Category: Blog

At what age am I at the greatest risk of scoliosis?

Posted on May 17, 2019 by - Blog

Scoliosis, like many conditions, is most common in certain age groups – and as a consequence, we recommend that these individuals be the most careful when checking for symptoms. The simplest answer to the question is that young adults are generally considered to be at the highest overall risk – but in fact, this question is a complicated one which is worth some discussion.

 

Scoliosis and age of diagnosis

Scoliosis is a difficult condition to diagnose – in large part, this is due to the complex nature of the condition and the fact it causes an individualised, three-dimensional shift in the spine. The rate at which scoliosis develops also varies, and is usually associated with growth spurts, rather than being steady.

One major challenge with scoliosis cases is estimating exactly when the condition began. Because scoliosis is very hard to detect (unless an individual is properly screened) until it has become large enough to cause visual distortions to the patient’s body, a diagnosis is often not made until the condition has existed for some time. Ideally, we would like to know when scoliosis began, as this has an impact on future prognosis – but in most cases, scoliosis is simply classified by the time it is diagnosed, not necessarily when it actually began.

 

Scoliosis in children is typically grouped into one of three types:

Infantile scoliosis – diagnosed in children from 0 -3 years old

Juvenile scoliosis – diagnosed in children from 4 – 10 years old

Adolescent scoliosis– Diagnosed in children and young people from 10 – 18 years old

 

Scoliosis first diagnosed in individuals older than 18 is classified as adult scoliosis and could be either a case of scoliosis which has progressed undetected throughout childhood (common in younger individuals) or a case caused by degeneration of the spine and supporting structures, known as de-novo scoliosis. (Very common in the over 60’s)

 

Which age group is most at risk?

While much of the literature on scoliosis focuses on scoliosis in younger people, the statistics are clear – the most affected group is actually the over 60’s, mainly from De-Novo scoliosis. While about 3 or 4 % of young people suffer from scoliosis, nearly 40% of the over 60’s have the condition.

Statically, Infantile scoliosis is the least common of all and comprises only about 1% of all idiopathic scoliosis in children. Unlike most forms of Scoliosis infantile scoliosis is more common in males – about 60% of patients are boys.

Juvenile scoliosis is less common than adolescent scoliosis but more common than infantile scoliosis – Juvenile scoliosis comprises approximately 10-15% of idiopathic scoliosis cases and is slightly more common in younger males and older females within this age range.

Adolescent scoliosis makes up the majority of cases in young people, somewhere between 80 and 85%. Whereas infantile and younger Juvenile scoliosis cases are more common on boys, 80% of all adolescent cases are girls. The very highest point for diagnosis is around 11-12 years of age in girls and slightly later in boys.

 

Risk of progression and severity – the key factors

If it’s actually older people who are most likely to suffer from scoliosis, why does most scoliosis treatment focus on the young? It’s an important question which goes to the heart of scoliosis itself and its treatment.

Scoliosis can vary hugely in its severity and its speed of progression – but in all cases, once scoliosis has started to develop, it generally does not stop until a young person has reached skeletal maturity. This means that the younger a scoliosis patient, the longer the condition has to develop to the point at which it becomes debilitating or requires major surgery to correct.  What’s more, scoliosis is closely linked to growth spurts – often worsening substantially over just a few months during a growth phase. Since younger children have much growth ahead of them, the risk of progression is significant.

It’s this risk of progression and the initial degree of the curvature which means cases in younger people are often considered as more serious – De-novo scoliosis, the form most commonly found in older adults, while a problematic condition, tends to be much less substantial in magnitude and much slower in progression. Addressing the problem can lead to a significant improvement in quality of life, but urgency is less of a factor.

By contrast, some research has demonstrated that Juvenile scoliosis greater than 30 degrees almost always increases rapidly and presents a 100% prognosis for surgery, whereas 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]

Today, with modern bracing technology, it has been demonstrated that timely conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis – and research has suggested drastically different outcomes. In one recent study of Juvenile 113 patients treated with bracing, the vast majority achieved a complete curve correction, and only 4.9% of patients eventually needed surgery.[ii]

While cases detected in adolescents do have less time to develop, they are often more severe once detected (they may well have began as a Juvenile anyway) and the high volume of cases in this age range means that this group are considered to be at the most risk. It’s thought that the changes which occur during puberty may be linked to the onset or progression of scoliosis, which may account for the spike in cases in this age range. If 3 or 4% of young people in this age bracket will develop scoliosis, that’s about one in each class at school and in most cases,  there will still be enough time for scoliosis to progress to the surgical threshold or at least cause significant disability.

 

So, who is at the greatest risk?

The answer to this question is simply that everyone should be aware of scoliosis, and take the simple steps needed to screen for the condition and address it early on. Our ScoliScreen tool is a great place to start.

Scoliosis in infants is certainly rare, but obviously presents the greatest possible opportunity for the condition to worsen over time. Juvenile scoliosis is also fairly uncommon, but the prognosis is not good if the condition is not treated early on. Most younger scoliosis patients are diagnosed as adolescents, meaning that children from 11-15, in particular, should be screened regularly.

Older individuals, while likely to develop a less severe form of scoliosis, have about a 4 in 10 chance of developing the condition over the age of 60.

If you are concerned about scoliosis, why not try out ScoliScreen tool, or get in touch today to arrange a professional consultation.

 

 

[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

I have Scoliosis – will my children have Scoliosis?

Posted on May 3, 2019 by - Blog

One of the questions which scoliosis sufferers often ask is as to whether they would be likely to pass scoliosis on to any children they may have. This is a good question since research does suggest that scoliosis (like most conditions) can run in families. Having said this, much more research is required before we can give a definitive answer, but here’s an overview of the latest thinking.

 

Is scoliosis genetic?

Before answering this question its important to remember that in children at least, 80% of all scoliosis cases are still considered idiopathic  – this literally means “without known cause” – so while we can make some useful observations on this topic, science is yet to form a complete conclusion, and that should be kept in mind.

It’s also important to be clear about the kind of scoliosis which is being discussed here – the causes of some forms of scoliosis are known. For example, de novo scoliosis in the over 60’s is caused by degeneration of the spine, while other genetic and neurological disorders (which certainly can be communicated to children) can also cause scoliosis. Here, we’ll be discussing the 80% of cases which are currently considered “idiopathic”.

One thing certainly has been established with clarity – results show that no ethnic group seems to be invulnerable to scoliosis, as is the case with some genetic conditions. Research suggests that whatever your heritage, scoliosis could be a risk.[1]

 

Scoliosis in twin studies

Perhaps the best way to study the importance of genetics in the inheritance of a certain condition is through the conduct of twin studies. Because of the unique relationship which twins have, they help researchers to examine the overall role of genes in the development of a trait or disorder.  Comparisons between monozygotic (MZ or identical) twins and dizygotic (DZ or fraternal) twins are conducted to evaluate the degree of genetic and environmental influence on a specific trait.  MZ twins are the same sex and share 100% of their genes.  DZ twins can be the same- or opposite-sex and share, on average, about 50% of their genes.

If MZ twins show more similarity on a given trait compared to DZ twins, this provides evidence that genes significantly influence that trait.  However, if MZ and DZ twins share a trait to an equal extent, it is likely that the environment influences the trait more than genetic factors.

So what do twin studies say about scoliosis? Such an approach has suggested that scoliosis may have a familial link since at least as early as 1922[2] and since then reports of multiple twin sets and twin series have consistently shown higher concordance (that is to say, similarity)  in monozygotic (MZ) compared to dizygotic (DZ) twins[3] – indicating a strong genetic link.  A meta-analysis of these clinical twin studies revealed 73% MZ compared to 36% DZ concordances[4]. Interestingly, in this series, there was a significant correlation with curve severity in monozygous twins but not dizygous twins. No correlation with curve pattern was found either, suggesting the importance of genetic factors in controlling susceptibility and disease course, but not necessarily disease pattern.

 

Will I pass scoliosis on to my children?

If research clearly shows that there may well be a genetic link, what are your chances of passing on scoliosis? One study[5] has tried to estimate the approximate chances, by comparing scoliosis prevalence with other common genetic diseases such as rheumatoid arthritis (RA), Crohn’s disease (CD), type 1 diabetes (T1D), or psoriasis vs the general population. The following table illustrates the findings and provides at least some broad context.

 

Calculated Sibling Risk Ratios for IS are Comparable to Other Well-Studied Complex Genetic Diseases

 

Disease Prevalence Risk ratio  
RA .01 2-17
CD .001 10
T1D .007 15
Psoriasis .02 4-11.5
IS (≥10°) .03 8
IS (≥20°) .005 23

 

The main message here is therefore that the more severe your scoliosis, the more likely you are to pass scoliosis on to your children – however, rheumatoid arthritis (RA), Crohn’s disease (CD), type 1 diabetes (T1D), or psoriasis are all more likely to be passed on than scoliosis resulting in a small curve, and scoliosis with a large curve is only fractionally more likely to be passed on than rheumatoid arthritis.

Therefore, research certainly suggests that if you have scoliosis, you do have a risk of passing it on to your children. Given the advances in treatment technologies however, this should not be a reason to put off having children in this day and age. Parents with scoliosis should of course be diligent with screening and monitoring for scoliosis, but in all fairness the same should go for all parents – not just scoliosis sufferers.

 

 

 

[1] Herring JA. Tachdjian’s Pediatric Orthopaedics. Philadelphia: WB Saunders; 2002. Scoliosis; p. 213.

[2] Staub HA. Eine skoliotikerfamilie.Ein Beitrag zur Frage der kongenitalen Skoliose und der Hereditat der Skoliosen. Z. Orthop. Chir. 1922;43:1

[3] Horton D. Common skeletal deformities. In: Rimoin DL, Conner MJ, Pyeritz RE, Korf BR, editors. Emery & Rimoins Principles and Practices of Medical Genetics. Amsterdam: Churchill Livingstone Elsevier; 2002. pp. 4236–4244

[4] Kesling KL, Reinker KA. Scoliosis in twins. A meta-analysis of the literature and report of six cases. Spine. 1997;22:2009–2014.

[5] ‘Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’

Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

Does Scoliosis cause Neck pain?

Posted on April 15, 2019 by - Blog

For some time, it has been thought that common problems such as back and neck aches and pains were not a symptom of scoliosis. Even many scoliosis specialists did not necessarily consider pain to be an important indicator of a problem – however, over the last few years, various studies have demonstrated that back pain at least is correlated with scoliosis, and new research now also suggests that neck problems are a common issue.

 

Back pain and Scoliosis.

While it was once thought that back pain was not necessarily correlated with scoliosis (since scoliosis certainly can exist without pain) it has become increasingly clear that there is a link.

Indeed, research from the last few years has sown that spinal pain is, in fact, a frequent condition in scoliosis patients, further supporting the need for early detection and screening to minimise potential pain and suffering[1]. Furthermore, in one study of patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[2] and in another of 2400 patients with AIS, 23% reported back pain at their initial contact[3].  Chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[4], while patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[5]

We also now know that part-time bracing in adult scoliosis cases can improve chronic pain[6] and that taken as a whole Scoliosis patients have between a 3 and 5 fold increased risk of back pain in the upper and middle right part of the back.[7]

At the very least, this evidence suggests we should reevaluate our view of the relationship between Scoliosis, and pain.

 

Scoliosis and neck pain.

Perhaps the most obvious common features of the studies just discussed is their focus on back pain. This certainly sensible, after all, scoliosis primarily affects the thoracic and lumbar spine – but this does beg the question – what about neck pain?

Studies examining scoliosis and neck pain are much more sparse, however, at least one 2017 study[8]does provide some useful insight.

The large scale study, conducted across the Karolinska University Hospital, Stockholm; the Skåne University Hospital, Malmö; the Sundsvall and Härnösand County Hospital, Sundsvall, and Sahlgrenska University Hospital, Gothenburg, sought to understand what if any correlation existed between scoliosis and neck problems.

One thousand sixty-nine adults with a mean age of 40 years, diagnosed with idiopathic scoliosis in youth, answered a questionnaire on neck and back problems. Eight hundred seventy of these answered the same questionnaire on a the second occasion in a mean of 4 years later. Comparisons were made with a cross-sectional population-based survey of 158 individuals. Statistical analyses were made with logistic regression or analysis of variance, adjusted for age, smoking status, and sex.

The results were telling – Individuals with scoliosis (either treated or untreated) had a higher prevalence of neck problems –  42% compared to 20% of the control group (non-scoliosis patients). Interestingly, the study also showed that there was no correlation between the methodology used to address the scoliosis, or by the age of onset of scoliosis; juvenile or adolescent – which suggests the risk is the same regardless of how you approach scoliosis treatment.

Given the prior interest in back pain and scoliosis, this study also provided some interesting information on the two as a combined issue  – if neck and back problems were taken together, then the percentage of scoliosis patients experiencing problems increased to 72% , while the control group rose to 37%.  Of the individuals with scoliosis having neck problems, 81% also reported back problems, compared to 59% of the individuals in the control group.

 

Conclusions

Given the research which has already taken place on back pain and with this 2017 study in mind, it seems fair to suggest that neck problems are more prevalent, and more often coexist with back problems in individuals with idiopathic scoliosis than in non-scoliosis patients – and indeed, many scoliosis patients seem to suffer from both of these issues.

For us as a clinic, this stands out as an area for further study and research – it perhaps telling that the current version of the widely used and validated Scoliosis Research Society (SRS)-questionnaire (at the time of writing) does not even include questions on neck pain.

At the UK scoliosis clinic, we do take pain into consideration when diagnosing and treating scoliosis – and as a broad-based clinic dealing with multiple complex postural issues, we have other screening tools on hand to assess and monitor neck pain, however, going forward it may well benefit the field for neck and back pain, to be considered with greater weight when diagnosing scoliosis.

 

[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] 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

[5] 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.

[6] 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.

[7] 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

[8] Christos Topalis, Anna Grauers, Elias Diarbakerli, Aina Danielsson and Paul Gerdhem, Neck and back problems in adults with idiopathic scoliosis diagnosed in youth: an observational study of prevalence, change over a mean four year time period and comparison with a control group Scoliosis and Spinal Disorders 2017 12:20

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