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.

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!

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 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.