Category: Blog

Vibration Based Therapy for Scoliosis

Posted on September 29, 2021 by - Blog

Scoliosis researchers are nothing if not creative, and today we’re looking at a lesser-known, but interesting additional approach published in 2017.

In the field of physiotherapy in general, there has recently been a trend to incorporate vibration platforms into routines designed both for prevention and rehabilitation. Whole-body vibration (WBV) is a reflex-based neuromuscular form of training, and Side-alternating WBV (sWBV) is a special form of WBV which uses a “side to side” type of motion. It’s already known that this kind of vibration platform can be of use of physiotherapy, with studies reporting increased muscle force and power as well as effects on neural activity.[1][2][3]

The study authors point out that vibration-assisted exercises have the advantage of short training periods with a high number of muscular contractions/ repetitions, while the increasing availability of these kinds of vibration platforms make a home training program a real possibility. A home program also has the advantage of possible better compliance compared to frequent visits for supervised therapy programs. With these benefits in mind, this study sought to investigate the possibility of incorporating vibration therapy with Schroth based exercise and bracing for Scoliosis patients.

 

Study details

The study[4] was a randomised controlled trial, with assessments performed at month 0 and moth 6. The participants were randomly assigned to either a scoliosis specific exercise program on a vibrating platform or “treatment as usual” – here, normal Schroth exercise.

40 participants were recruited through the Paediatric Rehabilitation Centre, UniReha GmbH, University of Cologne, Germany in collaboration with the Department of Orthopaedic and Trauma Surgery, University of Cologne, Germany. Included were girls with moderate AIS (according to the SOSORT criteria) aged 10 to 17 years. Further inclusion criteria were: experience with auto-corrective physiotherapy (specifically Schroth) and use of a Chêneau brace at least 16 hours per day.

Participants of the intervention group received an introduction to the sWBV system and the exercises before the start of the home-training program. They received an exercise program including four different exercises: standing (16-20 Hz), sitting (18-25 Hz) and two different kneeling positions (10-20 Hz). Exercises were designed to incorporate auto-correction and stabilising physiotherapy. Each exercise was performed at home for three minutes (4×3 minutes) five times per week.

Each participant received an exercise folder containing photos of the exercises and individual adaptations according to the severity of curvature and a training schedule. Each participant documented the home-training program in a training log. For six weeks the participants received a weekly in-patient check; then the check-up frequency was reduced to bi-weekly. Serious unexpected events were recorded at each visit.

The participants of the control group were instructed to continue with their usual auto-corrective physiotherapy. This usually contains bi-weekly training under the supervision of a physical therapist and a daily home-training program. Schroth exercises focus on strengthening of the spinal musculature and elongating shortened muscles on the concave side of the spinal curvature.

 

Results

The results from the study were certainly positive – and suggest that further research and experimentation with this method may well be worth considering. The major scoliosis curve in the sWBV group decreased significantly by -2.3°, compared to the difference in the control group of 0.3°. In the sWBV group 20% (n=4) improved, 75% (n=15) stabilized and 5% (n=1) deteriorated by ≥5°. In the control group 0% (n=0) improved, 89% (n=16) stabilized and 11% (n=2) deteriorated. The authors also observed that the clinically largest change was observed in the ‘before menarche’ sub-group.

While it’s important always to remember that a single study is not enough evidence to make a firm conclusion, this line of research is of great interest to us at the UK Scoliosis clinic, since we already utilise vibration-based therapy in treating other (non-scoliosis) conditions, and have observed results (in terms of speed of outcome) which are broadly consistent with these findings. We’ll be keeping this option under close review!

 

[1] Matute-Llorente A, Gonzalez-Aguero A, Gomez-Cabello A, Vicente-Rodriguez G, Casajus Mallen JA. Effect of whole-body vibration therapy on health-related physical fitness in children and adolescents with disabilities: A systematic review. J Adolesc Health. 2014;54:385–96.

[2] Cochrane DJ. The potential neural mechanisms of acute indirect vibration. J Sports Sci Med. 2011;10:19–30.

[3] Rittweger J, Mutschelknauss M, Felsenberg D. Acute changes in neuromuscular excitability after exhaustive whole body vibration exercise as compared to exhaustion by squatting exercise. Clin Physiol Funct Imaging. 2003;23:81–6.

[4] Sina Langensiepen et al. Home-based vibration assisted exercise as a new treatment option for scoliosis – A randomised controlled trial J Musculoskelet Neuronal Interact. 2017 Dec; 17(4): 259–267.

Physiotherapy may improve functional capacity in younger scoliosis patients

Posted on September 13, 2021 by - Blog

It’s been established (and we’ve written several times about it) that scoliosis can impact both quality of life, and functional capacity – that is to say, the ability of a patient to live without pain and move around normally without struggling. While not all patients are affected, a large number report either pain reduced functional capacity or both. A recent study suggests that a targeted, 12-week physiotherapy intervention can result in significant improvement where this is the case.

 

Scoliosis and functional capacity

While the primary issue with scoliosis is the spinal deformation, the conditional can also cause decreased spinal movement, weakening of muscles near the spine, chronic pain, psychological suffering, reduced pulmonary function, and respiratory dysfunction.[1] Typically, more significant scoliosis cases are associated with more severe symptoms, however abnormal ventilatory patterns and respiratory muscle involvement have been reported in patients even with asymptomatic mild scoliosis who may be free of any respiratory dysfunction at rest.[2] Impaired exercise tolerance and physical deconditioning can also be early manifestations in patients with mild scoliosis.[3]

The majority of research in this field, has to date, been focused on larger curves however – With this in mind, a recent study[4] sought to explore the pulmonary function and functional capacity in school children and adolescents with mild or moderate idiopathic scoliosis who were included in a rehabilitation programme

 

Study information

The study included 49 school children and adolescents with idiopathic scoliosis. The patients were selected from those who visited the Rehabilitation Department of Paediatric Surgery, Louis Turcanu Children’s Hospital Timisoara, Romania. For each participant, the study authors recorded their demographic characteristics (age, sex, weight, and height) and physical activity behaviours (hours of time spent at a desk and at a computer per week, and hours of competitive and non-competitive practice of exercise per week). The patients were assessed clinically by the same orthopaedic surgeon. An X-ray examination of the spinal column in the standing anterior–posterior view was then performed. The X-ray examination and Cobb angle measurement were performed by a single investigator who was a radiologist. Mild scoliosis was defined by a Cobb angle <20° and moderate scoliosis was characterized by a Cobb angle between 21° and 35°.

Study participants were assessed before beginning rehabilitation and then again at 12 weeks after an exercise-based rehabilitation programme. Each evaluation consisted of spirometry (breathing) tests and functional capacity testing (6-minute walk test). Assessment of pulmonary function and the 6MWT were performed by the same investigator who was a specialist in physical medicine and rehabilitation. At each assessment, the participants were also assessed for back pain – an issue which is increasingly being recognised as a feature of Scoliosis.

 

Physical therapy

The patients performed a 12-week exercise programme that consisted of three sessions per week in the Outpatient Rehabilitation Department. The goals of the rehabilitation treatment were to improve awareness of body alignment, axial elongation, de-rotation and stabilization of the spine, increase chest expansion, and enhance exercise capacity. The exercise programme consisted of stretching exercises on the concave side of scoliosis, strengthening exercises on the convex side of scoliosis, and breathing exercises. Some specific exercises for core stabilization were performed, including spider (patients faced the wall, leaned forward and walked with fingers up the wall rising to their toes, and after full extension, walked with the fingers back down), pelvic tilt, cat-camel pose, and basic trunk curl (crunch) exercises using a ball (back extensions, opposite arm, and leg rise), and quadriceps strengthening exercises, which are important in increasing work capacity. Patients used rotational breathing respiratory exercises, such as contraction of convex areas of the trunk and directing inspired air in the concave areas. In each case, the specific core stabilization programme was established according to the individual spinal characteristics.

Patients with moderate scoliosis also had the indication to wear a corrective orthosis (Chêneau brace) for 20 hours per day

 

Results

Overall, the study concluded that in the participants, pulmonary parameters and functional capacity were improved after 12 weeks of supervised physical therapy. Results from the spirometry tests, as well as the 6-minute walk test, showed improvement – although the authors did note that the study participants still lagged behind their non-scoliosis counterparts in terms of respiratory factors.

Also of interest, especially given other recent findings in this area, was that approximately three-quarters of the patients had back pain at the beginning of the study, whereas at the final evaluation, only 50% still had back pain.

Based on the results, the authors suggest treating scoliosis as soon as possible after diagnosis in a rehabilitation centre under medical qualified supervision. They also note that the Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment currently recommends physiotherapeutic scoliosis-specific exercises as the first step for treating idiopathic scoliosis to prevent or limit the progression of the deformity and bracing and stress that Scoliosis-specific exercise programmes should also be designed by specifically trained therapists – further, they stress (as do we) that These programmes must be individualized and performed regularly throughout treatment.

 

[1]  Weinstein, SL, Dolan, LA, Spratt, KFet al. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA 2003; 289: 559–567.

 

[2]  Durmala, J, Tomalak, W, Kotwicki, T. Function of the respiratory system in patients with idiopathic scoliosis: reasons for impairment and methods of evaluation. Stud Health Technol Inform 2008; 135: 237–245.

 

[3] Koumbourlis, AC. Scoliosis and the respiratory system. Paediatr Respir Rev 2006; 7: 152–160.

[4] Elena Amăricăi et al. Respiratory function, functional capacity, and physical activity behaviours in children and adolescents with scoliosis. Journal of International Medical Research Volume: 48 issue: 4,

What is Schroth best practice?

Posted on August 20, 2021 by - Blog

Schroth therapy is one of the oldest and most well-established approaches to Scoliosis – while it was once a somewhat niche approach (or at least viewed as such) in the years before significant research on non-surgical treatment options began to take place, today Schroth is a well-developed program backed by a great deal of scientific research – much of it supported by some of the most important names in the Scoliosis treatment field.

Schroth therapy has recently been “updated” and improved upon, taking into account more modern developments and research, this has been branded as the “Schroth best practice” program.

Schroth best practice offers not only an update to the traditional methods but also a simplification for the patient’s perspective. While the traditional Schroth therapy is still viewed in some circles as the best option for larger curves, Schroth best practice offers an easier to learn program effective for smaller curves. It has been shown by Borysov and Borysov[1] as well as in a paper by Lee 2014[2] that this new program can be highly effective.

These are just two more studies that show that Schroth therapy has real value for the right kind of patient – however, recent research has also called into the question the value of Schroth best practice, over the more traditional approach to Schroth.

 

Recent studies

A recent meta-analysis (that is to say, a study of studies[3]) looking at the overall effectiveness of Schroth based approaches have provided us with a timely reminder that the right treatment at the right time is critical – since contrary to the evidence from Borysov and Lee, this study found that the more traditional Schroth and Schroth 3d  treatment  programs actually have provided a more favourable effect than the newer best practice approach.

The finding is somewhat complex – among  15  studies that were included in this meta-analysis,  eight studies investigated general Schroth exercise, four studies investigated Schroth 3d treatment, and three studies investigated Schroth best practice. all 4 Schroth 3d treatment studies covered a 6 month (or longer) treatment period –  however,  only  1 Schroth best practice study was conducted over a 6 month period. The two other studies investigated  Schroth best practice treatment for  1   month and under 1 week. This is problematic since only “Bootcamp” style scoliosis treatment options actually provide treatment for under a month – and it’s widely recognised (including by the Schroth best practice school of thought) that longer duration treatment will be more effective – nonetheless, over the short term, the more traditional approaches appeared to be more effective.

 

From this, the study authors concluded that the improvements added to the Schroth best practice approach notwithstanding,  exercise duration is more important than the specific type of Schroth therapy being for overall results. [4]

 

Is Schroth best practice the way forward?

Schroth best practice is just one strand of treatment within the Schroth group of approaches – Like all approaches, some studies show better results and others, and, being a fairly new approach, it will also take some time for those truly long-duration studies to become available. At the UK Scoliosis clinic, we view Schroth best practice, like more traditional Schroth, as an excellent tool under the right circumstances. We believe in a wholly customised approach, taking the best from whichever therapy is most likely to assist the specific patient in question. What is clear, however, is that just as with bracing, choosing a treatment approach and sticking with it over time is critical for success in non-surgical scoliosis treatment.

[1] Maksym Borysov* and Artem Borysov Scoliosis short-term rehabilitation (SSTR) according to ‚Best Practice’standards-are the results repeatable? Scoliosis 2012, 7:1

[2] Lee  SG.  Improvement  of  curvature  and  deformity  in  a  sample  of patients with Idiopathic Scoliosis with specific exercises. OA Musculoskeletal Medicine 2014 Mar 12;2(1):6

[3] Joo-hee parK et al. Effects of the schroth exercise on idiopathic scoliosis:  a meta-analysis European Journal of Physical and Rehabilitation Medicine 2018 June;54(3):440-9

[4] Joo-hee parK et al. Effects of the schroth exercise on idiopathic scoliosis:  a meta-analysis European Journal of Physical and Rehabilitation Medicine 2018 June;54(3):440-9

We’re developing an App!

Posted on August 7, 2021 by - Blog

On this blog we’ve previously discussed the ways in which some technologies can augment and improve scoliosis diagnosis, and while we’ve also argued that apps cannot yet fully replace the skills of a scoliosis expert we do think that they’re a powerful too for raising awareness and helping people to spot the early signs of scoliosis. The sad reality is that most people today could not recognise scoliosis even in an obvious case – if we can change this even a little bit we’ll be able to improve the treatment outcomes for many patients!

 

Coming soon – the UK Scoliosis clinic screening app!

Scoliosis is a potentially serious condition which can require major surgery if not treated. Thankfully, today it’s easer than ever before to treat Scoliosis without surgery – but doing this relies on early detection. Could you have Scoliosis? About one child in each class at school will develop Scoliosis – now, the UK Scoliosis is going to help people know their risk with our Scoli Check app. It’s coming soon, initially on a web based platforms with plans to roll out for apple and google devices.

 

What’s Scoli Check?

Scoli Check is currently in development, and is intended as a scoliosis pre-diagnostic tool, designed to give you an idea of your risk of developing scoliosis. Scoli Check will be a free to use app which requires no data upload and does not retain any personal information.

Unlike some tools, Scoli Check can be used at home, at school or with friends – It’s easiest to use Scoli Check with a friend or family member, however you can use it alone if you have access to a mirror.

Our plan is currently to release a beta version of Scoli Check in October, so please watch this space for further developments!

It’s important to stress that Scoli Check is not intended as a substitute for a professional diagnosis, rather it is intended to help you begin to discover if you may have scoliosis and then seek help if you have signs and symptoms – we’d always recommend consulting with a scoliosis professional if you have concerns.

 

I think my Child has Scoliosis – 3 things NOT to do

Posted on July 23, 2021 by - Blog

As parents, we all want to do the best for our children – and when you suspect Scoliosis it can be hard to know what to do. Despite efforts from the Scoliosis community the condition is still widely unknown in the general population which can lead to confusion and that feeling of not knowing where to turn. The most important step to take if you do suspect scoliosis is simply to get active – reach out for help and get the ball rolling.

There are, however, a few things you should definitely not do – these three issues are, in our experience, the biggest pitfalls for parents of children with scoliosis, so, wherever possible, do not:

 

Be passive

Because Scoliosis is a lesser known condition, you may well not know anyone who has suffered with the condition. The reality is that Scoliosis should be treated as quickly as possible, as treatment is much easier with a smaller curve, however the lack of awareness in the community can lead to a false sense of lack of urgency. Even amongst those who do know about Scoliosis, many are still unaware that new, non-surgical treatment options now exist. 10- 15 Years ago, it was thought that surgery was the only effective option for treating scoliosis, so even many medial professionals were simply taught that the best approach to scoliosis is to “wait and see” if the curve becomes bad enough for treatment. The problem is that scoliosis almost never resolves on its own[1] so while it’s possible it may not progress further “wait and see” is never a good option – at the very least see a scoliosis specialist and ensure the condition is being monitored.

 

Ignore the costs

Unfortunately, very little non-surgical Scoliosis treatment is available in the UK through the NHS. This means that if you’re looking for non-surgical treatment, you’ll probably be taking about private care. Please do see your GP to find out what is available in your area, but you should expect that Scoliosis treatment will cost you money.

It’s easy to react to these costs by either ignoring them (which isn’t responsible) or failing to contextualise them properly (which isn’t realistic). There are two major factors to consider here. Firstly, if you are seeking help for a scoliosis case which is already severe, the chances for successful treatment without surgery are lower – the larger the existing curve, the higher the chance non-surgical approaches will fail. A reputable scoliosis practitioner will give you the best indication they can as to the possible outcomes of treatment and what you might expect in a best or worst case scenario – you should base your decision on the cost of treatment on your own expectations for outcomes, and how likely they are. In some cases, you may be paying simply to delay surgery which will be required anyway and this is important to remember.

At the other end of the scale, it’s critical to remember that Scoliosis treatment is a long process – the totality of your scoliosis treatment will extend from discovery of the condition through until your child has reached adulthood – it’s therefore essential to remember that the costs for treatment are spread over a very long period of time. The price of a Scoliosis brace, for example, is therefore best considered as a monthly one over duration of the brace, rather than a single one off cost.

 

Forget about mental health

Scoliosis can be stressful for everyone involved – and since it’s a condition which commonly affects teens and young adults, it comes at a time of life which is already delicate for many. There are two main approaches to scoliosis treatment plans to choose from – one is group based treatment, and one is individual treatment. Group based settings offer no privacy, but can potentially foster a ready made support group, whereas private one to one settings offer privacy without peer support.

The right kind of environment for you will of course depend on your own child’s preferences – so try to keep this in mind when choosing a clinic. At the UK Scoliosis clinic, we provide a private one to one environment, although we welcome as many relatives or friends that your child would like to have around them to attend consultations, exercise sessions and treatment reviews. Research has shown that having a calming and private environment to discuss and perform treatment can actually lead to better clinical outcomes, although this won’t be ideal for every child. [2]

 

 

Getting help

If you’re concerned about Scoliosis, please don’t hesitate to get in touch with us – we offer Scoliosis consultations online as well as at the clinic with no obligation to take up treatment, whatever you do, be active!

[1] Angelo G Aulisa et al. ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner, Scoliosis 2014 9:3

[2] Elisabetta D’Agata et al. Introversion, the prevalent trait of adolescents with idiopathic scoliosis: an observational study Scoliosis and Spinal Disorders (2017) 12:27

Why Scoliosis screening is important!

Posted on July 13, 2021 by - Blog

Although Scoliosis awareness month is now over, we wanted to take one last opportunity to highlight the importance of a subject which is dear to our heart at the clinic – scoliosis screening. It’s a simple step that we can all take to avoid the risk of serious scoliosis, yet it something that most people are still unaware of.

 

Why screening matters

Scoliosis screening is quick, easy – and in many countries, it’s done as standard by general health practitioners and in schools. Today, most scoliosis clinicians agree that school screening for scoliosis in the UK would be a positive step to take since, for relatively little cost, significant benefits can be obtained for the majority of patients. It’s not just schools either – Chiropractors and other health professionals could help by learning some basic screening steps, or even just by encouraging people to use a free screening app.

It’s for this reason that scoliosis screening is considered 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]

 

So why aren’t we all screening?

There are three main reasons which explain the lack of widespread screening in the UK. The first is simply the fact that many health professionals have little or no training on Scoliosis, and the general public has even less. So why is this the case? It goes back to the second main reason – the belief held for much of history, that scoliosis is treatable only with surgery and, therefore, that screening was of little value.

Until recently, this has been a valid point – but it’s critical to recognise that today there are far more options for scoliosis sufferers, and we’re now able to help many patients overcome scoliosis without ever thinking about surgery. Much of the evidence suggesting scoliosis can only be treated with surgery dates as far back as the 1940s[2] so it makes sense for us to re-examine the evidence and technology we now have available.

This is all the more important given the results of large scale studies, such as the BRAiST study in 2013[3], in which 58% of untreated patients had curves greater than 50° at skeletal maturity, while only 25% of patients treated with a scoliosis brace 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.

The third reason is cost – and the cost-based argument against screening also flows from the same line of thought – if surgery is the only treatment option, why invest in screening? Recent research has shown that scoliosis can be treated non surgically, and, 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 €.[4] It is reasonable to suggest that costs today could be even lower!

 

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, clinics and even through clubs and activities 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[5].

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[6].

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.[7] 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 scoliosis.[8]

In 2006, research from the University College Hospital and The London Clinic[9] assessed the severity of scoliosis presentation over 30 years. What the authors found was, that since mass school screenings were abandoned in the 1990s, 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 you can do

The point of Scoliosis awareness month is to get people talking about scoliosis – but we shouldn’t let it end on June 30th – just by talking about scoliosis and raising the issue with people you interact with day-to-day, we can encourage more people to screen at home, more professionals to seek training on spotting scoliosis and perhaps even put pressure on the government to implement screening in schools. At Complete Chiropractic we screen all patients for scoliosis as part of our initial consultation, and we’d love to see other chiropractors do the same.

Thank you all for your support during Scoliosis awareness month 2021 – we hope next year to be able to do much more to support the event in a (hopefully) covid-free way!!

 

 

 

[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] 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.

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

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

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

[6] 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.

[7] 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.

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.

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

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

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

5 Celebrity Scoliosis Stories

Posted on July 2, 2021 by - Blog

While the main focus of our blog is on treating, preventing and correcting Scoliosis, it’s always worth taking a moment to acknowledge the great things that many people with scoliosis have done. Scoliosis no matter how you opt to treat it (or not) does not have to ruin a life – and indeed, for some people, it can even give them a unique kind of strength. This week we’re taking a look at 5 interesting and diverse people who have or have had scoliosis, and what it means to them.

Please note that the UK Scoliosis clinic does not endorse (or cities) any of the views, nor the treatments (or lack of) discussed here.

 

1 – Usain Bolt

Usain Bolt is a Jamaican superstar sprinter and a five-time World and three-time Olympic gold medallist. He is the world record and Olympic record holder in the 100 meters, the 200 meters and the 4×100 meters relay – in short, he’s pretty good at what he does.

He is the reigning Olympic champion in these three events and is one of only seven athletes to win world championships at the youth, junior, and senior-level of an athletic event. He is also famously known as the ‘World’s Fastest Man’, after the 2012 London Summer Olympics where he won the 100 meters gold medal with a time of 9.63 seconds, setting a new Olympic record for that distance.

Bolt also suffers from scoliosis – which is believed to have been a factor in a serious injury that led to him cutting short his season in 2010. Of the condition, bolt says:

 “Scoliosis is not as serious as it sounds but for me, as a track athlete, it can be serious; I work really hard to keep it away but it’s still there.”

Bolt reportedly receives treatment from a homoeopathic German sports doctor a couple of times a year. He also has a masseuse who never leaves the sprinter’s side, travelling all over the world with him, warming him up before and after training and at every race  – although to be fair, this isn’t uncommon for athletes of his calibre! [1]

 

2 – Kurt Cobain

Music legend and cult figure Kurt Cobain suffered from Scoliosis – like many he experienced pain from the condition, but sadly this was long before we understood the link to pain, and well before effective non-surgical treatments were widely available.

Cobain’s story is interesting because, according to an interview with MTV – pain from the scoliosis actually became an important influence for him. He said:

    “… I have scoliosis. I had minor scoliosis in junior high, and since I’ve been playing guitar ever since, the weight of the guitar has made my back grow in this curvature. So when I stand, everything is sideways. It’s weird. ”

 

    “I go to a chiropractor every once in a while….. [scoliosis] gives me a back pain all the time. That really adds to the pain in our music. It really does. I’m kind of grateful for it.” [2]

 

3 – General Douglas MacArthur

Well known to history buffs and our friends in the US, General Douglas MacArthur was a critical figuring during the battle for the Pacific during WWII who served as supreme commander for the southwest pacific area and won the medal of honour for his defence of the Philippines.

Did you know, however, that this great military mind almost missed out on entrance to West Point – the prestigious officer school? He had the grades to qualify for entrance to West Point, but when he went for his preliminary physical examination, he received shocking news. The doctor informed MacArthur that he had curvature of the spine and was medically unfit to enter West Point.

McArthur, not being one to give up easily, consulted with Dr. Franz Pfister, a well-respected surgeon in Milwaukee, Wisconsin. Dr. Pfister told Douglas there was a possibility he could cure his spinal problem, as long as Douglas was prepared to do special scoliosis exercises everyday and follow all of his instructions for one year. Douglas jumped at the opportunity and made plans to move to Milwaukee, where he worked at his prescribed exercises every day.

After one year, he attempted the physical examination again – the doctor who conducted the exam saw that while he made great improvement – but his spine still wasn’t straight enough to pass. Undeterred, he continued on with the scoliosis specific exercises until in May of 1899 he finally passed his physical exam into West Point.[3]

 

4- Liza Minnelli

Liza May Minnelli was born in Hollywood, California. She is an American actress, singer and Broadway performer – you’ve probably seen her in something! Liza is the daughter of Judy Garland and film director Vincente Minnelli. Though her first appearances were with her superstar mother, Liza has established a substantial career as a performer. She is among the few entertainers who have won an Oscar, Emmy, Grammy, and Tony Award. She has also received two Golden Globes, a Grammy Living Legend award and induction into the Grammy Hall of Fame and numerous other awards and honours.

It has been speculated that Judy Garland herself may have had scoliosis, but it’s certain that Liza Minnelli has scoliosis. She has mentioned in interviews that her scoliosis forced her to move on stage in ways that didn’t affect her breathing or cause her pain.

In recent years, Liza has made appearances in various films and in television, perhaps most notable was her role on the TV comedy Arrested Development. Over the years, Liza has served and supported various charities and causes.

 

Of her condition, Minnelli says “I’ve got two false hips, a wired-up knee, scoliosis, which I’ve always had, and three crushed disks, but I feel great. I dance every day.”[4]

 

5 – King Tutankhamun

Perhaps the most famous figure from ancient history, King Tutankhamun may well have had Scoliosis. What’s more interesting, evidence also showed that one of Tut’s children (who was buried with him, having died in infancy) may have also had Scoliosis. This provides some ancient evidence for the purported genetic aetiology of scoliosis.

A 2010 article by the Journal of the American Medical Association outlined a study of the Egyptian king that estimates his death at around 17-19 years of age. Based on tests conducted on the remains of Tut, it is believed he died at such a young age of conditions including malaria and complications from a leg fracture.

The researcher’s CAT scanned King Tut’s mummy and also discovered he had “severe kyphoscoliosis an abnormal curvature of the spine in both coronal and sagittal planes”. They also found that he had oligodactyly, a toe malformation. They speculated that the condition would have made his left foot swell and would have caused excruciating pain when he walked[5].

Ancient drawings depict Tut shooting arrows sitting in a chariot, which researchers say is unusual. 130 walking sticks were found in Tut’s tomb. They were originally thought to merely represent power but now are thought to be ancient forms of crutches or canes. It is believed that Tut may have used them because he had difficulty walking and standing. Paintings, like the one below, found in Tut’s tomb show him leaning on such canes/crutches with his legs crossed awkwardly underneath him.

[1] https://usainbolt.com/

[2] http://www.mtv.com/news/1572103/kurt-cobain-about-a-son-from-beyond-by-kurt-loder/

[3] Douglas MacArthur: What Greater Honor. Pages 25-33

[4] https://www.timeout.com/newyork/film/that-70s-show

[5] Zahi Hawass, PhD; Yehia Z. Gad, MD; Somaia Ismail, PhD; et al, Ancestry and Pathology in King Tutankhamun’s Family,  JAMA. 2010;303(7):638-647. doi:10.1001/jama.2010.121

Scoliosis awareness month – Adult Scoliosis

Posted on June 25, 2021 by - Blog

Adult Scoliosis is technically any scoliosis case that exists either in those over 18, or those having reached skeletal maturity, either definition is valid but most scoliosis specialists would prefer the latter since we are focused more on the condition itself than an arbitrary point of “adulthood.”

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life.

The second type is Degenerative De-Novo Scoliosis (sometimes noted as DDS) – this is the development of a new scoliosis case, usually as a result of spinal degeneration.

 

What causes Scoliosis in Adults?

ASA – that was scoliosis carried into adulthood from adolescence, isn’t caused in adulthood – it may or may not worsen depending on a number of factors, but the condition originated at an earlier point in life. Degenerative scoliosis is somewhat unusual in the scoliosis world since we understand its cause well – it’s due to wear and tear on the spine, but it is also strongly associated with a variety of conditions. Osteoporosis, degenerative disc disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis.

Since De-Novo scoliosis is a consequence of spinal degeneration with age, it rarely presents before 40 years of age – although, in patients with no known history of scoliosis, differentiation from degenerative idiopathic scoliosis may be difficult. It is thought that as many as 40% of over 60’s suffer from de-novo scoliosis[1], although a percentage of these cases will be undiscovered scoliosis from earlier in life. In fact, a good number of adult scoliosis cases are discovered through an investigation for another condition (such as back pain).

 

What is the prognosis and treatment for Adult Scoliosis?

ASA can be considered both stable (progression is very slow or non-existent) or unstable, progression is continuing. Whether an ASA case will progress quickly, slowly, or not at all may well depend on the size of the curve itself when adulthood is reached. Research has suggested that simply put, large curves tend to get worse – smaller curves may well be stable. Weinstein et al. and Ascani et al. have reported results showing that children with curves < 30° at skeletal maturity did not demonstrate curve progression into adulthood, while the majority of curves > 50° progress at approximately 1° per year.[2] The degree of progression will be the best guide for treating ASA cases – bracing, exercise or even just periodic monitoring could all be the right approach, depending on the case.

De-Novo scoliosis, being in many ways a consequence of time itself, always continues – however, the impact upon a persons life can be greatly minimised with the correct treatment. While postural deformity can be a major issue, one of the most commonly reported complaints arising from de-Novo scoliosis is pain – what’s more, a small increase in scoliosis could cause a large increase in pain,  the deformity shifts the spine and pressure is applied to nerves.

The good news is that Recent advances in non-surgical treatment have shown significant improvement in terms of reduction of pain and symptoms in those with adult scoliosis.  One approach involves the patient learning how to self-correct their abnormal posture, not just strengthen their lower back or core. The most effective approach would be the use of a customised brace, such as a ScoliBrace which helps to support the posture in a more comfortable position, pain is reduced (even with part-time bracing)[3] and quality of life is improved.

When non-surgical treatment is ineffective, surgery is often the only option, especially when leg pain becomes incapacitating and walking is almost impossible. Unfortunately, surgery at this stage is always complex and with significant risk. This is why it is important to find not only a good spinal surgeon but also one who specialises in scoliosis for the best possible outcome.

 

What does Adult Scoliosis look Like?

The below X-ray shows an example adult Scoliosis case. It’s usually not possible to tell how severe scoliosis is without taking an X-ray, although external signs can suggest that the condition may be present. This is why regular screening is so important!

 

 

 

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

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

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

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986, 11:784-789.

[3] 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

Scoliosis awareness month – Adolescent Scoliosis

Posted on June 14, 2021 by - Blog

Most of the Scoliosis cases we treat at the clinic – and indeed, most of the scoliosis cases discovered are categorised as adolescent idiopathic scoliosis (often called AIS) That’s to say, scoliosis in a person older than 10, but who has not yet reached skeletal maturity, and a case without obvious cause, such as congenital or syndromic issues, or trauma.

Whereas infantile and younger Juvenile scoliosis cases are common in boys, 80% of all AIS cases are girls. It is usually noticed around 11-12 years of age in girls and slightly later when diagnosed in boys.  AIS is estimated to affect between 3 and 4% of teenagers. In most cases, AIS begins to develop noticeably at the initial onset of puberty and becomes more apparent as it worsens during growth spurts. AIS can be highly progressive, so it is important that the right sort of monitoring and treatment is sought as soon as the condition is noticed. When not appropriately treated it may result in significant deformity, physical disability and psychological issues – but when treated with effective modern approaches, the prognosis – as showed by the BrAIST study, is good – with as many as 90% of patients who comply with bracing prescriptions avoiding surgery[1]

 

What causes AIS?

Like all forms of idiopathic scoliosis, the exact cause of AIS is unknown. Like other forms, there have been a large number of possible causes suggested – one of the leading theories is a genetic link, although more research is required before we are able to make a definitive conclusion.

There is also some evidence that AIS may be associated with certain activities which stress and pull the spine away from its normal aligned position – for example, research indicates a higher incidence of scoliosis in ballet dancers and gymnasts, although it’s important to note that this does not necessarily mean that these activities cause Scoliosis, only that more cases are being detected (this could feasibly be simply because we’re looking for them more frequently).

It’s also worth clarifying that while scoliosis does cause postural issues, poor posture does not cause scoliosis, and nor (so far as the current research suggests) does diet.

 

What is the prognosis for AIS Scoliosis?

The prognosis for an AIS case depends on a number of key factors – the significance of the curve at the time of discovery, the flexibility of the curve, the age of the patient and the ability of the patient to comply with ongoing treatment.

The larger a curve is at discovery, the more work needs to be done to correct it – Bracing has been shown to be effective up to 60 degrees, but an ideal candidate is in the 20-40 degree range. Closely tied to this is the rigidity of the curve – that is to say how flexible the spine is, and therefore how likely we are to succeed with an approach such as bracing, which aims to gently guide the spine back to a correct alignment. A flexible curve is much easier to treat than a rigid one.

The age of the patient is important for two reasons – firstly, while scoliosis development does not always stop in adults, where it does continue it tends to slow and become predictable – developing at about 1 degree per year. Therefore a small curve in an individual close to adulthood has less time to progress to a significant degree, than does a large curve in a younger child. What’s more, research suggests that curves that are still small at adulthood do not continue to develop[2]

Secondly, it’s also long been thought that scoliosis worsens faster around growth spurts[3] – hence an older adolescent who has almost reached their full growth has less exposure to this potentially aggravating factor.  More recently, however, we have come to understand aspects such as the Risser sign (an indication of skeletal maturity) and the onset of menstruation are closely correlated with the potential for curve increase regardless of “growth spurts”. Immature children (Risser sign 0 or 1) with larger curves (20–29°) at initial diagnosis demonstrated a 68% risk for curve progression, whereas mature children (Risser 2–4) with similar curves at initial presentation had a 23% risk for curve progression. Conversely, immature children with smaller curves (5–19°) demonstrated 22% chance for curve progression, while mature children with smaller curves had only a 1.6% risk for curve progression.[4]

In both cases, we would like to detect and control curves in patients at the earliest possible opportunity, as this allows us to stabilise curves, and prevent progression throughout growth, and maximise the chance for curve correction and the avoidance of future issues in adulthood.

It’s for this reason that early screening and detection is so important in scoliosis cases – it’s too simplistic to say that cases that are detected early are guaranteed a better outcome, but by spotting cases as early as possible, you certainly allow the maximum number of options for treatment.

 

How can we treat AIS?

The best treatment for a scoliosis case depends on all of the above factors – but for simplicity, let’s take the question just by curve size. It’s important to remember that factors such as age and curve flexibility may modify this rough outline.

In curves between 10-20° scoliosis, specific exercises – a physiotherapy based approach to treatment – are typically recommended as an initial approach, while bracing may also be used as a preventative measure in the long term, or as a more convenient alternative to exercise-based approaches.

In curves over 20-25° with a moderate to high risk of progression, scoliosis bracing is typically considered and often will be used in conjunction with scoliosis specific exercise. As we discussed a the beginning of the month – bracing was shown to be effective in reducing the progression to the surgical threshold of 50° by the end of growth in 72% of cases compared to 48% of those who were purely observed. What is important to remember, is that those who wore the brace for more than 13 hours per day actually had a 90% success rate[5].

In curves 45-50°, conservative non-surgical treatment becomes more difficult. In older adolescents when a curve is less likely to rapidly progress, bracing may be used and combined with intensive scoliosis specific exercise. This may help to improve body aesthetics and reduce the curve size when surgery is not recommended.

In large curves in younger adolescents with a high risk of progression, or a high rate of curve development bracing may be used to slow curve development. This way surgery can be delayed until growth has finished so multiple surgeries are not required.

When curves are large and the risk of progression is high, surgery may be the only option. Surgery is recommended not purely on curve size, but also on curve location, future progression, loss of postural balance and when bracing has been unsuccessful.

 

What does Adolescent Scoliosis look like?

The below X-ray shows an example AIS case. It’s usually not possible to tell how severe scoliosis is without taking an X-ray, although external signs can suggest that the condition may be present. This is why regular screening is so important!

 

 

[1] 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

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

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

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986, 11:784-789.

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

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

[5] 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

Scoliosis awareness month – Early-onset Scoliosis

Posted on June 7, 2021 by - Blog

Early-onset Scoliosis is an umbrella term used by many organisations (including the scoliosis research society) to include scoliosis cases that present under the age of 10. Within this bracket, there are really two further categories of scoliosis we need to understand.

The first is Infantile scoliosis – which is the name given to scoliosis cases that are diagnosed in children between the ages of 0 to 3 years. Infantile Scoliosis is at least as common in boys as girls, which is worth bearing in mind since adolescent cases (which comprise the majority of overall cases) are predominantly female cases[1].

Juvenile scoliosis is therefore diagnosed when scoliosis of the spine is apparent between the ages of 4 and 10. It is less common than adolescent scoliosis and comprises about 10-15% of total idiopathic scoliosis cases.  It is found more often in boys between the ages of 4-6 and curves tend to be left-sided, while in older children it is more common in girls and curves are right-sided and similar to adolescent scoliosis.[2]

 

What causes early-onset Scoliosis?

There are several main categories that comprise early-onset scoliosis cases – these are:

  • Idiopathic – Curves for which there is no apparent cause – this is probably the kind of scoliosis you are most familiar with, as it forms the bulk of scoliosis cases, especially in teens.
  • Congenital – Here the cause is incorrect development of the Vertebrae in-utero. It is sometimes associated with cardiac and renal abnormalities.
  • Neuromuscular – In children with neuromuscular disorders including spinal muscular atrophy, cerebral palsy, spina bifida and brain or spinal cord injury.
  • Syndromic – Certain syndromes, such as Marfan’s, Ehlers-Danlos and other connective tissue disorders, as well as neurofibromatosis, Prader-Willi, and many bone dysplasias may be associated with EOS.

At the UK Scoliosis clinic, we mainly focus on the treatment of the idiopathic variety – which, as the name implies, is currently without defined cause. There are two main theories that explain the development of idiopathic infantile scoliosis – the first postulates that some children are simply born with a spine that is already curved, while the second suggests that the curvature occurs after birth and may be linked to the way a baby is handled. Much more research is required to clarify this, however.

 

What is the prognosis for early-onset Scoliosis?

The Scoliosis research society notes especially for early-onset cases, that early Scoliosis carries a risk of heart and lung problems in childhood which may become increasingly problematic in adult years[3] – but it’s worth noting that other research has shown that scoliosis can negatively impact the heart and lungs as the deformity increases in other age categories[4]. When untreated, severe EOS may be associated with an increased risk of early death due to heart and lung disease – the term Thoracic Insufficiency Syndrome (TIS) is commonly used to describe the potential combined spine and lung problems in EOS.

Idiopathic scoliosis has a number of possible treatment pathways, both non-surgical and surgical, whereas congenital and syndromic cases are more complex, and require in-depth evaluation to determine the best pathway. In all instances, it is important that suspected cases in infants should be investigated with a complete neurological examination and MRI or CT scan. This will serve to rule out any underlying neurological condition or disease process and allow the best treatment to be given as soon as possible.

 

How can we treat early-onset scoliosis?

Bracing may be an effective approach in idiopathic cases with good flexibility in the curve – however, rigid curves are less likely to benefit from this approach. Casting (which is a similar approach, using a plaster cast rather than a brace) is also a possible approach here.

Early-onset scoliosis is, however, the only broad category of scoliosis where the “wait and see” approach may have some value. The Scoliosis research society guidelines suggest that Idiopathic early onset scoliosis with curves greater than 30-35 degrees are most likely to progress and some studies have suggested the progression to surgical threshold for this group may be as high as 100%[5] – however, children younger than age 2 with infantile idiopathic curves less than 35 degrees stand a chance of the condition resolving without further treatment.

 

What does early-onset Scoliosis look like?

The below X-ray shows an example early onset Scoliosis case. It’s usually not possible to tell how severe scoliosis is without taking an X-ray, although external signs can suggest that the condition may be present. This is why regular screening is so important!

 

 

 

[1] https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/early-onset-scoliosis/infantile-idiopathic-scoliosis

[2] https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/early-onset-scoliosis/juvenile-idiopathic-scoliosis

[3] https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/early-onset-scoliosis

[4] 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

Barrios C, Pérez-Encinas C, Maruenda JI, Laguía M. Significant ventilatory functional restriction in adoles- cents with mild or moderate scoliosis during maximal exercise tolerance test. Spine. 2005;30(14):1610–5. doi:10.1097/01.brs.0000169447.55556.01

 

[5] 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.