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

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

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

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?

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

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

 

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

 

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

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.

 

14 Myths about Scoliosis

Note: This is an updated version of an article which we originally posted here.

Scoliosis is a complex 3 dimensional condition that results in bending of the spine to one side, a rotation to the front or back and a straightening of the spine in the side view. The most common scoliosis in adolescence is thought to be idiopathic which means its exact cause is multi-factorial or unknown.

As we do not know the exact cause nor the exact mechanism through which scoliosis develops, there are many misconceptions about scoliosis. Today, we’ll look at some of the more common misconceptions.

 

Myth 1 – Scoliosis causes pain

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

 

Myth 2 – “Watchful waiting” is the best approach

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

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

 

Myth 3 – Scoliosis screening doesn’t help scoliosis sufferers

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

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

We have a scoliscreen app right here on our site, which can guide you through an initial screening process. Give it a go!

 

Myth 4 – Scoliosis doesn’t progress into adulthood

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

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

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

Myth 5 – Swimming will help reduce scoliosis

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

 

Myth 6 – Bad posture causes scoliosis

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

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

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

 

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

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

 

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

After 8 months with scolibrace, The lumbar curve in this patient was corrected by a staggering 28 degrees!

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

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

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

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

 

Myth 9 – Scoliosis only affects girls

Scoliosis is more common in girls than boys, but boys can and do develop scoliosis.

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

 

Myth 10 – Spinal manipulation can reduce scoliosis

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

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

 

Myth 11 – Physiotherapy exercise reduces scoliosis

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

 

Myth 12 – Heavy backpacks cause scoliosis

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

 

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

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

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

 

Just one of our many scolibrace color options!

Myth 14 – Surgery is the only treatment for scoliosis

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

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

As previously mentioned early diagnosis is key, as the chances for arresting and correcting a relatively small angle are very good. If you think that you or someone you may know might be at risk of scoliosis, try our scoliscreen app!

 

Why UK Scoliosis Clinic?

Learning about scoliosis for the first time can be an uphill struggle, especially if you, or someone you love has just been diagnosed. There are lots of approaches out there – so how do you know which one is best?

 At the UK scoliosis clinic, we believe we’re better positioned to help you beat scoliosis than anyone else – and here’s why.

 

Our Ethos

Our fundamental starting belief is that all health professionals should follow well researched, evidence based techniques and approaches when implementing treatment plans with patients. That means our techniques must be based on treatment methodologies which have been proven successful in other patients, that it must be possible for us to monitor and quantify ongoing progress and that our treatments should provide a long term solution – not a quick fix.

Like all professions, the scoliosis treatment field has a guiding body – for us it’s the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment, otherwise known as SOSORT. SOSORT is an international organisation that guides health professionals on the most up to date, evidence-based recommendations in relation to the conservative treatment of idiopathic scoliosis. SOSORT’s ongoing mission is to constantly evaluate new treatment methodologies, and to publish guidelines for best practice for patient outcomes.

The latest guidelines were developed in 2011, and are always under revision as new evidence comes to light. At the UK scoliosis clinic we stay up to date with these guidelines to ensure we achieve the best possible patient outcome.

 

So, what do SOSORT recommend?

Firstly, SOSORT is clear that, each treatment approach should be closely related to the size of a patient’s scoliotic curve and also the maturity of the patient. This means that in order to be effective, a patient’s treatment plan should be individualised down to the fine details, and must be flexible to adapt to changes. At the UK scoliosis clinic, our specialists have a wide variety of treatment methods from which to choose, these range from scoliosis specific exercises to bracing with our scolibrace system or even simple preventative exercise regimes. When you join the UK scoliosis clinic as a client, we take a long term view of your treatment – designing a totally customised treatment plan for now, and the future. What’s more, we constantly monitor your progress (at our clinic, or by skype!) so we can make any changes to your plan as required.

Secondly, SOSORT stress that certain scoliosis treatments have not been endorsed as effective because of the lack of substantial evidence that scoliosis can be cured or improved by these treatments. Examples include foot orthotics (when used in isolation), oral supplements (neurotransmitter, mineral or vitamin), jaw bone positioning treatments and many, many others. These all lack substantial evidence that they can arrest or improve scoliosis. This does not mean to say that these treatments might not provide some assistance, but at the UK scoliosis clinic, we only provide treatments which have been proven to work.

Next, SOSORT recognise that recent research strongly supports bracing for adolescent idiopathic scoliosis patients with a high risk of progressing to surgery[1] Consequently, SOSORT supports bracing as a recommended intervention in the treatment of adolescent idiopathic scoliosis in many cases. That’s why we are the first clinic in the UK to offer the revolutionary Scolibrace system. Scolibrace is a lightweight, low profile scoliosis brace which, when used as part of a treatment plan can have outstanding outcomes.

Finally, SOSORT recommend that scoliosis specific exercises should also be introduced into a patient’s treatment plan, where they are likely to be beneficial. These are generally prescribed when curves are over the 10 degree mark for adolescents.  The exercise approach for treating scoliosis which commonly prescribed by SOSORT is the SEAS method (Scientific Exercise Approach to Scoliosis). This method incorporates the use of corrective movements that are in the opposite to the patient’s scoliosis. In this, the curved spine is essentially ‘untwisted and straightened’ and the action is then incorporated into activities of daily living for maximum long-term benefit. At the UK scoliosis clinic, we provide personalised SEAS guidance and training as recommended by SOSORT.

 

What makes a good scoliosis clinic?

Once again, let’s take a look at the SOSORT guidelines! According to SOSORT a reputable scoliosis clinic should be able to provide a range of treatment options for scoliosis ranging from scoliosis specific exercise to 3-dimensional bracing techniques supported by other methodologies where appropriate. A good clinician will recommend the most appropriate treatment option(s) for each individual case, and never simply try to fit every patient into the single treatment method they offer.

At the UK Scoliosis Clinic, we begin our relationship with each and every patient with a detailed consultation, we use this information to construct a totally individual treatment plan which we keep under regular review.  If scoliosis bracing is recommended, we use the latest 3D scanning technology to create a brace which is perfectly fitted to you and your needs – you can even choose your favourite colour and design!

In addition, we go beyond most clinics in offering a range of complementary treatments, which while they are not intended to prevent, or cure scoliosis can play a bit role in reducing and pain or discomfort you are expecting in the immediate term. We have on site specialists who can provide everything from chiropractic adjustments, to sports massage or postural analysis optimisation.

 

So how do I choose?

The diagnosis of scoliosis can be a confusing and overwhelming time for the patient and in many cases their parents too.  Choosing a Scoliosis Clinic who follows SOSORT guidelines and who can explain the evidence behind all available treatments will help ensure the best chance at good results.

If you’re suffering with scoliosis, or care for someone who is, why not give us a call to arrange your initial consultation today!

 

 

Note

The SOSORT recommendations we outlined above are readily available to anyone researching clinics and health professionals. It’s important to also take note of treatments which may be offered by some clinics, but are not supported by substantial evidence or research or supported by the SOSORT guidelines. It’s also important to realise that scoliosis is a highly individualised condition, and for best results needs to be treated on an individual basis.

Information about SOSORT and their guidelines can be found at http://www.sosort.mobi/index.php/en/
Reference – [1] Effects of Bracing in Adolescents with Idiopathic Scoliosis – The New England Journal of Medicine

Does ballet dancing increase your risk of scoliosis?

Does participation in ballet dancing increase your risk of scoliosis? A growing body of research seems to suggest that this might well be true.

To non-dancers, the link might seem an odd one – but if you are a dancer you probably know someone with scoliosis, or you might even have it yourself. Now, reseach has confirmed that participating in ballet training can, indeed, raise your chances of developing scoliosis.

 

The latest research

The study, conducted at the School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, sought to to determine one and for all any differences between the prevalence of adolescent idiopathic scoliosis in (female) ballet dancers, compared with non-dancers.  The study also aimed to establish if any relations exist between the presence of scoliosis and generalized joint hypermobility, age of menarche (the first occurrence of menstruation), body mass index (BMI), and the number of hours of dance training per week.

As part of the study, 30 dancers between the ages of 9 and 16 years were recruited from a certified dance school in Western Australia – each dancer also provided an age-matched nondancer to participate.

For both groups, measurements were taken for angle of trunk rotation using a scoliometer (a device used to measure the presence of scoliosis) and for height and weight to produce generalized joint hypermobility using Beighton criteria and an age-adjusted BMI, respectively. A subjective questionnaire regarding age of menarche and participation in dance and other sports was also completed.

The results of the study would probably come as no surprise to those in the dancing world – Thirty percent of dancers tested positive for scoliosis compared with only three percent of the nondancers. Calculating representative odds on the basis of these percentages, suggests that dancers are 12.4 times more likely to develop scoliosis than nondancers of the same age.

There was also a higher rate of joint hypermobility in the dancer group (70%) compared with the nondancers (3%); however, there were no statistically significant relations between scoliosis and hypermobility, age of menarche, BMI, or hours of dance per week, therefore we can conclude that the ballet training was the responsible factor in the higher incidence of scoliosis.

From the study, the authors conclude that adolescent dancers, like adult dancers, are at significantly higher risk of developing scoliosis than nondancers of the same age – it follows that vigilant screening and improved education of dance teachers and parents of dance students may be beneficial in earlier detection and, consequently, reducing the risk of requiring surgical intervention.

 

Why does ballet increase the risk of scoliosis?

While its too early to say that we fully understand the causal links, it seems reasonable to suggest that the way in which ballet students are taught to hold their spines in class – which tends to be the opposite of the spine’s natural curves – could be the cause. With our background in chiropractic care our specialists are experts at assessing and treating stresses on the spine which makes ideally placed to approach this complex issue. Recognising the development of a problem early enough allows us a wide variety of approaches to tackle the problem.

 

What can I do?

As a parent of a dancer, or as a dancer yourself, there are proactive steps you can take to lower your risk of developing scoliosis, and to take action to prevent the condition from developing if it does occur.

  1. Monitor your body for changes (or monitor your child’s body for changes) especially between the ages of 10 to 18. Is one shoulder higher than the other? Does one side of your ribcage protrude forward? Does one hip stick out more to the side than the other? These misalignments could indicate scoliosis. You can also use our scoliscreen app to screen for the common symptoms at home.
  2. If you notice potential symptoms, get a professional evaluation as soon as possible. Scoliosis, if spotted early is now simple to treat – we have a range of approaches designed to prevent, reduce, and eliminate scoliosis.
  3. Work to build your core strength in addition to your ballet training. Focus on exercises which require a neutral body position and which keep the spine in alignment. For advice on scoliosis preventative exercise, get in touch!
  4. Be mindful if you have family member who suffer from scoliosis. While scoliosis can occur with no family history whatsoever, a family history of scoliosis might predispose you to the condition.