Gamifying scoliosis treatment – could it work?

Posted on May 17, 2022 by - Blog

One of the most important factors in delivering successful scoliosis treatment is ensuring that patient compliance is high enough to derive a positive outcome. Put simply, treatment only works if you actually do it!

In terms of bracing, it’s easy to measure compliance – a brace is either worn, or it is not. If the brace is being worn, the treatment is being applied, if it is not, the brace does no good. Actually measuring bracing compliance has been a methodological issue in many bracing-based studies, since patients often do not accurately report the length of time for which they really wore the brace. More recent studies have relied on temperature based sensors to objectively measure when a brace is, or is not, being worn, which has been successful from the point of view of study investigators and is generally viewed favourably by patients.[1]

When it comes to scoliosis specific exercises, however, the picture is more complicated – patients must perform their exercises daily in order to have any chance of success, however, they must also perform them correctly. Therefore, simply taking the time to do a scoliosis specific exercise regime does not guarantee results – you must also ensure that you do it right from start to finish.  The need to perform exercise regularly and correctly is a limitation which needs to be considered especially when working with younger children – it’s no slight on any young person to question whether they will have the strength and indeed memory, to be able to perform exercises with precision every single day. What’s more, studies have actually shown that young children perform better when higher volumes of feedback are given  – by contrast, in adults, less feedback leads to higher precision[2] , therefore, home-based exercise approaches may lend themselves more naturally to adults, although it is often children with smaller curves who stand the benefit the most from them.

 

Gamifying Treatment

One novel, but interesting approach to this problem has been to develop video games and interactive apps which can guide young children in performing these kinds of exercises – these have the dual benefit of providing the additional feedback children seem to desire, and also adding some fun to what can be an otherwise boring routine.  One recent study looked at the effectiveness of a so called “Physiogame”, developed by the IT department of the FH JOANNEUM, University of Applied Sciences, Graz, Austria.[3]   The concept is simple, but effective – using the game with an interactive controller the player is instructed so that they remain within a desired splaying space and adopt correctly the 3D positions of the trunk and extremities which are individually adjusted to the corrective posture desired – the game only continues when the posture is correct. This provides both motivation and constant feedback which suits the need of younger participants.

A recently study[4] examing the impact of using such a game showed some real promise for this approach – While the study was small scale (8 patients) and the actual use time of the game in question varied, significant improvements in the accuracy of exercise performed were observed.

In the first month, the participants managed to stay in the predefined 3D space 73% of the gross playing time, and by the last month of the observation period, this increased to 83%. The children improved their performance of the exercise on average by 15%.  The improvement in staying in the corrective posture autonomously and being able to focus more on the game was reflected in the average increase of positive hits per second in-game: they increased from 0.33 in the first month to 0.56 in the last month, for an average increase of 66%.[5]

As part of the program, participants were also asked to evaluate their own performance – interestingly, the study showed that the self-assessment of general performance (“today I did well”) stayed almost the same over the study period, with an average of 2.7 (good) in the first month and 2.3 (very good) in the last month. Similarly, self-assessed stabilization of the vertebral column changed only slightly from 2.6 (good) in the first month to 2.3 (very good) in the last month[6] – hence, the patients improved in their accuracy of exercise without actually being aware of it.

 

Further research

The study authors conclude that further research into the use of these kinds of “gamified” treatments may well pay dividends, especially for younger patients. In the post-covid world, where pandemic resilience and an increased desire to perform more tasks from home are a key features, this kind of interactive “take-home therapist” may well play a key role in treatment in the future.

 

 

 

[1] Sabrina Donzelli et al. Adolescents with idiopathic scoliosis and their parents have a positive attitude towards the Thermobrace monitor: results from a survey Scoliosis and Spinal Disorders volume 12, Article number: 12 (2017)

[2] Sullivan KJ, Kantak SS, Burtner PA. Motor learning in children: feedback effects on skill acquisition. Phys Ther. 2008;88(6):720–32.

[3] Lohse K, Shirzad N, Verster A, Hodges N, Van der Loos HF. Video games and rehabilitation: using design principles to enhance engagement in physical therapy. J Neurol Phys Ther. 2013;37(4):166–75.

[4] Christine Wibmer et al. Video-game-assisted physiotherapeutic scoliosis-specific exercises for idiopathic scoliosis: case series and introduction of a new tool to increase motivation and precision of exercise performance Scoliosis and Spinal Disorders volume 11, Article number: 44 (2016)

[5] Christine Wibmer et al. Video-game-assisted physiotherapeutic scoliosis-specific exercises for idiopathic scoliosis: case series and introduction of a new tool to increase motivation and precision of exercise performance Scoliosis and Spinal Disorders volume 11, Article number: 44 (2016)

[6] Christine Wibmer et al. Video-game-assisted physiotherapeutic scoliosis-specific exercises for idiopathic scoliosis: case series and introduction of a new tool to increase motivation and precision of exercise performance Scoliosis and Spinal Disorders volume 11, Article number: 44 (2016)

I think my Child has Scoliosis – 3 things NOT to do

Posted on April 14, 2022 by - Blog

As parents, we all want to do the best for our children – and when you suspect Scoliosis it can be hard to know what to do. Despite efforts from the Scoliosis community the condition is still widely unknown in the general population which can lead to confusion and that feeling of not knowing where to turn. The most important step to take if you do suspect scoliosis is simply to get active – reach out for help and get the ball rolling.

There are however, a few things you should definitely not do – these three issues are, in our experience the biggest pitfalls for parents of children with scoliosis, so wherever possible do not:

 

1 – Be passive

Because Scoliosis is a lesser known condition, you may well not know anyone who has suffered with the condition. The reality is that Scoliosis should be treated as quickly as possible, as treatment is much easier with a smaller curve, however the lack of awareness in the community can lead to a false sense of lack of urgency. Even amongst those who do know about Scoliosis, many are still unaware that new, non-surgical treatment options now exist. 10- 15 years ago, it was thought that surgery was the only effective option for treating scoliosis, so even many medical professionals were simply taught that the best approach to scoliosis is to “wait and see” if the curve becomes bad enough for treatment. The problem is that scoliosis almost never resolves on its own[1] so while it’s possible it may not progress further “wait and see” is never a good option – at the very least see a scoliosis specialist and ensure the condition is being monitored.

 

2 – Ignore the costs

Unfortunately, very little non-surgical Scoliosis treatment is available in the UK through the NHS. This means that if you’re looking for non-surgical treatment, you’ll probably be taking about private care. Please do see your GP to find out what is available in your area, but you should expect that Scoliosis treatment will cost you money.

It’s easy to react to these costs by either ignoring them (which isn’t responsible) or failing to contextualise them properly (which isn’t realistic). There are two major factors to consider here. Firstly, if you are seeking help for a scoliosis case which is already severe, the chances for successful treatment without surgery are lower – the larger the existing curve, the higher the chance non-surgical approaches will fail. A reputable scoliosis practitioner will give you the best indication they can as to the possible outcomes of treatment and what you might expect in a best or worst case scenario – you should base your decision on the cost of treatment on your own expectations for outcomes, and how likely they are. In some cases, you may be paying simply to delay surgery which will be required anyway and this is important to remember.

At the other end of the scale, it’s critical to remember that Scoliosis treatment is a long process – the totality of your scoliosis treatment will extend from discovery of the condition through until your child has reached adulthood – it’s therefore essential to remember that the costs for treatment are spread over a very long period of time. The price of a Scoliosis brace, for example, is therefore best considered as a monthly one over duration of the brace, rather than a single one off cost.

 

3 – Forget about mental health

Scoliosis can be stressful for everyone involved – and since it’s a condition which commonly affects teens and young adults, it comes at a time of life which is already delicate for many. There are two main approaches to scoliosis treatment plans to choose from – one is group based treatment, and one is individual treatment. Group based settings offer no privacy, but can potentially foster a ready made support group, whereas private one to one settings offer privacy without peer support.

The right kind of environment for you will of course depend on your own child’s preferences – so try to keep this in mind when choosing a clinic. At the UK Scoliosis clinic, we provide a private one to one environment, although we welcome as many relatives or friends that your child would like to have around them to attend consultations, exercise sessions and treatment reviews. Research has shown that having a calming and private environment to discuss and perform treatment can actually lead to better clinical outcomes, although this won’t be ideal for every child. [2]

 

Getting help

If you’re concerned about Scoliosis, please don’t hesitate to get in touch with us – we offer Scoliosis consultations online as well as at the clinic with no obligation to take up treatment, whatever you do – be active!

 

 

[1] Angelo G Aulisa et al. ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner, Scoliosis 2014 9:3

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

What is the most common treatment for Scoliosis?

Posted on March 14, 2022 by - Blog

If you look around online, you’ll quickly see that lots of people are looking for advice on what the most common treatment for scoliosis is – in fact, “what is the most common treatment for scoliosis” is one of the most popular asked questions on google search!

 

 

The problem with “common” treatment as a concept…

We understand why this is – but for us, this question speaks to a real problem with most people’s understanding of Scoliosis! It’s essential to understand that Scoliosis is a highly individualised condition – yes, it has common hallmarks whenever it is present, but almost every aspect of the condition will, in fact, vary between patients. Because of this, treating scoliosis successfully requires a treatment approach which is personalised, rather than common or generic.

Usually, it’s not even enough to describe a broad treatment pathway when treating a Scoliosis case – simply saying that an exercise-based approach is used, for example, does not mean much – since a scoliosis specific exercise routine will be (or should be!) designed from the ground up to counteract the specific scoliosis which the patient is experiencing.

Furthermore, it’s rare that only one approach will be used in treating scoliosis. Surgery is a possible exception to this, but even in this case, most surgeons do recommend some form of physiotherapy post-surgery to speed recovery and promote health after the operation. It’s therefore much more helpful to think about the possible components of scoliosis treatment and to speak to a scoliosis professional about your specific case and how a treatment plan can be put together.

 

Components of scoliosis treatment plans

With that said, let’s look at a high level, at some of the most common options for treating scoliosis.

 

Wait and see

Wait and see used to be a common refrain amongst GP’s encountering scoliosis cases – for many years, surgery was thought to be the only option for correcting scoliosis (it’s now been shown that this is not the case), therefore the only real option was to watch a scoliosis case and see if it got bad enough to require surgery. It goes without saying that this is not a treatment, and today there is almost no circumstance where “wait and see” is truly a good approach.

 

Surgery

Spinal fusion surgery is the most common surgical treatment for severe scoliosis in adolescents. Using metal rods, hooks, screws, and wires (known as instrumentation), the procedure straightens the spine and solidifies the bone to prevent further abnormal curving. Such a procedure will stop scoliosis from progressing and can typically straighten the spine to a considerable degree. The main downside is the risk of complications from surgery as well as the longer-term issues associated with living with a fused spine. For those with large scoliotic curves, however, these issues are often far preferable to living with severe scoliosis.

 

Bracing

Scoliosis bracing has come a long way over the last 10-20 years. Once thought of as a way to potentially slow scoliosis progression, modern “over corrective” scoliosis braces can be effective in reducing and even totally eliminating scoliosis cases given the right conditions. For bracing to be effective, the patient typically needs to be young enough for their spine to remain flexible and have not yet reached spinal maturity. Luckily, this window aligns perfectly with the 10-15 age range where the majority of scoliosis cases are first spotted. Modern scoliosis braces are relatively comfortable to wear, low profile and effective when used as prescribed. Today, bracing is the best option for those with scoliosis cases over roughly 30 degrees and under 60 degrees. Larger curves may still be treated with bracing, but the degree of correction possible is likely to be less.

 

Exercise-based approaches

Also commonly used today, exercised based approaches utilise specialist disciplines within physiotherapy to allow a patient to actively oppose scoliosis with their own body – exercise-based approaches require commitment to show results, but can be effective in reducing smaller scoliotic curves when applied diligently. Exercise is very often used alongside bracing, as it has an especially noticeable effect on muscular strength and tends to oppose some of the muscular weakening which can occur with bracing.

 

Complementary approaches

There are many other complementary approaches which have been shown to have supportive benefits for scoliosis sufferers – these include disciplines such as massage, yoga or Pilates. None of these approaches have been shown to actively correct scoliosis, but they may play a valuable role in helping to reduce pain or discomfort associated with the condition.

 

Experimental methods  – more research required

Scoliosis treatment is an area where a great deal of research has been taking place recently, and there are a number of other approaches being investigated with a view to determining their effectiveness as scoliosis treatments. Some approaches, such as vibration-based therapy show promise in augmenting existing methodologies – at least one study has suggested that combining a vibration plate with scoliosis specific exercise may improve results.

Other areas not currently seen as effective treatments for scoliosis, such as chiropractic, are being actively investigated by organisations such as CLEAR. Indeed, some of these experiments have published promising results. Programmes such as CLEAR have not yet met the bar in terms of demonstrating efficacy for scoliosis treatment, but may do so in the future. At the UK Scoliosis Clinic, we stay on top of many developing methodologies and will be open to incorporating new ones if and when the literature supports this step.

 

Which scoliosis treatment is right for me?

This article is intended as a quick overview of some of the approaches which can go to make up the unique course of scoliosis treatment that all patients deserve. The critical thing is to find a clinic that has the breadth and depth of experience to provide the treatment which best fits you. At the UK Scoliosis clinic, we provide all of the non-surgical options listed above (except the experimental ones) and work closely with expert and highly respected spinal surgeons to refer those cases which would not benefit from non-surgical intervention.

For more information about any of these approaches, please browse our website and articles, or feel free to get in touch.

 

 

 

 

Bracing vs Exercise – Which Scoliosis Treatment is Cheapest?

Posted on March 1, 2022 by - Blog

When it comes to treating scoliosis, you shouldn’t just be trying to find the cheapest option – it’s critical to consider the likely outcome of treatment over the long term, and to remember that in many cases the cost of treatment will be spread out over many years. Quality treatment is always going to be more expensive, and the sad fact is that “cheap” treatment may not have any positive impact at all. This being said, it’s also only right that you do consider cost as part of your treatment selection process. Let’s look at some of the considerations to keep in mind when choosing between exercise-based, or bracing based treatment.

 

Bracing

Scoliosis bracing is the most effective way to treat Scoliosis, in terms of Cobb angle, without undergoing surgery. Bracing has the best chance of any treatment to not only stop the development of scoliosis but also to reverse the condition. Bracing is typically recommended for curves between about 30 and 60 degrees, but certainly can be used to treat smaller curves.

Scoliosis braces (at least ones worthy of the name) are custom made for the wearer and are expensive – the average brace will cost anywhere between 3000 and 4000 Uk Pounds. Some braces, such as the ScoliBrace we offer at the UK Scoliosis Clinic are adjustable within a certain degree, meaning you can get more life out of the brace.

While bracing does come with a high upfront cost it should be kept in mind that a brace will, in the vast majority of cases, last for many years. In adolescents with larger curves, more than one brace may be needed, since eventually, the scoliosis could improve to a point where a new brace would need to be fitted in order to keep up the reduction, but in many cases an adjustable brace such as ScoliBrace can cover an entire course of treatment. In younger children requiring bracing either to correct scoliosis or prevent a relapse multiple braces will be needed, but this will still be spread out over 10-15 years. On the other hand, when buying a brace as an adult, you can (assuming you do not go through significant weight loss or gain) essentially consider it as a lifetime investment.

Bracing also has the benefit of incurring next to no ongoing costs – it’s advisable to have check-up appointments at scheduled intervals, but other than this the treatment is paid for.

In real terms then, the cost of bracing in those not having reached skeletal maturity should be considered as between £1000 and £2000 per year. For those buying a brace as an adult, the cost would be considerably less when annualised.

Exercise-based approaches

Scoliosis specific exercise approaches are often offered alongside bracing as additional support but are mostly used to treat smaller scoliotic curves, at or below 20 degrees. There are essentially two ways to approach this – either through a “Bootcamp” style intensive course, which seeks to teach the patient how to establish and maintain an exercise program or through regularly scheduled appointments over the period of treatment.

Bootcamp style classes can be an attractive prospect – lasting only a few weeks to a month, however, they do not address the need for scoliosis specific exercises to be constantly evaluated and adjusted to keep the correction going. For those looking simply to prevent a small scoliotic curve getting worse, a Bootcamp may work well – but for longer-term treatment, regular appointments with a therapist are usually preferable.

A critical factor to consider with exercise-based approaches is the ability of the patient to perform the exercises correctly – either SEAS or Schroth exercises are not easy, and require physical strength, this means this many younger children may struggle to perform the techniques correctly, even if their compliance with the schedule is 100%.

Scoliosis specific exercise boot camps can cost anywhere from £2000-£5000, depending on the location and whether accommodation is included. Individual sessions range from £50 to £100 per session, based on 1 session per month this comes out to roughly £600 – £1200 per year, plus ongoing travel costs.

As you can see, in real terms, the annualised cost of bracing compares favourably with a Bootcamp style approach and bracing is likely to be only slightly more expensive than a session-based approach to treatment. Taking a Bootcamp type introduction to scoliosis specific exercise, and then following up with periodic appointments with a specialist to review will probably cost more than bracing.

 

Which should I choose?

Although the figures above represent rough guides  (the cost of any treatment will always be individualised and could be more or less than this) it’s hopefully clear to see that there is not likely to be a huge difference in cost when considered over a period of years.

The main factor to consider should, therefore, be the most appropriate treatment for your case. Certain situations are easy to determine – very large curves in young people require bracing in order to have a chance of avoiding surgery, Small curves in adults with a stable spine, without any pain can be easily managed with an exercise approach and curves of say, 45 degrees in young people require bracing for the fastest possible reduction before skeletal maturity is reached and the spine is too ridged to correct.

Often, convenience is more of consideration – for example, the parents of a young teen with a small curve may consider wearing a brace part-time a better investment than paying for ongoing exercise therapy, given that it’s much more effort to comply with an exercise prescription and almost no effort at all to put on a brace. Similarly, an older person might prefer to treat a smaller scoliotic curve which is not too bothersome with the session-based exercise approach, since raising a large amount of cash up-front for the purchase of a brace may not be justifiable.

Unfortunately, there is no easy answer as to which treatment ends up being the cheapest since treatment for scoliosis is always as individual as the patient, but in many cases, you will find that the real terms cost between the two isn’t that great.

 

 

Kyphosis Vs Hyperkyphosis

Posted on February 28, 2022 by - Blog

While Scoliosis is the main focus of our clinic, we also treat associated spinal conditions such as Hyperkyphosis – it’s a lesser-known condition, not least because Hyperkyphosis is often a progression of “regular” kyphosis, a common condition that can often be managed through approaches targeting postural adjustments, such as chiropractic or physiotherapy.

 

What is HyperKyphosis

Scoliosis is a condition of the spine that, ideally should not exist (or should be very small in a healthy individual)  whereas Kyphosis, in and of itself isn’t a problem as a kyphosis is essential for a healthy spine!

The spine is made up of three main sections: cervical, thoracic, and lumbar. When viewed from the front or back, the spine should appear straight (however in scoliosis it appears curved), and when viewed from the side, it has a slight ‘S’ shape.

This S shape is actually a critical characteristic of the spine which allows it to perform its job. The natural curves of the cervical spine (neck) and lumbar spine (lower back) bend outwards and are referred to as ‘lordosis’. The thoracic spine (middle and upper back) features a curve that bends inwards, and this type of curve is referred to as ‘kyphosis’ – so, kyphosis is in fact, a totally normal condition for the spine to exhibit.

So, if kyphosis is a normal inwards bending of the spine, Hyperkyphosis is said to exist when the kyphotic curve becomes excessive, leading to a rounded appearance of the upper back, a “hunched” posture and often, back pain. We are all individuals with a slightly different spinal and physical makeup, it’s therefore hard to say what an “ideal” kyphotic curve is – for most people a healthy figure is between 20 and 45 degrees, but when a curve falls beyond that healthy range, problems can occur.

When a kyphotic curve exceeds approximately 50 degrees, this is referred to as ‘Hyperkyphosis’ – in many circles, the word “kyphosis” is also often used to mean “Hyperkyphosis” which is unhelpful!

 

 

Types of Hyperkyphosis

There are three main types of Hyperkyphosis – broken down by cause, these are postural, congenital and Scheuermann’s

Postural kyphosis is the most common type and is associated with the “hunched” posture we often expect in adolescents. While it’s not true that the use of electronic devices actually causes Hyperkyphosis, the terrible posture this tends to promote most certainly can. Postural kyphosis is the simplest diagnosis to treat, since the condition is caused by poor posture and weakened muscles resulting from it – any treatment approach which aims to address this problematic posture will generally resolve postural Hyperkyphosis.

Congenital Kyphosis is more complex – whereas, in postural kyphosis an individual is born with a normal spine that develops an issue through misuse, a person with congenital kyphosis is born with the condition. There are a number of malformations in the spine which fall under the category of congenital Kyphosis – these include vertebrae not forming properly, or multiple vertebrae fusing together into one solid bone, rather than forming separate and distinct vertebrae.

Some congenital Kyphosis cases may benefit from bracing, but the best treatment will vary considerably depending on the individual.

Finally, Scheuermann’s Kyphosis is a structural condition which affects the way that vertebra develop. In a person with a “normal” spine, vertebrae are rectangular in shape – thus, they sit on top of each other in a fairly level alignment. In patients with Scheuermann’s kyphosis, a number of consecutive vertebrae are more triangular in shape, meaning that they naturally want to curve irrespective of the health of surrounding supporting muscle.

Abnormal spinal curvatures caused by this type of kyphosis are often angular, stiff, sharp, and rigid, which is why this form is more complex to treat and can’t simply be corrected with a change of position. Scheuermann’s is more common in boys and is progressive during growth, which is why proactive treatment is so important.

 

 

Kyphosis, which treatment is right for me?

The vast majority of Hyperkyphosis cases tend to be postural in nature, so, while expertise is required to provide a suitable treatment there are many approaches that can help. Chiropractic and physiotherapy are two approaches we utilise at the UK Scoliosis Clinic, but any approach which alters the problematic posture will, over time tend to resolve this condition. It’s also true that many kyphosis cases which are visible, or cause pain do not reach the threshold for Hyperkyphosis – you should, however, look to treat the condition as early as possible, since it will tend to progress without intervention -, even if that only means getting some professional advice on improving your workspace to promote good posture.

Congenital cases and Scheuermann’s kyphosis can often benefit from more specialist treatment through a spinal clinic, like the UK Scoliosis clinic. Spinal bracing, similar to that used for Scoliosis can be appropriate in some circumstances – in others, the best approach may still be a manual therapy coupled with postural work although for more complex cases it’s often worth coordinating this through a specialist centre.

Do I need to treat my Scoliosis?

Posted on February 21, 2022 by - Blog

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

Posted on February 10, 2022 by - Blog

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

Posted on January 25, 2022 by - Blog

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

Posted on November 20, 2021 by - Blog

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!

Posted on November 1, 2021 by - Blog

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.