Category: Blog

Is exercise recommended for people with scoliosis?

Posted on March 30, 2019 by - Blog

The role of sport and exercise as it relates to scoliosis and its treatment is a complex one. It has been known for some time that participants in some activities, such as gymnastics, seem to have a higher risk of developing scoliosis – at the same time, it has also long been suggested that exercises such swimming could help to reduce scoliosis. These are just two examples of the seemingly contradictory information available on scoliosis and exercise – this week, we summarise the latest findings and guidelines.

 

Do some forms of exercise cause scoliosis?

At present, there is certainly evidence to suggest that participants in some activities, such as gymnastics or dance have a higher chance of developing scoliosis. Indeed, research suggests that gymnasts are up to 12 times more likely to develop scoliosis than non-gymnasts on the whole.[1] There is a 10-fold higher incidence of scoliosis among rhythmic gymnasts[2] and an increased incidence of scoliosis has been reported in ballet dancers (24%)[3] What this observation does strongly suggest is the value of regular scoliosis screening for those involved in gymnastics, ballet and other forms of exercise which involve much contortion of the body and spine. What this evidence does not necessarily mean is that gymnastics causes scoliosis, since correlation does not necessarily mean causation.

While it does seem as though patients with scoliosis are more likely to participate in sports like gymnastics[4] it is now thought that this is because patients with scoliosis tend to have a higher prevalence of joint laxity than the general population this makes them more flexible[5], which would be a natural advantage in these activities. Therefore, avoiding such activities probably won’t do anything to prevent or avoid scoliosis.

 

Isn’t exercise good for everyone?

At the risk of providing a very simplistic answer, yes. Almost all scoliosis clinicians agree that those with scoliosis should actively take part in sport and physical activities[6]. This is not least because the psychological and social aspects of exercise are shown to be related to the patient’s self-image in a positive way[7] – indeed, it has also been reported that persons with scoliosis who exercise regularly, show higher self-esteem and have better psychological outcomes from treatment[8]. Therefore, SOSORT also recommends that patients with scoliosis should remain active in sports activities[9], especially since, as outlined above, participation does not seem to directly affect the occurrence or degree of scoliosis[10].

 

Can exercise cure scoliosis?

Tired out girl

Specialised forms of exercise can treat scoliosis, but most forms of exercise still make a positive contribution to health !

It was once thought that a range of everyday exercises may be beneficial for scoliosis suffers – today the picture s more refined. For example, it was once widely reported that popular forms of general exercise, such as swimming (which has traditionally been recommended as a good sports activity for scoliosis and even prescribed by some physicians as a treatment),could be a possible corrective approach. Now we know that swimming does not seem to have any positive effect on scoliosis, although its certainly a great low-impact form of exercise, and a lot of fun!

To return to the point about causation and correlation, there is also at least one older study from 1983, which screened 336 competitive adolescent swimmers for scoliosis and found the prevalence of scoliosis to be 6.9%[11], which is more than double the average. Despite this, there is no evidence to suggest that swimming is a causative factor of scoliosis.

If general exercise does not seem to improve scoliosis, is there an approach that can? In fact, there are several forms of specialised exercise which have now been developed with the sole aim of reducing and controlling scoliosis – these are the Schroth and SEAS approaches, both of which have proven to be successful alone, and far more successful when combined with bracing. You can learn much more about both approaches on our site – but for more information please don’t hesitate to get in touch!

 

 

[1] 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

[2] Tanchev PI, Dzherov AD, Parushev AD, Dikov DM, Todorov MB. Scoliosis in rhythmic gymnasts. Spine. 2000;25(11):1367–72.

[3] Warren MP, Brooks-Gunn J, Hamilton LH, Warren LF, Hamilton WG. Scoliosis and fractures in young ballet dancers. Relation to delayed menarche and secondary amenorrhea. N Engl J Med. 1986;314(21):1348–53.

[4] Meyer C, Cammarata E, Haumont T, Deviterne D, Gauchard GC, Leheup B, et al. Why do idiopathic scoliosis patients participate more in gymnastics? Scand J Med Sci Sports. 2006;16(4):231–6.
Meyer C, Haumont T, Gauchard GC, Leheup B, Lascombes P, Perrin PP. The practice of physical and sporting activity in teenagers with idiopathic scoliosis is related to the curve type. Scand J Med Sci Sports. 2008;18(6):751–5.

[5] Kesten S, Garfinkel SK, Wright T, Rebuck AS. Impaired exercise capacity in adults with moderate scoliosis. Chest. 1991;99(3):663–6.

[6] Liljenqvist U, Witt K-A, Bullmann V, Steinbeck J, Völker K. Empfehlungen zur Sportausübung bei Patienten mit idiopathischer Skoliose. Sportverletz Sportschaden. 2006;20(01):36–42.

[7] Fällström K, Cochran T, Nachemson A. Long-term effects on personality development in patients with adolescent idiopathic scoliosis. Influence of type of treatment. Spine. 1986;11(7):756–8.

[8] Liljenqvist U, Witt K-A, Bullmann V, Steinbeck J, Völker K. Empfehlungen zur Sportausübung bei Patienten mit idiopathischer Skoliose. Sportverletz Sportschaden. 2006;20(01):36–42.

[9] Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, et al. Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal deformities. Eura Medicophys. 2005;41(2):183–201.

[10] Kenanidis E, Potoupnis ME, Papavasiliou KA, Sayegh FE, Kapetanos GA. Adolescent idiopathic scoliosis and exercising: is there truly a liaison? Spine. 2008;33(20):2160–5.

[11] Becker TJ. Scoliosis in swimmers. Clin Sports Med. 1986;5(1):149–58.

Does playing football increase the risk of Kyphosis?

Posted on March 14, 2019 by - Blog

Like Scoliosis, Kyphosis is a common condition which affects the spine. While in scoliosis, the spine is deformed so that It “curves” to the side, in Kyphosis it “bends” further forwards than is ideal. In a normal individual, when the spine and posture are viewed from the side, the ear, shoulder, hip, knee and ankle should all be roughly in alignment, but in Hyperkyphosis sufferer, the head will be noticeable forward and the shoulders hunched.

In a healthy spine, a gentle “s” curve would be visible on an x-ray taken from the side. In the neck (the cervical spine) and lower back (the lumbar spine) these curves have a pattern known as Lordosis, whilst in the mid-back (thoracic spine) the curve is called Kyphosis. Some degree of Kyphosis is completely normal, and required for normal movement – something under 40 degrees is typical. When spinal kyphosis is greater than 45° however, the term “Hyperkyphosis” is used to refer to a spine which is too Kyphotic.

 

Causes of Hyperkyphosis

The causes of Hyperkyphosis are quite varied and depend on the time in life that they develop.  In adults, Hyperkyphosis is often associated with poor posture but is also sometimes the result of structural factors which involve an alteration to the shape of the thoracic vertebra, causing them to become more wedged.

Wedging of the thoracic vertebra can be caused by congenital vertebra malformations from birth, Scheuermann’s disease in adolescence, osteoporotic fractures in adulthood, thoracic compression fractures due to trauma and spinal tumours and infections.

More recent  research has however suggested that participation in some activities during childhood may also raise the risk of increased kyphosis, and the development of Hyperkyphosis. In the same way that some activities seem to raise the risk of Scoliosis.

 

Does football cause kyphosis?

Some research suggests that footballers are at a greater risk of Kyphosis

A 2009 study performed a clinical analysis of 102 males age 11-16 who played competitive football at least two to three times per week – the aim was to determine what, if any difference to the spine this activity caused. [1]

During the study, simple measurements of kyphosis were taken using widely accepted methods, just like we use at the clinic. Interestingly, when researchers compared measurements from their test group to a “normal” sample of 180 boys of the same age range, who did not play football, they found a statistically significant increase in the degree of kyphosis – an average of 36.6 in the footballers, vs 33.6 in the non-footballers. [2]

Does this mean that playing football will give you Hyperkyphosis? Not directly – however it does strongly reinforce the importance of working for good spinal health and getting regularly checked by a spinal health professional. 33.6 degrees is just about within the normal limit – but consider many of these same children will probably experience poor posture as they grow older, and the risk of Hyperkyphosis suddenly looks much greater.

Perhaps the most interesting point, however, is that this study goes against the traditional view of Hyperkyphosis being primarily associated with those of us who spend long hours hunched over at a desk – clearly, even those of us who are more active than average are at risk of Hyperkyphosis. Whereas with many conditions, being active and staying healthy can help reduce risk, this is not necessarily the case with spinal disorders such as Kyphosis and, indeed, Scoliosis.

It wasn’t all bad news however – the study investigators also noticed that the footballers showed an overall lower level of low back pain than the non-footballers!

 

Could I have Hyperkyphosis?

While the symptoms of kyphosis are often considered to be less severe than scoliosis, the condition can have a significant impact on the health of not addressed.

Common signs and symptoms include:

  • Rounding of the shoulders or a “hunchback” appearance
    •       The head is in front of the hips or pelvis when standing
    •       Mid-back aching and stiffness that often worsens with standing and eases when laying down
    •       Tenderness of the spine and surrounding muscles in the mid-back
    •       Tiredness after standing or repetitive bending
    •       In more severe cases difficulty breathing may develop as the lungs become compressed and indigestion, heartburn due to stomach compression

 

How can we treat Hyperkyphosis

Like Scoliosis, treatments for Hyperkyphosis vary depending on the cause In cases where Hyperkyphosis has developed due to poor posture (that is to say, there is no spinal deformity involved) a scheme of specialised exercises and postural correction work will often be successful.

In cases where the underlying cause is Scheuermann’s disease (learn more about Scheuermann’s here), the  deformity will continue to prefer as the spine grows throughout adolescence – not dissimilarly to the way in which Scoliosis tends to progress. Here, as with Scoliosis, bracing is often the best option, and out Kyphobrace is an excellent choice for this task.

In adult patients who are becoming more hunched forward, a specific spinal rehabilitative programme involving Chiropractic Biophysics can be performed to help strengthen the postural muscles, learn awareness of correct posture and stretch or traction the spine back towards upright posture.

In adults where pain and posture worsen when standing upright, a Kyphobrace worn for periods throughout the day can help to ease discomfort and maintain upright posture, and, combined with corrective training, can eventually remedy the condition.

 

[1] S Negrini, F Zaina, S Atanasio, C Fusco and M Taiana, Adolescent soccer is correlated with an increase of kyphosis but a reduction of low back pain: a controlled cross-sectional survey Scoliosis20094 (Suppl 2) :O3

[2] S Negrini, F Zaina, S Atanasio, C Fusco and M Taiana, Adolescent soccer is correlated with an increase of kyphosis but a reduction of low back pain: a controlled cross-sectional survey Scoliosis20094 (Suppl 2) :O3

What causes scoliosis? (and what doesn’t)

Posted on March 1, 2019 by - Blog

Perhaps one of the most common questions we are asked about scoliosis is simply “what causes scoliosis” – a quick google search yields far less information than you might think since in many cases the answer is still “we aren’t sure”. At the UK Scoliosis clinic, we like to provide all the information we can, however, so here’s a bit more detail on the latest thinking as to what does and does not cause scoliosis.

 

What does cause scoliosis?

While research is ongoing, it’s a sad fact that it’s still not possible to say for sure what causes the majority of scoliosis cases. At this point, however, there are 5 major possibilities to consider:

 

Possibility number 1 –  we don’t know.

80% of scoliosis cases are idiopathic – which means we don’t really know the cause!

Scoliosis can be a frustrating diagnosis, especially for many parents, since in young people at least 80% of cases are what’s known as “idiopathic” – this literally means “without known cause”.  There is much research going on to determine the case of scoliosis, but (as unhelpful as it might be) we’ve put this answer first because when dealing with young people, it’s overwhelmingly likely to be the answer. To all parents reading this, we can at least reassure you that the presence of scoliosis is certainly not an indicator that you “did something wrong” – all of the evidence so far points to a genetic cause or one of the following other conditions.

Today, treating idiopathic scoliosis is easier than ever before- and with specialist clinics like the UK Scoliosis clinic, success rates are very high.

 

Possibility number 2 – Neurological or congenital causes.

If 80% of scoliosis cases (in children) are idiopathic, that leaves about 20%. Of this 20 %, neurological or congenial causes are one of the major possibilities. Scoliosis can be a symptom of conditions such as Cerebral palsy or Muscular dystrophy or of Genetic disorders like Marfans syndrome and Downs syndrome.

Congenital scoliosis begins as a baby’s back develops before birth. Problems with the formation of the bones which make up the spine (called vertebrae), can cause the spine to curve. The vertebrae may be incomplete, fail to divide properly or develop in an abnormal shape. Doctors may detect this condition when the child is born but it is also often detected during scoliosis screening.

Depending on the underlying condition, different treatments will be required to achieve the best results.

 

Possibility number 3 – Genetics

It is generally accepted amongst the scoliosis treatment community that having a family history of scoliosis does predispose you to a higher risk of developing scoliosis yourself. This is common with many conditions, so seems like a reasonable assumption. Since we don’t know the exact mechanism which causes scoliosis, to begin with, it’s also hard to say for certain that genetic inheritance is certainly a risk factor, but it seems highly likely. Possible genetic markers for scoliosis are one of the most intense fields of research at present, so hopefully, we will know more soon.

 

Possibility number 4 – Degeneration of the spine

Degenerative scoliosis is very common in the over 60’s

“De-novo” or degenerative scoliosis is a common form of scoliosis, which affects nearly 40% of the population over 60. Unlike childhood scoliosis, de-novo scoliosis is well understood. It’s the result of the gradual degeneration of the spinal bones due to wear and tear with age.

Many of the same treatments used for idiopathic scoliosis are effective in slowing and preventing de-novo scoliosis from developing.

 

Possibility number 5 – Non-structural scoliosis

All of the above conditions result in what is collectively called “structural scoliosis” – that is to say a condition where the spine itself is actually curved as a primary condition. Another possibility is the presence of “non-structural scoliosis” – a condition where the spine appears to be curved, but only as the result of an associated condition. Whereas structural scoliosis treatment cases required direct intervention to correct scoliosis, non-structural cases will usually resolve when the root cause is addressed.

Non-structural scoliosis might be apparent on a short-term basis as a result of a condition causing significant inflammation, such as appendicitis – over the long term, factors such as a leg length discrepancy can cause the spine to curve as the body tries to compensate.

 

Possibility number 6 – Some activities

It’s possible (but not confirmed) that some activities which involve significant distortion to the spine may cause scoliosis. At least one study has suggested that dangers and gymnasts are up to 12 times more likely to develop scoliosis than individuals who do not participate in these activities[1] – but it’s important to remember that correlation does not necessarily mean causation.

 

What does not cause scoliosis?

Perhaps just as important as the question of what does cause scoliosis, is the question of what does not. There is much misinformation to be found in this realm, so let’s clear up a few common ones now!

Posture

While many of us associate young people with poor posture – and scoliosis can cause postural issues, there is no evidence which suggests that having poor posture can actually cause scoliosis (although it is much more strongly associated with kyphosis – read more about that here).

 

Injury

While it has been suggested that childhood injuries could be responsible for scoliosis, there is no strong evidence to suggest this is the case. While recent research has suggested that being involved in impact sports, or even “heading” the ball too much when playing football could predispose the cervical spine to degeneration later in life[2] there is no evidence that scoliosis can result.

 

Diet

Heavy backpacks don’t cause scoliosis (but should be avoided anyway!)

 

For some time, some researchers have suggested that certain diets may help to improve scoliosis. Although there is currently no evidence which suggests that diet can improve scoliosis, at least one study has noted that many idiopathic scoliosis patients also have lower selenium levels than normal.[3] While this is an interesting observation, there is nowhere near enough evidence to suggest that selenium deficiency or any other nutritional factor is responsible for scoliosis.

 

Heavy backpacks

While heavy backpacks are to blame for many childhood spinal complaints, (ideally, keep backpacks to less than 10% of body weight) scoliosis isn’t one of them. Similarly, while it’s best for patients with scoliosis to avoid uneven loading of the spine (so carrying a backpack on one shoulder isn’t a good idea) there no research to suggest that carrying your back this way can cause scoliosis in the first place.

 

 

 

[1] 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.

[2] Pain Physician 2005:8391-7

[3] Yalaki, Zahide et al. Investigation of Serum Levels of Selenium, Zinc, and Copper in Adolescents with Idiopathic Scoliosis Dicle Medical Journal / Dicle Tip Dergisi. 2017, Vol. 44 Issue 1, p35-41.

Why scoliosis should be examined by a trained professional

Posted on February 5, 2019 by - Blog

At the UK Scoliosis clinic, we are always campaigning for the widespread adoption of scoliosis screening in schools, clubs and anywhere else where young people gather! It’s not just younger people who need to be concerned about scoliosis either – as we recently wrote on this blog, adult onset or “de-novo” scoliosis now affects 1 in 3 people over the age of 60.

Screening is a vital first step, since spotting scoliosis early makes it easier to treat, no matter the age of the patient. What’s important to remember, however, is that screening is just that – a first step. This week, we take a look at why those who suspect scoliosis after initial screening should seek a consultation with a scoliosis professional as a soon as possible.

 

What is a scoliosis consultation, or a professional evaluation?

Screening and consultations are always available at the UK Scoliosis Clinic

Scoliosis screening is a simple process, designed to identify some of the most common signs and symptoms of scoliosis.  Screening (which takes just a few minutes and  can be done at home) allows you to spot scoliosis developing before it would necessarily become noticeable in everyday life. Once you have confirmed signs of scoliosis, the next step is to seek a professional opinion from a trained scoliosis practitioner.

Where screening can highlight potential signs of scoliosis, and make you aware of any risk factors you may have, only a professional consultation will allow a suitably trained practitioner to offer you a formal diagnosis of your condition. Often, a practitioner will be able to confirm that scoliosis is, in fact, present – however, some screening results can be “false positives”  and turn out to be the sign of a postural problem or other condition instead.

When scoliosis is confirmed, a scoliosis practitioner can offer you a tailored treatment designed to stop the development of scoliosis and reverse the trend as soon as possible.

What you should not do is seek advice from non-scoliosis professional. While there are many reputable professionals who work with the spine and associated conditions (chiropractors, physiotherapists, osteopaths etc.) these individuals must also be either trained scoliosis specialists or have at least received specialist instruction in diagnosing scoliosis in order for their diagnosis to be truly accurate. Scoliosis is a complex, 3D condition which requires a complex response, and that’s something only a trained professional can really deliver.

Accessing a scoliosis professional might mean travelling, and while that can certainly be inconvenient there are many good reasons why you should opt for the right clinic.

 

So why choose a scoliosis professional?

Scoliosis professionals offer a clear advantage

It’s hopefully already obvious that a scoliosis professional offers the best choice when investigating a potential case of scoliosis, but as opposed to non-specialists, those clinics who focus on the treatment of scoliosis offer many other benefits. Professional clinics who specialise in scoliosis can:

Offer a reliable diagnosis – based on years of training and experience, not only can scoliosis practitioners diagnose scoliosis at a fundamental level, they can measure and map the precise nature and magnitude of your scoliosis and recommend an ideal treatment on this basis. While many everyday practitioners may be able to notice scoliosis, only a scoliosis professional can gather the detailed information required to formulate  an effective, evidence based treatment plan which is individually tailored to your case.

Utilise the correct diagnostic tools – It cannot be stressed enough that without the correct diagnostic equipment it is almost impossible to correctly understand a patients scoliosis.  Reputable clinics should be able to provide and evaluate X-Rays to properly understand the nature of your scoliosis. Today, some clinics try to claim that “radiation free” methods of diagnosis (such as ultrasound or laser measurement) are suitable for diagnosing scoliosis. Unfortunately, this is just not the case – currently, only an X-Ray or MRI scan can provide enough detail for a professional to make an initial diagnosis. Other methods can be excellent ways to monitor the progress of treatment, but simply do not provide enough clarity for initial diagnosis.

Rule out congenital factors – Most cases of scoliosis will be either idiopathic (in younger patients) or de-novo (in older individuals). There are other causes of scoliosis, such as congenital or neurological factors which also need to be ruled out, however. In the event that scoliosis may be related to an underlying neurological or congenital condition, a patient should be referred to a specialist in these areas and should not be treated with traditional scoliosis correction methods without further investigation. Reputable, professional clinics can rule out such causes, and also help to refer you to the right person if need be.

Offer personalised treatment – Scoliosis, unlike some conditions, is truly unique in every patient. While there are certainly some common features and trends, each scoliosis treatment is as complex and varied as the patient themselves. What’s more, scoliosis treatment needs to be constantly re-evaluated and adjusted in order to achieve the best results as fast as possible.  All this means that the “standardised” treatment plans offered by some non-specialist clinics are far from ideal when it comes to scoliosis. In some cases, you may just end up with sub-optimal results, but the wrong treatment at the wrong time can actually worsen the condition in some patients.

Chose from multiple treatment methodologies – Clinics and professionals who specialise in scoliosis will certainly have a variety of approaches to treating scoliosis to draw from. Creating a treatment plan for a scoliosis patient will usually involve at least scoliosis specific exercise and some form of bracing but might also include a wide variety of complementary approaches such as chiropractic care or massage for short term management of discomfort. Today, it’s rare that a scoliosis case will be best treated with only a single approach, so a clinic which can offer a variety of treatments, all with scoliosis in mind, presents a clear advantage. Clinics who offer only a single treatment approach may do so with the best of intentions, but this is rarely the best option for the patient.

Offer advice based on the latest research – Scoliosis professionals who are members of a relevant body, such as SOSORT are required to stay up to date with the latest research in the field of scoliosis treatment. This means that a scoliosis professional will always be fluent with the latest thinking, but you’re far more likely to be treated with the most up to date approaches available at a specialist clinic.

School screening isn’t just effective – it’s cheap!

Posted on January 28, 2019 by - Blog

As regular readers of this blog will know, the UK Scoliosis clinic is a strong advocate for the introduction of school screening programs for scoliosis here in the UK. Currently, there is no national plan nor program for scoliosis screening, even though almost all scoliosis clinicians agree that implementing school screening would be a positive step.

 

Why is school screening important?

Scoliosis is easier to treat if spotted early

School screening is an important way to reduce the number of people who eventually require scoliosis surgery since scoliosis tends to be noticed first amongst school age children. In addition, like many conditions, scoliosis is much easier to treat when it is spotted early.[1]

In fact, it’s not just school screening which would be beneficial – any kind of environment which has a high percentage of young people, aged roughly 8-15 in particular, would be an excellent place to implement a screening program. It’s already the case that many clubs and organisations involved with activities which seem to carry a higher risk of scoliosis (such as ballet or gymnastics) do either offer some form of screening or have invested in specialist scoliosis awareness training for their staff.

In fairness, it should also be mentioned that some schools in the UK have begun to offer scoliosis screening on an independent basis – but it’s also true that many of these are private schools, meaning that some of the least well-off children in our society have a far lower chance of benefiting from screening. A well organised, national program would go a long way to remedy this imbalance.

 

What does screening cost?

The only real argument against implementing a nationwide screening program is that it would cost too much. There’s no question that today school administrators have a harder time than ever in deciding where to spend their allotted funding, but the existing research does show that the real world cost of screening is very low.

In fact, this data has been available for quite some time – a detailed financial analysis on the cost of scoliosis screening was conducted between 2000 and 2006[2], with a view to understanding the total cost of all the factors included.  During the period of 1-1-2000 to 14-5-2006, 6470 pupils aged 6–18 years old were screened at schools for spinal deformities. The examiners were properly trained Health Visitors and occasionally Orthopaedic and General Medicine residents and Physiotherapists. The number of examiners who were involved in the program and their working hours, their salary on an hourly basis and the expenditures required for travel etc were all considered.

During the study period, 20 examiners were involved in the program. The total number of working hours was 602, which was used to calculate staffing costs based on hourly pay. In total, the study showed that average cost for the examination of each child for the studied period was just £2.31[3]

 

Is school screening in the UK viable?

School screening is inexpensive, and easy to implement

Although the above study sampled only a small number of children (given the number of children attending school each year in total) the cost of screening was still shown to be very low. It is also important to remember that a nationwide screening program would doubtless benefit from economies of scale and would likely offer an even lower cost per child.

By way of comparison, it is worth considering that a spinal fusion for the typical right thoracic deformity seen in scoliosis costs around £1500 per vertebra, meaning that just one spinal fusion operation can total nearly as much as the cost of screening nearly 6500 students. Of course, by screening the students, scoliosis is detected earlier, allowing much more cost effective (and less invasive) non-surgical treatment, such as bracing or scoliosis specific exercise to be used.

 

What can I do?

If like us, you would like to see school screening introduced across the UK, there are several proactive steps you can take:

  • Firstly, write to your school and local authority – feel free to send them a link to our website for more information on scoliosis screening
  • Secondly, if you are within a reasonable distance of the UK Scoliosis clinic, feel free to get in touch with us to arrange a free screening event at your school or club.
  • Thirdly, if you wish, free scoliosis screening is available at the UK Scoliosis clinic itself.
  • Finally, you can screen your friends or loved ones at home, using our ScoliScreen tool – which makes self-screening simple and easy.

 

[1] Fong DY, Cheung KM, Wong YW, Wan YY, Lee CF, Lam TP, Cheng JC, Ng BK, Luk KD, ‘A population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening’ Spine J. 2015 May 1;15(5):825-33.

[2] Grivas et al. Cost analysis of a school-screening program Scoliosis 2007:2 (Suppl 1) :S42

[3] The figure given in the original study in is euros (2.24€.) we have adjusted this figure for inflation, and performed a currency conversion to arrive at this figure.

Happy New Year from the UK Scoliosis Clinic

Posted on January 18, 2019 by - Blog

A happy new year from everyone here at the UK Scoliosis Clinic!

If you’re a scoliosis sufferer or know someone who is, you might be looking for some impactful new year’s resolutions which can benefit scoliosis sufferers. With that in mind, here are some scoliosis friendly New Years resolutions which we recommend you take on!

 

Number one – Don’t wait and see!!

“Wait and see” is not a treatment!

“Wait and see” or “observation” is the “old school” approach to scoliosis treatment. Observation simply means watching the scoliosis develop with the hope that it will not progress to the surgical threshold. Observation is therefore not a treatment, sadly observation almost always results in a negative outcome, since recent research has shown that scoliosis almost never resolves without treatment.[1] If you’re currently stuck with “wait and see” make this the year you take control!

Don’t just wait – Book a consultation with a scoliosis specialist! Observation once made sense, because it was thought that surgery was the only visible treatment option. Furthermore, it was also assumed that many cases of scoliosis would not process. Today was known that both are untrue – modern research has demonstrated, for example, that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery. Curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[2]

On the positive side, the latest work on scoliosis has also shown that modern bracing technology allows for highly effective treatment, such that it has now been demonstrated that conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[3]  As with all treatment, earlier action means better results so don’t wait! (or wait and see!)

 

Number two – Start screening your children

The gift of a scoliosis screening might be a life-changing one for your child. Two to three percent of adolescents between the age of 10 and 15 will develop scoliosis. That might seem like a small percentage, but in fact, it’s about one per class at school. Some studies have suggested a higher level, but two to three percent is an accepted figure.  The risk is highest amongst girls and appears to be greater in individuals who participate in activities such as gymnastics.

If scoliosis is noticed in its very early stages, it is far easier to treat, so screening can make a real difference. What’s more, scoliosis screening is easy to do at home using our ScoliScreen tool. ScoliScreen was developed in Australia by our partner ScoliCare, who spent years researching and designing the easiest home screening tool available. Screening with ScoliScreen at home takes about 10 minutes – you don’t have to take any pictures or upload any information, just follow the steps on screen and note down your results. ScoliScreen isn’t an alternative to a professional consultation, but it’s a highly effective tool to use as a starting point.

 

Number Three- Find balance in your physical activities

Scoliosis SEAS treatment

Specialist exercises can reduce the imbalances created by Scoliosis

Since asymmetrical strength and tension in the involved musculature is a common feature of scoliosis, it makes sense to try to avoid participating in activities which exaggerate this problem. That is to say since scoliosis often leads the muscles one side of the body to be stronger than the other, it makes sense to avoid making that worse with activities which build strength on one side of the body, but not the other. In fact, much of the work done with scoliosis specific exercise is aimed at correcting this imbalance.

Some practitioners suggest that activities which tend to asymmetrically load the body (most things with a bat or racket) should, therefore, be avoided – however, this approach is too broad in most cases and tends to cut off many of the most enjoyable sports!

The better solution is not to avoid these activities, but instead to carefully monitor growth and symmetry and perform targeted exercise on the non-playing side of the body (usually the non-dominant side) in order to balance out development. While this point is important to scoliosis patients, it’s actually good advice for anyone!

Once again, the best way to access professional monitoring and treatment is through a scoliosis specialist.

 

Number four – Raise awareness about scoliosis

Although scoliosis is a relatively common condition in young people (and actually a very common one in older people) scoliosis is also a mystery to many of us. This is partly because treatment options were limited for many years, but as we have shown this is not the case today.

In order to treat scoliosis more effectively and reduce the number of people eventually requiring surgery, most scoliosis clinicians now agree that school screening for scoliosis would be a positive step to take – for relatively little cost, significant benefits can be obtained for the majority of patients. Screening for scoliosis in schools and other groups, like classes or clubs is quick, easy and cheap. Using our ScolisScreen app, it’s also possible to pre-screen a friend or a family member at home in less than 10 minutes – but individual screening does little to raise awareness overall.

It’s no surprise that scoliosis screening is considered as a beneficial stage of treatment amongst the treatment community, and has been recommended by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Despite this, school screening is still not provided in the UK, although it is now common in many other countries.

Because of the misplaced belief in limited treatment options which is common not only amongst the general population but also amongst GP’s – as well as the lack of screening programs, many cases go undetected and therefore progress.

Despite this, there’s much you can do to raise awareness about scoliosis – if you have friends or family with children – especially those between about 10 and 15 – send them the link to our ScoliScreen tool and let them know about screening.  Be sure to let people know that today treatment is accessible and viable!

If you are active in a local school community, ask them about setting up a scoliosis screening program. The UK scoliosis clinic provides free school screening events for schools within a reasonable distance, and many other clinics will be happy to do the same.

Perhaps you’re involved in a larger community group or club – if you’re within a reasonable distance of our clinic get in touch and we’ll be happy to work with you on a group screening or awareness talk event.

 

 

[1] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42

[2] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[3] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

Is observation a treatment for scoliosis?

Posted on December 17, 2018 by - Blog

When first seeking treatment, many scoliosis sufferers are advised that they should “watch and wait” or  “wait and see” how their condition progresses, in the hope that their curve will remain small enough to avoid surgery.  Medically, this approach is known as “observation”.

 

Is observation ever the right choice?

The argument for observation was once much stronger than it is today – for much of recent history the consensus view has been that surgery was the only effective way to treat scoliosis and since surgery is obviously best avoided wherever possible, observation is the only other choice. Although surgical treatment was once the only option for scoliosis sufferers, this is no longer the case – today non-surgical approaches are highly effective, meaning that observation is probably never the right choice.

 

Avoiding surgery with non-surgical treatment

Today, non-surgical treatment from scoliosis consists of two major approaches, exercise-based and bracing. Scoliosis braces are the most effective non-surgical method for reducing cobb angle[1]. There are many different kinds of scoliosis brace and the way they work is different, however broadly speaking braces can be classified as active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position).

Exercise methods such as the Schroth method (remove comma) or SEAS focus on teaching the scoliosis sufferer to self-correct their scoliotic position. Schroth and SEAS can both be effective as a standalone treatment for smaller curves and is often paired with bracing for superior results.

In both cases, however, catching scoliosis early with screening, and then taking appropriate action to stabilise and correct the Cobb angle is the key to a successful outcome. Unfortunately, many medical professionals today are still unaware of the non-surgical options for treating scoliosis and how effective they can be – unlike 20 years ago, today the prognosis is a good one.

 

Why observation does not work

Simply put, Observation is not a treatment for scoliosis, it is simply the act of watching and waiting, hoping the condition does not worse – however recent research has shown that scoliosis almost never resolves without treatment.[2] While it was once thought that scoliosis would not always progress, modern research has demonstrated, for example, that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery. Curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[i]

Because observation is not a treatment, it most often leads to the patient requiring surgery and does not promise any improvement. By contrast, modern bracing technology allows for highly effective treatment, such that it has now been demonstrated that conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[ii]

 

What should I do if I have been prescribed observation?

If you have been diagnosed with scoliosis but have been advised that observation or “wait and see” is the best approach, the best option is to book a consultation with a scoliosis specialist. Even if your condition is not serious enough to merit bracing, some targeted scoliosis specific exercise can, at the very least, help to prevent the curve from developing further rather than simply allowing it to increase.

 

 

 

 

 

[1] 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 (2018) [Publish Ahead of Print]

[2] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42

[i] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[ii] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

Can yoga treat scoliosis?

Posted on December 8, 2018 by - Blog

While the main non-surgical methods for treating scoliosis are bracing or scoliosis specific exercise, there are also a wide variety of complimentary therapies which can also be useful as part of a broader treatment program. One popular approach is Yoga. Yoga for scoliosis is a field which is being investigated, and there are some yoga specialists who do focus on scoliosis.

Can yoga reduce cobb angle?

Research to date does not suggest that Yoga alone can correct cobb angle (curve severity). There have been some recent studies which have however suggested that yoga may have a positive role to play in reducing cobb angle as part of a broader program.[1]

Having said this, at least one case study has demonstrated a reduction in Cobb angle from 49 to 31 degrees – the problem is that in this case the progress was achieved over a period of 35 years[2], and of course, this is also only a single case.

 

How can yoga help with scoliosis?

Yoga is an excellent exercise for general health

While yoga alone cannot reduce cobb angle, there are other benefits which Yoga can bring to scoliosis treatment. There’s is no doubt that some patients do report pain reduction and improved balance when practising yoga poses optimised to support scoliosis.  Scoliosis often causes the supporting muscles of the spine to become either too tight or too lose – and in this sense yoga poses which stretch muscles that have tightened and strengthen muscles that have become weak can certainly help to reduce pain and improve posture.

Some existing forms of yoga, such as Iyengar Yoga have been demonstrated to be effective in improving coordination and physical function in scoliosis patients[3], whereas some specialist programs are designed to reduce the symptoms of scoliosis have also been developed.

 

Is yoga recommended for people with scoliosis?

Like any form of exercise, yoga is an excellent way to keep fit and can assist in improving and maintaining mental health – these are great reasons for anyone to practice yoga. These reasons certainly also apply to those with scoliosis, although If you are a scoliosis sufferer, you should keep this in mind when choosing your specific yogic practices. Avoid movements which exaggerate or encourage a scoliotic posture and ideally opt for practices which actively oppose the curvature of the spine. Since asymmetrical muscle balance is a common problem for scoliosis suffers, it is also advisable to favour movements which improve balance and posture and concentrate on maintaining an even, rather than a contorted posture.

Whether or not you add yoga to a scoliosis treatment programme, will also depend on the age of the person. In a adolescent spine which is growing and characterised by flattening of the sagittal curves or a flat back and the severity of the scoliosis developing is associated with the degree of flattening, it would be inadvisable to perform movements that promote bending backwards and flattening the thoracic spine. Hyper-mobility and ligament laxity is common amongst adolescents with idiopathic scoliosis, so promoting increased flexibility with yoga would be inadvisable as it could further weaken ligaments and de-stabilize the spine lead to further progression.

In adults where scoliosis is well developed, growth has stopped and general stiffness is increasing with age, yoga may help to improve flexibility, balance and overall posture. Breathing exercises can also be incorporated to improve lung function and expansion. In these circumstances, yoga is more likely to be of benefit, rather than in the attempt to purely reduce a cobb angle.

There are some forms of yoga which have been developed specially for scoliosis sufferers and although they are relatively few in number, specialist yoga scoliosis practitioners do exist. These practitioners may incorporate some Schroth therapy and breathing exercises into their yoga and teachings. If you are interested in taking up yoga as part of a treatment program, consult with an expert in this regard, or speak with a scoliosis specialist first.

 

How does Yoga interact with scoliosis exercise?

Scoliosis SEAS treatment

Yoga can help to improve awareness of the body

Scoliosis is a complex three-dimensional condition and needs to be treated with this in mind. Scoliosis specific exercises in the form of Schroth or SEAS are therefore designed to work in a three-dimensional way to address the condition.

One of the goals of scoliosis specific exercise is to allow the patient to become aware of the imbalances in the body. In this respect,  yoga is especially effective in helping students to discover a way of being sensitive to the asymmetries of the body and to deal with them intelligently. Much like scoliosis specific exercise, yogic practice exercises each dimension of the body —the vertical plane through lateral flexions that create side bends, the sagittal plane through flexion and extension patterns that create forward and backward motion, and the horizontal plane through rotations. Because of this similarity, practising yoga can help patients to develop the awareness they need to utilise scoliosis specific exercise more effectively.

 

 

[1] Yoga for scoliosis: new findings. University of California at Berkeley Wellness Letter (UNIV CALIF BERKELEY WELLNESS LETT), Jul2018; 6-6.

[2] Elise B Miller Yoga therapy for scoliosis: an adult case approach Scoliosis 2007:2 (Suppl 1) :P6

[3] Marcia Monroe Yoga and somatic therapy for the treatment of adolescent idiopathic scoliosis: adult case report Scoliosis2007:2 (Suppl 1) :P7

Does a having a short leg cause scoliosis?

Posted on November 22, 2018 by - Blog

Leg length discrepancy, commonly known as a short leg, and medically known as Anisomelia is a condition in which one leg is shorter than the other, resulting in a limping gait and often chronic lower back pain.  In fact, a small leg length discrepancy is not unusual and is frequently treated by specialists such as a chiropractor – however, Anisomelia is said to occur if there is a difference of over 1cm, and surgery can be necessary for differences over 2cm.[1]

A short leg can cause scoliosis

Leg length discrepancy (LLD) has been observed in between 3–15% of the population[2] and there are two possible types, apparent or true.

True LLD is where the shortening of one leg compared to the other can lead to scoliosis as the body tries to compensate. In this case, scoliosis will usually reduce when the LLD is treated.

By contrast, apparent LLD is a symptom of a problem, not the actual cause. Apparent LLD is a condition in which the legs are actually the same length but appear to be different due to an underlying pelvic or spine disorder. In this case, treating the pelvic and/or spine disorder resolves the LLD.

Because of these relationships, it has long been suggested that True LLD can cause or worsen scoliosis[3] – despite this, there had not been any definitive studies on the relationship between LLD and scoliosis until this year.

 

How common is LLD in scoliosis patients?

Despite  the fact that many health professionals see a link, information on the exact relationship of LLD to scoliosis has been difficult to obtain and studies have produced mixed results.  One study of 23 young adults[4] suggested that scoliosis was minor in patients with discrepancies of < 2.2 cm. At the other end of the scale, another study measuring the x-rays of 106  patients in a private chiropractic practice showed that those with LLD > 6 mm often (53% of the cases) had scoliosis and/or abnormal lordotic curves.

 

Does LLD cause scoliosis?

There has certainly been evidence to suggest that there may be a causal link between LLD and scoliosis. Although a direct link has not been established, it Is accepted that LLD causes pelvic obliquity.[5] Pelvic obliquity simply means that one side of the pelvis sits higher than the other.  Since we also know that 40% to 60% of children with lumbar scoliosis also have pelvic obliquity, it seems reasonable to suggest that LLD may indirectly lead to scoliosis.[6]

 

Pelvic Obliquity is common in scoliosis patients

LLD and Scoliosis, new research results

With this background in mind, a 2018 study[7] aimed to find out if there is a measurable association between pelvic obliquity, LLD and the scoliotic curve in an adolescent patient or not.  The researchers also wanted to discover whether scoliotic curve progression was linked to different amounts of leg length discrepancy

During the study, seventy-three patients with an average age of 13.3 years at initial examination were given an X-Ray and then had this compared with a later follow up. Scoliosis was confirmed in all 73 patients. At initial examination, pelvic obliquity appeared in 23 (31.5%) patients with scoliosis, and LLD was identified in 6 (8.2%) patients with scoliosis and pelvic obliquity. The majority of the patients in the study were under observation for their scoliosis, allowing the researchers to observe the relationship between scoliosis and leg length.

At a subsequent visit, at an average of 2.8 years later, no significant change in LLD was observed, but a statistically significant increase in scoliotic and pelvic deformity was found.  The study, therefore, concluded that in the adolescent patient population with thoracic or thoracolumbar scoliosis, the LLD remains stable with growth but both the scoliotic deformity and pelvic obliquity continue to progress.[8]

 

So what is the relationship between LLD and scoliosis?

This most recent study suggests that in adolescent patients at least, LLD stays stable and does not seem to have a direct association with the progression of scoliosis. Having said this, the small number (6 out of 73, 8.3%) of patients with LLD in this study suggests that a larger sample set should be explored before drawing any firm conclusions.

Perhaps most importantly, the authors suggest that future research could focus on younger patients less than 10 years with LLD to detect early-onset scoliosis prevalence and how it changes with growth and treatment since it is entirely possible that LLD may have a more significant impact at this early stage.

For now, it seems advisable to conclude that LLD is just one of a number of conditions which can be associated with scoliosis, and certainly with spinal disorders more widely. If you or a loved one have noticeable LLD, it is advisable to see a spinal specialist.

 

[1] Steen H, Terjesen T, Bjerkreim I, Anisomelia. Clinical consequences and treatment Tidsskr Nor Laegeforen. 1997 Apr 30;117(11):1595-600.

[2] Gurney B. Leg length discrepancy. Gait Posture. 2002;15:195–206.

[3] Steen H, Terjesen T, Bjerkreim I, Anisomelia. Clinical consequences and treatment Tidsskr Nor Laegeforen. 1997 Apr 30;117(11):1595-600.

[4] Papaioannou T, Stokes I, Kenwright J. Scoliosis associated with limb-length inequality. J Bone Joint Surg. 1982;64:59–62.

[5] Anderson M, Green WT, Messner MB. Growth and predictions of growth in the lower extremities. J Bone Joint Surg. 1963;45-A:1–14.

Asher MA. Scoliosis evaluation. Ortho Clin North Am. 1988;19:805–14.

Brady RJ, Dean JB, Skinner TM, Gross MT. Limb length inequality: clinical implications for assessment and intervention. J Orthop Sports Phys Ther. 2003;33:221–34.

Burwell RG, Aujla RK, Freeman BJ, Dangerfield PH, Cole AA, Kirby AS, et al. Patterns of extra-spinal left-right skeletal asymmetries in adolescent girls with lower spine scoliosis: relative lengthening of the ilium on the curve concavity & of right lower limb segments. Stud Health Technol Inform. 2006;123:57–65.

Cummings G, Scholz JP, Barnes K. The effect of imposed leg length difference on pelvic bone symmetry. Spine. 1993;18:368–73.

D’Amico M. Scoliosis and leg asymmetries: a reliable approach to assess wedge solutions efficacy. Stud Health Technol Inform. 2002;88:285–9.

[6] Schwender JD, Denis F. Coronal plane imbalance in adolescent idiopathic scoliosis with left lumbar curves exceeding 40 degrees: the role of the lumbosacral hemicurve. Spine. 2000;25:2358–63.

Walker AP, Dickson RA. School screening and pelvic tilt scoliosis. Lancet. 1984;2:152–3.

[7] Avraam Ploumis et al. Progression of idiopathic thoracic or thoracolumbar scoliosis and pelvic obliquity in adolescent patients with and without limb length discrepancy Scoliosis and Spinal Disorders 2018 13:18

[8] Specht DL, De Boer KF. Anatomical leg length inequality, scoliosis and lordotic curve in unselected clinic patients. J Manip Physiol Ther. 1991;14:368–75.

There’s an app for that – why technology can’t replace clinicians just yet!

Posted on November 10, 2018 by - Blog

A number of the conditions we treat here at the clinic (but most commonly Scoliosis and Kyphosis) are often treated at least in part with an exercise program. In some cases, the exercise program might be a primary line of treatment, whereas in other instances it is used as a support mechanism.

Here at the clinic, we will usually provide an exercise prescription which patients should then undertake each day at home. Sometimes this is the correct approach, but one of the most significant problems posed by this approach is exercise adherence. The simple fact is that programs such as Schroth or SEAS do not work if they are not performed every day and for the correct amount of time.

At the UK Scoliosis clinic, we work to avoid this problem by staying in touch with our patients and scheduling regular check-up appointments, but exercise adherence is still a significant factor in determining treatment success.

In recent years, it has often been argued that either an app or computer program might replace the role of the clinician in encouraging exercise adherence. It’s certainly an attractive idea, however as yet, the research indicates this approach is not practical.

 

There’s an app for that

There’s no question that augmenting face to face treatment with software-based approaches has great promise, and it certainly stands to reason that apps could have the potential to play an essential role in promoting exercise adherence in the future. Apps can monitor patients remotely, are cheap, can provide reminders, and can enable feedback to patients. Many of us also now use apps for fitness purposes, either as exercise trackers, heart rate monitors or in place of a traditional personal trainer. Despite this, app-based exercise programs have not been widely incorporated in rehabilitation for adolescents with musculoskeletal disorders[1]

So far, research has not suggested that apps have been particularly effective as a replacement for traditional contact with professionals more generally –  a recent systematic review showed limited evidence regarding the effectiveness of using apps to increase physical activity in adolescents[2]. Furthermore, apps aimed at increasing physical activity in adolescents were not effective[3].

 

Exercise adherence in Hyperkyphosis

Scoliosis and Kyphosis can both be disruptive conditions

One of the conditions we treat at our clinic is Hyperkyphosis. While hyperkyphosis is sometimes seen as less serious than Scoliosis, research shows that adolescents with hyperkyphosis have decreased quality-of-life (particularly the self-image and appearance components[4]. Hyperkyphosis is also associated with back pain in long-term follow-up studies[5]. Hyperkyphosis is often treated with an exercise prescription, either in advance of bracing or as a complementary approach.  Milder cases of Hyperkyphosis have been shown to respond well to exercise-based programs – although the biggest issue is ensuring that patients adhere to their exercise plan.

 

 

A Kyphosis case study

Given that few attempts have been made to use apps specifically to treat musculoskeletal conditions, a recent study was set up to assess the potential of an app-based exercise program for adolescents with Hyperkyphosis and back pain[6].

App usage was not impressive in the study

The study focused on 21 participants, between 10 and18. All of the participants were given an initial one-time exercise treatment session and were instructed to continue using an app provided for the study to track and guide their home-based exercise over  a period of 6 months.

After participants logged in to the app, they were shown their prescribed exercises by image and exercise name. To perform an exercise, users only had to click on the exercise, which shows the same picture and written instructions on how to perform the exercise. The prescribed amount of time counts down similar to an interval timer while the participant performs the exercise.

Although the format was relatively simple, and the exercise sessions prescribed only lasted approximately 15 minutes a day, the study shows that most participants did not use the app. One participant did not have a Smartphone or tablet, this participant did participate in the exercise program, and logged exercise adherence on a sheet of paper. One participant complied with the program 100%, but the remaining participants either did not use the app or used it less than once per week. When investigators questioned the participants about their usage, they also indicated themselves that they used the app less than weekly.  Unsurprisingly, the patient’s quality of life scores (measured with the SRS-22 form) did not significantly improve over the 6 months.

 

What can we learn from these results?

These results serve mainly to confirm what has been suspected for some time – many users just do not stick to their exercise program, absent encouragement and mentorship from scoliosis or kyphosis professional.  For parents of children with kyphosis or scoliosis, the critical question is therefore whether exercise-based approaches are the most suitable treatment, given that adherence to the program is so important. In some instances, parents may prefer to opt for a kyphosis or scoliosis brace, which does not suffer from these same issues.

Does this mean apps are useless in the treatment of musculoskeletal disorders? Almost certainly not  – some apps, such as our ScoliScreen allow users to perform an initial diagnosis of their scoliosis, and monitor their conditions. The study discussed here did also show that the app had a positive effect on the study participant who fully committed to the exercise program, which suggests that a combination of an app and personal encouragement from a clinician may be a superior way forward.  At the UK Scoliosis clinic, we are always researching the best way to give a superior experience to our patients, and apps are a field that we are investigating with interest!

 

[1] Madden M, Lenhart A, Cortesi S, Gasser U. Teens and mobile apps privacy. Washington, DC: Pew Internet & American Life Project; 2013. [2015-04-21].

[2] van Sluijs EMF, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ. 2007;335(7622):703.

[3] Direito A, Jiang Y, Whittaker R, Maddison R. Apps for IMproving FITness and increasing physical activity among young people: the AIMFIT pragmatic randomized controlled trial. J Med Internet Res. 2015;17(8):e210.

[4] Petcharaporn M, Pawelek J, Bastrom T, Lonner B, Newton PO. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument. Spine (Phila Pa 1976). 2007;32(20):2226–31.

Lonner B, Yoo A, Terran JS, et al. Effect of spinal deformity on adolescent quality of life comparison of operative Scheuermann’s kyphosis, adolescent idiopathic scoliosis and normal controls. Spine (Phila Pa 1976). 2013;38(12):1049–55.

[5] Murray P, Weinstein S, Spratt KF. Natural history and long-term follow-up of Scheuermann kyphosis. J Bone Joint Surg Am. 1993;75A(2):236–48.

Ristolainen L, Kettunen JA, Heliövaara M, Kujala UM, Heinonen A, Schlenzka D. Untreated Scheuermann’s disease: a 37-year follow-up study. Eur Spine J. 2012;21(5):819–24.

[6] Karina A. Zapata, Sharon S. Wang-Price, Tina S. Fletcher and Charles E. Johnston Factors influencing adherence to an app-based exercise program in adolescents with painful hyperkyphosis Scoliosis and Spinal Disorders 201813:11