yehuda L. Danon: Growth and ethnicity in scoliosis
Young scoliotic adults are taller and markedly lighter and thinner
Discussion on association between scoliosis and low vitamin D levels
Alisha J. Rovner Kimberly O. O’Brien:
Hypovitaminosis D Among Healthy Children in the United States
A Review of the Current Evidence
Daruwalla JS, Balasubramaniam P, Chay SO, Rajan U, Lee HP: Idiopathic
scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren.
J Bone Joint Surg Br. 1985 Mar;67(2):182-4.
Anecdotal evidence for partial penetration of western style toilets into Singapore
Chen ST:Comparative growth of Malay, Chinese and Indian school children in Malaysia.
Idiopathic Scoliosis: How Chiropractic Can Help
(Article suggests defects in the melatonin signaling pathways acause of scoliosis)
This article is dedicated to the memory of William Levaditis, who passed away on
February 17th 2010.
His report on how
(deep squatting) normalizes the posture was the inspiration for this article.
If you have a history of recent severe back pain, you should consult a medical
professional before attempting to do the full deep squat as illustrated. Nevertheless
if spine health permits, it is a very healthy ideal to work toward.