Tag: exercise

Disadvantages of Scoliosis-Specific Exercise

Posted on March 19, 2023 by - Blog

While there are several non-surgical treatment options available for scoliosis, scoliosis-specific exercise is a popular method that, like bracing, is gaining popularity. However, like any treatment approach scoliosis specific exercise also has its disadvantages that need to be considered.

 

Scoliosis Specific Exercise

Scoliosis-specific exercise is a highly specialised area of physiotherapy-based approaches to treating musculoskeletal conditions – unlike normal forms of physiotherapy, it does not focus on symmetrical, therapeutic movements, but rather attempts to use a person’s own body and strength to oppose a Scoliotic curve. Scoliosis-specific exercise – specifically the Schroth method, is the oldest approach to scoliosis treatment and has now been practised for over a hundred years. There’s no question that exercise-based approaches can indeed stop the development of Scoliosis and reduce it in some cases[1] – so it’s well worth considering. However, there are some disadvantages:

 

Limited impact on larger curves

One of the biggest disadvantages of scoliosis-specific exercise is the lack of scientific evidence supporting its effectiveness in larger curves. Most studies conclude that bracing is a better approach for larger curves and is a faster way to correct scoliosis overall. Some studies do show that exercise approaches may be effective in slowing the growth of a curve[2], but what’s needed (especially in a more significant case) is correction – not just slowing.  That being said, it does seem that combining an exercise-based approach with bracing is more effective than bracing alone.[3]

 

Requires commitment and consistency

Like any exercise program, Scoliosis specific exercise requires commitment and consistency. The exercises must be performed regularly to see any benefits, and this can be challenging for some patients – especially young children. Some patients may find it difficult to maintain the same level of motivation over a prolonged period. This can be especially challenging for people who are already struggling with chronic pain, making it harder for them to keep up with the exercises. Sadly without consistency, exercise-based approaches will not work.

 

Requires supervision

Scoliosis-specific exercise programs require supervision to be truly effective – like bracing, a treatment plan needs constant monitoring and adjustment to have the best possible impact. This can be a disadvantage for people who live in remote areas or do not have easy access to a scoliosis specialist. Patients who attempt to perform exercises without proper guidance may inadvertently worsen their condition. This is why it is crucial to seek professional advice and maintain it while using exercise-based approaches to treatment.

 

Can lead to muscle imbalances

Scoliosis-specific exercise focuses on strengthening specific muscles to correct the curvature of the spine. However, this can lead to muscle imbalances, where some muscles become overdeveloped while others remain underdeveloped. Muscle imbalances can cause pain and discomfort, and in severe cases, can lead to other medical conditions such as joint problems. When a program is properly monitored by a professional this shouldn’t be a problem – but it’s a risk for anyone who does not have the proper guidance.

 

Does not address underlying issues

While exercise-based approaches may be effective in reducing the curvature of the spine and alleviating pain in some cases, it does not address the underlying issues that led to scoliosis. In some cases, scoliosis may be caused by underlying medical conditions such as neuromuscular disorders or genetic factors, but the typical idiopathic scoliosis seen in teenagers and young people cannot be “cured” with exercise. To be fair, it cannot be “cured” with bracing either – the only way to truly manage the condition is to maintain the spine in as straight an alignment as possible until skeletal maturity is reached. Many professionals view that this is easier to do with bracing than exercise, because of the cost and effort involved in 10-15 years of exercise monitoring.

 

Is Scoliosis specific exercise right for me?

Scoliosis-specific exercise can be a valuable part of an overall treatment plan and may be the right option for some smaller curves, or stable curves in adults. This being said, it has its disadvantages, and patients should carefully consider these before deciding on this treatment option alone.

 

 

[1] ‘SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises‘
Romano M, Negrini Am Parzini S, Tavernaro M, Zaina F, Donzelli S and Negrini S 2015, Scoliosis 2015 10:3, DOI: 10.1186/s13013-014-0027-2

 

[2] ‘Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study’
Negrini A, Donzelli S, Negrini M, Negrini S, Romano M, and Zaina F 2015,, Scoliosis Jul 11 10:20

 

[3] ‘The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteira: a prospective study‘
Negrini S, Donzelli S, Lusini M, Minnella S and Zaina F 2014, BMC Musculoskelet Disord. 2014; 15: 263, Published online 2014 Aug 6. doi:  10.1186/1471-2474-15-263

 

5 Tips to Help Reduce Scoliosis Pain

Posted on January 14, 2023 by - Blog

For most of the history of Scoliosis treatment, the widely held view has been that Scoliosis does not cause pain. It’s certainly true that many Scoliosis patients present at our clinic with no pain nor discomfort – but recent research, as well as our experience, has shown that in many cases Scoliosis can be painful.

At least one research study suggests evidence of a possible 35-42% prevalence of lower back pain in adolescents with idiopathic scoliosis[1] (AIS), in another study of 2400 patients with AIS, 23% reported back pain at their initial contact[2]. Chronic non-specific back pain (CNSBP) also seems to be frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[3]  – in addition, patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[4]

In patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[5] and Scoliosis patients have between a 3 and 5-fold increased risk of back pain in the upper and middle right part of the back[6].

While this does not mean that everyone with Scoliosis will experience pain – in fact the numbers roughly support about a 50/50 chance – there are still a significant number of individuals for whom the management of Scoliosis & pain is a factor. At the UK Scoliosis Clinic, we utilise a number of approaches to help manage the pain associated with scoliosis – but there are also some steps you can take yourself.

 

1 – Keep active, Keep fit

Being physically active and reducing the amount of time spent in sedentary positions is very important, not only for pain management but for your overall health and well-being. While it’s true that Scoliosis can make some activities more difficult, and there are some exercises (especially “one-sided” activities, like racket sports) which we might advise against – there’s no reason why Scoliosis should stop you from being as active as possible. If pain is already a significant issue, low-impact activities such as Yoga or Pilates  can be an excellent way to keep moving, and may even provide some additional pain relief. Swimming, once thought to treat Scoliosis (sadly, based on current research, does not[7]) is nonetheless an excellent way to stay fit with almost no risk or injury.

 

2 – Improve your posture.

While it’s not true that poor posture causes Scoliosis – poor posture can cause pain, both for Scoliosis sufferers and those without Scoliosis.

A huge part of Physiotherapy based approaches to Scoliosis is increasing awareness of posture – when sitting and standing and to take note of the position of your spine. Are you collapsed to one side or slouching? Try to straighten & lengthen your spine and keep balanced, avoid leaning to one side as this can aggravate pain – instead, try to remain in a neutral or corrected position. Many people with Scoliosis pain find that regular movement helps to reduce pain too.

 

3 – Avoid extended sitting/extended standing

Where possible, avoid extended sitting when working, studying or at school. Regular postural changes/breaks (every 20-30 minutes) are very important and can be as simple as standing up, walking to the other side of the room, or stretching, before sitting back down.

This is, like most of these tips, a good idea to do regardless of your Scoliosis status as long periods of sitting encourage imbalances in muscles and ligaments – in fact, it’s the cause of a huge percentage of back pain cases treated by Chiropractors every year.

 

4 – Light Stretching or Massage

Stretching or Massage, either as a targeted activity or part of something like Yoga can be highly beneficial for Scoliosis suffers –focussing on elongation and decompression of the spine is likely to help relieve pain for many, and can often be performed at home using a tennis ball, foam roller or massager. That being said it’s best to consult with a Scoliosis expert when it comes to stretching or flexibility routines, for example many people with AIS will have reduced spinal curves or flat backs, so it is important that significant hyper-extension/arching backwards is not performed as it may increase the flattening of the back which may in turn progress the scoliosis.

Repetitive one-sided movements, or exercises & stretches leading to excessive spinal rotation may actually worsen pain – due to the 3D nature of scoliosis. Repetitive twisting or one-sided movements can potentially put your spine into an unfavourable position or even counteract an ongoing treatment program, so use with care.

 

5 – The Best Option, Scoliosis Specific Exercise

The best option to address Scoliosis pain is, of course a professional plan. A Scoliosis professional can design a series of Scoliosis Specific exercises, that will help improve posture, manage pain and slow the progression of your condition. These scoliosis-specific exercises, once mastered, can be incorporated into your day-to-day life or form part of an active treatment program.

In some cases, the part-time use of a Scoliosis brace could also be considered – for example, while bracing in adults is not likely to reduce the Scoliotic curve itself, research does indicate that bracing can be effective in reducing chronic pain.[8]

 

 

 

 

[1] Théroux, J., et al.Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review. Chiropractic & manual therapies, 25(1), 1-6.

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

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

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

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

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

[7] Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al.: Physiotherapy scoliosis-specific exercises—a comprehensive review of seven major schools. Scoliosis Spinal Disord, 2016, 4: 1.

Zaina, F., Donzelli, S., Lusini, M., Minnella, S., and Negrini, S. (2015). Swimming and spinal deformities: A cross-sectional study. The Journal of Pediatrics, 166(1): 163-167.

Gonen Aydin C, Oner A, Hekim HH, Arslan AS, Oztas D, Akman YE. (2020) The prevalence of scoliosis in adolescent swimmers and the effect of swimming on adolescent idiopathic scoliosis. Turk J Sports Med.;55(3):200-6.

[8] Scoliosis bracing and exercise for pain management in adults—a case report Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.

­­­­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!

 

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.

 

 

What is Schroth best practice?

Posted on August 20, 2021 by - Blog

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

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

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

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

 

Recent studies

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

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

 

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

 

Is Schroth best practice the way forward?

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

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

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

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

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

How is scoliosis treated in 2021? – Part 2

Posted on May 7, 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]

 

5 scoliosis facts that may shock you!

Posted on April 11, 2020 by - Blog

If you’ve been reading this blog for a while, or if you have an interest in scoliosis, you will certainly have noticed some themes which come up again and again. Even a quick browse through the recent research in the field, demonstrates that the main areas of interest are fairly constant – adolescent idiopathic scoliosis, the genetic links for scoliosis and the most effective methods for reducing cobb angle come up more often than not. There’s more to scoliosis treatment than just these factors however – so this week, we look at some lesser-known but potentially surprising scoliosis facts.

 

Surprising scoliosis fact number 1

The group most at risk from scoliosis is older adults.

Because of the risk of progression, and the potential consequences if treatment is not forthcoming, much research, advertising and awareness campaigning in the scoliosis field concentrates on adolescent idiopathic scoliosis – next in line is probably juvenile scoliosis. The fact is, only about        2-3% of the population in these groups will develop scoliosis. That’s still a very large number of cases, all with a significant risk of progression, but when you crunch the numbers, its clear that older people are, in fact, the most likely to suffer from scoliosis – the risk is nearly 10 times higher!

Research indicates that approximately 30% of those over 60 suffer from scoliosis[1] – the majority of cases are termed “de-novo” which is a scoliosis that develops due to spinal degeneration and can respond well to treatment.

 

Surprising scoliosis fact number 2

Scoliosis is sometimes more common in males 

It’s true that 75% of adolescent idiopathic scoliosis cases are females, and since this gets the lions share of attention in the field, it’s little surprise that most screening campaigns and tools are targeted at young girls. That being said, in some instances scoliosis is actually more common in boys. Specifically, this is the case in cases of infantile scoliosis. Infantile scoliosis is the least common of all forms of idiopathic scoliosis and comprises only about 1% of all idiopathic scoliosis in children. However, about 60% of patients in this group are boys. Infantile scoliosis can sometimes resolve spontaneously, but presents the highest possible risk for progression, so should be monitored and treated urgently.

 

Surprising scoliosis fact Number 3

Which is better, bracing or exercise? …. Actually, it’s both!

When it comes to treatment methodologies, it’s usually a case of picking the best approach and sticking with it. As it concerns scoliosis treatment, a multiple studies have confirmed that when bracing and exercise approaches are combined the results are greater than the sum of the parts. Curve correction with a dual approach is superior to either approach alone.[2]  What’s more, it seems that using exercise approaches before and after bracing can speed correction, and then prevent loss of correction after bracing.[3]

 

Surprising scoliosis fact Number 4

Your GP knows a lot less about scoliosis treatment than you might hope.

This point isn’t about criticising GP’s – they do a fantastic job, but there’s only so much any one person can know, and as it goes, scoliosis is fairly low down the list of major concerns for the general population. The situation is especially difficult in the UK, since the National Health Service (NHS) is (understandably) not in the business of recommending private companies, and the best bracing technologies on the market today are only available privately. It’s for this reason, that you must seek a specialist scoliosis consultation whenever possible – the braces on offer through the NHS are still mainly “passive” options, which don’t correct scoliosis, just try to stop it progressing.

 

Surprising scoliosis fact number 5

Active bracing is often the most cost-effective option.

Active scoliosis braces, like ScoliBrace, are advanced medical devices and aren’t cheap – and while no one would claim that the cost of a scoliosis bracing treatment is insignificant, in many cases it can be substantially less financially impactful than many other options.

Lets briefly consider the main treatment methodologies available:

Surgery – Through the NHS in the UK, surgery for scoliosis is of course free. So naturally the issue here isn’t a financial one, but rather the cost of surgery is often in terms of complications after the event – or with the disruption that it can cause to a young persons’ life. The UK Scoliosis Clinic isn’t anti-surgery – on the contrary, we know that spinal surgeons can do fantastic work for patients who have no other option – we do, however, believe that surgery should be the last resort since for many, recovery is long and complicated. While it won’t be the case for everyone, recent meta-analyses of published research have suggested that the complication rate could be as high as 89%.[4]

Exercise – Exercise-based treatment plans are only supported by research  for small curves with a low risk of progression and while exercise might initially seem cheaper than bracing, this is only true if the treatment is appropriate. In young growing spines, the risk of scoliosis progressing in moderate to large curves is high, thus a curve must be constantly straightened via a brace rather than through the intermittent use of scoliosis specific exercise. In cases where a brace has been required and only scoliosis specific exercise used, curves will often progress and surgical correction will be required.

Other forms of bracing – Regular readers will know that Scoliosis braces are not created equal. Passive models, which don’t correct scoliosis but attempt to hold the curve in its current position, do absolutely nothing to “treat” the condition.  Other braces on the market, while still active in nature, unlike Scolibrace are often not adjustable – meaning that their corrective capacity is limited, thus a new brace is frequently required as the curve changes. This means that in many cases, an advanced adjustable brace, like ScoliBrace will be cheaper in the long term.

 

 

 

[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.

‘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

 

[2] ‘The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteira: a prospective study‘
Negrini S, Donzelli S, Lusini M, Minnella S and Zaina F 2014, BMC Musculoskelet Disord. 2014; 15: 263, Published online 2014 Aug 6. doi:  10.1186/1471-2474-15-263

‘Adult scoliosis treatment combing brace and exercises‘
Papadopolous D 2013, Scoliosis 20138(Suppl 2):O8, DOI: 10.1186/1748-7161-8-S2-O8

 

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

 

[4] Hans-Rudolf Weiss and Deborah Goodall, Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature, Scoliosis, 2008, 3:

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

Posted on September 11, 2018 by - Blog

 

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

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

 

 

1 – Screen for scoliosis at home

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

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

 

2 – Get a professional consultation

Screening and consultations are always available at the UK Scoliosis Clinic

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

There are a few reasons for this – Firstly, while no question that GP’s do fantastic work, with so many different conditions to recognise and treat most GP’s simply don’t have time to research the latest options for scoliosis treatment. Years ago, it was thought that surgery was the only effective option for treating scoliosis, so many medial professionals were simply taught that the best approach to scoliosis is to “wait and see” if the curve becomes bad enough for treatment. The problem is that scoliosis almost never resolves on its own[1] so “wait and see” is never a good option. If your GP tells you to “wait and see” please bear in mind they aren’t trying to be dismissive, they just aren’t experts on the non-surgical options which are available today (but scoliosis clinicians are!).

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

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

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

 

3- Get X-rays

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

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

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

 

4 – Understand your treatment options

Scoliosis SEAS treatment

Specialist exercises can reduce Scoliosis

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

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

 

5 – Chose a clinic which conforms to the SOSORT guidelines

Like all professions, the scoliosis treatment field has a guiding body – for us it’s the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment, otherwise known as SOSORT. SOSORT is an International organisation that guides health professionals on the most up to date, evidence-based recommendations in relation to the conservative treatment of idiopathic scoliosis. SOSORT’s ongoing mission is to constantly evaluate new treatment methodologies and to publish guidelines for best practice for patient outcomes[3].

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

 

6 – Get the best brace

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

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

 

7 – Consider mental health

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

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

 

8 – Ask questions

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

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

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

 

9 – Consider the cost of treatment carefully

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

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

 

10 – Get on with your life!

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

 

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

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

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

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

New research – Scoliosis impacts functional capacity

Posted on May 28, 2018 by - Blog

Tired out girl

Scoliosis can make exercise more difficult

Adolescent idiopathic scoliosis (AIS) is by far the most common cause of spinal deviation; it comprises about 80% of all idiopathic vertebral deformities and affects 2%–4% of adolescents.[1] The exact cause of AIS is still being investigated, but scientists generally agree that it is largely determined by genes that are activated by different factors.

When thinking about how we should direct the treatment of scoliosis, we often tend to focus on the well-known potential outcomes of the condition if left untreated- these include physical deformity, disability, pain and discomfort.  What we often forgotten is the impact that scoliosis can have in terms of overall health and fitness.

As it stands, research has already confirmed that that scoliosis influences factors like ease of breathing during exercise in a negative way[2] However, brand new research just published in the Journal of Paediatric exercise science now allows us to understand the degree to which cobb angle (the degree of the scoliotic curve) actually has an impact.

The research conducted at the Federal University of São Paulo in 2018, hypothesised that Individuals with scoliosis would have lower exercise tolerance in cardiopulmonary exercise testing (CPET) and in the incremental shuttle walk test (ISWT) – a suggestion which has already been confirmed in preceding studies.[3]  Researchers then sought to evaluate the functional capacity (that is to say, the ability of the participants bodies to cope with exercise) in patients with AIS with specific regard to the functional capacity and respiratory variables in patients with different degrees of scoliosis severity.

 

Participants

The study tested a cross section of participants with varying degrees of scoliosis severity. The group included eighteen patients with mild and moderate scoliosis, 8 patients with severe scoliosis, and 10 adolescents from a control group. Patients were selected from the Orthopaedic Clinic at a local hospital, and  they  were  submitted for radiography to evaluate the Cobb angles prior to the study.

In order to ensure the results were relevant and valid, patients were excluded if they had a previous or current history of heart, lung diseases or neuromuscular disorder, cognitive changes that influenced the understanding of tests, and all those who failed to perform the assessment proposed.

 

Results

A 54 Degree Cobb angle (X-ray)

During the ISWT participants are asked to walk between two cones, placed 10 meters apart. Participants aim to match the pace provided by a simple beeping prompt. In this study, each of the partcipants performed the test twice, in order to try to ensure more even results.

Heart rate, blood pressure and fatigue were measured by modified Borg scale before and after the test[4]. The results of the study were conclusive. In the study, patients with AIS definitely performed worse than test subjects without scoliosis. Those with scoliosis found the test harder (more physically taxing) and also displayed a lower level of respiratory function. What’s more, the performance of the individuals with scoliosis was worse in individuals with a more severe cobb angle. Overall, patients with AIS walked shorter distance during the ISWT when compared with adolescents without scoliosis. Patients with  AIS > 45°  and  AIS < 45°  walked,  respectively, 156 m and 117 m less than the control group.

This study therefore identified that patients with severe scoliosis present worse functional capacity and, perhaps of greatest interest, it draws attention to the fact that even patients with mild and moderate scoliosis already show a significant reduction in functional capacity.

 

What we learn from this study.

At the UK scoliosis clinic, we are committed to ensuring that all our approach to treating scoliosis is always grounded in the most up to date scientific research available. From the results of the study there are two important take-aways.

In the first instance, the study goes to show the degree to which even a minor case of scoliosis (of the sort which may respond particularly well to bracing) may impact the quality of life and capability of an individual to participate in exercise – both for health-related purposes, and indeed as a social exercise. This is particularly interesting given that the authors of this study also noted a correlation between individuals with scoliosis and low exercise participation rates. Specifically the authors note “Adolescents with scoliosis for some reason are physically unconditioned; some authors believe that this fact is related only to the low adherence of individuals to physical activity, mainly due to the constraint of the disease deformity” .  This research therefore goes to underscore the importance of early intervention in dealing with cases of adolescent idiopathic scoliosis.

Secondly, this study (by its methodology) suggest that the ISWT can be a valuable tool for assessing functional capacity in patients with AIS. As a relatively low-cost but widely applicable test, the ISWT may therefore be worth further consideration within the scoliosis treatment community. Dr Irvine is keen to follow up on this insight and will be considering its possible applications within our clinic.

 

The main source article for this post was:

 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

 

 

[1] Weinstein SL, Dolan LA, Cheng JCY, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008;371:1527–37. PubMed doi:10.1016/S0140-6736 (08)60658-3

 

[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] 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

 

Sperandio EF, Vidotto MC, Alexandre AS, Yi LC, Gotfryd AO, Dourado VZ. Exercise capacity, lung function and chest wall shape in patients with adolescent idiopathic scoliosis. Fisioter Mov. 2015;28(3):563–72. doi:10.1590/0103-5150.028.003.AO15

 

Barrios C, Pérez-Encinas C, Maruenda JI, Laguía M. Significant ventilatory functional restriction in adoles- cents with mild or moderate scoliosis during maximal exercise tolerance test. Spine. 2005;30(14):1610–5. doi:10.1097/01.brs.0000169447.55556.01

 

Bas P, Romagnoli M, Gomez-Cabrera MC, et al. Beneficial effects of aerobic training in adolescent patients with mod- erate idiopathic scoliosis. Eur Spine J. 2011;20 Suppl 3: 415–9. PubMed doi:10.1007/s00586-011-1902-7

 

[4] Hommerding PX, Donadio MV, Paim TF, Marostica PJ. The Borg scale is accurate in children and adolescents older than 9 years with cystic fibrosis. Respir Care. 2010;55(6):729–33. PubMed