Is observation a treatment for scoliosis?

Posted on December 17, 2018 by - Blog

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

 

Is observation ever the right choice?

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

 

Avoiding surgery with non-surgical treatment

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

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

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

 

Why observation does not work

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

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

 

What should I do if I have been prescribed observation?

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

 

 

 

 

 

[1] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine (2018) [Publish Ahead of Print]

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

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

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

Can yoga treat scoliosis?

Posted on December 8, 2018 by - Blog

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

Can yoga reduce cobb angle?

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

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

 

How can yoga help with scoliosis?

Yoga is an excellent exercise for general health

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

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

 

Is yoga recommended for people with scoliosis?

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

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

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

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

 

How does Yoga interact with scoliosis exercise?

Scoliosis SEAS treatment

Yoga can help to improve awareness of the body

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

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

 

 

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

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

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

Does a having a short leg cause scoliosis?

Posted on November 22, 2018 by - Blog

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

A short leg can cause scoliosis

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

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

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

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

 

How common is LLD in scoliosis patients?

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

 

Does LLD cause scoliosis?

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

 

Pelvic Obliquity is common in scoliosis patients

LLD and Scoliosis, new research results

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

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

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

 

So what is the relationship between LLD and scoliosis?

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Posted on November 10, 2018 by - Blog

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

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

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

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

 

There’s an app for that

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

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

 

Exercise adherence in Hyperkyphosis

Scoliosis and Kyphosis can both be disruptive conditions

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

 

 

A Kyphosis case study

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

App usage was not impressive in the study

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

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

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

 

What can we learn from these results?

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

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

 

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

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

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

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

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

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

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

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

The UK Scoliosis Clinic is in this week’s OK magazine

Posted on October 27, 2018 by - Blog

If you pick up a copy of OK magazine this week you’ll find some great info form our own Dr Paul Irvine in the health section. We’re really excited to be getting this message out about scoliosis and how to spot it, since early detection makes such a huge difference.  This week, let’s review some of the key symptoms to look out for.

Scoliosis : what to look out for

We’re in this week’s OK!

Two to three percent of adolescents between the age of 10 and 15 will develop scoliosis. That might seem like a small percentage, but as we pointed out in OK, it’s about one per class at school.  Among adults over 50, the rate is as high as 40% – this means that you almost certainly know at least a few people with scoliosis.

Scoliosis is a complex condition and can affect individuals in different ways. In fact, scoliosis is often difficult to detect early on, which is why screening is so important.

When scoliosis has first started to develop, visual symptoms are often the main issue – uneven shoulders, hips, or a rib hump are commonly noticed. While these symptoms don’t necessarily pose a significant health risk on their own, they are strongly associated with psychological problems, such as low self-esteem, anxiety and depression.

Once scoliosis develops and becomes more pronounced it can have an impact on everyday life as well as being more obvious visually. Symptoms might include:

  • Changes with walking. When the spine abnormally twists and bends during walking, it can cause the hips to be out of alignment which changes a person’s gait or how they walk. You might also notice you get tired quickly when walking.
  • Reduced range of motion. You might notice a reduced flexibility, or even pain and stiffness when moving.
  • Trouble breathing. If the spine rotates enough and diverges from its normal position enough, the rib cage can twist and tighten the space available for the lungs.
  • Cardiovascular problems. Similarly, if the rib cage twists enough, reduced spacing for the heart can hamper its ability to pump blood.
  • Many scoliosis patients report back pain ranging from moderate to severe. More research is required to determine if scoliosis is the main cause of the pain or if the pain is associated with issues, such as muscle tightness, which come with scoliosis, but pain is nonetheless often the symptom which causes people to seek treatment.

 

How can I screen for scoliosis?

Screening for scoliosis is easy and takes about 5 minutes – you can learn more about how to screen for scoliosis here, or use our ScoliScreen tool, which will guide you through the process.

 

Spot scoliosis early and improve your prognosis!

Early detection Is especially important in scoliosis cases since research has shown a direct link between the age of detection and the outcomes achievable. Today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is now highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery[1]

In the 2015 study, it was shown that curve correction was accomplished in 88 patients (77.8%) and stabilization was obtained in 18 patients (15.9%). Only 7 of the patients (6.19%) had progression of their scoliosis, and only 4 of these were recommended for surgery. Critically however, the study also demonstrated that treatment appears to be more effective with curves under 30° (incidence of surgery: 1.6%) than curves over 30° (incidence of surgery: 5.5%) – which strongly suggests the need to catch curves early.[2]

 

Have questions about scoliosis?

If you have questions about scoliosis, feel free to get in touch with us by phone or email – or upload your x-rays for a free scoliosis assessment.

 

 

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

[2] Ibid.

Scoliosis FAQ with Dr Paul Irvine

Posted on September 30, 2018 by - Blog

This week, we take some of the most frequently asked questions we have here at the clinic and put them to our founder, Dr Paul Irvine. While these quick FAQ’s are a good starting point, please keep in mind that scoliosis is a complex, 3D condition which requires a personal treatment plan designed by a scoliosis professional to treat properly.

As always, if you have you own questions, just get in touch.

 

What causes scoliosis, can anyone get Scoliosis?

Paul with Tony Betts at the 2018 SOSORT conference

There are two types of scoliosis – scoliosis in adults, which is sometimes known as “degenerative”  scoliosis and scoliosis in children.

Degenerative scoliosis is just that – the product of degeneration of the spine with age. Degenerative (also called de-novo) scoliosis is actually much more common than many people think, nearly 40% of adults over 50 will experience it.

The other main type of scoliosis is childhood scoliosis – the truth  is that we aren’t 100% sure what causes childhood scoliosis. While about 20% of cases can be attributed to an underlying condition, spinal deformity or a neurological or congenital cause, 80% of scoliosis cases are classified as “Idiopathic” scoliosis. Idiopathic literally means “without known cause”.

Having said that, researchers believe there are some common threads which may raise your risk of scoliosis.  Firstly, some studies have suggested that certain activities, such as ballet, gymnastics and dancing might predispose someone to scoliosis – One study has suggested that gymnasts are as much as 12 times more likely to develop scoliosis, for example.

Secondly, having a family member with scoliosis does seem to predispose someone to developing the condition.

 

Do genes play a part in scoliosis?

We know that individuals with a family history of scoliosis are more likely to develop scoliosis than those without – this strongly suggests that there may be a genetic cause (or contributor) to the development of scoliosis. There is research being carried out in this area at the moment, but at this time there is still insufficient evidence to make a definite conclusion.

 

How common is Scoliosis? 

Two to three percent of adolescents between the age of 10 and 15 will develop scoliosis. That might seem like a small percentage, but in fact it’s about one per class at school. Some studies have suggested a higher level, but two to three percent is an accepted figure.  Among adults over 50, the rate is as high as 40% – this means that you almost certainly know at least a few people with scoliosis.

 

Will Scoliosis go away on its own?

On this issue research is clear – scoliosis almost never resolves on its own, whereas proactive treatment carries a very high success rate. Left untreated, scoliosis can be a life limiting condition, whereas the majority of patients treated with non-surgical methods today can live a totally normal life and often experience total curve correction. The exception to this rule is infantile scoliosis, which does sometimes resolve on its own – however if you suspect infantile scoliosis you should seek a professional consultation as soon as possible.

 

Does scoliosis affect males and females equally?

No. While both boys and girls can and do develop scoliosis, but 70% of cases are girls (with ballet dancers and gymnasts being 12 times more likely to be affected). My professional experience at the clinic backs this up – the majority of cases we see are females. That being said, its possible that scoliosis might be more prevalent in boys than we yet know.  Since girls are far more likely to be involved in sports such as ballet and gymnastics (where coaches now often look for scoliosis) the figures might be slightly skewed in their favour simply because scoliosis in girls is more often noticed.

 

Is scoliosis most common in young people, whose spines are still developing?

As we already mentioned, scoliosis is common in both adults and children. The cause in adults is usually spinal degeneration and is better understood.  Scoliosis in children usually starts to develop between 10 and 15, but the rate of scoliosis development increases rapidly form age 11 to 14.

 

How serious does scoliosis need to be before surgery is the only option?

When we talk about the severity of scoliosis, we consider a measurement known as cobb angle – cobb angle is simply the degree of curvature of the spine away from the normal position.

As a general rule, a cobb angle over 45 degrees will often be considered an indicator for surgery, however some braces (such as our ScoliBrace) have been shown to be effective in reducing the progression of scoliosis and improving the curve in patients up to 60 degrees cobb.

At our clinic we often combine bracing with exercise-based approaches to scoliosis treatment, such as SEAS and the Schroth method. These approaches teach patients to actively correct their scoliosis using physical therapy exercises and can be effective for treating small curves (less than 20 degrees) as a standalone treatment. That being said, many parents prefer part time, or night time bracing in these situations as exercise must be performed correctly and routinely to have a chance of success.

The latest generation of scoliosis braces are far more effective than older versions. There has been a great deal of research in the field over the last 10 years, so that today the majority of patients who wear a brace will see significant curve correction, and there is an excellent chance of complete correction of the scoliosis – especially when spotted early.

 

What is the prognosis for people with scoliosis? Can it be completely cured?

This depends mainly upon age and the severity of scoliosis. If curves are spotted early and treated before they reach 30 degrees, there is an excellent chance of avoiding surgery and it is highly likely that a complete or near complete curve correction can be achieved.

To give some numbers, studies show that 30-50% of scoliosis cases which are left untreated progress to the surgical threshold – whereas when bracing is used 70-90% will not progress and can be improved. Roughly 10% of cases will progress to surgery despite bracing.

Without a doubt, some cases will always progress even with bracing, however a significant number of the 10% of cases which do not respond to bracing will be as a result of the patient not wearing the brace for the allotted time.

In cases where bracing is not successful, surgery remains an option. At our clinic we strongly encourage people to try modern non-surgical approaches before taking the considerable step of undergoing a surgical procedure, as this comes with many risks and complications – but there is no doubt that orthopaedic surgeons can do fantastic work in treating scoliosis in cases where non-surgical approaches are not successful.

 

Does poor posture cause Scoliosis?

While many people with scoliosis might report poor posture, it is not thought that poor posture causes scoliosis. The main known factors are heredity and participation in some sporting activities, as mentioned above. There has been a small amount of research which has suggested that factors such as diet may have an impact, but far more research is needed before anything authoritative can be said in that regard.

 

Is there anything I can do to avoid scoliosis?

The best way to reduce your risk of having your life limited by scoliosis is to regularly screen for scoliosis in the first place. Scoliosis which is spotted early is much easier to treat and can almost always be prevented from developing.

There is no research which clearly indicates any positive action will reduce the chance of scoliosis developing – although avoiding ballet, gymnastics etc. might reduce risk.

Since that isn’t much fun – especially for young girls – Scoliosis screening is the best thing to do. Screening is easy to do (we even have an online screening tool people can use) with their friends or family at home – self screening takes about 5 minutes!

A great deal of research recommends screening in schools as a method for spotting scoliosis early – and most researchers agree that screening is an effective way to reduce the number of patients eventually requiring surgery. In the UK scoliosis screening is not implemented in schools, although some sports clubs (particularly ballet) do perform screening.  By contrasting example, Hong Kong offers scoliosis screening to all students.

 

Can I check if my child has scoliosis?

You certainly can, and it’s easy to do. We have an online tool called scoliscreen which you can use to perform a screening at home (try here) or you can simply follow the simple screening guidelines on this page. If you do suspect scoliosis, be sure to get a professional consultation from a scoliosis practitioner sooner rather than later. Most reputable clinics should offer this service for free.

 

Will scoliosis go away on its own?

Posted on September 22, 2018 by - Blog

When you or a loved one are first diagnosed with scoliosis its natural for your first thoughts to be about the best treatment available – and perhaps whether treatment is even necessary. Indeed, many medical professionals today still believe that a “wait and see” approach is the best way forward in most scoliosis cases. Despite this view, research is clear – scoliosis almost never resolves on its own whereas proactive treatment carries a very high success rate. Left untreated, scoliosis can be a life limiting condition, whereas the majority of patients treated with non-surgical methods today can live a totally normal life and often experience total curve correction.

 

What’s wrong with wait and see?

“Wait and see” is never the best approach

The “wait and see” approach (often called observation) means simply watching and waiting to see if a scoliosis case gets worse. This approach is based upon the (now outdated) view that surgery is the only effective option for scoliosis treatment. If your doctor or medical professional has recommended “wait and see” this does not mean they are being negligent however – historically surgery was thought to be the only effective treatment for scoliosis but today there are a wide variety of effective non-surgical options.

Non-surgical treatment for scoliosis has been shown to be successful up to 60 degrees cobb angle (cobb angle is the measure of scoliosis curvature), but the best results can be achieved when scoliosis is treated early.  Since the objective of observation is simply to see if the scoliosis progresses to a significant enough curve to require surgery (typically 40 degrees plus) patients are often told to simply keep “waiting and watching” while their opportunity to maximise non-surgical approaches sadly slips away.

It can not be stressed enough that if you have been diagnosed with scoliosis and have been advised to “wait and see” you should contact a scoliosis clinic and schedule a consultation as soon as possible.

 

What happens if scoliosis is left untreated?

If scoliosis is left untreated, or a policy of “observation” is employed, scoliosis is overwhelmingly likely to continue to progress. In the very small number of cases where scoliosis does not progress it will certainly not reduce – meaning that (at best) the patient spends the rest of their life with symptoms associated with scoliosis.

Research has demonstrated that cases of Juvenile scoliosis greater than 30 degrees tend to progress quickly – studies suggest that 100% of these patients will progress to the surgical threshold. Juveniles with curves from 21 to 30 degrees are more difficult to predict in terms of progression but can frequently end up requiring surgery, or at least are left living with significant disability.[1]

In cases which do not progress to the surgical threshold there are still many common symptoms which scoliosis sufferers will experience throughout their life without treatment. Some of the most common include pain, physical deformity, limited mobility and difficulty breathing during exercise.[2] Some recent research has also suggested that even a small cobb angle can have a significant negative impact upon a person’s ability to be active and keep fit and healthy.[3] Since we understand how important staying fit and active is to long term health, it is also fair to say that left untreated scoliosis could be a predictor for longer term health problems.

 

How can scoliosis be treated?

Today (while surgery remains and option for severe cases) most scoliosis patients can be treated non-surgically, although the sooner treatment is sought the better the prognosis and the simpler the treatment program required. Whereas “wait and see” can result in as much as 100% of patients progressing to the surgical threshold, through modern bracing technology it has been demonstrated that conservative treatment with a brace can reduce the number of patients requiring surgery to as low as 4.9% – in addition the vast majority of patients can active complete curve correction.[4]

 

 

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

[2] 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]  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

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

My child has Scoliosis: Top 10 things to do right away

Posted on September 11, 2018 by - Blog

 

If you have recently discovered that your child has scoliosis, or you suspect that scoliosis might be an issue it can often be a stressful and confusing time. There is a great deal of new information to consider and often it can seem there simply isn’t enough time.

To help out with this, here’s out top 10 list of things that you should do when first considering scoliosis treatment.  Get these 10 done, and you’ll be well on your way!

 

 

1 – Screen for scoliosis at home

If you have already had your child screened for scoliosis, either at home or by a professional you can skip this step. If you have not yet performed a scoliosis screening however, begin here.

Scoliosis screening is easy to do at home using our ScoliScreen tool. ScoliScreen was developed in Australia by our partner ScoliCare, who spent years researching and designing the easiest home screening tool available. Screening with ScoliScreen takes about 10 minutes – you don’t have to take any pictures or upload any information, just follow the steps on screen and note down your results. ScoliScreen isn’t an alternative to a professional consultation, but it’s a highly effective tool to use as a starting point.

 

2 – Get a professional consultation

Screening and consultations are always available at the UK Scoliosis Clinic

We can’t stress enough that getting a professional consultation with a scoliosis specialist is a must. Many parent’s natural reaction is to take their child to see their GP about their concerns– but this isn’t always the best step.

There are a few reasons for this – Firstly, while no question that GP’s do fantastic work, with so many different conditions to recognise and treat most GP’s simply don’t have time to research the latest options for scoliosis treatment. Years ago, it was thought that surgery was the only effective option for treating scoliosis, so 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 “wait and see” is never a good option. If your GP tells you to “wait and see” please bear in mind they aren’t trying to be dismissive, they just aren’t experts on the non-surgical options which are available today (but scoliosis clinicians are!).

Secondly, properly diagnosing scoliosis requires taking X-rays to fully understand the position of the spine – since GP’s have to justify any referral it can be difficult to argue for x-rays to be taken when “wait and see” is the standard recommendation.

Finally, scoliosis has often been a condition which hasn’t received the attention it really should, so many people think that the GP is their only option. One child in each class at school will develop scoliosis[2], so a significant number of people are affected, but most people are unaware of the condition. If you are reading this blog as a first port of call, please know there are numerous specialist clinics out there waiting to help!

At the UK Scoliosis Clinic, scoliosis screening as well as consultations for those with scoliosis are always available.

 

3- Get X-rays

Scoliosis is a complex Three Dimensional condition which can be successfully treated only with a thorough understanding of the condition of the spine. X-rays are the best way to properly establish the situation and also to rule out any other underlying conditions which might be causing or contributing to scoliosis. At the UK Scoliosis clinic, we have a brand-new state of the art digital X-ray machine on site for instant results – other clinics might refer you to another provider to get X-rays taken in advance of your consultation.

Some clinics offer what is often marketed as “radiation free imaging” – this simply means they do not provide X-rays and use an alternative, less effective imaging method. In real terms, this means that practitioners simply cannot get as good a picture of what is going on with the spine, which increases the risk of treatment failure, misdiagnosis or even injury from inappropriate treatment.

Are X-rays dangerous? The short answer is a handful of X-rays are far less risky than requiring major spinal surgery due to failed scoliosis treatment. The longer answer is that in fact, we are all exposed to a small amount of background radiation everyday without ill effect. For context, an average lumbar X-ray exposes you to only about as much radiation as 2 months of normal background radiation in the UK. An average airline pilot is exposed to about an eighth as much radiation as an x-ray on each transatlantic flight, meaning that most pilots are exposed to about the same amount of radiation as found in your x-ray every other week.

 

4 – Understand your treatment options

Scoliosis SEAS treatment

Specialist exercises can reduce Scoliosis

Today the non-surgical scoliosis treatment field is growing fast and there are many different approaches which can be utilised, these include treatments backed up by extensive research, such as Schroth and SEAS exercise methodologies and bracing as well as some emerging approaches which might or might not be effective, but currently lack enough research – such as chiropractic approaches.

Many clinics, like the UK Scoliosis Clinic offer a range of treatments and will tailor your treatment options based upon your needs, but some clinics only offer one approach. In this case, be sure that the treatment being offered is actually the right one for your case – and get a second opinion if you feel unsure.

 

5 – Chose a clinic which conforms to the SOSORT guidelines

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[3].

Reputable clinics are run by clinicians who follow the SOSORT guidelines and stay in touch with the latest research – check that your clinician is keeping up to date by attending the yearly conference or contributing to the journal for example.

 

6 – Get the best brace

In many cases, bracing is going to be the most effective, fastest and easiest way to correct scoliosis. However, not all braces are created equal – be sure to quiz your scoliosis care provider about the braces they offer and the features they provide. Many braces (including those available in some areas through the NHS) are designed to hold the spine in its already scoliotic position. This kind of brace might stop the scoliosis progressing, but it wont help to improve it.

At the UK Scoliosis Clinic, we recommend ScoliBrace – a totally custom brace designed with 3D imaging and computer aided design. The ScoliBrace is an active correction brace – meaning it actually guides the spine back into the correct position, rather than just holding it still.

 

7 – Consider mental health

While everyone’s scoliosis experience is varied and depends much upon personality, some research has shown that children and young adults are more at risk of stress and even depression as a result of scoliosis. At the UK Scoliosis clinic, we provide a private one to one environment, and welcome as many relatives or friends that your child would like to have around them. Research has shown that having a calming and private environment to discuss and perform treatment can actually lead to better clinical outcomes[4].

When considering bracing, try to also take into account the impact wearing a brace could have on a young person’s life. This is one of the reasons we are so confident in our ScoliBrace – unlike many braces ScoliBrace is low profile and is easily hidden under normal clothes. Additionally, ScoliBrace does not impede a child’s ability to participate in sports and physical activities and was designed specifically with maximising mobility in mind. ScoliBrace is also customisable in a range of colours and patterns to suit your tastes!

 

8 – Ask questions

Dr Paul Irvine and Dr Jeb MacAviny at the SOSORT conference 2018

Ask questions, ask lots of questions – and encourage your child to ask questions. A scoliosis consultation appointment is a great opportunity to do this, but feel free to phone our clinic for more information. Scoliosis treatment is a fast-moving field in which new research is always being published, so as scoliosis clinicians we spend much of our time asking questions and keeping up with research too. Avoid a clinic who can’t (or wont) answer your queries and opt for one that shows they are up to date with the latest information.

Whenever you speak with a scoliosis practitioner, consider making a list of things you would like to know and make sure you get answers! Reputable clinics will be able to answer any queries you may have, and back these answers up with the latest published scientific research papers.

 

9 – Consider the cost of treatment carefully

When considering the cost of scoliosis treatment, its important to remember that a scoliosis treatment program is not a “quick fix” – time is required to initially correct scoliosis, and then further maintenance treatment of some kind is then required to keep the spine properly aligned until the end of growth. This means that parents need to ensure that the treatment options they choose represent a sensible choice over the long term.  To give an example, this might mean that a more expensive scoliosis brace, which is adjustable to last for a long period of time may be more cost effective than two or three cheaper braces. Similarly, for small curves a ScoliNight brace might be a better long-term investment than continued scoliosis specific exercise sessions.

This decision depends to a great extent upon your own preferences and your child’s– but keep the long term in mind.

 

10 – Get on with your life!

Scoliosis does not need to be an impediment to life – and if treated properly and early on can usually be corrected without any serious impact on the young person concerned. If properly treated and corrected scoliosis will not affect your child’s life going forward, so plan for tomorrow!

 

[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] Gutknecht S, Lonstein J & Novacheck T ‘Adolescent Idiopathic Scoliosis: Screening, Treatment and Referral’ 2009, A Pediatric Perspective, vol. 18, no. 4, pp. 1-6.

[3] Information about SOSORT and their guidelines can be found at http://www.sosort.mobi/index.php/en/

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

Does scoliosis cause back pain? Research update

Posted on September 3, 2018 by - Blog

For some time, it has been thought that adolescent idiopathic scoliosis (AIS) does not necessarily cause back pain – however research is now beginning to indicate that in fact, scoliosis does most likely cause pain especially in patients with larger curves.

 

Scoliosis and back pain, current opinion

scoliosis back pain

Research is unclear, but many believe scoliosis causes back pain

For some time, it has been suggested that scoliosis might be responsible for back pain. Although the issue has been debated, some evidence suggests there is a link – A recent study of almost 2000 patients less than 21 years-old referred for a spine evaluation reported that when an underlying condition was identified as the cause of the pain, the most frequent diagnosis was scoliosis (1439/1953), followed by Scheuermann’s kyphosis.[1]

Although this evidence suggests there may be a link, other studies which have considered the issue have produced mixed results. On the one hand, Ramirez et al. reported on more than 2400 subjects with AIS. Of these, 23 % reported back pain at the time of diagnosis – a substantial number. An additional 9%, initially free of pain and managed with observation alone, developed pain during follow-up[2].

Sato et al. examined more than 30,000 adolescents with various spinal issues and concluded that the subgroup with scoliosis had an approximately 3 to 5 fold increased risk of back pain in the upper and middle right part of the back[3].

On the other hand, Lonner et al. compared three groups of adolescents including 894 with AIS and 31 control individuals without, when considering pain score using the SRS pain score method, they found that the differences between the AIS and control group were not significant. [4]

With this mixed picture in mind, one 2016 review concluded that while back pain in adolescents is quite common, especially in girls – pain does not seem to be a major problem for the vast majority of adolescents with an idiopathic form of scoliosis.[5] This is the view which tends to prevail amongst most scoliosis practitioners today.

Despite this conclusion, however, there have been a number of studies which have suggested much more strongly that back pain is a common issue amongst scoliosis sufferers. Research has indicated that chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than the one seen in adolescents without scoliosis (33%)[6]. Furthermore, Clark et al. reported that participants who were diagnosed with AIS at age 15 were 42% more likely to report back pain at age 18.[7]

 

New evidence

The regions of the spine

The most recent research is a Canadian study by Théroux et al.  It considered 500  patients from the orthopedic scoliosis outpatient clinic from the CHU Ste-Justine Centre, a university-teaching paediatric hospital with a view to exploring the relationship between scoliosis and back pain more accurately.

The conclusions from this study were of great interest. The study showed that spinal pain was a frequent problem for the AIS sufferers included in the study.  Overall, 68% of the participants reported pain. Furthermore, pain intensity increased with scoliosis severity in the main thoracic and lumbar regions – the degree of disability caused by pain was also positively associated with scoliosis severity in the proximal thoracic, main thoracic and lumbar regions.[8]

Perhaps of most interest for us as a clinic, the results showed that spinal bracing was associated with lower spinal pain intensity in the thoracic and lumbar regions. Bracing was also related with lower disability for all spinal areas. [9]

 

Does scoliosis cause back pain?

More research will be needed before a definitive answer can be provided to this question – however it seems reasonable to suggest that back pain is associated with scoliosis in a good number of cases, given our own experience and the foregoing evidence, we would suggest a repetitive figure for the risk of back pain associated with scoliosis is likely to be  40 – 50% , with factors such as curve location being key factors.

Thankfully research and our own experience clearly indicates that proactive scoliosis treatment, whether with bracing or (ideally) a combined bracing and exercise program can be highly effective in reducing back pain in scoliosis cases.

 

 

 

 

 

[1] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[2] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8.

[3] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9.

[4] Lonner B, Yoo A, Terran JS, Sponseller P, Samdani A, Betz R, et al. Effect of spinal deformity on adolescent quality of life: comparison of operative scheuermann kyphosis, adolescent idiopathic scoliosis, and normal controls. Spine (Phila Pa 1976). 2013;38:1049–55.

[5] Ibid.

[6] Cited in Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[7] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[8] Ibid

[9] Ibid

Scoliosis specific exercise prevents loss of correction after bracing

Posted on August 21, 2018 by - Blog

When we think about scoliosis treatment we tend to focus on there here and now – normally this means concentrating on getting the correct diagnosis and making sure the right treatment program is put in place. What’s often less discussed however, are plans for going forward after you have completed your treatment.  This is especially the case when bracing – we know that bracing can offer a significant reduction in cobb angle, but what happens when it’s time to stop wearing the brace?

 

Does the end of bracing mean the return of scoliosis?

At our clinic we often encounter clients who wonder whether the end of bracing means a reversal in the correction achieved – will scoliosis start to develop again after bracing?  It’s a fair question – but thankfully research shows that a scoliosis specific exercise program – exactly the same kind of program which is usually used to support bracing – can actually be highly effective in reducing loss of correction after bracing.[1] The results of the study suggest that simply continuing with a scoliosis specific exercise program can, in fact, prevent any loss of correction.

Scoliosis specific exercises are already recommended not only as a compliment to bracing, but also as a means to avoid some of the pitfalls associated with wearing a brace – the most common issues being muscular stiffness loss of strength.[2] In fact, it’s common to use scoliosis specific exercises for a period before beginning bracing – as some research suggests this may promote a quicker correction.[3]

It’s therefore not surprising that exercises may have a valuable role to play during the weaning phase of treatment too. Brace weaning itself is a critical phase of treatment which can vary in both its nature and duration according to the patient. In some instances, clinicians reduce the daily hours of brace in a somewhat rapid way, shifting from full-time wearing (18 or more hours per day) to the point that the patient is totally free from the brace within a period of six to 12 months. Others progressively and slowly reduce the hours of brace use, with a mean reduction of two to three hours every six months.[4]  Researchers currently believe that a failure to properly support and train the trunk muscles during this period may be responsible for the loss of correction which sometimes accompanies the end of treatment – however, scoliosis specific exercises can be used to address this specific problem.

 

What does the research say?

Scoliosis SEAS treatment

SEAS exercises can reduce loss of correction in scoliosis cases

The results of one of the few studies on this specific issue were certainly encouraging– in the 2008 study, sixty-eight patients were monitored throughout their process of brace weaning. The patients were divided into two groups according to whether or not exercises were performed during the weaning period. The exercise group included 39 patients and was further divided into two sub-groups: a SEAS group, who performed SEAS exercise programs, and an “other” group – who performed a variety of other forms of scoliosis specific exercise.  29 patients were placed in the non- exercise group.

The study followed the patients for 2.7 years – at the end of treatment, Cobb angle had increased  in the non-exercise group (by approximately 3.5 degrees) – however both the SEAS and other exercise groups saw their cobb angles remain stable – no change was detected.

 

So does the end of bracing mean the return of scoliosis?

In short, it certainly does not have to! From a patient’s perspective it’s important to find a clinic which also provides a solid aftercare plan however. At the UK Scoliosis clinic, we take great care to plan a course of treatment which includes appropriate brace weaning support, so that maximum correction can be maintained. As new research becomes available in this regard, we’ll apply it to our programs wherever appropriate.

 

 

 

[1] Fabio Zaina et al. Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients: Winner of SOSORT’s 2008 Award for Best Clinical Paper,  Scoliosis 2009, 4:8

[2] Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, Tedeschi C, Venturin A: Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal

deformities. Eura Medicophys 2005, 41(2):183-201

[3] Negrini S, Negrini A, Romano M, Verzini N, Parzini S: A controlled prospective study on the efficacy of SEAS.02 exercises in preparation to bracing for idiopathic scoliosis. Stud Health Technol Inform 2006, 123:519-522.

[4] Negrini S: The Evidence-Based ISICO Approach to Spinal Deformities. 1st edition. Milan, Boston: ISICO; 2007.