Scoliosis and Physiotherapy Management
When someone is diagnosed with scoliosis, the word itself can sometimes cause some anxiety as most people don’t really understand what it is. The truth is, although scoliosis can lead to very serious consequences when left unchecked, it’s often a very manageable condition when diagnosed on time and treated properly. Scoliosis is simply a disorder that causes the abnormal curvature of the spine or backbone. There is a normal curvature the spine has when looking from the side, but the spine should appear straight when checked from the front. People with scoliosis develop an additional sideways curve of the spine or backbone. The spine of a person with scoliosis usually forms a C or S-shaped curve in the back.
How to Spot Signs of Scoliosis?
• Scoliosis may cause the head to appear off-center or leaning to one side.
• Shoulders may appear uneven with one shoulder blade appearing to be more prominent than the other.
• Uneven waist, one hip is higher than the other.
• In severe cases, it causes problems in heart and lungs, leading to shortness of breath and chest pain.
• In most cases, scoliosis is not painful but certain types can cause back pain, rib pain, neck pain and muscle spasms.
Causes and Types of Scoliosis
About 80% of scoliosis is idiopathic, so there is no known cause. Idiopathic type is common in adolescence and it occurs as the child grows leading to a curving and twisting of the spine. Some types of scoliosis appear early in childhood between birth and 10 years. There are also some less common types of scoliosis:
• Neuromuscular scoliosis: conditions which affect the nerves and muscles such as cerebral palsy or muscular dystrophy.
• Functional scoliosis: a result of a leg length discrepancy, bad posture, or carrying of heavy weight which can lead to uneven weight bearing/distribution across the body.
• Congenital scoliosis: presence at birth affects the development of the bones of the spine.
• Degenerative scoliosis: this occurs in older adults. It is caused by wear and tear in the spine due to age and this can result in the curve of the spine.
• Syndromic scoliosis: can develop alongside other syndromes namely connective tissue disorders (e.g Marfan syndrome).
• Scheuermann’s kyphosis: where the front section of the vertebrae grows more slowly than the back sections during childhood
The risk factors for developing idiopathic scoliosis (the most common type):
• Age: signs and symptoms are often seen during the growth spurt that occurs prior to puberty (between age 9-15)
• Sex: females have a higher risk of worsening spine curvature than males.
• Family history/genetics: although many people who have scoliosis do not family members with it, a family history of scoliosis increases the risk of the disease.
How is Scoliosis Diagnosed?
• Scoliosis is usually confirmed through a physical examination, an x-ray, spinal radiograph, CT scan or MRI.
• Cobb Method: measures and diagnoses the curve of the spine in terms of severity by the number of degrees. Grade ranges from mild (100-200), moderate (200 – 500) and severe (greater than 500)
• Adam’s forward bend test: which is a standard exam that is sometimes used by paediatricians and in grade school screenings.
Physiotherapy may have many roles involved in the treatment of scoliosis. A physiotherapist is often the one to screen for early diagnosis. After diagnosis, physiotherapy management will involve educating the patient and providing various other interventions as needed. The goal is to prevent the progression of curve, reduce pain, strengthen and build muscular endurance, increase range of motion, restore better posture and body mechanics and improve respiratory capacity. Physiotherapy treatment of scoliosis most commonly consists of physical exercises, bracing and manipulation. However, there are different care models that are being used, and all models follow the same standard procedure:
1) 3-dimensional self-correction
2) Training activities of daily living (ADL)
3) Stabilization of the corrected posture.
Some examples of popular care models are:
1. Schroth Method is a nonsurgical option for scoliosis treatment. It uses exercises tailored to the patient’s need to return the curved spine to a more neutral position. The goal of Schroth exercises is to rotate, elongate and stabilize the spine in a 3-dimensional plane. Therapy that uses the Schroth method focuses on restoring muscular symmetry, teaching awareness of body posture and training to breathe on the concave side of the body.
2. Lyon Method is a conservative approach that uses therapy in conjunction with casting and bracing. Lyon’s treatment approach is specifically determined by the type of scoliosis and the age of the patient. The basis of this method is to avoid spinal extension during exercise and enhance kyphosis of the thoracic region with lordosis of the lumbar spine as well as frontal plane correction. The main goal is to improve motivation with bracing, educate patient on self-awareness of postural defects, increase range of motion and muscle strength, train neuromuscular control of the spine and improve respiratory function.
3. Side shift is based on the theory that a flexible curve can be stabilized with lateral movements. The goal of the side shift method is active correction of the spinal curve by directing treatment to the apex of the scoliosis with side shift movement of the trunk towards the concavity. Side shift exercises involves the use of active postural corrections in all planes, teaching breathing exercises to improve vital capacity and reduction of mechanical pain caused by excessive postural deviation.
4. Scientific Exercise Approach to Scoliosis (SEAS) is an individualized exercise program scientifically adapted to all aspects of the conservative treatment of scoliosis based on the most current research and is continuously evolving with the introduction of new knowledge from the scientific literature. SEAS exercises train neuromotor systems to activate a reflex of self-correction of posture during activities of daily living. It is effective in reducing the rate of progression of scoliosis and help to avoid brace prescription.
If you suspect you or your child may be developing a scoliosis, it’s best to act quickly. The sooner treatment begins, the better the outcome. Starting a program guided by your doctor and physiotherapist in the early stages will prevent progression of the condition as well as any symptoms that come along with it. To get screened, give us a call at PCA. We can evaluate your symptoms, address your concerns and advise on the most appropriate way forward.