­­­­Scoliosis – some posture tips

Posted on October 26, 2022 by - Blog

Contrary to popular belief, poor posture cannot give you Scoliosis – the known causes of Scoliosis include degenerative changes in the spine (associated with ageing), neurological conditions and some genetic conditions. It’s also possible to end up with Scoliosis as the result of an accident or injury, or perhaps due to complications during surgery for another issue. All other scoliosis cases are considered idiopathic, meaning the exact cause is unknown – however, there is no evidence to suggest that bad posture causes Scoliosis.

 

Nonetheless, posture is an important thing for Scoliosis sufferers to keep in mind – now that it is more widely recognised that scoliosis can cause pain and discomfort, many people naturally wonder if there are ways we can reduce discomfort and support treatment during scoliosis correction. While everyday postural changes designed to correct scoliosis are a critical part of approaches such as Schroth therapy, there are also some small changes which one can make in order to potentially improve their overall quality of life.

 

Sitting and standing

When standing or sitting; good posture uses less energy than poor posture – this is true whether you have scoliosis or not! Some people with scoliosis might find sitting or standing with good posture difficult, either because of the spinal deformity or because of tiredness associated with scoliosis exercise treatment (this is normal!).  Because of this, it’s not uncommon for scoliosis patients to sit or stand with weight shifted more to one side than the other – either trying to overcompensate, or simply leaning on the strong side due to tiredness.

The ideal posture when standing is to have weight evenly spread – the neck should be straight with no tilt, the hips level, and the pelvis neutral (this means not tilting forward or backwards). The knees should be straight or alternatively, one knee straight, the other slightly bent. It can help to check your posture regularly in the mirror or get others to check it for you. Imagine yourself as a puppet with a string attached to the top of your head pulling you straight. The important thing to remember is not to overcompensate – if you lean slightly to one side, try to aim for this neutral posture – but don’t go further the other way!

When sitting, it’s easier to centre yourself correctly – the key is to allow the chair to take your weight evenly, which a normal char will. Try to sit back in a chair with your weight on your buttocks and thighs and your back straight. Try not to sit forward on the edge of your seat and keep the pelvis neutral (not tilting forward or backwards). Try to select a chair that allows your knees to be bent at roughly a 90 – 75 degree angle when sitting so that your knees are level with, or slightly lower than your hips. Keep feet flat on the floor and shoulder-width apart. Try not to sit for too long at any one time. It is best to move every 30 minutes to avoid getting stiff, whether you have Scoliosis or not!  Low soft sofas, chairs without arms, chairs that are too low or too high, bucket chairs and deep chairs can all be especially uncomfortable for those with Scoliosis.

Some patients find that lumbar (lower back) supports, cushions or memory foam can assist with any pain when sitting – for the most part these are safe to use, but t’s worth checking with your scoliosis practitioner if possible.

 

Exercise

Exercise is an essential part of everyday health and may well also form part of your Scoliosis treatment – if you are using an exercise-based approach to Scoliosis you will be well aware of the importance of maintaining a balanced and symmetrical spine unless you are specifically performing a corrective exercise.

It’s easy for people with scoliosis to get sore, stiff or tired when using the gym or exercising due to the additional strain which the spine is already under. Similarly, it’s not always a good idea to perform stressful exercises after a scoliosis specific exercise session, as parts of your back will feel tired.

If you do want to perform any kind of weight-bearing exercise, be sure to discuss the best way to do this with your scoliosis practitioner – and always work within your limits, especially during treatment. Very often, low impact and symmetrical exercises, such as swimming are an excellent way to augment scoliosis treatment while keeping fit and with a very low risk of injury or strain.

 

Beds and sleeping

Choosing the right bed is very important as you spend around 8 hours of the day in it. If you are comfortable you are more likely to sleep well. Getting enough is critical for mental as well as physical health.

As with a chair, it’s recommended to have a bed that allows you to sit on it with your knees at or just below 90 degrees – this should make it easier to lie down and get up.

The mattress should not be too hard or too soft. It needs to support your weight without sagging or giving way at the hips and shoulders – many Scoliosis patients find that a memory foam mattress is more supportive for them – don’t forget that these can be bought separately and added to your bed!

Some patients, especially those with Lumbar curves can experience discomfort when sleeping and laying in bed – this is, in fact, the case for many people, scoliosis sufferer or otherwise, since sleeping flat on your back with your legs straight can put a strain on the lumbar spine. Sleeping on your back, with your knees bent, on your side with your leg bent forward or on your side with a pillow between your legs or under your knees for better support can all help to relieve this discomfort. While not a universal rule, we also find that most scoliosis patients find sleeping on their front somewhat uncomfortable – so you may want to avoid this!

 

Paul at the ScoliCare Online Symposium, 2022

Posted on October 15, 2022 by - Blog

After attending several fantastic events this year as an attendee, Paul was thrilled to be invited to present some results and cases from the UK Scoliosis Clinic at this year’s ScoliCare Annual Online ScoliCare Symposium.

 

ScoliCare Symposium 2022

As we’ve often said, one of the most critical factors when it comes to improving outcomes from Scoliosis treatment in general, and bracing in particular, is staying involved and up to date on the latest research. At the UK Scoliosis Clinic, we’re constantly evaluating research into innovative approaches to scoliosis treatment, with a view to integrating promising methods into our own programmes.

ScoliCare’s Annual Online ScoliCare Symposium brings together global healthcare leaders to provide an update on the latest in scoliosis treatment -being an online event it’s possible to incorporate a very wide variety of views and case studies to allow attendees to benefit from cutting-edge research from around the globe.

The Symposium was a jam-packed six hours of content from non-surgical scoliosis clinicians, researchers, surgeons and exercise rehabilitation providers. Some of the topics covered included:

  • The latest scoliosis research from around the world
  • Complex scoliosis management insights
  • Sagittal balance in scoliosis focus
  • Scoliosis-specific exercise overview
  • Scoliosis and sport
  • Adult bracing
  • The surgeon’s perspective
  • Wide range of case studies

Paul was thrilled to present some fantastic case studies from the UK Scoliosis Clinic as part of the Session: Neuromuscular Scoliosis and Suspension Bracing.

 

Case study

The case presented arrived at our clinic at the end of October 2018 with a 42° right thoracic curve, having no pain and being otherwise healthy. Although the signs of Scoliosis had been observed, the surgeon advised “watch & wait”.

The UK Scoliosis clinic designed a treatment plan designed primarily to stop the progression of Scoliosis and avoid surgery, with the secondary desire to reduce the curve if possible. The plan for this case included full-time brace wear of 21-23 hours/day, Corrective PSSE, Mirror image over corrective exercises, SEAS self-correction and General core stability exercises and calisthenics – rather than focusing on just a single approach, we opted for a combined plan which aimed to address each of the core aspects impacted by Scoliosis.

Overall the case was a fantastic success, between October 2018 and April 2022, the Scoliosis reduced from 42 to 21°, ATR reduced from 17 to 13°, Grown in height from 3cm from 172.5cm to 175.5cm was observed, along with Improved aesthetics.

 

 

 

 

 

World Spine Day, 2022!

Posted on October 11, 2022 by - Blog

The theme emphasizes diversity of spinal pain and disability as part of the global burden of disease and addresses the need for access to quality essential spinal health services worldwide. With an estimated 540 million people in the world suffering with low back pain at any one time, it remains the leading cause of years lived with disability.

 

What is 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 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.

An estimated one billion people worldwide 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.

Populations in under-served parts of the world often have no access to conventional healthcare resources to care for spinal pain and disability. Dedicated spinal health professionals do not exist in many parts of the world, helping people to self-manage their conditions is important. Even in high-income countries, back pain afflicts many millions of people, resulting in an enormous impact on industry and the economy.

Organized by the World Federation of Chiropractic, World Spine Day has over 800 official organizational supporters worldwide.

 

The Campaign for 2022

Each year, World Spine Day is marked on October 16th – it’s a unique and important opportunity to recognise the importance of spinal health!

This World Spine Day, Complete Chiropractic, in association with World Spine Day participants everywhere, is calling for action to focus on the global burden of spinal disorders while emphasizing #EVERYSPINECOUNTS, highlighting the diverse challenges of living with low back pain in all regions, cultures, backgrounds, and across the life course; prioritizing a condition that is more prevalent than cancer, stroke, heart disease, diabetes and Alzheimer’s Disease combined.

This year’s campaign – #EVERYSPINECOUNTS  – will focus on highlighting ways in which all 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.

Believed to be the largest global public health event dedicated to promoting spinal health and well-being, World Spine Day is observed by health professions and public organizations concerned with spine care throughout the world.

At the UK Scoliosis Clinic, our objective this year is to educate our community about the importance of their spine and posture and the benefits of Chiropractic and an active lifestyle.

As part of this effort, we are offering a number of special promotions within the clinic – watch this space!

Clinic closed – September 19th 2022.

Posted on September 14, 2022 by - Blog

Dear all – just a quick update to let you know that the UK Scoliosis Clinic will be closed on September 19th as we mark the Funeral of Her Majesty, Queen Elizabeth II.

The official state funeral of Her Majesty The Queen will take place at Westminster Abbey on Monday 19th September at 11 AM, and we will take this opportunity to give thanks for her commitment to our commonwealth, and reflect on her life’s work.

After this, We’ll reopen as normal on September 20th.

On the passing of Queen Elizabeth II

Posted on September 10, 2022 by - Blog

With great sadness at her passing, we at the UK Scoliosis Clinic wanted to take the opportunity with this weeks blog simply to thank the late Queen Elizabeth II for her record service as our monarch, and champion for the commonwealth.

Elizabeth II was Queen of the United Kingdom and other Commonwealth realms from 6 February 1952 until her death, and therefore was our longest serving Monarch, with a reign of 70 years and 214 days.

While most in the UK will remember her for her appearances at important national events in and around London, it’s important to remember that Elizabeth served as queen regnant of 32 sovereign states during her lifetime, and 15 at the time of her death. This of course includes Australia, from where our very own Paul Irvine originates.

We will update all our patients on any changes to opening hours which arise as a result of the period of national mourning which will follow

Paul at SCOSYM, 2022

Posted on September 1, 2022 by - Blog

One of the most enjoyable aspects of working in a field which is growing and innovating as fast as the Scoliosis treatment space is getting to interact with, and learn from, a huge variety of specialists from different backgrounds, all working towards the common goal of developing the most effective Scoliosis treatment approaches possible. With this in mind, our founder, Paul Irvine will be in Greece next week to attend the 3rd SCOSYM Symposium.

Just one of many such events which are fast becoming critical landmarks for Scoliosis professionals everywhere, this meeting represents the 3rd SCOSYM Symposium in a series of successful meetings.

SCOSYM, like several non-surgically oriented events, recognises the tremendous contribution the traditional medical disciplines have made to scoliosis treatment, but also notes that the medical societies that specialize in this ailment have, to quote the organisers “tended to focus their efforts on the study of the epidemiology, aetiology, pathobiomechanic and laboratory, clinical and imaging documentation and treatment, either non-operative or operative.”  Critically for those attending SCOSYM then, it’s vital to recognise that the advent of new technologies is key to the study and advancement of our insight into these diseases, with a goal to improve the quality of life of this group of people.

This year, the conference is focused on these emerging technologies and the opportunities they bring, with a special view to recognising the impressive developments in the implementation of scoliosis school screening programs, physiotherapeutic-specific scoliosis exercises and new surgical approaches for growth modulation for the surgical treatment of early onset scoliosis (read more about all of these on our blog!)

Another key focus, and one which we’re pleased to see being recognised as an essential aspect of treatment for scoliosis, is quality of life – according to the organisers “These developments have led to better patient quality of life compared to what was experienced in the past. However, this topic is still under development and new instrumentation systems are being introduced.

When proper management is not implemented, spinal disorders may lead to significant social problems and to enormous economic losses. Therefore, treatment decisions based on the recent evidence-based literature will result in the optimum outcome. Proper management, including prevention and non-operative or operative treatment, must be tailored and implemented.”

Raising awareness is a core aspect of what we do at the UK Scoliosis clinic and SCOSYM is yet another fantastic event helping to do this, the conference notes that “It is, therefore, very important to increase awareness and advocacy for a social mission regarding the early detection of scoliosis and prevention of progressive spinal deformity. It is imperative to raise awareness about scoliosis and to inform the public, healthcare and policymaking communities about the individual, familial and societal burdens of spinal deformity, as well as the benefits of proper detection, diagnosis and optimal care for all patients.” – we couldn’t agree more!

Paul will be spending his time learning about the best and most promising new research to integrate into our own processes in the clinic, and perhaps enjoying a spot of good weather too!

 

 

Does bracing reduce quality of life?

Posted on September 1, 2022 by - Blog

While modern Scoliosis bracing represents a huge leap forward in the non-surgical treatment of Scoliosis it’s no secret that wearing a brace can be taxing, especially for young people. Modern braces like ScoliBrace have the additional benefit of being low profile, easy to move in and almost invisible under clothing, but no doubt wearing a brace is an additional stressor for a young person to cope with.

 

The Psychology of bracing

Although clinical evidence regarding bracing effectiveness continues to strengthen, there is still uncertainty regarding the impact of brace wear on psychosocial well-being, as well as the impact of psychological well-being on brace wear adherence. We’ve reported on numerous studies which have argued the case both ways on this issue – overall, it’s fair to say that the majority of research suggests that bracing can be a stain for patients, but that interventions designed to support them during the process are also effective in reducing any possible harm.

Some research has found that full-time brace wear can indeed negatively impact a patient’s, emotional, and social well-being, including a significant worsening of body image.[1] In addition, research has found that the adverse effects on a patient’s psychosocial well-being induced by brace treatment can then result in poor brace wear adherence[2]  – on the flip side, some studies have confirmed that interventions aimed at improving poor psychological outcomes can improve brace adherence.[3]

While we might naturally expect these results, other research has found no negative impact on psychological well-being induced by brace treatment[4].

 

Recent study

A recent study has now added to the debate, by going beyond just the obvious question of wheather bracing has negative psychological impacts or not. Rather, the authors noted that some of the discrepancies in the brace wear adherence research could well be due to the type of brace wear data used to assess adherence. It’s an (unfortunate) fact that the majority of research on brace wear adherence is based on subjective reports, such as self-reports through brace wear diaries and logs – even at our clinic, were mostly reliant on patients accurately self-reporting their brace wear (or their parents doing so) in order to continue to tailor and tweak treatment as bracing progresses.

The new paper[5] points out that in many studies bracing adherence rates have ranged from 41% of wearing hours/prescribed to as high 100% of wearing hours prescribed – making it very difficult to make an accurate assessment of the linkage between actual brace wear and any potential negative effects. This study, therefore, addressed this limitation, by using body heat monitor data from the landmark BrAIST study, rather than self-reports to assess relationships between body image, quality of life (QOL), and brace wear adherence. The use of temperature monitors during the BrAIST study was one of the factors which made the research so impactful and the data is considered reliable.

Using this data, the study analyzed relationships among brace wear adherence, body image, and quality of life. Thanks to the BrAIST data, it was possible to compare those patients who wore their brace most consistently, for the longest time – and those who only wore it periodically. If the groups who were more adherent to the brace-wearing time experience more psychological issues than those who wore the brace very little, it would seem reasonable to suggest the two are correlated. When looking at differences between the least-adherent and the most-adherent brace wear groups, however, the findings from the study actually supply no evidence that the amount of brace wear negatively impacts body image or QOL, or that poor body image and poor QOL negatively impact brace wear adherence.

 

Important takeaway

This is perhaps not the result that many parents, in particular, would expect to see – nonetheless, the outcome of the study was to say that those patients who did not wear their braces as prescribed were no better off Psychologically for doing so – they did, however, most likely have a lower curve correction than otherwise would have been the case. Conversely, those who wore their braces as instructed and received the best curve correction possible faced no additional stress or strain for doing so – they simply gave themselves the best chance at an excellent result.

As a Scoliosis clinic, it’s easy for us to repeat the message on the importance of sticking to brace wear time – we’ve pointed out in many articles that doing so directly correlates with better outcomes – as a parent, of course, it’s harder to coerce a child into wearing their brace if you’re also concerned about the stress it might be causing them. This article isn’t to say that bracing isn’t hard (although we try to make it as easy and fun as possible!) but do keep these results in mind!

 

 

[1] Pham VM, Houlliez A, Caprentier A, et al. Determination of the influence of the Cheneau brace on quality-of-life for adolescent with idiopathic scoliosis. Ann Readapt Med Phys. 2007;51:3–8.

[2] Rivett L, Rothberg A, Stewart A, et al. The relationship between quality of life and compliance to a brace protocol in adolescents with idiopathic scoliosis: a comparative study. BMC Musculoskeletal Disorders. 2009;10:5.

Chan SL, Cheung KM, Luk KD, et al. A correlation study between in-brace correction, compliance to spinal orthosis and health-related quality of life of patients with adolescent idiopathic scoliosis. Scoliosis. 2014;9:1.

Donnelly MJ, Dolan LA, Grande L, et al. Patient and parent perspectives on treatment for adolescent idiopathic scoliosis. The Iowa Orthopaedic Journal. 2004;24:76–83.

[3] Donnelly MJ, Dolan LA, Grande L, et al. Patient and parent perspectives on treatment for adolescent idiopathic scoliosis. The Iowa Orthopaedic Journal. 2004;24:76–83.

Matsunaga S, Hayashi K, Naruo T, et al. Psychologic management of brace therapy for patients with idiopathic scoliosis. Spine (Phila Pa 1976). 2005;30:547–550.

[4] Hasler CC, Wietlisbach S, Buchler P. Objective compliance of adolescent girls with idiopathic scoliosis in a dynamic SpineCor brace. J of Children’s Orthop. 2010;4:211–218.

Schwieger T, Campo S, Weinstein SL, et al. Body Image and Quality-of-Life in Untreated Versus Brace-Treated Females with Adolscent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2016;41.

Danielsson AJ, Wiklund I, Pehrsson K, et al. Health-related quality of life in patients with adolescent idiopathic scoliosis: A matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J. 2001;10:278–288.

Merenda L, Costello K, Santangelo AM, et al. Perceptions of self-image and physical appearance: Conversations with typically developing youth and youth with idiopathic scoliosis. Orthop Nurs. 2011;30:383–390.

Olafsson Y, Saraste H, Ahlgren R. Does bracing affect self-image? A prospective study on 54 patients with adolescent idiopathic scoliosis. Eur Spine J. 1999;8:401–405.

[5] Traci Schwieger, PhD,corresponding author* Shelly Campo, PhD,* Stuart L. Weinstein, MD,* Lori A. Dolan, PhD,* Sato Ashida, PhD,* and Keli R. Steuber, PhD Body Image and Quality of Life and Brace Wear Adherence in Females With Adolescent Idiopathic Scoliosis J Pediatr Orthop. 2017 Dec; 37(8): e519–e523.

Bracing Scoliosis over 45 degrees

Posted on July 25, 2022 by - Blog

For many years it was considered to be the case that surgery was the only option for reversing Scoliosis – while Scoliosis braces did exist, their primary function was simply to stop Scoliosis from progressing. The best outcome available from bracing was therefore to slow Scoliosis down enough that a patient reached adulthood with a tolerable curve.

Today, modern Scoliosis braces have the ability not only to stop the progression of Scoliosis but also to reverse the condition. Such “over corrective” braces, such as the ScoliBrace we offer at the UK Scoliosis Clinic do this by applying gentle pressure to the scoliotic curve in the opposite direction to the curvature – over time, this can gradually help the spine to return to proper alignment. The success of bracing treatment depends on several factors – one of the most important being the flexibility in the spine, however, it’s possible for patients with Scoliosis up to around 60 degrees[1] to see excellent correction when they are young and flexible enough.

Nonetheless, the “wait and see” followed by surgery approach is still common today, which means Scoliosis patients should always do their research and explore their options before committing to a specific course of treatment.

 

When to brace

When to brace a Scoliosis curve is a tricky question, and one of the major benefits of seeing a Scoliosis specialist – very small curves may not need bracing, with an exercise methodology being enough to control the condition. Larger curves, but those under roughly 30 degrees could benefit from either bracing or exercise-based approaches, so the patient’s lifestyle factors and preferences start to play an important role in treatment selection. For curves over 30 degrees Cobb (Cobb angle being the way in which Scoliosis is measured), bracing is usually the best way forward – however many patients with curves over 45 degrees are often recommended a surgical approach, is this the only option?

 

Bracing curves over 45 degrees – study results

A 2011 study[2] looked specifically at treating Scoliosis patients who were recommended surgery but declined it. The purpose of the study was to verify if it was possible to achieve improvements of scoliosis of more than 45° through a complete conservative treatment – in most cases, this means a combination of bracing and exercise. Specifically, the methods comprised full-time treatment (23 or 24 hours per day) for 1 year with Risser cast, Lyon, or Sforzesco brace; weaning of 1 to 2 hours every 6 months; with strategies to maximize compliance through the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) management criteria applied and specific scientific exercises approach to scoliosis exercises (SEAS) performed.

Out of 1,148 idiopathic scoliosis (IS) patients at the end of treatment, the sample comprised 28 subjects older than 10 years, still growing, with at least one curve above 45°, who had continually refused fusion. The group comprised 24 females and four males, including 14 in which previous brace treatments had failed; at the start of treatment, the age was 14.2±1.8 years and Cobb degrees in the curve were 49.4° (range, 45°-58°). Subgroups considered were gender, bone age, type of scoliosis, treatment used, and previous failed treatment.

After the course of treatment, two patients (7%) remained above 50° Cobb but six patients (21%) finished between 30° and 35° Cobb and 12 patients (43%) finished between 36° and 40° Cobb. Improvements were therefore found in 71% of patients, with only a single 5° Cobb progression observed in one patient. As such, the conclusion was that bracing can be successfully used in patients who do not want to undergo operations for Scoliosis, with curves ranging between 45° and 60° Cobb, given sufficient clinical expertise to apply good braces and achieve great compliance.

 

Is bracing always the right choice for larger curves?

Weather bracing is the right choice for any given curve depends very much on the patient – as studies like this show it’s certainly possible to achieve great results without undergoing surgery – however, the spine needs to be sufficiently flexible and there needs to be time before skeletal maturity is reached still remaining so that treatment has time to work. A consultation with a Scoliosis specialist is always the best way forward when dealing with a suspected or confirmed Scoliosis case, but today it’s certainly true that there are far more tools we can use to prevent and treat Scoliosis than ever before.

 

 

 

[1] Maximum indicated cobb angle for ScoliBrace

[2] Stefano Negrini  1 , Francesco Negrini, Claudia Fusco, Fabio Zaina, Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements Spine J. 2011 May;11(5):369-80.doi: 10.1016/j.spinee.2010.12.001. Epub 2011 Feb 2.

Do curves continue to grow after bracing?

Posted on July 15, 2022 by - Blog

Scoliosis Bracing is one of the most effective ways to treat Scoliosis – today it’s the preferred method used by Scoliosis specialists, and increasingly it’s seen as a worthwhile methodology even by some spinal surgeons. Bracing works by gently applying pressure to the spine while the brace is being worn – this slowly guides the spine back into the correct position, correcting Scoliosis over time. A natural question which often comes up is, therefore, what happens after bracing? Will the curve return?

 

Scoliosis progression

Scoliosis itself is a progressive condition – this means it tends to get worse over time. In children and young adults it worsens very quickly, especially around growth spurts. Once the body reaches Skeletal maturity (which is usually a bit later than the point at which someone is legally considered an adult) the progression of Scoliosis tends to stop, or at least slow. Research suggests that the size of  a Scoliotic curve a person carries into adulthood is a major factor in determining wheather their cure continues to grow. Larger curves (approximately 30 degrees or more) which are carried into adulthood tend to progress throughout life – about 1 degree per year is a commonly cited figure[1] – conversely, curves which are less than 30 degrees often don’t progress.

Scoliosis also commonly impacts older individuals – the prevalence of scoliosis increases with age, so that roughly 30% of the population over 60 have adult scoliosis, although in older people the cause is slightly different – most cases are age-related due to wear and tear on the spine, although having Scoliosis already can make this kind progress more quickly.

What we can take away from this is that the core objective of Scoliosis bracing should be to get people to skeletal maturity with a curve as small as possible, and below 30 degrees wherever viable. This gives a person the best chance of living the rest of their life with minimal or no impact from Scoliosis.

 

Curves after bracing

While most of the research being carried out in the Scoliosis field relates to treating curves in the first place, some studies have looked at the issue of loss of correction. One recent study aimed to evaluate the

loss of the scoliotic curve correction in patients treated with bracing during adolescence and to compare patient outcomes of under and over 30 Cobb degrees, 10 years after brace removal.

As part of the study, researchers reviewed 93 (87 female) of 200 and nine patients with adolescent idiopathic scoliosis (AIS) who were treated with the Lyon or PASB brace at a mean of 15 years (range 10–35). All patients answered a simple questionnaire (including work status, pregnancy, and pain) and underwent clinical and radiological examination.

The patients underwent a long-term follow-up at a mean age of 184.1 months (roughly 15 years) after brace removal. The pre-brace scoliotic mean curve was 32.28° (± 9.4°); after treatment, the mean was 19.35° and increased to a minimum of 22.12° in the 10 years following brace removal. However, there was no significant difference in the mean Cobb angle between the end of weaning and long-term follow-up period. The curve angle of patients who were treated with a brace from the beginning was reduced by 13° during the treatment, but the curve size lost 3° at the follow-up period.

The groups over 30° showed a pre-brace scoliotic mean curve of 41.15°; at the end of weaning, the mean curve angle was 25.85° and increased to a mean of 29.73° at follow-up; instead, the groups measuring ≤ 30° showed a pre-brace scoliotic mean curve of 25.58°; at the end of weaning, it was reduced to a mean of 14.24° and it increased to 16.38° at follow-up.

The basic conclusion was therefore that Scoliotic curves did not deteriorate beyond their original curve size after bracing in both groups at the 15-year follow-ups.  Interestingly, there was also no significant difference in the mean progression of curve magnitude between the ≤ 30° and > 30° groups at the long-term follow-up, which tends not to support the traditional thinking that larger curves progress more through adulthood.

 

Preventing loss of correction

From the above, we can conclude that a small amount of curve increase is likely when discontinuing bracing treatment – however, It’s important to keep in mind that rather than simply weaning off of a brace, it’s possible to be more proactive about the end phases of treatment. One option, for example, is to continue with a Scoliosis specific exercise regimen – research demonstrates that doing so can help to prevent loss of correction after treatment.[2]

While we are not aware of any specific studies which have looked at this issue, one other factor to consider is a possible weakening of muscles which can take place during bracing. A brace takes much of the load off of the musculature which surrounds the spine, so that after a period of years wearing a brace a person may be less able to support themselves and maintain good posture. Studies have shown, however, that Scoliosis specific exercise can be effective in reducing muscle stiffness and loss of strength during bracing[3] suggesting again that a “proactive” end to bracing may help to reduce the risk of loss of correction even further.

 

 

 

 

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

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

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

 

[2] 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

 

[3] 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

 

Scoliosis Bracing in Older Adults, New Research

Posted on June 24, 2022 by - Blog

If you’ve been following the blog this Scoliosis Awareness month, you’ll know that Adult Scoliosis is generally defined as any scoliosis case that exists either in those over 18, or those having reached skeletal maturity – either definition is valid but most scoliosis specialists would prefer the latter since we are focused more on the condition itself than an arbitrary point of “adulthood.”

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

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

Much recent (and not so recent) research into scoliosis treatment, especially bracing, has focused on younger patients – this is primarily because this group stands to gain the most from bracing – proper treatment of, say a 15 year old with mild to moderate scoliosis stands a good chance of allowing him or her to live the rest of their life free of the condition. Those who have reached adulthood with a scoliotic curve, or develop one through ageing have less of a chance for improvement in the cobb angle (degree of scoliosis) but equally, lower rates of progression in the curve itself. Bracing, however, has been shown to have positive effects for older individuals, primarily around daily function and pain reduction. A recent literature review of relevant studies has confirmed this view.

 

What causes Scoliosis in Adults?

Since there are two kinds of scoliosis in adults, we should take a moment to understand why and how they are different.

ASA is scoliosis carried into adulthood from adolescence, isn’t caused in adulthood – it may or may not worsen depending on a number of factors, but the condition originated at an earlier point in life.

Degenerative scoliosis, by contrast, does occur in adult life and is attributable to wear and tear on the spine, but is also strongly associated with a variety of conditions. Osteoporosis, degenerative disc disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis.

Since De-Novo scoliosis is a consequence of spinal degeneration with age, it rarely presents before 40 years of age. For many patients, drawing a distinction between the two types may be academic at any rate, since in patients with no known history of scoliosis it may well be impossible to say whether a newly discovered case is a Do-Novo one, or ASA. It is thought that as many as 30% of over 60’s suffer from De-novo scoliosis[1], although a percentage of these cases will be undiscovered scoliosis from earlier in life. In fact, a good number of adult scoliosis cases are discovered through an investigation for another condition (such as back pain).

 

Recent study

The newest study[2] taking a broad view of the literature on scoliosis bracing for older adults was a review of relevant papers published between 1967 and 2018 – the study investigators used standardised criteria to select relevant papers for inclusion in their work.

In total, ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Right away, this shows one of the biggest issues with Scoliosis research, especially in older adults – there is a clear gender bias (probably due to the higher incidence of adolescents in females, about 75% of cases) and overall a lack of research, only 8 studies considering rigid bracing of the kind now most frequently employed isn’t a huge number!

In the studies, brace wear prescriptions ranged from 2 to 23 hours per day, and there was mixed brace wear compliance reported, both are consistent with our actual experience of bracing in older adults. Most of the included studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing.

 

Study conclusions

After their review, the study authors reported some key conclusions which are well worth noting. Firstly, they showed that there is evidence to suggest that spinal brace/orthosis treatment may have a positive short – medium-term influence on pain and function in adults with either de novo degenerative scoliosis or progressive idiopathic scoliosis. This finding essentially supports the use of bracing in older adults and tallies with our own experience in helping older patients to reduce and manage pain as well as improve function through bracing.

Secondly, and importantly, it was noted that a particular focus on female patients with thoracolumbar and lumbar curves made it difficult to make firm conclusions on the efficacy of bracing for males, and other curve types. It would therefore be highly desirable for further research in this area to focus on a wider variety of case types, in order for us to better understand treatment pathways for older individuals.

 

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

[2] Jeb McAviney et al. A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data BMC Musculoskeletal Disorders volume 21, Article number: 87 (2020)