Category: Blog

Scoliosis Treatment – Scoliosis exercise Vs. Bracing, which is best?

Posted on August 3, 2018 by - Blog

Today the two main methodologies involved in the non-surgical treatment of scoliosis are Bracing, and Specialist exercise methodologies. In most cases we use both approaches throughout the course of treatment with our patients since both approaches have their strengths. We are however, often asked which treatment methodology is best – so let’s consider the latest research on this question.

 

Bracing vs Exercise – New research

The first thing to realise when comparing scoliosis treatment is that while many patients often want to know “which is best”, this question is often less explored in the scientific literature. For the most part, scoliosis practitioners want to focus their time and attention towards improving their methodologies of choice, rather than on making comparisons with other approaches. Because of this, few studies have tried to directly compare bracing and exercise approaches – although a recent 2017 study has done just this[1].

In the study conducted in China, 53 patients (age of 10 – 17 years, Cobb angle ≥ 20 – 40 degrees,) were randomly assigned to either a bracing group or exercise group. Twenty-four patients (19 females) were placed in the bracing group and 29 patients (22 females) in the exercise group.

Patients in the bracing group were provided with a rigid thoracolumbosacralorthosis (a Scoliosis brace – TSLO) and asked to wear their brace 23 hours a day, while patients in the exercise group were treated with the Scientific Exercise Approach to Scoliosis (SEAS) protocol. Data regarding angle of trunk inclination, Cobb angle, shoulder balance, body image, quality of life (QoL)[2] were collected every 6 months.

At the first visit, patients assigned to the bracing group were prescribed with a rigid (TLSO) and received an initial pre-treatment evaluation to allow for brace fabrication. To achieve optimum correction, patients were invited to the scoliosis clinic to check the fit and modify (if necessary) the brace after the first month of intervention and then every three months as recommended by SOSORT[3].

The SEAS patients took part in a session of 1.5 hours at which they learned and practiced the core content of their program every two to three months, in which they learnt their personalised exercise protocol. The patients continued treatment at the clinic once a week (40 minutes) plus one daily exercise session at home (10-15 minutes)[4].

 

 

Study Results

At this stage, it’s important to mention that while this study represents an important beginning in this comparative project, the results available at this time reflect only a year of treatment. It is likely that the trends illustrated here will hold good over a longer period, and thankfully we will be able to verify this since the study is still ongoing.

 

Cobb angle 

A 54 Degree Cobb angle (X-ray)

The bracing group achieved a significantly larger reduction in Cobb angle – at 6 months, the mean reduction of cobb angle in the bracing group was 3.13 degrees, and at 12 months the mean reduction was 5.88 degrees.  In the exercise group, the 6 months mean reduction was just 0.66 degrees, and at 12 months was 2.24 degrees.[5]

 

Quality of Life

The SRS-22 form used for gauging quality of life factors consists of a number of subsets of data, each of which was individually evaluated during this study. These include a score for pain, function, mental health and self-image. Taken as a whole, the results showed that for the bracing group, the SRS functional score (a measure of the impact of scoliosis on everyday life) as well as the total score (a broader measure of quality of life factors) all showed significant improvement between the initial consultation and 12-month evaluation as well as between the 6-month and 12-month evaluations.  The one exception to this was pain level, which did not differ significantly across the three evaluations.

The researchers also noticed that self-image was significantly improved in the bracing group, especially at the 12 months follow up, this was interesting given the negative self-image association which is sometimes linked to bracing.  Participants did report an increase in their overall satisfaction levels (taking all factors into account), although this was most apparent after passing the 6-month mark.

For the exercise group, all the SRS-22 quality of life subsets showed a slightly larger improvement across the three visits than bracing – especially in terms of the functional score. The exception here again was pain, where no significant change was detected[6].

 

 

Overall comparison

In comparing the two treatment groups, the study investigators noted it was interesting to find that the overall improvement of quality of life was more significant in the exercise group. Although the quality of life scores improved in both groups, at all three visits, the average scores of most subsets in the SRS-22 were higher in the exercise group.  By contrast, the improvement in cobb angle was significantly greater in the bracing group, although the exercise group did also show an improvement at the 12-month mark.

 

 

So which is better?

At this stage, it seems fair to suggest that the results of the study reflect what many scoliosis clinicians are already aware of – Scoliosis Bracing is by far the most effective way to reduce a cobb angle – Indeed, the authors note how “There is no doubt that bracing has proven efficacy in halting the progressive nature of the deformity and reducing the need for surgery”.

At the same time, scoliosis specific exercise has a more positive impact on functional capacity – this comes as no surprise to scoliosis practitioners, since scoliosis specific exercise is intended to reduce muscular imperfections and promote better everyday posture. Exercise approaches also seem to correlate with a greater improvement in quality of life factors than bracing, although this is also to be expected since it is almost universally accepted that any form of exercise serves to boost quality of life in most individuals.

Taking these two points, its easy to see how a combination approach is often the best possible option – by pursuing both treatment methodologies it is possible to achieve functional improvement, cobb angle correction and an improvement in quality of life in a flexible way which works for the patient.

More results from this particular study, as well as further research can be expected in this area and we will report it to you as soon as it becomes available!

 

scolibrace results

An example of successfull bracing with ScoliBrace

 

 

[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 [Publish Ahead of Print]

[2] The SOSORT SRS-22 Form was used for this data collection.

[3] Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 2012;7:3.

[4] Romano M, Negrini A, Parzini S, et al. SEAS (Scientific Exercises Approach to Scoliosis):a

modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis 2015;10:3.

[5] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent

idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine [Publish Ahead of Print]

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

Scoliosis bracing is becoming more effective

Posted on July 27, 2018 by - Blog

For some time now, scoliosis clinicians have broadly accepted the view that scoliosis bracing is an effective way to halt the progression of scoliosis, and (with the use of the correct brace) is also an effective way to reduce the curve.

The outlook for bracing was not always a positive as it is today – historically, studies suggested that bracing was only as effective as observation. Over time however, research has tended to show bracing to be more effective than was once thought, so that today the rates of success with bracing are very high.

In 2005, the Scoliosis Research Society (SRS) attempted to standardize the inclusion criteria and outcome measurements for bracing studies, to enable comparison among studies. In the guidelines, it was suggested that a curve progression of less than 5 degrees should be regarded as success. At the time, SRS did not even consider that bracing might actually serve to improve a curve – although it was quickly realised that this was possible. For this reason, the criteria for “improvement” (being a reduction of curve of at least 6 degrees) was established in 2009.

Despite some scepticism in the mid 2000’s however, some bracing studies today have demonstrated rates of surgery prevention as high as 100%[1][2] and the field is one of the major areas of study and advancement – so what caused such an improvement in the prognosis?

 

Braces are getting better

scoliosis braces

Scoliosis braces have come a long way!

One of the major reasons for the improvement in bracing effectiveness has been the improvement in braces themselves.  A recent review study conducted in 2016, attempted to explore this issue by examining 53 studies published between 1990 and 2016[3]. It showed that when comparing the percentage of patients eventually requiring surgery and the improvement rate in the past 26 years, we find that there is a trend towards reduction in surgical rate and an increase in improvement rate. Yet, close inspection showed that the change is strongly related to the type of brace used.

Key factors in bracing outcome are the amount of in-brace correction and comfort for the wearer. In the study, it was shown that large in-brace correction in excess of 50% would be accompanied by improvement at skeletal maturity[4][5] and hours of brace wear are positively associated with the rate of treatment success[6]. Simply put, an active correction brace which is also comfortable to wear is a key factor in significantly reducing surgical requirement[7]. This is why so much effort has been expended in ensuring that our ScoliBrace is the most comfortable brace available!

The study also showed that the effectiveness of a brace depended on the quality of its construction, not just its design[8]. In 2007 Danielsson et al pointed out the importance of the skill and dedication of the orthotist in creating a brace as a critical factor in the eventual success of treatment and similar views have been forwarded by other authors[9]. Today, advancements in technology mean that a higher quality of brace design and manufacture than ever before is available to us. Indeed, at the UK scoliosis clinic we use the latest laser scan and computer aided manufacture processes to create a brace for each client, which fits their needs perfectly.

 

Combination treatment is most effective

Today we also appreciate that in most instances an individualised treatment plan based on a number of complementary methods provides the best chance for a significant reduction of the curve. In fact, today it is generally accepted that bracing should not be employed alone in the management of Adolescent Idiopathic Scoliosis in particular – instead individualised scoliosis specific exercises should also be incorporated. This is because Scoliosis specific exercises improve the muscle strength of the trunk and the postural awareness of the patients. More importantly perhaps, when combined with bracing, evidence suggests the results are an improvement in curve reduction[10]. Properly tailored exercise programs may also help to reduce the loss of correction which frequently accompanies the end of brace treatment if not properly managed.[11]

 

Scoliosis clinicians are working hard to improve bracing technology.

scolibrace

Modern scoliosis braces are highly effective

At the UK scoliosis clinic, we respect and value the work that surgeons can do in correcting very serious cases of scoliosis which are unsuitable for conservative treatment. However, the 2016 review study has suggested that a conflict of interest in bracing development might be a negative factor for patients[12].

One of the lest effective forms of brace is the Boston brace – yet these are often favoured by orthopaedic surgeons (especially in the US)[13]. The Boston brace is at least outdated, and in some situations may complicate scoliosis treatment unnecessarily. Boston braces also encourage thoracic flat back, which has been shown to be detrimental to the correction of curves[14].

Why are these braces sometimes favoured then?  –  This maybe because in the event that the brace fails to achieve the objective, the surgeon can go on to treat the patient using surgery, although this might not be the patient’s preference. Conversely, the kinds of modern braces we use at our clinic and which are widely implemented throughout Europe today are predominantly used by physicians who treat patients conservatively. In this instance, failure of the brace requires an external referral for surgical treatment[15] – hence it is in the interest of non-surgical clinics to constantly develop and improve their braces, which results in highly advanced modern braces, like ScoliBrace.

 

 

 

 

[1] De Giorgi S, Piazzolla A, Tafuri S, Borracci C, Martucci A, De Giorgi G. Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery? Eur Spine J.2013;22(6):S815–22.

[2] Aulisa AG, Guzzanti V, Perisano C, Marzetti E, Falciglia F, Aulisa L.Treatment of lumbar curves in scoliotic adolescent females with progressive action short brace: a case series based on the Scoliosis Research Society Committee Criteria. Spine (Phila Pa 1976). 2012;37(13):E786-E791.

[3] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[4] Landauer F, Wimmer C, Behensky H. Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up.

[5] Appelgren G, Willner S. End Vertebra Angle – A roentgenographic method to describe a scoliosis. A follow-up study of idiopathic scoliosis treated with the Boston brace. Spine (Phila Pa 1976) 1990;15(2):71- 74.

[6] A large number of studies are cited in Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[7] Wiley JW, Thomson JD, Mitchell TM, Smith BG, Banta JV. Effectiveness of the Boston brace in treatment of large curves adolescent idiopathic scoliosis. Spine. 2000;25(18):2326–2332.

[8] Rigo MD, Villagrasa M, Gallo. A specific scoliosis classification correlating with brace treatment: description and reliability. Scoliosis. 2010;5(1):1. doi:10.1186/1748-7161-5-1.

[9] For example see Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner- Bonneau D. Ameta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am. 1997;79(5):664-674.

[10] Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S. Active self-correctionand task-oriented exercises reduce spinal deformity and improve quality of life insubjects with mild adolescent idiopathic scoliosis. Results of a randomized controlled trial. Eur Spine J. 2014;23(6):1204-14. doi:10.1007/s00586-014-3241-y.

[11] Goldberg CJ, Dowling FE, Hall JE, Emans JB. A statistical comparison between natural history of idiopathic scoliosis and brace treatment in skeletally immature adolescent girls. Spine. 1993;18(7):902-9088.

[12] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[13] Wynne JH. The Boston brace and TriaC system. Disabil Rehabil Assist Technol2008; 3(3):130-135. doi:10.1080/17483100801903988.

[14] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[15] Ibid.

Catch scoliosis early, and don’t “wait and see”!

Posted on July 23, 2018 by - Blog

Catching scoliosis early with screening, and then taking appropriate action to stabilise and correct the cobb angle is the key to a successful outcome. Our message today, to parents in particular, is to have your children screened regularly and act on any concerns you may have. 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.

 

Scoliosis school screening is vital

children

3 – 4 % of children will develop Scoliosis

Since Scoliosis usually develops in children and should be treated as soon as possible to maximise the chances of a successful outcome, school scoliosis screening has been a topic of much debate and is something that we strongly advocate here at the clinic.

Studies have shown that school screening can effectively reduce the risk of requiring invasive spinal

fusion surgery[1]. Although there has been debate about the effectiveness of school screening in the past, it is now clear that screening does improve outcomes for children affected by scoliosis. The clinical effectiveness of scoliosis screening has been assessed in numerous studies of different designs, which have been synthesized in a systematic review with clear results.  The review covered 28 studies

published between 1977 and 2004 and concluded that there was sufficient evidence to suggest that school scoliosis screening is safe, may detect cases of Adolescent idiopathic Scoliosis (AIS) at early stages, and may reduce the risk of surgery[2].

Despite this, school screening is still not commonplace in the UK, although this is not the case everywhere. In Hong Kong, for example, scoliosis screening has been conducted as a routine health service since 1995, thereby making it one of the regions with the longest history of routine scoliosis screening in the world. Hong Kong’s screening protocol was demonstrated to be clinically effective for children who studied in the fifth grade during the first two academic years after the program was started; however, no longer term evaluation was attempted[3][4]. In response to this, a longer term study has now been undertaken, in which a total of 306,144 students participated in scoliosis screening. Clearly, screening is considered valuable around the world!

 

Why does early detection matter?

Early detection Is especially important in scoliosis cases since research has shown a direct link between the age of detection and the outcomes achievable. Today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is now 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.[5]

The 2015 study included patients aged between 4 to 10 years at the beginning of treatment and with a curve magnitude of 20°-40° Cobb. Curves between 20° and 25° Cobb degrees were included only in the presence of documented curve progression. Patients were prescribed an appropriate scoliosis brace and wear time, based on their individual cases.

The results from the study showed that curve correction was accomplished in 88 patients (77.8%), stabilization was obtained in 18 patients (15.9%). 7 patients (6.19%) have a progression and 4 of these were recommended for surgery. Critically however, the study also demonstrated that treatment appears to be more effective with curves under 30° (incidence of surgery: 1.6%) than curves over 30° (incidence of surgery: 5.5%) – which strongly suggests the need to catch curves early. [6]

 

Juvenile scoliosis almost never resolves without treatment

Scolibrace

Scolibrace is a comfortable and effective advanced brace

Unfortunately, “wait and see” is still a common approach here in the UK – unfortunately this approach is outdated and fails to recognise the outcome of research which has clearly shown that juvenile scoliosis tends to worsen, sometimes aggressively and almost never resolves.

Research has demonstrated that Juvenile scoliosis greater than 30 degrees 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[7].

A 2006 study followed (but did not treat) 205 patients of which 99 (48.3%) were operated on. Of 109 curves less than or equal to 20 degrees at onset of puberty, 15.6% progressed to greater than 45 degrees and were fused. Of 56 curves of 21 degrees to 30 degrees, the surgical rate increased to 75.0%. It was 100% for curves greater than 30 degrees[8].

This research is particularly troubling, in light of the above study, which showed a very high likelihood of total curve correction up to and including 30-degree angles, had these cases been screened, caught early and treated with a corrective brace.

 

How we can help

At the UK Scoliosis clinic, we offer free screening to anyone concerned about Scoliosis. If you have already had a diagnosis and have been advised to wait and see, we especially urge you to book an appointment to see our specialists in order to avoid compromising your chances at a highly effective treatment plan.

 

[1] Richards BS, Vitale MG. Screening for idiopathic scoliosis in adolescents. An information statement. J Bone Joint Surg Am 2008;90: 195–8.

[2] Sabirin J, Bakri R, Buang SN, Abdullah AT, Shapie A. School scoliosis screening programme—a systematic review. Med J Malaysia

2010;65:261–7.

[3] Luk KD, Lee CF, Cheung KM, Cheng JC, Ng BK, Lam TP, et al. Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine

2010;35:1607–14.

[4] Yawn BP, Yawn RA, Hodge D, Kurland M, Shaughnessy WJ, Ilstrup D, et al. A population-based study of school scoliosis screening.

JAMA 1999;282:1427–32.

[5]  ‘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

[6] ‘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

[7] 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.

[8] Ibid.

Scoliosis specific exercise can reduce curve progression in adult scoliosis patients

Posted on July 13, 2018 by - Blog

While many of the patients we see at our clinic are children with juvenile or adolescent scoliosis, adult scoliosis cases also represent a significant percentage of those we help. There are many approaches which can be used in tackling adult scoliosis, but one of the most commonly chosen is scoliosis specific exercise. It was once thought that surgery was the only effective treatment for adult scoliosis, but today research is confirming that high quality, individualised treatment programs can be effective in stopping the progression of scoliosis in adults.

 

Adult scoliosis – an important field of research

While scoliosis clinicians often tend to focus on scoliosis in adolescents, it has long been known that idiopathic scoliosis can (and often does) continue to progress during adulthood after skeletal maturity[1], when growth has stopped.

While the development of scoliosis in adults is slower, over time the curve does worsen which can lead to a reduction in functional capacity and the development or the worsening of spinal pain and associated radicular symptoms[2](pain which radiates from the root of a nerve at the spinal column into the arms or legs), as well as spinal degenerative changes. This means that research into the best ways to tackle adult scoliosis is equally important as in adolescent scoliosis.

In fact, more than 60 % of cases of adult scoliosis progress, particularly in the case of curves exceeding 30 ° Cobb at skeletal maturity, regardless of the curve pattern[3]. Unlike adolescent scoliosis however, Marty-Poumarat[4] has shown that the rate of progression in adult scoliosis is linear (regular and constant) and can therefore be used to establish an individual prognosis. This rate of progression, if left untreated is deemed to be around 0.5-1 °per year[5].

While the prevailing view for some time has been that adult idiopathic scoliosis was only suitable for treatment with surgery when the curve becomes significant enough – more recent research clearly suggests that non-surgical approaches can be effective in reducing curve magnitude and halting progression, potentially eliminating the need for surgery in many cases.

In a short-term case series Weiss et al. showed 43.93 % of 107 patients improved 5 or more Cobb degrees immediately after 4 – 6 weeks of in-patient scoliosis specific exercise program[6], while Morningstar et al. showed that 19 patients treated with spinal manipulation and various physiotherapeutic procedures reported immediately after the therapy an average correction of 17 ° Cobb [7][8]. In an earlier case report, Negrini et al. showed a 18.5 Cobb degrees reduction after one year of Scoliosis Specific SEAS exercises[9].

 

Treating adult scoliosis with scoliosis specific exercise – new research

Now, a larger study by Negrini et al. has now gone further in establishing the effectiveness of SEAS exercises in reducing the progression of scoliotic curves. SEAS exercises (one of the types we utilise in our own clinic) are scoliosis-specific exercises. In adult patients they are aimed to recover postural collapse, postural control and vertebral stability through the process known as active self-correction. Typically, therapy includes at least two weekly exercise sessions each lasting 45 min – but exercise prescription varies significantly in both length and frequency, since to be effective an exercise program must be individually tailored.

The study considered adults (18 years or more) who exhibited curves larger than 30° and documented curve progression during adulthood (at least 6° Cobb) or adults with curves larger than 40° who had refused surgical treatment. Patients were prescribed Scoliosis Specific SEAS Exercises exclusively and were required to practice their exercises regularly for at least ten months per year. Patients were assessed a minimum of 1 year after their first assessment, via x-rays which were independently verified.

 

Results

The results from the study were highly encouraging – it confirmed that that Scoliosis Specific Exercises can be effective to obtain stability and, in some cases, to reduce the Cobb angles by degrees. In highly progressive curves, exercises appear to slow down the progression of the curvature (worsening).  Of the 34 patients included in the study, an average reduction of 4.1 degrees cobb was achieved after one year. [10]

More broadly, the study also went to confirm the fact that scoliosis specific exercise programs need to be maintained and monitored, and that the patient must continue to adhere to the exercise program in the long term in order to see sustained improvement.[11]

While the authors of the study were pleased with the outcome, it’s fair to say that more research on scoliosis specific exercise is required and will continue to be published over the coming months and years. Future larger, long term, observational studies will provide us with more insight on defining the best Scoliosis Specific Exercises management approach and explore other very important issues associated with adult progressive spinal deformities, such as, sagittal global balance, back pain, disability and quality of life.

 

Treatment for adult scoliosis at the UK Scoliosis Clinic

At the UK Scoliosis clinic, we utilise a variety of approaches as part of our scoliosis specific exercise program. This allows us to tailor our approach to our patient’s specific needs – this might include exercise programs based on the SEAS or Schroth methodologies as well as bracing if required. It’s because our scoliosis specialists have such a wide variety of tools at their disposal that we’re able to achieve targeted, measured and provable results for our patients.

 

 

[1] Collis DK, Ponseti IV. Long-term follow-up of patients with idiopathic scoliosis not treated surgically. J Bone Joint Surg Am. 1969;51(3):425 – 45

[2] Guigui P, Rillardon L. Adult spinal deformities. Rev Prat. 2006;56(7):701– 8

[3] Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA, J Am Med Assoc. 2003;289(5):559 – 67, Weinstein SL. Natural history. Spine. 1999;24(24):2592–600

[4] Marty-Poumarat C, Scattin L, Marpeau M, Garreau De Loubresse C, Aegerter P. Natural history of progressive adult scoliosis. Spine. 2007;32(11):1227 – 34, discussion 1235.

[5] Ibid.

[6]Weiss HR. Influence of an in-patient exercise program on scoliotic curve. Ital J Orthop Traumatol. 1992;18(3):395 – 406

[7] Morningstar MW, Woggon D, Lawrence G. Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. BMC Musculoskelet Disord. 2004;5:32.

[8] We wish to note that in this instance, the term ‘immediately’ should be taken literally – more research is needed to establish the long term prognosis offered by CLEAR  and associated approaches.

[9] Negrini A, Parzini S, Negrini MG, Romano M, Atanasio S, Zaina F, et al. Adult scoliosis can be reduced through specific SEAS exercises: a case report. Scoliosis. 2008;3:20

[10] Negarini et al. Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study. Scoliosis (2015) 10:20

[11] Ibid.

Is bracing an effective treatment for Adolescent Idiopathic Scoliosis? BRAIST study says yes!

Posted on July 9, 2018 by - Blog

Adolescent idiopathic scoliosis is characterized by a lateral curvature of the spine, with a Cobb angle of more than 10 degrees and vertebral rotation. Scoliosis develops in approximately 3% of children younger than 16 years of age, although rates of Scoliosis are typically much higher amongst at-risk groups such as dancers and gymnasts.  Curves larger than 50 degrees are typically associated with a high risk of continued worsening throughout adulthood and thus are most likely to be recommended for a surgical procedure.[1]

Scolibrace

Our Scolibrace is comfortable, effective and low-profile

Treatment with rigid bracing (thoracolumbosacral orthosis or TLSO) is the most common non-surgical treatment for the prevention of curve progression. There are many different brace designs, but with all of them, the objective is to restore the normal contours and alignment of the spine while preventing scoliosis progression. The most effective designs (like our Scolibrace system) seek to deliver superior outcomes by providing active correction of the curve.

But is bracing effective?  – Today you’ll still find some practitioners who are unclear on the outcomes you can expect from bracing. This is because although historical studies of bracing in adolescent idiopathic scoliosis had suggested that bracing decreases the risk of curve progression.[2] in some of these earlier studies results were inconsistent, the studies were observational, and only one prospective study enrolled both patients who underwent bracing and those who did not.[3] Thus, for some time the effect of bracing on curve progression and rate of surgery was unclear. This all changed thanks to the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST), which finally determined the effectiveness of bracing – as compared with observation – in preventing progression of the curve to 50 degrees or more.

The BRAIST study was a large-scale endeavour, conducted in 25 institutions across the United States and Canada. Enrolment began in March 2007.  The target population for this study was patients with high-risk adolescent idiopathic scoliosis who met current indications for brace treatment – specifically this meant an age of 10 to 15 years, skeletal immaturity and a Cobb angle for the largest curve of 20 to 40 degrees.[4] To be eligible, patients could not have received previous treatment for adolescent idiopathic scoliosis.

 

Methods

During the BRAIST study, patients in the observation group received no specific treatment, whereas patients in the bracing group received a rigid brace, prescribed to be worn for a minimum of 18 hours per day. Participating centres prescribed the type of brace used in their normal clinical practice. Wear time was determined by means of a temperature logger embedded in the brace and programmed to log the date, time, and temperature every 15 minutes. A temperature of 28.0°C (82.4°F) or higher[5] indicated that the brace was being worn.

Both patients and clinicians were aware of the assigned treatment. However, all radiographic (x-ray) evaluations and outcome determinations which were made at the conclusion of the study were performed by experts without knowledge of the treatment protocol, to avoid bias.

 

Results

During the study, a total of 146 patients (60%) received a brace, and 96 (40%) underwent observation only. The two study groups were generally similar with respect to baseline characteristics, except that the patients in the bracing group were slightly taller on average than those in the observation group (156.5 cm vs. 153.6 cm).

The results shown at the end of the study were conclusive – the rate of treatment success was 72% in the bracing group and 48% in the observation group. By contrast, the rate of treatment failure was only 25% with bracing, but 58% with observation alone.[6]

Therefore, given a large sample set and a study carried out across reputable institutions, it was determined that adolescents with idiopathic scoliosis who were considered to be at high risk for curve progression that would eventually warrant surgery, bracing was associated with a significantly greater likelihood of reaching skeletal maturity with a curve of less than 50 degrees, as compared with observation alone.

The study also showed a significant association between the average hours of daily brace wear and the likelihood of a successful outcome. These findings corroborate those of previous prospective observational studies, which have shown a significantly lower rate of surgery among patients who wore a brace than among those who were untreated[7]and a strong relationship between wear time and outcome.[8]

 

Our analysis

The BRAIST study is without a doubt one of the most important pieces of research which informs our work here at the clinic. Since we’re strongly committed to providing the latest, most up to date treatment methodologies available we welcome any and all research which can assist us in fine turning our approach to non-surgical scoliosis treatment.

BRAIST has shown conclusively that bracing is an effective way to treat scoliosis non-surgically, and also confirms a link between correctly prescribed wear time and positive outcomes. At the UK scoliosis clinic, we’re also committed to helping to find ways to treat the 25% of individuals who didn’t get the result they would have liked from the BRAIST study. One of the ways we do this is by offering what we believe is the best scoliosis bracing system available, the Scolibrace system – which is an active correction, individually customised brace designed for maximum correction. Since a variety of braces were used during this study, we hypothesise that the successful treatment figures could have been even higher if more modern concepts in brace design had been adopted for the study. You can learn more about scolibrace here.

 

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

[2] Dolan LA, Weinstein SL. Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine (Phila Pa 1976;32:Suppl:S91-S100

Dolan LA, Weinstein SL. Best treatment for adolescent idiopathic scoliosis: what do current reviews tell us? In: Wright JG, ed. Evidence-based orthopaedics: the best answers to clinical questions. Philadelphia: Saunders, 2009.

Focarile FA, Bonaldi A, Giarolo MA, Ferrari U, Zilioli E, Ottaviani C. Effectiveness of nonsurgical treatment for idiopathic scoliosis: overview of available evidence. Spine (Phila Pa 1976;16:395-401

Lenssinck ML, Frijlink AC, Berger MY, Bierman-Zeinstra SM, Verkerk K, Verhagen AP. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Phys Ther 2005;85:1329-1339

Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev 2010;1:CD006850-CD006850

Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am 1997;79:664-674

Screening for idiopathic scoliosis in adolescents. Rockville, MD: Preventive Services Task Force, June 2004 (http://www.uspreventiveservicestaskforce.org/uspstf/uspsaisc.htm).

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

Danielsson AJ, Hasserius R, Ohlin A, Nachemson AL. A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity. Spine (Phila Pa 1976;32:2198-2207)

[4] Richards BS, Bernstein RM, D’Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976;30:2068-2075)

[5] Dolan LA, Weinstein SL, Adams BS. Temperature as a diagnostic test for compliance with a thoracolumbosacral orthosis. Presented at the Annual Meeting of the Pediatric Orthopaedic Society of North America, Waikaloa, HI, May 3–7, 2010 (poster).

Helfenstein A, Lankes M, Ohlert K, et al. The objective determination of compliance in treatment of adolescent idiopathic scoliosis with spinal orthoses. Spine (Phila Pa 1976;31:339-344

[6] Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. Effects of Bracing in Adolescents with Idiopathic Scoliosis N Engl J Med 2013; 369:1512-1521

DOI: 10.1056/NEJMoa1307337

[7] Danielsson AJ, Hasserius R, Ohlin A, Nachemson AL. A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity. Spine (Phila Pa 1976;32:2198-2207

[8] Katz DE, Herring JA, Browne RH, Kelly DM, Birch JG. Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am 2010;92:1343-1352

June is Scoliosis awareness month

Posted on June 18, 2018 by - Blog

Scoliosis is a serious condition which can cause discomfort, disability and eventually require major surgery if left untreated. Catching scoliosis early makes it much easier to treat, so this week please take a moment to read this quick primer on scoliosis and pass it on to those you care about.

 

What is scoliosis?

Scoliosis is a disorder in which there is a sideways curve of the spine. Curves are often S-shaped or C-shaped. In most people, there is no known cause for this curve, although those who have a family history of scoliosis do seem to be at greater risk.

 

What are the signs and symptoms of scoliosis?

In the absence of formal screening programs scoliosis is often first discovered by parents when they see an obvious curve or hump on their child’s back, especially when bending forwards.

Occasionally scoliosis might be detected through a complaint of back pain, but scoliosis is frequently present without pain.

Typical symptoms include:

  • Uneven shoulders
  • Head appears to be off centre
  • Uneven waist
  • One side of the rib cage is higher than the other when bending forward

 

 

How common is scoliosis

Scoliosis is much more common than most people think. The latest research suggests that between 2 and 3% of children aged 10-15 years will develop scoliosis. This might seem like a small number, but 3% would be 3 in every 100 – which would be one in every 30. Therefore, about one child in each school class will develop scoliosis.

Girls are more likely to develop scoliosis than boys (about 75% of scoliosis patients are girls) but boys can and do develop scoliosis too. Research suggests that some sports and activities are associated with a higher risk of scoliosis – the most notable example are ballet dancers and gymnasts, where the condition is us up to 12 times more prevalent[1][2].

 

How is scoliosis treated

If scoliosis is not diagnosed early, or if the scoliotic curve is left to develop unchecked then surgery to fuse the spine may eventually be required. It was once thought that this was the only effective means of treating scoliosis – which is one of the reasons why a screening program was not put into place. [3]

Today there are a wide variety of approaches which can be used to treat scoliosis non-surgically. These methods are far less physically invasive and much less emotionally disturbing, especially for young people. Evidence strongly indicates that non-surgical treatment can be highly successful in reducing the chance that surgery will eventually be required.[4]

Often, more than one approach can be used to develop a treatment program – the two main approaches used at our clinic are scoliosis specific exercise and scoliosis bracing, however we may also complement these approaches with evidence-based Chiropractic treatment or postural correction programs. While these additional tools do not directly reduce scoliosis, they can often assist the sufferer in terms of pain relief, or with regards to improving body symmetry.

 

What can I do?

The biggest single factor in ensuring a good outcome for scoliosis patients is early diagnosis – a very small curve is much easier to stabilise and correct than a larger one. June is Scoliosis Awareness Month. Throughout the month, our aim is to raise awareness about scoliosis screening and the importance of early detection -you can help by raising the issue of scoliosis with your child’s school, local clubs or youth groups.

This month, we are offering free scoliosis screening sessions and informational talks to schools. So if you know anyone who might be interested, please ask them to get in touch!

You can screen for scoliosis yourself, at home, using our scoliscreen tool – available at  (https://scoliosisclinic.co.uk/scoliscreen/) if you’re a parent please feel free to use this tool to screen your own children.  It’s an excellent idea to screen all children, but those between 10 and 15 are at the highest risk. If you do have a child who participates in a high-risk activity, please take a moment to screen them if you possibly can.

If you have concerns about a young person, please don’t worry – simply get in touch to book a free professional screening here at our clinic.

 

[1] Tanchev, Panayot I. MD; Dzherov, Assen D. MD; Parushev, Anton D. MD; Dikov, Dobrin M. MD; Todorov, Miroslav B. MD, Scoliosis in Rhythmic Gymnasts, Spine: June 1st, 2000 – Volume 25 – Issue 11 – p 1367-1372

[2] Longworth, Brooke et al. Prevalence and Predictors of Adolescent Idiopathic Scoliosis in Adolescent Ballet Dancers Archives of Physical Medicine and Rehabilitation , Volume 95 , Issue 9 , 1725 – 1730

[3] R Shands, JS Barr, PC Colonna, L Noall, End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopedic Association.  J Bone Joint  Surg 23A  (1941) 963-977.

[4] M Rigo, C Reiter, HR, Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil 6(3-4)  (2003) 209-14.

Why Scoliosis Screening matters, and what we’re doing about it

Posted on June 13, 2018 by - Blog

Screening for Scoliosis..

Today, most scoliosis clinicians 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, its also possible to pre-screen a friend of family member at home in less than 5 minutes. Early detection of a developing scoliotic curve means it is easier to treat and has a more successful outcome.

It’s for this reason that scoliosis screening is considered as a beneficial stage of treatment amongst the Orthopaedic community, as it is reported in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)[1].

For years, clinicians have argued that school screening would be the best way to maximise the benefit of what we now know about scoliosis – Despite this, school screening has still not been routinely performed in the UK for many years. At the UK scoliosis clinic, we strongly support school screening – which is why we have an ongoing outreach program designed to provide exactly this service.

 

Arguments against screening

The main arguments against scoliosis screening in schools have been the associated cost, and the possibility of false positives.

Let’s take the cost issue first. It’s fair to say that in the past this argument carried weight – historically It was thought that surgical approaches were the only effective treatment for scoliosis, although some of the studies which informed this opinion were actually highly problematic[2]. Based on this assumption, early detection of scoliosis was not thought to be especially useful, with the argument following that the expenditure was not justified.

The argument that only surgery was an effective treatment for scoliosis also resulted in the argument that a child can simply wait until the curve is severe before it is detected – this means that the child will in the end require spinal fusion. However, this is not in line with the current thoughts of leading world experts from SOSORT and the Scoliosis Research Society (which include the world’s leading scoliosis surgeons).

They both recommend that bracing should be performed as a first line defence against scoliosis progression. When results were published from the BRAiST study in 2013[3], 58% of observed patients had curves greater than 50° at skeletal maturity, while only 25% of braced patients reached curves over 50°. This meant there was a 56% reduction of relative risk to surgery levels in braced patients and treatment costs for braced patients were less than those requiring surgery.

There are some significant issues with this argument however –  firstly, the evidence on which this approach was based was initially conducted all the way back in the 1940s[4] so it makes sense for us to re-examine the evidence and technology we now have available.

Secondly this research did not actually seek to define the cost of scoliosis screening on an individual basis – nor did it do so in the context of the kind of quick and easy screening which is available today, so any judgement about the cost is highly subjective.

In actual fact, we do now know exactly what scoliosis screening in schools would cost on an individualised basis – research carried out between 2000 and 2007 demonstrated that the direct cost for the examination of each child who participated in the program for the above period was just 2.04 €.[5] It is reasonable to suggest that costs today could be even lower!

 

Adams test

The Adams test is a simple test for scoliosis

The second argument against screening has been the chance of false positive results. For many parents, the chance of a false positive is far less of a concern than a missed diagnosis – however there is a great deal which can be done to reduce false positives.

At the UK scoliosis clinic, our scoliosis staff have specialist scoliosis screening training which allows us to screen scoliosis with a high degree of accuracy. Essentially, preventing false positives comes down to properly trained staff using appropriate methods. The best screening services will therefore always be those offered by scoliosis specific clinics, but there is no reason that local medical staff could not be trained to improve their screening ability, taking into account the latest research just as we do at the clinic.

Getting screening right relies on really understanding the way scoliosis and the spine work – For example, by screening children in sitting position with the use of a scoliometer, the number of false referrals can be decreased dramatically because the effect of leg length inequality and pelvic obliquity on the spine is eliminated. The sitting position reveals the true trunk asymmetry which could be associated with Idiopathic Scoliosis (IS)[6] – it is therefore one of our standard diagnostic tools.

 

Why we should screen

Aside from the fact that the arguments against screening no longer seem to stand up it’s also clear that screening for scoliosis in schools provides the best (sometimes only) opportunity for early diagnosis and therefore allows for non-surgical treatment, which is often not the case in the absence of screening[7].

In their most recently published joint information statement on scoliosis screening, the American Academy of Orthopaedic Surgeons, Scoliosis Research Society, Paediatric Orthopaedic Society of North America and American Academy of Pediatrics all agreed that there does not appear to be any significant medical reason not to screen for scoliosis[8].

Scoliometer

A scoliometer is used to measure scoliosis

Today there is significant evidence which shows that the number of scoliosis sufferers eventually requiring surgery can significantly be reduced where non-surgical treatment (such as scoliosis specific exercise, or bracing) is available on a high standard.[9][10][11] If we work from a modern viewpoint, rather than an outdated one, we can therefore see the real value of school screening. Indeed, school screening is often the only tool we have to detect mild and moderate spinal curves which can be easily treated with non-surgical methods.

The most recent research also confirms that this is more than just informed speculation – research does confirm that in areas where screening programs exist, fewer patients ultimately require surgery for IS.[12]

In 2006, research from the University College Hospital and The London Clinic[13] assessed the severity of scoliosis presentation over 30 years. What the authors found was, that since mass school screenings were abandoned in the 1990’s, in the year 2000 only 8% of patients had been identified at school compared to 32% in 1985 and that the number of patients presenting with curves greater than 40° had increased to 70%. This meant that for many of these patients non-surgical care would be less effective and the likelihood of requiring surgery was much greater. The author’s recommended that greater community awareness was required to enable earlier detection.

 

What we’re doing

At the UK Scoliosis clinic, our guiding principle is to follow the latest research in order to treat scoliosis with the most up to date methods available. We’re therefore strongly in favour of screening in schools, and amongst higher risk populations such as gymnasts and dancers.

On our website you can find our free to use scoliscreen tool – which will help you to screen a friend or family member for scoliosis. This is a great starting point if you have concerns.

Professional and highly detailed (but totally painless!) screening is always available at our clinic – book in for a consultation and we’ll be able to determine if you have scoliosis, or if you might be at the risk of development. If scoliosis is detected, were ideally positioned to help.

The UK Scoliosis clinic also offers scoliosis screening events to schools, sports groups and organisations.

 

 

 

 

[1] TB Grivas, MH Wade, S Negrini, JP O’Brien, T Maruyama, M Rigo, HR Weiss, T Kotwicki, ES Vasiliadis, LS Neuhaus, T Neuhous, School Screening for Scoliosis. Where are we today? Proposal for a consensus. Scoliosis 2(1)  (2007) 17

[2] R Shands, JS Barr, PC Colonna, L Noall, End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopedic Association.  J Bone Joint  Surg 23A  (1941) 963-977.

[3] BRAiST https://www.nejm.org/doi/full/10.1056/NEJMoa1307337

[4] AR Shands, JS Barr, PC Colonna, L Noall, End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopedic Association.  J Bone Joint  Surg 23A  (1941) 963-977.

[5] TB Grivas, ES Vasiliadis, C Maziotou, OD Savvidou, The direct cost of Thriasio school screening program.  Scoliosis 2(1) (2007) 7.

[6] TB Grivas, E Vasiliadis,  G Koufopoulos,  D. Segos, G Triantafilopoulos, V Mouzakis, Study of trunk asymmetry in normal children and adolescents.  Scoliosis 1(1)  (2006) 19.

[7] WP Bunnel, Selective screening for scoliosis. Clin Orthop Relat Res 434  (2005) 40-5.

[8] Information Statement: Screening for idiopathic scoliosis in adolescents. American Academy of Orthopaedic Surgeons (AAOS), Scoliosis Research Society (SRS), Pediatric Orthopaedic Society of North America (POSNA) and American Academy of Pediatrics (AAP), October 1, 2007.

[9] M Rigo, C Reiter, HR, Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil 6(3-4)  (2003) 209-14.

[10] T Maruyama, T Kitagawa, K Takeshita, K Mochizuki, K Nakamura, Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment?  Pediatr Rehabil 6(3-4)  (2003) 215-9.

[11] B Lee, The Correct Principles of Treatment of Angular Curvature of the Spine. 1872, Philadelphia, USA.

[12] T.B. Grivas et al.  “How to Improve the Effectiveness of School Screening for IS” The Conservative Scoliosis Treatment (2008) p 120

[13] Detection of adolescent idiopathic scoliosis, Muhammad Ali Fazal, Michael Edgar, Acta Orthopaedica Belgica, 2006, 72, 184-186

 

Scoliosis and sport- what’s the best approach?

Posted on June 6, 2018 by - Blog

When many people discover they have scoliosis (or when parents discover their child has scoliosis) one of the first things they ask is often “do I need to give up X sport”.

There is a great deal of misinformation around scoliosis and sport, perhaps this is mainly because there is a perception that scoliosis and sport don’t mix. It’s certainly true that on average scoliosis sufferers do tend to be less physically active – in some cases this might be related to the condition (severe scoliosis can make exercise more difficult)[1] but the cause can also often be social in nature.

It’s also true that some activities (Especially those which involve contorting the spine) do tend to correlate with a higher incidence of scoliosis sufferers amongst its participants. Ballet and rhythmic gymnastics are good examples.

Today, we’ll attempt to tease out some easy to follow guidelines for scoliosis sufferers – here’s what we do know:

 

Should I exercise with scoliosis?

Cardiovascular exercise is always good for you.

Whether you suffer from scoliosis or not, exercise in any form is going to be beneficial to your body. Exercise results in health benefits such as an increase in cardiovascular health, increased aerobic capacity, increased bone density, improved mental outlook, reduced body fat and increased life expectancy.

This means that in general, it certainly is advisable for scoliosis patients to exercise regularly. What might need some consideration is the type of exercise undertaken – especially when dealing with adolescents who are still growing and are therefore more skeletally immature.[2] This being said, much of the advice that goes for adolescent scoliosis patients could also be applied to non-scoliosis patients!

 

Which exercises should scoliosis sufferers be careful with?

At the UK scoliosis clinic, we focus heavily on individualised care. Rather then taking the group treatment or “bootcamp” route, we tailor scoliosis treatment to an individual’s exact requirements. For that reason, we’re not so quick to say that certain exercises should be avoided altogether. That being said, there are some forms of exercise which need to be performed carefully and with a mind to avoiding stressing the spine, especially in adolescents. These include:

 

Impact sports carry a risk to the spine for everyone

Impact sports

Impact sports such as rugby are a cause for concern not only with scoliosis patients, but with adolescents in general. The risk here is obvious, an impact injury always carries a risk of concussion, spinal injury or damage to the joints. In a scoliosis sufferer, this kind of injury might serve to worsen the progression of the scoliotic curve. [3]

When considering impact sports, we should also include athletic events such as long jump or high jump which can place significant load on the spine if performed with poor technique.

Adolescents are at the highest risk here, but much of this can be mitigated by playing non-impact versions of the sport in question, such as touch rugby – which is probably to be recommended anyway!

 

Resistance training

Some forms of resistance training, such as free weight lifting can post a risk to the scoliosis sufferer. The curvature of the spine disturbs the body’s natural balance and makes it more likely that an injury arising from spinal loading will occur. This is not to say that resistance training should be avoided altogether – instead, targeted programs using appropriate equipment (lean towards fixed weights and bands) should be used.  Also of concern is the mount of weight used during resistant training , due to increased lading or compressional forces, which can compress the growth plates and potentially inhibit vertebral body growth and may progress or worsen scoliosis.

At the UK scoliosis clinic, we are especially well equipped to work with patients to improve their balance and posture, which will greatly reduce this risk – through methodologies such as chiropractic biophysics, postural analysis and scoliosis specific exercise.

 

“One-sided” activities

Asymmetric loading simply means that the spine is being subjected to different degrees of force on either side. If you carry a rucksack on your back by a single strap, you’re asymmetrically loading your spine.

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

The risk with asymmetric sports is that over time, one side of the body (and of the muscle supporting the spine) becomes stronger and larger than the other side – this factor can then serve to worsen scoliosis. Assuming a proper warm up there is very little risk in actually participating in these kinds of sports.

The solution is 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. Again, this is important to scoliosis patients, but good advice for anyone!

 

Are there exercises which cause scoliosis?

Ballter dancer

Ballet dancing can increase scoliosis risk substantially

There is some evidence that certain types of exercise – those which contort the spine – may promote scoliosis. These include ballet, dance and rhythmic gymnastics. Various studies have suggested that scoliosis incidence is anywhere between 12 and 30% more common amongst gymnasts[4]

Much more research on these correlations is required in order to make concrete determinations about the risk posed by these kinds of activities – it may, for example, simply be the case that scoliosis is more likely to be noticed among these disciplines, since there is more awareness of it.

It seems reasonable, however, to suggest that you book an appointment for an individual consultation before continuing with dance, ballet or gymnastics. In most cases, scoliosis does not need to prevent you from participating – but a personalised treatment plan should be put in place to ensure you are properly supported.

 

Which exercises are good for scoliosis sufferers?

It was once thought that swimming might be an effective treatment for scoliosis, and there’s no doubt that some scoliosis sufferers do use swimming as an enjoyable part of their scoliosis specific workout routine. Recent research has unfortunately suggested that swimming is not an effective treatment for scoliosis[5] – but more research is required in this area. Incidentally, the same study showed that swimming might increase the risk of hyper-kyphosis.

In general, low impact exercise is ideal for scoliosis sufferers, as is exercise which does not progress to the point of exhaustion. Since a many scoliosis patient also suffer with poor coordination exercises designed to improve coordination can also be beneficial as this helps to improve the body’s sense of position. Exercise taken to the point of exhaustion increases the risk of injury in anyone but carries more risk for the scoliosis sufferer.

Therefore, shorter runs or working out on an elliptical machine is a good alternative for basic cardio workouts. Biking is also a good alternative, as long as there is not too much forward flexion of the lumbar spine.

 

Summary

The most important factor to take away from this blog is the need for individualised care. Each scoliosis sufferer is an individual and requires a treatment plan which works for them and their choice of sport.

At the UK scoliosis clinic, we have in house sports therapists, postural specialists and chiropractors certified in chiropractic biophysics who can work with you to make modifications to your exercise routine to minimise risk whatever your sport!

 

 

[1] Pediatric Exercise Science. 30, 2, 243-250, May 2018

[2] Eur Spine J. 2011 August; 20(Suppl 3): 415–419. Beneficial effects of aerobic training in adolescent patients with moderate idiopathic scoliosis

[3] J Pediatr. 2015 Jan;166(1):163-7. doi: 10.1016/j.jpeds.2014.09.024. Epub 2014 Oct 25.

[4] https://scoliosisclinic.co.uk/blog/ballet-dancing-increase-risk-scoliosis/

[5] J Pediatr. 2015 Jan;166(1):163-7. doi: 10.1016/j.jpeds.2014.09.024. Epub 2014 Oct 25.

New research – Scoliosis impacts functional capacity

Posted on May 28, 2018 by - Blog

Tired out girl

Scoliosis can make exercise more difficult

Adolescent idiopathic scoliosis (AIS) is by far the most common cause of spinal deviation; it comprises about 80% of all idiopathic vertebral deformities and affects 2%–4% of adolescents.[1] The exact cause of AIS is still being investigated, but scientists generally agree that it is largely determined by genes that are activated by different factors.

When thinking about how we should direct the treatment of scoliosis, we often tend to focus on the well-known potential outcomes of the condition if left untreated- these include physical deformity, disability, pain and discomfort.  What we often forgotten is the impact that scoliosis can have in terms of overall health and fitness.

As it stands, research has already confirmed that that scoliosis influences factors like ease of breathing during exercise in a negative way[2] However, brand new research just published in the Journal of Paediatric exercise science now allows us to understand the degree to which cobb angle (the degree of the scoliotic curve) actually has an impact.

The research conducted at the Federal University of São Paulo in 2018, hypothesised that Individuals with scoliosis would have lower exercise tolerance in cardiopulmonary exercise testing (CPET) and in the incremental shuttle walk test (ISWT) – a suggestion which has already been confirmed in preceding studies.[3]  Researchers then sought to evaluate the functional capacity (that is to say, the ability of the participants bodies to cope with exercise) in patients with AIS with specific regard to the functional capacity and respiratory variables in patients with different degrees of scoliosis severity.

 

Participants

The study tested a cross section of participants with varying degrees of scoliosis severity. The group included eighteen patients with mild and moderate scoliosis, 8 patients with severe scoliosis, and 10 adolescents from a control group. Patients were selected from the Orthopaedic Clinic at a local hospital, and  they  were  submitted for radiography to evaluate the Cobb angles prior to the study.

In order to ensure the results were relevant and valid, patients were excluded if they had a previous or current history of heart, lung diseases or neuromuscular disorder, cognitive changes that influenced the understanding of tests, and all those who failed to perform the assessment proposed.

 

Results

A 54 Degree Cobb angle (X-ray)

During the ISWT participants are asked to walk between two cones, placed 10 meters apart. Participants aim to match the pace provided by a simple beeping prompt. In this study, each of the partcipants performed the test twice, in order to try to ensure more even results.

Heart rate, blood pressure and fatigue were measured by modified Borg scale before and after the test[4]. The results of the study were conclusive. In the study, patients with AIS definitely performed worse than test subjects without scoliosis. Those with scoliosis found the test harder (more physically taxing) and also displayed a lower level of respiratory function. What’s more, the performance of the individuals with scoliosis was worse in individuals with a more severe cobb angle. Overall, patients with AIS walked shorter distance during the ISWT when compared with adolescents without scoliosis. Patients with  AIS > 45°  and  AIS < 45°  walked,  respectively, 156 m and 117 m less than the control group.

This study therefore identified that patients with severe scoliosis present worse functional capacity and, perhaps of greatest interest, it draws attention to the fact that even patients with mild and moderate scoliosis already show a significant reduction in functional capacity.

 

What we learn from this study.

At the UK scoliosis clinic, we are committed to ensuring that all our approach to treating scoliosis is always grounded in the most up to date scientific research available. From the results of the study there are two important take-aways.

In the first instance, the study goes to show the degree to which even a minor case of scoliosis (of the sort which may respond particularly well to bracing) may impact the quality of life and capability of an individual to participate in exercise – both for health-related purposes, and indeed as a social exercise. This is particularly interesting given that the authors of this study also noted a correlation between individuals with scoliosis and low exercise participation rates. Specifically the authors note “Adolescents with scoliosis for some reason are physically unconditioned; some authors believe that this fact is related only to the low adherence of individuals to physical activity, mainly due to the constraint of the disease deformity” .  This research therefore goes to underscore the importance of early intervention in dealing with cases of adolescent idiopathic scoliosis.

Secondly, this study (by its methodology) suggest that the ISWT can be a valuable tool for assessing functional capacity in patients with AIS. As a relatively low-cost but widely applicable test, the ISWT may therefore be worth further consideration within the scoliosis treatment community. Dr Irvine is keen to follow up on this insight and will be considering its possible applications within our clinic.

 

The main source article for this post was:

 SARAIVA, BA; et al. “Impact of Scoliosis Severity on Functional Capacity in Patients With Adolescent Idiopathic Scoliosis”. Pediatric Exercise Science. 30, 2, 243-250, May 2018

 

 

[1] Weinstein SL, Dolan LA, Cheng JCY, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008;371:1527–37. PubMed doi:10.1016/S0140-6736 (08)60658-3

 

[2] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041

 

[3] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041

 

Sperandio EF, Vidotto MC, Alexandre AS, Yi LC, Gotfryd AO, Dourado VZ. Exercise capacity, lung function and chest wall shape in patients with adolescent idiopathic scoliosis. Fisioter Mov. 2015;28(3):563–72. doi:10.1590/0103-5150.028.003.AO15

 

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Bas P, Romagnoli M, Gomez-Cabrera MC, et al. Beneficial effects of aerobic training in adolescent patients with mod- erate idiopathic scoliosis. Eur Spine J. 2011;20 Suppl 3: 415–9. PubMed doi:10.1007/s00586-011-1902-7

 

[4] Hommerding PX, Donadio MV, Paim TF, Marostica PJ. The Borg scale is accurate in children and adolescents older than 9 years with cystic fibrosis. Respir Care. 2010;55(6):729–33. PubMed

SOSORT 2018 Conference in Dubrovnik

Posted on May 13, 2018 by - Blog

The view!

The idea of traveling to Dubrovnik, Croatia, made it a very easy decision to attend this years SOSORT conference. As expected it turned out to be a very beautiful venue with amazing views and sunsets while at the same time I was able to be updated with the latest knowledge and developments in every area concerning scoliosis.

It was great to renew acquaintances and meet different scoliosis experts from throughout the world. Over 250 delegates had travelled from 37 countries including Australia, Singapore, Hong Kong, Turkey, North America and from all over Europe to present the latest developments in research on scoliosis to help scoliosis sufferers throughout the world.

I was able to spend time with Dr Jeb McAviney from Scolicare, Australia, the developer of Scolibrace and learn of new developments in the bracing system. He was presenting research on the accuracy and efficacy of ScoliScreen as a online tool that can be used in the initial screening for scoliosis. This was a pilot study and showed that ScoliScreen was accurate as a screening tool and deserved more research into its effectiveness. You can find the ScoliScreen app on our clinic website.

Paul and Jeb

Dr McAviney also presented a case study on the treatment of a 11 week old boy with Infantile Idiopathic Scoliosis. Traditional gold standard treatment will typically require serial hard plaster casting up until the age of 2 years, this is usually done under a general anaesthetic which may adversely affect the child’s brain development. Once the child was determined to not have any underlying medical issues that could cause scoliosis, Dr McAviney made a rigid over-corrective 3D brace with computer generated imaging which doesn’t require anaesthetisation and rigid casting. The brace was gradually built up to being worn 6 hours per day for the following 8 months, at the end of that time the curve had reduced from 31 to 7 degree’s. This case study, was a great step forward in building evidence on rigid over-corrective bracing in infants as it means that they may not necessarily have to be in a full time plaster cast which cannot be removed and need another general anaesthetic every time a new brace is done.

 

I was able to meet and spend time with Mr Tony Betts one of the head physiotherapists at the Royal Orthopaedic Hospital in Stanmore. Mr Betts has worked with scoliosis patients for many years and has a wealth of knowledge on the various treatment approaches to scoliosis. He has been trained in a variety physiotherapy scoliosis exercise techniques and lectures on scoliosis, so it was great to discuss with him the different exercise approaches towards scoliosis.

Paul and Tony

One point that was re-iterated by several speakers including the conference organisers Dr Suncica Bulat Wuersching & Andreas Wuersching during the conference was the age sensitive time that adolescent idiopathic scoliosis develops and the importance in management of associated psychological factors. Adolescents can find brace wear challenging at times and will often report their brace wearing time to be greater than the actual brace wear time. In patients where brace wear is less than prescribed the effectiveness of bracing significantly reduces. When patients are able to speak and talk freely with appropriately trained psychologists and supportive parents, brace compliance improves. This re-iterates that bracing success not only depends upon the adolescent, but also upon the support of their family, friends and healthcare team.

 

 

What was most inspiring about the conference was the fact that, so many different professions from all over the world had come together to improve the lives of people with scoliosis. This focus is paving the way towards improving earlier diagnosis and risk analysis, less invasive and more appropriate treatment, more effective exercise and bracing treatment, understanding longer term prognosis and outlook and a better overall patient experience. This means that exciting times lay ahead for patients as the international knowledge base builds, enabling scoliosis to be detected earlier so the right treatment is given and  progression prevented.