Do I need to treat my Scoliosis?

Scoliosis, in most cases, is a progressive condition – this means it gets worse with time. For this reason, we recommend most people (and all young people who have not reached skeletal maturity) treat, and try to correct Scoliosis as soon as possible. There are, however, some circumstances where treatment of Scoliosis may not be required – let’s take a look.

 

Scoliosis in children – does it need to be treated?

We started out by saying that for young people, scoliosis should always be treated – the reason is simple – Scoliosis tends to progress over time, and in a very young person there is a lot of time for scoliosis to continue to progress. It’s true that once a person reaches adulthood the development of scoliosis slows considerably – and below a certain cobb angle the curve may stop completely, but sadly most young people will reach a surgical threshold before this.

Research has demonstrated that cases of Juvenile scoliosis greater than 30 degrees tend to progress quickly – studies suggest that as much as 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 a significant disability.[1]

There is always a chance that scoliosis may not progress as much as predicted, and an individual who experiences scoliosis at a young age may make it to adulthood without requiring surgery. There are, however, still many common symptoms that 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.

Since, with modern, active, bracing there is an excellent chance of not only preventing scoliosis development but actually reversing it. So there are almost no circumstances where active treatment of scoliosis isn’t worth at least investigating.

The only significant exception here would be in the case of an individual who is certainly going to require surgery regardless of attempts to slow or reduce scoliosis through a non-surgical method such as bracing. Bracing can sometimes be used in severe cases as a way to try to delay surgery, but this is not always a net benefit in the long term.

 

How about in adults?

There are two types of scoliosis in adults – these are adolescent scoliosis in adults (ASA) (Essentially, scoliosis carried over from childhood) and de-novo scoliosis. De-novo scoliosis will be discussed in a moment, so let’s consider ASA first.

The rate of progression of scoliosis in adults varies – but is certainly slower than in children. As a rough figure, about 1 degree per year can be expected. There is, however, quite some variation in the actual worsening experienced by an individual – with research suggesting that this may be correlated to the degree of scoliosis on reaching adulthood – those with larger curves tend to progress more in adulthood, those with smaller curves progress less and many not progress at all.

This is the first case in which there are a large group of people who probably do not need to treat scoliosis – although they should have regular check-ups to ensure that the condition has not started to worsen. An adult with a relatively small curve, which does not cause pain or discomfort and is not progressing, does not stand to gain significantly from Scoliosis treatment. Although it is not impossible to slightly reduce a scoliotic curve in an adult, any correction will be much smaller than in a child hence, if there are no other symptoms, monitoring scoliosis is probably the best approach.

Adults with a curve which does seem to be progressing, or who are experiencing pain or other symptoms from scoliosis may want to consider either an exercise-based approach or bracing as a method to manage Scoliosis. Both approaches are suitable for adults since there is less concern about adherence to an exercise regime (a common problem with children). The appeal of bracing for adults is likely to be ease of use, and, although bracing is expensive, it’s worth keeping in mind that an adult brace will likely last a lifetime if well cared for.

While we often associate scoliosis with younger people – especially girls (certainly, these are the group we most often think about treating today) this stereotype is somewhat unhelpful. In fact, the group most often impacted by Scoliosis are the over 60’s – here, as much as 30% of the cohort suffer from degenerative or “de-novo” scoliosis, a condition caused by spinal degeneration induced by ageing which can cause pain and discomfort. [4]

In older adults, the decision to treat scoliosis is more nuanced – although de-novo scoliosis does progress, cases tend to do so more slowly, hence the main issue to be addressed is often pain. Approaches such as bracing can be an excellent option here, but they do come with a cost – for some older adults with only mild discomfort from their scoliosis the cost of bracing base treatment may therefore be too high to justify, although an exercised based approach can be an excellent compromise between cost and results.

 

 

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

The prevalence and radiological findings in 1347 elderly patients with scoliosis
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.,  Journal of bone and joint surgery 2010 Jul;92(7):980-3

 

Complementary therapies and Scoliosis

The primary goal of any scoliosis treatment is to stop the development of and, if possible reduce the cobb angle – that is to say, the degree of scoliosis ie the “curve” in the spine. To date, there are only two non-surgical options that have been shown to be effective in scientific studies – these are bracing and exercise-based physiotherapy approaches.

When treating scoliosis, however, it’s critical to remember that every case is different – the same degree of curve may affect two people in a totally different way on a day-to-day level. Either bracing, or exercise will always be the core of effective scoliosis treatment, but with this in mind, we can also make use of numerous complementary therapies to form part of an overall treatment plan. Let’s look at some of the approaches which may be of benefit.

 

Massage

Massage therapy is a substantial field in and of itself, with many different approaches that practitioners may use based on the needs of a specific case. Broadly speaking, however, we can say that message can play a valuable role in supporting the rehabilitation of functional issues in scoliosis patients and is also beneficial for improving overall health factors such as sleep patterns.[1]

One of the main ways in which massage can assist in scoliosis treatment is by relieving muscular pain which may result from imbalances arising from the Scoliosis. Due to the elongated musculature on one side and the shortened musculature on the opposite side, back pain, shallow breathing, sciatica, headaches and insomnia are frequent issues that a person with scoliosis may experience. Various massage approaches are effective in helping to manage these symptoms and some approaches used in sports therapy may be valuable in helping to relax and stretch muscles that are too tight.

Massage, like many complementary approaches, may also help in increasing body awareness, which in turn can help patients to work to change movement habits that contribute to functional scoliosis.

The level of research on massage specifically for scoliosis is currently limited – studies do confirm that scoliosis suffers have shown an improvement in pain levels, trunk rotation, posture, quality of life, and pulmonary function through massage therapy.[2] More research is needed to establish the effectiveness of massage specifically since most of the current studies available consider the treatment of scoliosis with massage as part of a broader variety of manual therapies.[3]

 

 

Yoga

In truth, Yoga is more of a system of being than a specific treatment – there’s no doubt that countless people around the world find peace and tranquillity through yoga which is of course a huge benefit to scoliosis sufferers (and just about anyone else too!)

On a more practical level though, there are also some specific characteristics of Yoga that are helpful in Scoliosis treatment. Firstly many yoga positions are symmetrical and therefore are, in essence, aiming to achieve the same kind of body symmetry taught through scoliosis specific exercise. Further, Yoga can be especially effective in helping patients to discover a way of being sensitive to the asymmetries of the body and detecting them more readily without external input. This in turn could improve patient engagement with scoliosis specific exercise.

Secondly, Yoga practice can exercise 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. While scoliosis specific exercise goes beyond simply balancing the body in order to try to correct scoliosis, the ability to consciously maintain balance and flexibility in the body throughout a range of movements can be highly valuable in terms of controlling scoliosis.

Some small scale studies (mostly case studies) have suggested that yoga may have a positive role to play in reducing cobb angle[4] and at least one case study has demonstrated a reduction in Cobb angle from 49 to 31 degrees, although in this instance progress was achieved over a very long period of 35 years.[5] At this time there is not sufficient evidence to suggest that yoga can effectively reduce cobb angle however the complimentary benefits provided are often enough to cause scoliosis practitioners to recommend yoga alongside more traditional treatment.

Pilates

Pilates is similar to the more physical disciplines within yoga, in that it is a system of exercise focusing upon controlled movement, stretching and breathing. Pilates is popular today not only for physical fitness but also for rehabilitation programs for many conditions.

Currently, Pilates is not recommended as a standalone treatment for scoliosis, but like yoga, there are some excellent reasons to consider it as a complementary aspect to an overall program.

A 2018 review of 23 papers that considered Pilates as a potential treatment for scoliosis showed that in 19 of the studies, Pilates was more effective than a placebo at improving outcomes – most notably including pain and disability levels.[6]

There is some limited evidence that indicates that Pilates may have a role to play in reducing cobb angle, although more research is required. It is also worth noting that when Pilates is compared with a specialised exercise methodology such as Schroth, it has been shown that Schroth therapy is more effective over the same time span[7] – what has not yet been studied (so far as we are aware) is whether combining Pilates with a more traditional exercise approach could yield better results still.

Whereas some aspects of Yoga can be tricky, and many disciplines do also recommend a focus on meditation as a complement to physical work, Pilates is more focused on being active and is arguably simpler to pick up and start enjoying. This might make it a better selection for those who prefer more active muscle strengthening approaches or those who would like to perform several short workouts throughout the day.

 

The Alexander Technique

The Alexander Technique is a system that aims to retrain a person to be more aware of their posture. It helps you to notice the bad habits you have picked up during your lifetime and helps you correct them. The idea is that by adjusting our movement and posture, we can reduce pain and discomfort associated with sub-optimal movement.

While a simple concept, the technique does have some objective research to back up this claim – a large randomised controlled trial was published in December 2008, which showed that NHS patients with chronic or recurring back pain who took part in Alexander technique lessons reported a long-term (measured up to 1 year) reduction of days with pain, a measurable increase in the number of daily tasks they could do, and benefits in quality of life, compared with patients who received usual care from their doctor.[8]

Perhaps one of the biggest advantages of the Alexander Technique is that many patients report really enjoying learning and using the technique. Unlike the other options discussed here, the Alexander Technique can be practised at any time during the day, even while undertaking everyday activities or relaxing.

There is no evidence to show that the technique has any particular impact on scoliosis – however, some practitioners do suggest that it can be an excellent approach to help children, in particular, manage some of the discomfort from wearing a scoliosis brace, in particular by helping them learn how to move “with” the brace, rather than against it. More research into this approach is certainly needed, however.

 

[1] M Hamm, Impact of massage therapy in the treatment of linked pathologies: scoliosis, costovertebral dysfunction, and thoracic outlet syndrome. Journal of Bodywork & Movement Therapies (J BODYWORK MOVEMENT THER), Jan2006; 10(1): 12-20.

[2] A LeBauer, The effect of myofascial release (MFR) on an adult with idiopathic scoliosis. Journal Of Bodywork And Movement Therapies [J Bodyw Mov Ther] 2008 Oct; Vol. 12 (4), pp. 356-63

[3] Michele Romano and Stefano Negrini, Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review. Scoliosis 2008 3:2

[4] Yoga for scoliosis: new findings. University of California at Berkeley Wellness Letter (UNIV CALIF BERKELEY WELLNESS LETT), Jul2018; 6-6. (2/3p)

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

[6] Keira Byrnes et al. Is Pilates an effective rehabilitation tool? A systematic review. Journal of Bodywork & Movement Therapies Jan2018, Vol. 22 Issue 1, p192

[7] Gichul Kim, Effects of Schroth and Pilates exercises on the Cobb angle and weight distribution of patients with scoliosis J. Phys. Ther. Sci. 28: 1012–1015, 2016

[8] Paul Little et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain  Br J Sports Med. 2008 Dec;42(12):965-8.

Types of ScoliBrace

At the UK Scoliosis Clinic, our current “go-to” solution for Scoliosis treatment is the ScoliBrace. ScoliBrace is, in our opinion, currently the best scoliosis bracing solution available – we’re always open to adding alternative braces, but for the time being we feel that ScoliBrace is an excellent solution for nearly every case requiring bracing. We’re able to say this is because ScoliBrace design itself, is unique & flexible and is available in many different variants. This week, we’re taking a look at a few of the options.

 

Standard ScoliBrace

The “standard” model of ScoliBrace is optimised for treating “classic” adolescent scoliosis. Of course, each scoliosis case is totally unique – however, the standard ScoliBrace design covers the majority of those “typical” curve profiles.

This brace is ideal for Major thoracic curves, Thoraco-lumbar curves, and Lumbar curves – although it has the significant advantage of also being suitable for treating Double curvatures with a major thoracic and lumbar component, as well as complex triple curves with a high thoracic component (i.e. apex at T2-T6)

 

ScoliBrace comes in a wide variety of colours and is a low profile solution in all cases, making this brace an effective tool for treating most scoliosis cases.

 

High Thoracic ScoliBrace

The High Thoracic scolibrace is designed to target Thoracic curves for more rapid treatment. This version of the ScoliBrace uses a high thoracic closure, which helps maintain stability of the correction in larger degree curvatures and helps in the treatment of high thoracic curves. This kind of brace is unsurprisingly suitable for curves which are located in the thoracic spine.

 

 

 

 

Lumbar ScoliBrace

The Lumbar Scolibrace is focused on the correction of curves in the lower spine – this is often an area associated with degenerative Scoliosis, making this brace an excellent supportive option for those suffering with “de-novo” scoliosis. This brace specifically targets single lumbar or thoracolumbar curvatures, but without any thoracic compensation, making it unsuitable for patients with any thoracic curvature.

As an additional advantage, this brace is incredibly low profile, especially under clothing and  maintaining excellent in brace correction of lumbar and thoracolumbar curves.

 

 

 

ScoliNight

ScoliNight is a version of the ScoliBrce which is designed primarily for night time wear – this kind of brace is therefore best for those needing a smaller brace wear time, and therefore tends more towards the treatment of smaller curves. ScoliNight is considered an option for patients with smaller, less complex curves – such as single thoracic, lumbar or thoracolumbar curves less than 25 degrees.

On average a ScoliNight brace will only be worn for roughly 8 hours at night, which may be more convenient for some patients – however, it’s also possible that a scoliosis case which would be viable for a ScoliNight brace could be treated more quickly with a standard brace – an important point to consider.

 

 

 

KyphoBrace

The KyphoBrace is a sister product to the ScoliBrace, which, as you may imagine is designed primarily to treat Hyperkyphosis, rather than Scoliosis. Unlike Scoliosis, the majority of Kyphosis cases do not get significant enough to require treatment, hence the  KyphoBrace is recommended for curves from 50-80 degrees (Kyphosis)  and is suitable for thoracic and thoracolumbar hyper-kyphosis, as well as Scheuermann’s hyper-kyphosis.

KyphoBrace uses a pair of pivoting shoulder paddles to hyperextend the upper thoracic spine. This keeps the brace essentially invisible under clothing while still maintaining an excellent in brace correction of the kyphosis.

 

 

 

Hybrid Kypho-ScoliBrace

To address the needs of patients with mid scoliosis alongside Kyphosis, there is also a hybrid Kypho-Scolibrace, designed to counteract both conditions at once. This kind of brace is suitable only for milder instances of both conditions, however.

 

 

 

Want to know more?

Do you, or does someone you know suffer from Scoliosis – to find out if ScoiBrace could be a good option please just get in touch! We’re now offering a free X-ray review service for those who want to learn more about their options for treatment, so don’t wait  – contact us today!

How is scoliosis treated in 2021? – Part 2

Last week we began looking at how we can best treat Scoliosis in 2021 – this week we’re continuing to look at treatments, this time in terms of exercise and physiotherapy based approaches.

Schroth Therapy

Schroth therapy is a well-established and easy to use exercise methodology which some experts consider to be the best exercise-based approach for treating Idiopathic Scoliosis. [i]

As an independent treatment, some studies have shown a reduction of cobb angle of 10-15 degrees over the course of a year[ii] – however Schroth therapy combines particularly well with bracing. When Schroth is combined with bracing superior results can often be achieved more quickly.[iii]

The Schroth method itself is comprised of more than 100 individual exercises, which are chosen and organised individually for each patient. A Schroth program usually consists of 6-8 core exercises which are specifically targeted for the curve in question. This is because the Schroth method recognises that what’s appropriate for the common 3-curve, right thoracic scoliosis, for example, would not work for the 4-curve variety.

At the UK Scoliosis clinic, we adhere to the guidelines of the Schroth Best Practice program, the most up to date development of the methodology based on recent evidence by Dr Hans-Rudolf Weiss, Grandson of Katharina Schroth and son of Christa Lehnert-Schroth. Schroth best practice incorporates the latest evidence-based approaches and includes several new methods for treating specific conditions common to scoliosis sufferers more directly than the original version.

 

SEAS

SEAS is the acronym for “Scientific Exercise Approach to Scoliosis”.

SEAS is an approach to scoliosis exercise treatment with a strong grounding in the most modern approaches in physiotherapy. SEAS treatment programs are usually constructed by a practitioner, who will then teach the patient their individual routine. After this, SEAS can be performed at home.

The objective of SEAS exercise is to promote self-correction of the scoliotic posture, using exercises which are often incorporated into a broader exercise program designed to improve overall function and lessen the symptoms of scoliosis.

Unlike other therapies, the SEAS methodology is constantly evolving, so seeking out a practitioner who demonstrates familiarity with the latest research is especially important.

SEAS is also used alongside bracing treatment and is especially useful for avoiding a loss of correction after the conclusion of treatment with a brace. A 2008 study showed that post-brace patients treated with SEAS experienced no loss of correction after 2.7 years.[iv]

 

So….Which treatment is best for me?

In most cases, the best treatment for scoliosis will be bracing – be this part time, full time or night-time based bracing. Whichever treatment you choose, be sure to opt for a clinic which offers customised one to one treatment – If you suspect scoliosis you should seek a professional consultation, but as a rough guide we would suggest:

For small curves, less than 20 degrees a scoliosis exercise program based on SEAS or Schroth might be sufficient, especially if there is a low risk of progression.

For curves over 20 degrees, or curves with a high risk of progression, bracing is the best option. Today, it is fair to say that specialised scoliosis bracing when prescribed for high-risk patients can prevent the need for surgery in most cases.[v] Research indicates that non-surgical treatment with a brace is highly effective in treating juvenile idiopathic scoliosis, whereas part-time bracing in adults significantly reduces progression of curvatures and improves quality of life.[vi]

Often exercise is combined with bracing as part of an overall treatment program – but research shows that in head to head comparison bracing is the most effective treatment in most cases. A recent study showed that over 12 months, bracing led to a mean reduction in cobb angle of 5.88 degrees, whereas exercise reduced curves by just 2.24 degrees.[vii]

 

[i] Steffan K, Physical therapy for idiopatic scoliosis,  Der Orthopäde, 44: 852-858; (2015)

[ii] Kuru T, et al. The  efficacy  of  three-dimensional  Schroth  exercises  in   adolescent idiopathic scoliosis: A randomised controlled clinical trial,

Clinical  Rehabilitation,  30(108); (2015)

[iii] Marinela, Rață;Bogdan, Antohe, Efficiency  of the Schroth and Vojta Therapies in Adolescents with Idiopathic Scoliosis. Gymnasium, Scientific Journal of Education, Sports, and Health Vol. XVIII, Issue 1/2017

[iv] 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

[v] Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs. ‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’ [Results of the BrAIST Clinical Trial] N Engl J Med 2013; 369:1512-1521

[vi] Palazzo C, Montigny JP, Barbot F, Bussel B, Vaugier I, Fort D, Courtois I, Marty-Poumarat C. ‘Effects of Bracing in Adult With Scoliosis: A Retrospective Study’ Arch Phys Med Rehabil. 2016 Jun 22 . pii: S0003-9993(16)30256-8

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

 

Our New App!

Scoliosis is a potentially serious condition that can require major surgery if not treated. Thankfully, today it’s easier than ever before to treat Scoliosis without surgery – but doing this relies on early detection. At the UK Scoliosis clinic, we’re always investing in new technology to help detect, prevent and treat Scoliosis – today were pleased to announce that we’re releasing a beta version of our new Scoliosis screening app, Scoli Check.

 

What is Scoli Check?

Scoli Check is a scoliosis pre-diagnostic tool, designed to give you an idea of your risk of developing scoliosis – this means it isn’t intended to formally diagnose a scoliosis case but can give you an excellent way to assess risk at home.  Scoli Check is also a free to use app which requires no data upload and does not retain any personal information. Scoli Check can be used at home, at school or with friends.

Scoli check tries to make scoliosis screening easier and to reduce false positives by allowing the user to compare their own body shape and characteristics to a series of representative images. We feel that this is more effective as a method for detecting scoliosis, compared with simply listing signs and symptoms for people to watch out for. Rather than focusing only on images which show Scoliosis, Scoli check also presents users with a “normal” baseline image which makes for a more meaningful comparison.

Since the tool is comparison based It’s easy to use Scoli Check with a friend or family member – however, you can certainly use it alone if you have access to a mirror. Screening which scoli check does not require the person observing you (or yourself, if using a mirror) to have any understanding of anatomy or scoliosis related terms, an area which we find a weakness in similar screening tools.

Scoli check also aims to educate the public about scoliosis, and provides some further information on each of the areas it examines while using the app – we hope that this will allow those who do not have scoliosis to become more aware of signs which they may then notice in others!

 

Try it out!

You can trial the new app at doihavescoliosis.com

If you have a family member with scoliosis or have been told that you may have scoliosis, we strongly suggest you try Scoli Check. Scoli Check. Scoli Check is not a substitute for a professional diagnosis, rather it is intended to help you begin to discover if you may have scoliosis.

 

World Spine Day 2021

World spine day is here again, and it’s an excellent opportunity for us to reflect on the importance of spinal health. Unfortunately, the ongoing pandemic restrictions mean we won’t be able to offer any events in the clinic this year, however, we’re encouraging all of our patients and followers to help us raise awareness this month and especially his week!

 

What’s world spine day?

Taking place on October 16 each year, World Spine Day highlights the burden of spinal pain and disability around the world. With health professionals, exercise and rehabilitation experts, public health advocates, schoolchildren and patients all taking part, World Spine Day is one of the few awareness days which is truly celebrated on every continent.

World Spine Day highlights the importance of spinal health and well being. Promotion of physical activity, good posture, responsible lifting and healthy working conditions will all feature as people are encouraged to look after their spines and stay active. This is more important now than ever, since an estimated one billion people worldwide now suffer with spinal pain. It affects people across the life course and is the biggest single cause of disability on the planet. Effective management and prevention is therefore key and this year’s World Spine Day will be encouraging people to take steps to be kind to their spines.

 

BACK2BACK

Each year, world spine day has a different theme and focus – and this year it’s “BACK2BACK”.

According to the organisers, the theme reflects the need to reset and refocus on spinal pain and disability as part of the global burden of disease – this seems especially relevant given all the focus we’ve put on COVID-19 over the last few years. With a bit of luck, the fight against COVID-19 is nearing its end, but the fight against spinal pain and disability goes on!

This World Spine Day, the objective is, therefore, to call for action to focus on the global burden of spinal disorders and get “BACK2BACK”, the main thrust of the campaign is on highlighting the challenges of living with low back pain and a need for society to prioritize a condition that is more prevalent than cancer, stroke, heart disease, diabetes and Alzheimer Disease combined. The campaign calls for greater global commitment to tackling spinal pain and disability by governments, communities and public health bodies. World Spine Day also recognizes the lack of access to quality spine care and rehabilitation in under-served communities – For many populations, spinal pain and disability is not just a minor inconvenience – it can mean not being able to work and provide food and sustenance.

While back pain isn’t the first thing which comes to mind when we talk about Scoliosis – this theme actually comes at an excellent time for the Scoliosis field, as it is now starting to be recognised that Scoliosis can, and often does cause spinal pain. We’ve written numerous articles on this over this year and we’d recommend you check them out!

 

The objective for 2021

The aim of the BACK2BACK campaign will therefore be to focus on highlighting ways in which people can help their spines by staying mobile, avoiding physical inactivity, not overloading their spines and adopting healthy habits such as weight loss and smoking cessation. To this, we’d like to add the need to focus on spinal screening, especially for those suffering from pain. In many cases, Scoliosis will not be the cause – but early detection of scoliosis (as well as any other spinal condition) can be a significant factor in the success and quality of treatment outcomes.

BACK2BACK will focus attention on spinal pain and disability at home, in the workplace, in schools and in our communities. The World Spine Day organizing committee Chair, Richard Brown, said, “Public health initiatives like World Spine Day are critical in raising awareness, providing information and empowering the public to care for their spines.” “For spine health experts, World Spine Day provides a perfect opportunity to meaningfully contribute and proactively participate in their communities.” “We call on all spine health professionals worldwide to get involved in World Spine Day 2021’s BACK2BACK campaign”.

 

 

Vibration Based Therapy for Scoliosis

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

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

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

 

Study details

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

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

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

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

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

 

Results

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

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

 

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

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

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

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

Physiotherapy may improve functional capacity in younger scoliosis patients

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

 

Scoliosis and functional capacity

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

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

 

Study information

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

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

 

Physical therapy

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

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

 

Results

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

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

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

 

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

 

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

 

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

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

What is Schroth best practice?

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

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

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

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

 

Recent studies

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

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

 

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

 

Is Schroth best practice the way forward?

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

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

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

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

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

We’re developing an App!

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

 

Coming soon – the UK Scoliosis clinic screening app!

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

 

What’s Scoli Check?

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

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

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

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