Category: Blog

14 Myths about Scoliosis, Revisited!

Posted on January 7, 2021 by - Blog

Nearly three years ago we posted an article entitled “14 Myths about Scoliosis” – and by all accounts, it’s one of our most-read articles of all time. Perhaps there’s something about myth-busting, which is especially needed in the scoliosis world. Three years ago, we pointed out that much of what we know and understand about scoliosis is based on emerging research, or out of date information – scoliosis treatment is a rapidly advancing field, in which the best clinics need to stay on top of the technological and research developments.

After just a few years, this week, we revisit the 14 myths to see what we can add.

 

Myth 1 – Scoliosis causes pain

In 2017 we wrote that “while Scoliosis may be associated with pain as it develops, typically, scoliosis in the early phases does not cause pain. This is why scoliosis screening is so important, and why we provide the scoliscreen app. In Children especially, the early onset of scoliosis might go completely unnoticed.”

This has been perhaps the biggest change on the list – really, this no longer belongs on a list of “Myths” – to be clear, research now suggests that scoliosis does cause pain, at least in some cases. Certainly, we can no longer assume that the presence of pain means scoliosis is not a factor to consider.

This view was mostly based on older research, which had gone mainly unchallanaged for decades. Since then there has been a great deal of study on pain in scoliosis, so that today, we’re of the view that pain is, in fact, often a symptom of scoliosis. Research has now shown that Spinal pain is a frequent condition in AIS patients, further supporting the need for early detection and screening to minimise potential pain and suffering[1] –  that In patients under 21 treated for back pain, scoliosis was the most common underlying condition[2] and that in one study of 2400 patients with AIS, 23% reported back pain at their initial contact[3].

Studies have also shown that s coliosis patients have between a 3 and 5 fold increased risk of back pain in the upper and middle right part of the back[4] , that Chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[5] and that patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[6]

 

 

Myth 2 – “Watchful waiting” is the best approach

In 2017 we wrote: “In the UK and many other parts of the world a “wait and see” approach is often favoured when it comes to scoliosis. The condition is monitored to see if it gets worse, with a view to undertaking a surgical fusion of the spine if the situation becomes bad enough.

In the past, this might have been the best approach, but today we have the know-how and technical ability required to create a scoliosis specific exercise program and a customised bracing solution, which can serve to correct the problem before it progresses to the point where surgery would be required. It is easier to improve a more flexible and smaller curve with bracing and scoliosis specific exercise than it is to change a large more rigid curve – so early diagnosis and appropriate treatment make a big difference.”

Since 2017 we’ve discussed the cost benefits of early screening on a number of occasions – bracing and treatment costs have come down meaning that early detection and treatment makes all the more sense financially.

Earlier this year, we reported that many specialists still take the view that scoliosis can only be treated surgically (this is false!), in many cases you may not be seen by a specialist until scoliosis has developed beyond 45 degrees, which is typically considered the threshold for surgery. Bracing and other non-surgical methods are certainly still possible in curves up to 60 degrees depending on the individual case and risk of future progression.

Recent research by the British Scoliosis Society (BSS) has now illustrated just how long “wait and see” can go on, even after getting an appointment for a consultation. They showed that most patients face another long wait for treatment during which scoliosis tends to progress. Their 2018 study specifically looked at scoliosis progression whilst waiting for a consultation and eventual surgery. In the study, 41 females and 20 males with a mean age of 11.8 years with a mean Cobb angle (curvature) of 58° were followed –  Average waiting time to be seen in the clinic for an initial consultation was 16 months – thereafter, the average waiting time for surgery was 10 months. Rapid curve progression was seen in twelve patients, of which 10 required more extensive surgery than originally planned. Their mean Cobb angle at presentation was 48° which increased to a mean of 58° at surgery[7]. Many of those cases could have been treated non surgically before the “waiting” – but probably not after.

 

 

Myth 3 – Scoliosis screening doesn’t help scoliosis sufferers

In 2017 we wrote: “Current UK policy does not support mass screenings due to the cost, potential of false positives, belief that bracing doesn’t work and that if the curve is severe enough family or other adults will notice it.

As we mentioned above, since scoliosis does not always cause pain (and most people don’t know how to recognise scoliosis anyway) it’s entirely possible that the condition can go unnoticed in many cases. The earlier the detection, the more appropriately the right treatment can be given at the right time.”

Research continues to support the need for early screening, although we do now recognise pain as a symptom. Newer online screening tools (including our own, which will be released soon) are helping to make screening faster, and easier than ever before – the scoliosis treatment community will probably resolve this issue through technology long before government takes any action.

 

 

Myth 4 – Scoliosis doesn’t progress into adulthood

In 2017 we wrote “Historically, scoliosis was most strongly associated with growth – from this it was assumed that when an adolescent stops growing, scoliosis would not progress. It is now known that it often will progress into adulthood – in addition, the bigger the existing curve the more likely it is to progress.

The major reason for progression is the weakening of the ligaments in the spine as we age. As the ligaments weaken, the spine loses stability and the spinal deformity worsens. This means that appropriate exercises and chiropractic care are highly beneficial for us all as we age – but can make a huge difference to a scoliosis sufferer.

The weakening of ligaments causes 30% of the population over the age of 60 years to have scoliosis versus only 3% of adolescents!”

 

Since 2017, we’ve successfully treated many older adults suffering from degenerative scoliosis – and we’ve seen first hand the positive effects such as a reduction in pain, even from part-time bracing – in this sense, our results are in line with the research which was emerging back in 2017.[8]

 

Myth 5 – Swimming will help reduce scoliosis

In 2017 we wrote “Over many years children have been told to swim to treat scoliosis. While swimming is a great form of exercise in general, there is no evidence to support this idea – although there actually has been some research which suggests that scoliosis can be worsened after swimming. This research is not strong enough to suggest that scoliosis patients should avoid swimming, but we can now say that swimming alone is not an effective treatment.”

Since then, we aren’t aware of any studies which have specifically looked at swimming – and this is mainly because there is much greater focus on scoliosis specific exercises which can help to control or reduce Scoliosis in a significant way.

 

 

Myth 6 – Bad posture causes scoliosis

In 2017 we wrote that “You might think that telling your child to sit upright will stop scoliosis – this makes sense since often adolescents will have slumping posture, however, the slumping posture itself is not necessarily linked to the development of scoliosis.

In fact, for children with scoliosis, the spine will often be straighter than is observed in the average population. Typically, the thoracic kyphosis in adolescent idiopathic scoliosis will be reduced and sometimes even bend in the opposite direction!

Often children’s shoulder blades will lift off the thorax (aka winging of the scapula) due to weakness of the serratus anterior muscle which will give the appearance of hunching.”

The only point we would add here today is that the advances in research around pain and scoliosis are significant for teens and young adults – if your child is complaining of back pain, we now advise that you seek the help of a spinal professional, at least to rule out scoliosis. A consultation with a scoliosis practitioner is ideal – but most professional chiropractors will be able to provide you with an X-ray which could show early signs of scoliosis. If your child shows any kind of unusual posture, we recommend scoliosis screening as soon as possible.

 

Myth 7 – You can correct scoliosis by just sitting up straight

In 2017 we wrote “Scoliosis is more than just twisting of the spine, it causes is often multi-factorial thus a multi-factorial treatment must be given.  Sitting up straight might help a little since postural exercises might well be an effective element of a treatment program, but the right treatment will be different for every patient – that’s why we take time to go through a detailed consultation process with each patient.”

It’s still true that you can’t correct scoliosis by changing your sitting patterns – but with higher than ever levels of young people coming into our clinic with neck problems, it’s worth keeping in mind. Long term postural problems could predispose you to the development of de-novo scoliosis later in life – so a focus on posture now may pay dividends later.

 

Myth 8 – Spinal braces don’t work in correcting scoliosis

In 2017 we wrote that “Spinal bracing has been the subject of intense research over the past 15-20 years. Far from the myth that they are ineffective, spinal braces have been shown to reduce progression in 70 to 80% of cases compared to those who aren’t braced.

Among some healthcare professionals, the notion that scoliosis braces don’t work does still exist however this is most usually because there is confusion about the kind of bracing being discussed. Bracing technology itself has come a long way in the last few years.  Traditional medical braces are designed to hold the spine in the patient’s scoliotic position, which might halt progression, but it actually does nothing to improve the curve.

In contrast, our Scolibrace braces are an active over-corrective brace which works to shift the spine in the opposite, direction back towards normal posture. In addition, they help to shift the mechanical loading of the spine to stimulate normal spinal growth. This not only helps to reduce the likelihood of progression but also improves the potential correction.

Traditional braces, therefore don’t work in correcting scoliosis (although they might stop it getting worse) Scolibrace braces, however, actively work to correct the position of the spine, and have been shown to be highly effective in doing so.”

In recent years there has been yet more improvement in bracing technology, with research to further explore its effects being published regularly. Since 2017, it’s been established that Bracing is far more effective than exercise in reducing cobb angle. In one study, the 6-month reduction in Cobb angle from a bracing group was 3.13 degrees and at 12 months the mean reduction was 5.88 degrees.  In the exercise group, the 6 months mean reduction was just 0.66 degrees, and at 12 months was 2.24 degrees[9] There’s no question that the exercise approach still have value – not least because they address the muscular imbalances that bracing does not – but today, we recommend bracing to most of our clients, either full time or part-time.

 

Myth 9 – Scoliosis only affects girls

In 2017 we wrote “Scoliosis is more common in girls than boys, but boys can and do develop scoliosis.

Scoliosis is particularly common in ballet dancers and gymnasts, which might be at the heart of this misconception, but there is no doubt the boys and girls can both develop scoliosis.”

Our experience since then shows this to be true – more girls than boys experience scoliosis, but we have seen many male patients of all ages at the clinic. To be a little more specific on the Gymnastics question, research has shown that Gymnasts (and ballet dancers) are as much as 12 times more likely to develop scoliosis than non-gymnasts[10] however, we still urge caution with this statistic – we’ve discussed this issue a few time since 2017, and each time we’ve noted the awareness of scoliosis in these fields, which doubtless leads to higher reporting.

 

Myth 10 – Spinal manipulation can reduce scoliosis

In 2017 we wrote that “Spinal adjustment and manipulation can often help to improve spinal mobility and ease areas of aches and pains in those who have scoliosis, just as it can for those who don’t – but spinal manipulation alone will not reduce scoliosis.

While chiropractic adjustments can form a valuable part of an overall treatment regime, there is no evidence from the scientific literature to support the assertion that spinal manipulation and adjusting techniques alone can reduce scoliosis. Where adjustments may be highly beneficial is in support of an exercise and lifestyle regime, as a method of increasing range of motion, and reducing pain in some cases.”

Over time, serious research into chiropractic based treatment as an approach to reducing scoliosis has been coalescing around the CLEAR institute, who have certainly published some interesting research. In a sample of 140 patients using the prospective CLEAR technique, (and according to the CLEAR institute themselves) improvement in Cobb angle was documented in all 140 cases. The average amount of reduction in Cobb angle was 37.7% after an average of 12.3 visits. 23 patients were no longer classified as having scoliosis after their treatment (e.g., the Cobb angle was reduced to below 10 degrees).

While the study results were published[11], they were not peer-reviewed and therefore do not currently meet the standard of proof for us to consider this technique at the UK Scoliosis Clinic – we will keep this under review, however, should independently reviewed research become available.

 

Myth 11 – Physiotherapy exercise reduces scoliosis

In 2017 we wrote: “Just like chiropractic care, physiotherapy can help to improve mobility and function for scoliosis patients and might form part of an overall program – however again there is no evidence to show that generalised exercise, massage, mobilisation or core stability will improve a scoliotic curve.  Bracing and scoliosis specific exercise are currently the only non-surgical methodologies which is clinically indicated as effective in treating scoliosis.”

As outlined above, this still holds true – we believe that scoliosis specific exercise is a solid approach for treating small curves, and for addressing issues around muscular imbalance and some kinds of pain associated with scoliosis. Research continues to show that a combination of both approaches is greater than the sum of its parts. Interestingly, research since 2017 has demonstrated that exercised based approaches tend to yield a slightly higher quality of life scores (SRS Questionnaire-based) than bracing alone[12].

Our view is now that Bracing is the primary tool for reducing Cobb angle – exercised based approaches are an invaluable “force multiplier” in this regard.

 

Myth 12 – Heavy backpacks cause scoliosis

In 2017 we wrote that “Heavy backpacks cause uneven loading and are never good for children’s spines and posture… but they don’t cause scoliosis. If it was the case every child would have scoliosis!”

This is still the case – but please do be kind to you child and think about their spine health overall, not just scoliosis!

 

Myth 13 – Scoliosis worsens in pregnancy or will stop me having children

In 2017 we wrote that “Current research knowledge shows that women are not at an increased risk of progression in pregnancy, however carrying a baby will produce more stress upon the body and the spine which will increase the likelihood of pain and discomfort as for all women in pregnancy.

At birth, it is important for the anaesthetist to be aware that a mother has scoliosis, as it will affect the position of the spine if they need to give an epidural injection. It will not however affect the woman’s ability to carry a child or give birth.”

Again this position I unchanged – Scoliosis will not affect your fertility.

 

Myth 14 – Surgery is the only treatment for scoliosis

In 2017 we wrote that “Surgery is sometimes the only option for large curves at high risk of progression.  50 degrees is the typical indicator for surgery as the curve is at a high risk of progression into adulthood.

Scolibrace with scoliosis specific corrective exercise has been shown to be clinically effective in reducing curves between 20 and 60 degrees, whereas curves between 10 and 20 degrees with a low risk of progression can sometimes be treated by scoliosis specific exercise alone.

As previously mentioned early diagnosis is key, as the chances for arresting and correcting a relatively small angle are very good.”

Since 2017, we’ve helped patients from all backgrounds, ages and genders beat scoliosis – and in the vast majority of cases, we have been able to help them avoid surgery. Where this hasn’t been possible, it is almost always because they sought treatment too latte – had scoliosis been caught sooner, a non-surgical option would almost always have been open to them.

As always, screen regularly – and if you have questions get in touch – don’t wait and see!

 

 

[1] ‘Back Pain and Adolescent Idiopathic Scoliosis: A Descriptive, Correlation Study’,
Theroux Jean, Le May Sylvie, Labelle Hubert [University of Montreal, Quebec, Canada; Murdoch University, Perth, WA, Australia], Spine Society of Australia 27th Annual Scientific Meeting (8-10 April 2016)

‘Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis A Cross-sectional Study’
Jean Theroux, DC, MSc, PhD, Sylvie Le May, RN, PhD, Jeffrey J. Hebert, DC, PhD,and Hubert Labelle, MD : SPINE 153607

 

[2] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

 

[3] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

 

[4] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

 

[5] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

 

[6] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

 

[7] H V Dabke, A Jones, S Ahuja, J Howes, P R Davies, SHOULD PATIENTS WAIT FOR SCOLIOSIS SURGERY?  Orthopaedic ProceedingsVol. 88-B, No. SUPP_II

[8] Scoliosis bracing and exercise for pain management in adults—a case report
Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407

[9] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine [Publish Ahead of Print]

 

[10] ‘Prevalence and predictors of adolescent idiopathic scoliosis in adolescent ballet dancers’
Longworth B., Fary R., Hopper D, Arch Phys Med Rehabil. 2014 Sep;95(9):1725-30. doi: 10.1016/j.apmr.2014.02.027. Epub 2014 Mar 21.

 

[11] Woggon D, Woggon A, and Chong S: Developing a scoliosis-specific chiropractic protocol: preliminary results from 140 consecutively-treated scoliosis cases. The American Chiropractor, Dec 2013; 35(12):16-22.

[12] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine [Publish Ahead of Print]

 

Happy new year from the UK Scoliosis clinic!

Posted on January 2, 2021 by - Blog

We hope that you’ve had the best Christmas possible, and, like us, you’re looking forward to a fresh start!

 

2020 is over!

What a year 2020 has turned out to be!

Without question, this has been the most difficult year the clinic has faced – through lockdowns and even periods of less restriction, it’s been a challenge to provide the services to our patients that we want to. At times, it’s been tough to keep positive!

Despite this, we have managed to continue operating and, covid notwithstanding, we’ve still helped many people overcome and manage Scoliosis. Thank you so much to all of you for your support and cooperation over this time – at the moment, your compliance with guidelines and restrictions is absolutely essential for us to continue to operate at all, and your help is very much appreciated.

 

The UK Scoliosis clinic in 2021

Let’s be honest – 2021 still looks uncertain – we hope that as lockdowns lift we’ll be able to welcome international clients back to the clinic and we certainly look forward to an easier time for our clients here in the UK. It’s also possible that we may see the return of more restrictions, but we’re pleased to say that after nearly a year we are now very well prepared whatever the next 12 months bring!

We’re fully committed to providing the best possible treatment that we can, no matter what the conditions re: covid. In line with government guidelines, we’ll continue to use all appropriate PPE and additional cleaning at the clinic as and when face to face consultations can take place. We’re also offering online consultations and check-ups, and we would encourage all of our patients to ensure you attend in one way or other in order to keep your treatment moving ahead successfully.

We’ll be staying in touch with everyone as and when regulations start to change, and with any luck we’ll seen be “back to normal”.

 

Here’s to (hopefully) a great 2021!

COVID Update (WE ARE OPEN)

Posted on November 5, 2020 by - Blog

Dear Clients,

I just wanted to quickly update you on arrangements at The UK Scoliosis Clinic given that a new national lockdown has now been announced.

While it’s devastating for all of us, were back in lockdown – thankfully, businesses who cannot work remotely are allowed to remain open and we will be doing so. The UK Scoliosis Clinic will remain open.

Thanks to the hard work we put in earlier in the year, as well as the incredible cooperation we’ve seen from all our clients we can, and will, continue to operate the clinic as usual and in line with the COVID-Secure practices, which we have now had in place for nearly 6 months.

Given the individualised nature of scoliosis consultations and treatments, we have found it relatively easy to adapt the clinic to operate in a way which keeps everyone as safe as possible, and we’re fully confident we will continue to be able to do so.  

We would ask all patients to please ensure they are following the guidelines when at the clinic, as well as day to day. If we all work together, we can beat this thing sooner!

I will make a further update if required in the future, however I want to be clear that our intention is to remain OPEN to serve our patients.

If you have any questions or concerns please just give us a call.

 

Looking forward to seeing you soon!

 

Do Boys Get Scoliosis?

Posted on July 8, 2020 by - Blog

Do boys get scoliosis? It’s a good question – and it’s one which we don’t hear people ask enough. While it’s certainly true that the majority of scoliosis cases which you’ll hear about in the news are females – and if you know someone with scoliosis, they’re more likely to be female, Males, can, and do get scoliosis.

 

Scoliosis and Gender

It’s a generally stated fact that scoliosis affects girls more than boys, or, more broadly, it’s frequently noted that about 75% of adolescent idieopathic scoliosis cases are females. Both statements are true – but adolescent idiopathic scoliosis is not the only kind of scoliosis, and 25% is still a large number of people!

To be a little more specific, let’s break the question down – first, scoliosis in children.

Idiopathic scoliosis is a 3-dimensional distortion of the spine and trunk that occurs in otherwise healthy children. 80% of scoliosis cases in this age group are considered to be “Idiopathic” or “of unknown cause” – scientists are fairly sure that genetics can play a role, but the exact onset of scoliosis Is still not fully understood.

A well-recognised theory about how scoliosis develops in adolescence revolves around asymmetrical growth of the vertebrae which de-stabilises the spine and makes the vertebrae prone to becoming wedged. Wedging of the vertebrae then creates a lateral spinal curve which places uneven loading on the vertebrae and precipitates further asymmetrical growth and progression. It is then thought that spinal cord tension develops as the spine bends and twists and brain function and growth is altered as muscle asymmetry develops.

We break idiopathic scoliosis down further into age groups – and here’s where the numbers get interesting.

Infantile idiopathic scoliosis is the name given to idiopathic scoliosis cases which are diagnosed in children between the ages of 0 to 3 years. Statistically, it is the least common of all forms of idiopathic scoliosis and comprises about 1% of all idiopathic scoliosis in children – while the numbers of overall cases are smaller about 60% of patients are boys.

Juvenile idiopathic scoliosis is diagnosed when scoliosis of the spine is apparent between the ages of 4 and 10. It is less common than adolescent idiopathic scoliosis but more common than infantile. In total, it comprises 10-15% of idiopathic scoliosis cases.
Juvenile scoliosis is also found more often in boys between the ages of 4-6, whereas between 6 and 10 it becomes more common in girls.

Adolescent idiopathic scoliosis is the type which we most frequently hear about – and here is where between 75% and 80% of cases are girls. It is usually noticed around 11-12 years of age in girls and slightly later when diagnosed in boys.  AIS is estimated to affect between 3 and 4% of teenagers. In most cases, AIS begins to develop noticeably at the initial onset of puberty and becomes more apparent as is worsens during growth spurts.

While it’s clear that when taken as a whole, girls will tend to make up the majority of scoliosis cases, there are substantial age groups where boys are the most common patients. It’s also critical to understand that while all scoliosis cases should be considered as potentially debilitating, the time available for scoliosis to progress (it typically stops at skeletal maturity) is a huge factor in determining risk.  Scoliosis discovered in a 5-year-old boy has considerably more time to progress, than in a 16-year-old girl.

Finally, there’s another common form of scoliosis to consider – affecting a very different age group. Older adults are at considerable risk of another common form of scoliosis, known as “de-novo” (degenerative) scoliosis. De-novo scoliosis is caused by wear and tear to the spinal discs as we age, and is therefore quite common – research suggests that as many as 30% of the over 60’s suffer from scoliosis. Although de-novo scoliosis progresses much more slowly than childhood or adolescent scoliosis it can still have a major impact on quality of life, if not properly treated.[1] De-novo scoliosis affects both males and females – and since such a large percentage of older people can suffer from this condition, there’s a very real argument to be made suggesting that taken over a lifespan, the rates of male and females scoliosis are much closer together than it might seem at first glance.

 

If you think you may have scoliosis

If you think you may have scoliosis, the advice is simple – regardless of gender, see a scoliosis specialist sooner rather than later. At the UK Scoliosis clinic, we offer in-person consultations at our Essex clinic, as well as online consultations from the comfort of your own home.

 

 

 

[1] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

‘The prevalence and radiological findings in 1347 elderly patients with scoliosis‘
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.,  Journal of bone and joint surgery 2010 Jul;92(7):980-3

 

I Have Back Pain… Is it Scoliosis?

Posted on June 30, 2020 by - Blog

Back pain is probably the single most troublesome and common condition for people to suffer from today – our changing lifestyles as well as more time spent at a desk (or a home desk.. perhaps even worse) mean that BUPA now estimates that a many as 2 in 3 of us will suffer from back pain in our lives.[1] I began my career in spine care as Chiropractor, and proudly practice to this day. Each and every week I treat hundreds of patients for all kinds of back pain – most often it’s a common symptom, stemming from a common problem with a clear treatment pathway. Sometimes, however, back pain can be a symptom of something more serious – like scoliosis. So, could your back pain be due to scoliosis, and should you see a professional?

 

Does scoliosis cause back pain?

The issue of scoliosis and back pain has been somewhat contentious – many organisations will still tell you that back pain is not a symptom of scoliosis, or that scoliosis is “painless”. Today, however, these views are out of date – there’s a growing body of research that shows that while pain may not be the main symptom of scoliosis, it can certainly be a factor.

One recent study concluded that “Spinal pain is, in fact, a frequent condition in AIS patients, further supporting the need for early detection and screening to minimise potential pain and suffering”[2] and at the UK Scoliosis clinic, we support this view.

Research has also shown that in patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[3] while another, involving 2400 patients with adolescent idiopathic scoliosis showed that 23% reported back pain at their initial contact[4]. Estimates suggest that scoliosis patients have between a 3 and 5 fold increased risk of back pain in the upper and middle right part of the back[5] – and support the view that chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[6] It’s also been shown that patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[7] – and finally, more positively, that part-time bracing in adult scoliosis cases can improve chronic pain[8]

So, can scoliosis cause back pain? Yes it can.  Does that mean your back pain is caused by scoliosis? Possibly – let’s explore more.

 

Back pain in adults

Back pain is incredibly common in adults – as stated above, 66% of us at least will suffer from it. The vast majority of these cases will not be scoliosis. Scoliosis progression is lowest in adulthood, and the incidence of new cases is almost nil amongst the general young and middle aged adult population. It’s certainly possible that undiagnosed, untreated childhood scoliosis is the source of your pain – but there are any number of common conditions which are far more likely. If you’re aged 25 – 60, it’s highly unlikely that scoliosis will be your problem.

As we age, the picture starts to change, however – mainly due to the presence of a condition known as “de-novo” or degenerative scoliosis. De-novo scoliosis is caused by wear and tear to the spinal discs as we age, and is therefore quite common – research suggests that as many as 30% of the over 60’s suffer from de-novo scoliosis. Although de-novo scoliosis progresses much more slowly than childhood or adolescent scoliosis it can still have a major impact on quality of life, if not properly treated.[9]

To the core point of this article, while most forms of scoliosis are detected at a scoliosis specific screening,  De-novo scoliosis is most often discovered as the result of a back-pain investigation. Patients with degenerative De-Novo scoliosis typically present for treatment with complaints ranging from debilitating back or lower extremity pain to spinal imbalances, as well as as a response to incidental findings on lumbar radiographs.

Counter-intuitively, the pain caused as a result of adult scoliosis is not related to the size of the curve. Several good studies show there is little to no relationship between the size of the curve and the intensity of pain – therefore a 20 degree and a 55 degree curve have the same chance of causing pain in an adult. Pain in adults is more commonly linked to the degree to which vertebrae individually shift to the side in what is called ‘lateralisthesis’ and their ‘postural balance’ or degree to which their trunk or upper body is shifted to the side or forward over their pelvis This means that a visual observation is not always sufficient to rule out scoliosis in adults, and a professional consultation is the best approach. Put simply, if you’re over 60, and suffering with new back pain – a scoliosis consultation isn’t at all a bad idea.

 

Back pain in Children and Young people

Finally, let’s look at the youngest population – children and teens. While we often associate back pain with older populations, this is a bit of a misconception – One meta-study from 2013 (nearly 7 years ago now) suggested a rate of low back pain among adolescents aged 9–18 years of about 12% at any given moment, whereas the number who would experience an episode of pain during a 12 month period was 34%.[10] This number certainly will not have improved!

It’s important to note that this headline figure is an average too – and the studies used in this broad-spectrum analysis showed great variation in the estimates of prevalence. For example, estimates from the Nordic countries showed a weekly occurrence of spinal pain in young people at around 20%[11], and a small Danish study showed a lifetime prevalence of spinal pain of 86% in a population of adolescents aged 11–13 years, with neck pain being the most prevalent.[12]

Scoliosis, whilst statistically less common in the young than the older, is far more risky for the young – since the opportunity for the condition to progress to the surgical threshold is greatest. Scoliosis is also known to develop rapidly and unevenly during growth spurts, making this a time for real concern. As an average figure, 3-4% of teens will develop scoliosis. Left untreated in young people, Scoliosis can be a life-limiting condition –  but treated early, its impact can be almost entirely mitigated. Back pain won’t always be present in a scoliosis case – so if you have concerns about the shape of a young persons back (this is the most common way scoliosis is detected) do not be dissuaded from seeking a consultation due to the absence of back pain – but, if presented with a young person with new back pain, a scoliosis consultation may be a wise approach.

 

 

[1] https://www.bupa.co.uk/health-information/back-care/back-pain

[2] ‘Back Pain and Adolescent Idiopathic Scoliosis: A Descriptive, Correlation Study’,
Theroux Jean, Le May Sylvie, Labelle Hubert [University of Montreal, Quebec, Canada; Murdoch University, Perth, WA, Australia], Spine Society of Australia 27th Annual Scientific Meeting (8-10 April 2016)
Jean Theroux, DC, MSc, PhD, Sylvie Le May, RN, PhD, Jeffrey J. Hebert, DC, PhD,and Hubert Labelle, MD : SPINE 153607

[3] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[4] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

[5] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

[6] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[7] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[8] Scoliosis bracing and exercise for pain management in adults—a case report
Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.

[9] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

‘The prevalence and radiological findings in 1347 elderly patients with scoliosis‘
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.,  Journal of bone and joint surgery 2010 Jul;92(7):980-3

[10] Calvo-Munoz I, Gomez-Conesa A, Sanchez-Meca J (2013)  Prevalence of Low Back Pain in Children and Adolescents: A Meta-analysis  BMC Pediatr. 2013 (Jan 26); 13: 14

[11] Torsheim T, Eriksson L, Schnohr CW, Hansen F, Bjarnason T, Valimaa R (2010)
Screen-based activities and physical complaints among adolescents from the Nordic countries.
BMC Public Health 10:324

[12] Aartun E, Hartvigsen J, Wedderkopp N, Hestbaek L (2014)  Spinal Pain in Adolescents: Prevalence, Incidence, and Course:
A School-based Two-year Prospective Cohort Study in 1,300 Danes Aged 11-13
BMC Musculoskelet Disord. 2014 (May 29); 15: 187

COVID-19 and Scoliosis – What you need to know

Posted on June 17, 2020 by - Blog

As we all know, COVID-19 seems, for the most part, seems to have a more significant impact on those with pre-existing health conditions. Sadly, many fit, healthy younger people have died from the virus, but it’s clear that those with health complications or who are simply a little older are disproportionately represented in the death statistics.

We have had questions from many clients, and indeed non-clients, wondering about how COVID-19 impacts those with scoliosis. While it’s important to stress that you should consult with your GP on your individual case, here are our best answers to some of your common questions at this stage.

 

Does scoliosis increase my risk to COVID-19?

At present, the UK government has defined two groups of people who are expected to be extremely vulnerable, and moderately vulnerable to COVID-19. At the present time, there is no evidence to suggest that Scoliosis itself is a factor in COVID-19 risk, although there are some areas where we would advise our clients to be cautious.

These lists are subject to change as we learn more about the virus, however at this time, the conditions listed are:

 

People at high risk (clinically extremely vulnerable)

People at high risk from coronavirus include people who:

  • have had an organ transplant
  • are having chemotherapy or antibody treatment for cancer, including immunotherapy
  • are having an intense course of radiotherapy (radical radiotherapy) for lung cancer
  • are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors)
  • have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
  • have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
  • have been told by a doctor they have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)
  • have a condition that means they have a very high risk of getting infections (such as SCID or sickle cell)
  • are taking medicine that makes them much more likely to get infections (such as high doses of steroids or immunosuppressant medicine)
  • have a serious heart condition and are pregnant

 

People at moderate risk (clinically vulnerable)

People at moderate risk from coronavirus include people who:

  • are 70 or older
  • have a lung condition that’s not severe (such as asthma, COPD, emphysema or bronchitis)
  • have heart disease (such as heart failure)
  • have diabetes
  • have chronic kidney disease
  • have liver disease (such as hepatitis)
  • have a condition affecting the brain or nerves (such as Parkinson’s disease, motor neurone disease, multiple sclerosis or cerebral palsy)
  • have a condition that means they have a high risk of getting infections
  • are taking medicine that can affect the immune system (such as low doses of steroids)
  • are very obese (a BMI of 40 or above)
  • are pregnant – see advice about pregnancy and coronavirus

 

While scoliosis is not specifically listed here, there are several conclusions and cases we can take into account.

Firstly, severe cases of scoliosis can restrict breathing and reduce respiratory function – it has been shown that even under normal circumstances, those with scoliosis tend to have the lower functional capacity in this regard (that is to say, the ability to respire effectively). Many individuals with scoliosis do not experience these difficulties, however, it may be prudent to practice very strict social distancing out of caution. If you are aware that you have breathing difficulties as a result of scoliosis, we would suggest that you contact your GP for further advice, but consider yourself at higher risk.

Secondly, many scoliosis patients are older individuals suffering from de-novo scoliosis. De-novo scoliosis is very common in the population over 70 and again, may serve to limit mobility and perhaps respiration. In line with government guidelines, we recommend that this group take extra care.

Thirdly, while scoliosis is not generally considered a major issue as far as pregnancy is concerned, we suggest you inform your care team immediately if they do not already know you have scoliosis. It is important, for example, when placing an epidural, for your clinical care team to be aware that you have scoliosis. Because of the additional factors which scoliosis can bring to birth specifically, we recommend that you plan to have your child in hospital rather than considering a home birth or an alternative due to coronavirus.

 

Lockdown and scoliosis – what should I do?

Lockdown, while unpleasant has thus far been the most effective method available to control coronavirus. It’s clear that by reducing social contact we can slow the spread of the virus – however, it’s also becoming clear that many are now not persuing medical issues and treatment which they otherwise would. Initially, it was not possible to continue with many treatments, however, most clinics are now running as normal, with safety measures in place. We recommend the following while in lockdown:

  • Try to stay active as you normally would – if you have prescribed exercises, ensure that you do them each day as normal.
  • If you are bracing, continue with your wear time as usual. Do not be tempted to alter this yourself without consultation.
  • If you are due a brace or exercise review, the clinic is now open for you, if you are able to attend.
  • If you cannot attend the clinic in person, we can arrange a telehealth appointment for you as an alternative. We would suggest that a telehealth appointment is preferable to travel on public transport at this time, although if you can attend the clinic using private transportation this is better still.

 

I think I may have scoliosis, what should I do?

It’s critical that new scoliosis cases continue to be treated as quickly as possible, notwithstanding COVID-19. In Adolescent cases, in particular, even a few weeks can make a significant difference to the path of treatment as well as the potential outcome.

The UK Scoliosis clinic has re-opened for current patients and new or suspected worsening scoliosis cases. Social distancing can be maintained at all times at our clinic and special measures have been put in place to protect you. The total exposure to others required for a scoliosis consultation and even the instigation of a treatment plan is very low.

What is scoliosis anyway?

Posted on June 9, 2020 by - Blog

As you may – or may well, or well not ­– be aware, June is Scoliosis awareness month. Since so many of us are working from home, or simply having to take a break from normal life at the moment, you may well have noticed some talk about this online, so, what is Scoliosis, and why should be you be aware of it?

 

What is Scoliosis?

Simply put, scoliosis is a spinal disorder which causes the spine itself to be curved from side to side. A normal spine does indeed have a forwards and backwards curvature, so that viewed from the side it looks like an “S” shape – but in scoliosis, the spine also has a side to side curvature, so that viewed from the front or the back, it has an “S” or “C” shape. In fact, scoliosis is more complicated than this – there’s typically also a rotation of the vertebra (the spinal bones), but the general shape is what you might be able to notice in someone’s posture.

 

Can I see Scoliosis?

Scoliosis is sometimes possible to see, usually in more severe cases. In some individuals with very low body fat, it may be possible to notice the curvature of the spine – however, most common signs (like uneven shoulders and hips, or a rib hump when bending forward or one shoulder blade seeming to stick out more than another) tend to be the only noticeable change. It’s true that the worse a scoliosis case is, the more visible it will tend to be – but scoliosis can remain almost invisible for a long time before reaching this point.

Like all conditions, scoliosis is much easier to treat if it’s spotted early –  this is where scoliosis screening comes in. Scoliosis screening is a fast, painless and simple procedure which you can even try at home. In fact, many countries include scoliosis screenings as part of their public health measures, however, this isn’t the case in the UK.

 

Who can get Scoliosis?

Anyone can get scoliosis – on average, about 3% of children will develop scoliosis, whereas some forms of scoliosis, common amongst the older population can affect up to 30%.[1]

There are many different sub-types of scoliosis, but for ease of explanation we typically divide them into two groups – these are adult, and childhood scoliosis.

Adult scoliosis is caused either by the degeneration of the spinal bones, ligaments & discs with age or as a result of childhood scoliosis which was not treated. Childhood scoliosis (affecting infants through to young adults) is more of a mystery – right now the exact cause for about 80% of cases is unknown. This is termed “Idiopathic” scoliosis. The remaining 20% of cases are typically caused by congenital or genetic conditions, spinal malformations, underlying neuromuscular conditions, metabolic conditions or trauma.

Idiopathic scoliosis in children is typically classified according to the age that it is diagnosed. It is most common in adolescents (over 10 years) but also occurs in infants (under 3 years) and juvenile’s (3-10 years).

Approximately 3-4% of children are affected by scoliosis, that’s about one in each class at school. In adults over the age of 50, this figure increases to 30-40%.

The earlier scoliosis is detected, the more effective a treatment and management plan will be. This helps reduce the risk of progression and the potential need for surgery. If scoliosis specific exercise and/or bracing are used early enough in the development of scoliosis, curve progression can be stopped, and surgery avoided. In some cases, near-complete correction of the curve is possible.

 

How do I screen for scoliosis?

Screening for scoliosis is easy to do and takes less than 5 minutes – remember that early detection is the most important factor, so screen regularly and if you have concerns, get in touch with a scoliosis professional.

 

 

[1] Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘

Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

Online consultations now available!

Posted on May 20, 2020 by - Blog

Get answers on Scoliosis- Fast, and from home.

If you have concerns about Scoliosis, perhaps after a screening or worry that you or a loved one may be developing Scoliosis, help form the UK Scoliosis Clinic is on hand when you need it. If you are unable to visit the clinic in person or want to get an initial opinion in advance, an online “telehealth” consultation could be a great option for you.

A Telehealth consultation can take place in your own home, wherever in the world you live – it’s also a fantastic option for those who have other medical concerns, such as coronavirus, which may discourage them from traveling unless strictly necessary.

Scoliosis is a complex condition which develops differently in each patient, so an in-person appointment at the clinic is always required at the start of a treatment program – however, an online consultation is an excellent first step to discerning if Scoliosis is or isn’t the cause of your problems. It is usually not possible to formally diagnose a new case of Scoliosis via a web consultation – however, if you already have X-rays we often can. At the end of your consultation, we will be able to provide you with a very strong indication of your likely diagnosis and how you might proceed to the best treatment options.

Online consultations are also an excellent way to quickly get a second opinion on a scoliosis case, which we strongly advise before embarking on a course of treatment.  In some instances, we may also recommend online consultation as a method of checking and updating exercise programs for those who are currently undergoing an exercise-based treatment plan.

As you would expect, the content of your online consultation will be held in the strictest confidence.

 

How does an online consultation work?

A telehealth consultation is much like a discussion on skype, or any other video conference system. For telehealth, we have to conform to strict guidelines around security and data handling but as a patient, your experience will be much the same as a normal chat.

To participate, you will need:

  • a laptop/ PC with built-in webcam and speakers
  • OR a laptop or computer with external webcam and speakers
  • OR an iPad/tablet device with webcam and speakers
  • a stable internet connection
  • a well-lit area with a clear wall/plain background
  • to wear clothes suitable for exercise or assessment
  • the webcam set up so your full posture can be seen on screen (from feet to top of head)
  • any prescribed exercise equipment ready for the session
  • if the consultation is related to a brace, have it ready
  • For those under 18, a parent or guardian must be present during the entirety of the consultation.

 

After your consultation

After your consultation you will receive a written report from Dr Irvine, detailing his observations on your case, recommendations for treatment (if required) and next steps.  If it is agreed that you would benefit from an in-person scoliosis consultation, we can arrange this for you at the earliest possible convenience.

Please note that our online consultation service is a “stand-alone” option, and there is absolutely no obligation to commit to a course of treatment at the UK Scoliosis Clinic after your consultation.

 

What does an online consultation cost?

Your online, private consultation with Dr Irvine is £120 for a 30 minute appointment.

Fees are payable in advance when you book your consultation. We accept all major credit /debit cards as well as bank transfer.

 

Book your online consultation

To book your scoliosis consultation please phone the clinic to arrange an appointment at a time which is convenient for you.

 

 

 

Does scoliosis always get worse?

Posted on May 14, 2020 by - Blog

One of the first questions which many people ask when they are diagnosed with scoliosis is “will it get worse?” There’s also a lot of misconceptions around this issue to deal with. It’s true that some scoliosis cases do simply stop developing – but despite what you might read on the internet, this is very rare. Today, we understand scoliosis much better than ever before, and so while we can’t fully explain the condition, we can now make some very sensible assumptions about its likely progression.

This week, let’s look at some of our current best information on this question.

 

Scoliosis development

Firstly, it’s important that we outline exactly what we mean by “worse” in this situation.  Scoliosis is a condition which causes a host of unpleasant symptoms, ranging from physical deformity to problems breathing and, perhaps most impactful for most people, a drastic impact on self-confidence. While these are all perfectly valid ways of understanding how ”bad” scoliosis is, in a clinical setting we tend to focus on an accepted measurement called  a “cobb angle”.  A Cobb angle measures the deviation of the spine from normal, such that a more pronounced scoliotic curve is said to have a greater cobb angle, or be of a greater magnitude. It is generally true that as cobb angle increases, symptoms will also become more severe. So, what do we understand about the factors which seem to predispose individuals to a greater increase in this regard?

 

Growth potential

Growth potential – that is to say, how much growing a skeleton has already done, and (roughly) how much more it has to do has been strongly correlated with curve progression.  This has been established since the early ’70s , when it was predominately believed that scoliosis progression was fastest during adolescent growth spurts.[1] More recently, however, we have come to understand that in fact, aspects such as the riser sign (an indication of skeletal maturity) and the onset of menstruation are closely correlated with the potential for curve increase.  Immature children

(Risser sign 0 or 1) with larger curves (20–29°) at initial diagnosis demonstrated a 68% risk for curve progression, whereas mature children (Risser 2–4) with similar curves at initial presentation had a 23% risk for curve progression. Conversely, immature children with smaller curves (5–19°) demonstrated 22% chance for curve progression, while mature children with smaller curves had only a 1.6% risk for curve progression. [2]

        The younger the child or the more growth left in the spine the greater the risk of progression.

 

Size of curve

Perhaps intuitively to most of us, the size of the curve at the point of discovery is also a factor in predicting its growth. Much research has examined the relationship between age and curve magnitude – for example, Nachemson et al, and Weinstein et al, correlated curve progression with age and curve magnitude,[3] however, today we also understand that curve magnitude can be an independent predictor of curve progression – that is to say that generally speaking, larger curves tend to get larger, and can also progress after skeletal maturity. Weinstein et al. and Ascani and colleagues reported that children with curves < 30° at skeletal maturity did not demonstrate curve progression into adulthood, while the majority of curves > 50° progressed at approximately 1° per year[4]

The larger the curve the more likely the curve will progress into adulthood.

 

Family History

A family history of scoliosis is a major indicator for the development of scoliosis – research indicates that those with a family member who has scoliosis go on to develop scoliosis in between 11.5 and 19% of cases – considerably more than the 2-3% average in the population as a whole. Research also suggests that those who have family members with severe curves are likely to develop more severe curves themselves, although the correlation is not total.[5] Other factors clearly influence scoliosis, which can also impact the severity of a curve, but those with family members with larger curves should be especially aware.

              If a family member has scoliosis and the bigger their curve is, the more likely other family members will have scoliosis.

 

Gender

On average, girls are up to 5 times more likely than boys to develop scoliosis and hen you also consider that many activities which are popular with young women and girls, such as gymnastics, have scoliosis rates up to 12.4 times as high as the general population. [6] While this is a complex area, since boys can, and do, get scoliosis – it’s important to note that 70% of scoliosis cases are girls. If you perform a home screening, or someone mentions that your child may have scoliosis, you should be especially cautious of that child happens to be a girl.

                      Girls and ballet dancers or gymnasts are more likely to have scoliosis.

 

And here’s the key takeaway

We now know a lot about the progression of scoliosis – far more than we ever did in the past. This means that we are far better able to predict the outcome of a case and to treat it appropriately. The keyword here is treat – since there’s one common theme which runs through each of these points – most of the time, scoliosis will progress, and often, it will progress quickly. While there is a chance that some curves may stop growing, it’s highly unlikely – research shows that juvenile cases, for example, almost never resolve spontaneously.[7]

Today, scoliosis treatment is highly advanced – if caught early, surgery can be avoided and most cases can be corrected quickly and in a non-invasive way. The longer cases are left to progress, however, the more difficult they are the treat, and the longer this will take.

At the UK scoliosis clinic, we see far too many young people in particular who have developed scoliosis and which has been allowed to progress. Sometimes the curve progression is sadly just too large for us to help – but each of these cases would have started out as a relatively small curve which, while certainly not desirable for a young person, would have been relatively simple to treat.

Please, do not wait to screen for scoliosis – do it today and if you have concerns get in touch!

 

 

[1] Duval-Beaupere G: Pathogenic relationship between scoliosis and growth. In Scoliosis and Growth Edited by: Zorab P. Edinburgh, Scotland: Churchill Livingstone; 1971:58-64.

[2] Bunnell WP: The natural history of idiopathic scoliosis before skeletal maturity. Spine 1986, 11:773-776.

Lonstein JE, Carlson JM: The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg (Am) 1984, 66:1061-1071.

[3] Nachemson AL, Peterson LE: Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg (Am) 1995, 77:815-822.

Peterson LE, Nachemson AL: Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society. J Bone Joint Surg (Am) 1995, 77:823-827.

Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

[4]Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine

1986, 11:784-789.

[5] ‘ Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’
Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

[6] ‘ Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’
Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

[7] Charles YP, Daures JP, de Rosa V, Diméglio A,  Progression risk of idiopathic juvenile scoliosis during pubertal growth‘ Spine (Phila Pa 1976). 2006 Aug 1;31(17):1933-42. DOI:10.1097/01.brs.0000229230.68870.97

Telehealth consultations – Now available!

Posted on May 1, 2020 by - Blog

The COVID-19 Crisis sweeping the world is making everyday life hard for all of us. While there are many issues which can be put “on the back burner” a scoliosis consultation should not be one of these. For patients at a high risk of progression – for example, those between 10 and 18 – scoliosis can evolve very quickly, which means a swift consultation is a must.

Effective immediately, Dr Paul Irvine, Dr of Chiropractic and founder of the clinic, will be offering Scoliosis consultations online in a highly secure, private environment. While a teleconsultation is not a replacement for an in-person appointment, it represents an excellent way to get an initial diagnosis and further information about next steps.

We will be posting more information about this option shortly – in the meantime, if you are urgently seeking an appointment please get in touch via our normal phone number and we will arrange an appointment with you, and answer any questions you have.