Tag: scoliosis exercise

Is scoliosis a risk factor for mental health?

Like all reputable clinics, the UK scoliosis clinic focuses the majority of its time and effort on providing the best possible treatment for scoliosis cases. For the most part, this means keeping up with the latest research, bracing and exercise based techniques which can assist in controlling and reducing scoliosis, however, where we also concentrate a lot of time and attention is to the psychological aspects of living with and being treated for scoliosis.

 

Scoliosis and Psychological factors

Like any condition, Scoliosis can obviously cause distress and concern – but there are some specific factors associated with scoliosis which may make the condition especially difficult for many patients to cope with. The key areas include:

  • The fact that Scoliosis does cause physical deformity, and very often strikes at the most sensitive time in a young person’s life. It’s normal and expected for teens and young adults to experience stress and difficulty associated with physical changes in their body and the formation of their adult identity, even under typical circumstances – scoliosis can certainly complicate this.
  • Misinformation about scoliosis which is frequently repeated. Many still believe that a diagnosis of scoliosis necessitates surgery, which, ironically, can prevent some people from taking advantage of screening. It’s also commonly believed that scoliosis can impact on the ability to have children, take part in physical activity or even live a normal life. While it’s true that if left untreated scoliosis could lead to some of these outcomes, early treatment can often make such outcomes almost completely avoidable.
  • Concerns about bracing, and stigma associated with bracing. It’s certainly the case that “old style” braces such as the Boston brace were visible, clunky and certainly embarrassing for young people – but modern CAD/CAM braces, such as ScoliBrace, are virtually invisible under clothing.
  • Fear of being unable to participate in normal activities. Again, with modern bracing technology this is rarely if ever, an issue – today’s braces are so easy to put on and take off that they can simply be removed for exercise, although designs such as ScoliBrace are actually flexible enough to be left on.

With each of these concerns, the critical point to stress is that Scoliosis, if caught early enough can now usually be treated non-surgically and quite quickly, through bracing, exercise or a combination of both. The best possible way to detect scoliosis is through a routine screening, which can often allow the condition to be detected long before it has progressed to a significant degree.

 

Scoliosis and psychological health : scientific research

There has been some limited research which has sought to understand the impact that scoliosis can have on a young person’s psychological health – although it’s still fair to say that only a small part of the literature relating to scoliosis considers this angle, there is still sufficient a body of evidence for us to draw some meaningful conclusions.

One such study looked at adolescents with and without scoliosis in Minnesota who were 12 through 18 years of age. During the study, six hundred eighty-five cases of scoliosis were identified from the 34,706 adolescents. The prevalence was therefore 1.97%  (incidentally, this is slightly below the average figure). The researchers wanted to calculate the odds ratio of scoliosis to some common psychological issues.

Put simply, an odds ratio is a measure of how strongly related two items are – An odds ratio of more than 1 means that there are a higher odds of property B happening with exposure to property A, whereas an odds ratio of exactly 1 means that exposure to property A does not affect the odds of property B. An odds ratio is less than 1 is associated with lower odds of two factors being related. [1]

In the study, of the 685 adolescents with scoliosis, the odds ratio for having suicidal thought among adolescents with scoliosis, compared to adolescents without scoliosis, was 1.40 after adjustment for race, gender, socioeconomic status, and age. The odds ratio for having feelings about poor body development among adolescents with scoliosis was 1.82 compared with adolescents without scoliosis after adjustment for race, gender, socioeconomic status, and age. Scoliosis was therefore deemed to be an independent risk factor for suicidal thought, worry and concern over body development, and peer interactions.

In a 2019 study, which compared scoliosis treatment approaches, the SRS-22 (a standardised scoliosis quality of life screening form) was used to explore the impact which treatment had on psychological health.  Here, researchers noticed that self-image was significantly improved amongst patients treated with a scoliosis brace, especially at a follow up after 12 months of treatment, this was especially interesting given the negative self-image association which is sometimes linked to bracing

Researchers found a similar improvement in patients treated with an exercise methodology –  all the SRS-22 quality of life subsets showed a slightly larger improvement across the three visits than bracing, although the correction of scoliosis was less.[2]

 

Does scoliosis affect psychological health?

From the research which has been conducted, as well as our own experience at the clinic we feel it’s safe to say that scoliosis can be a significant risk factor for psychological health – especially in young people. While this certainly does not mean that everyone with scoliosis will struggle with mental health as a result, it’s clearly important that scoliosis clinicians are aware of the risk, and work to mitigate it.

At the UK Scoliosis clinic, we believe that properly researched information, coupled with effective treatment, applied as quickly as possible is the best possible way to address the psychological risks associated with scoliosis. It’s for this reason that we continue to recommend frequent screening throughout high risk years. It cannot be stressed enough that early detection, coupled with good information can go the majority of the distance in diffusing some of the  main concerns around a scoliosis diagnosis. We would caution parents and sufferers from relying on general advice or information pulled from the internet – the best option is by far a consultation with a scoliosis professional.

[1] Payne, William K. III, MD, et al. Does Scoliosis Have a Psychological Impact and Does Gender Make a Difference? Spine: June 15, 1997 – Volume 22 – Issue 12 – p 1380–1384

[2] 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]

Is exercise recommended for people with scoliosis?

The role of sport and exercise as it relates to scoliosis and its treatment is a complex one. It has been known for some time that participants in some activities, such as gymnastics, seem to have a higher risk of developing scoliosis – at the same time, it has also long been suggested that exercises such swimming could help to reduce scoliosis. These are just two examples of the seemingly contradictory information available on scoliosis and exercise – this week, we summarise the latest findings and guidelines.

 

Do some forms of exercise cause scoliosis?

At present, there is certainly evidence to suggest that participants in some activities, such as gymnastics or dance have a higher chance of developing scoliosis. Indeed, research suggests that gymnasts are up to 12 times more likely to develop scoliosis than non-gymnasts on the whole.[1] There is a 10-fold higher incidence of scoliosis among rhythmic gymnasts[2] and an increased incidence of scoliosis has been reported in ballet dancers (24%)[3] What this observation does strongly suggest is the value of regular scoliosis screening for those involved in gymnastics, ballet and other forms of exercise which involve much contortion of the body and spine. What this evidence does not necessarily mean is that gymnastics causes scoliosis, since correlation does not necessarily mean causation.

While it does seem as though patients with scoliosis are more likely to participate in sports like gymnastics[4] it is now thought that this is because patients with scoliosis tend to have a higher prevalence of joint laxity than the general population this makes them more flexible[5], which would be a natural advantage in these activities. Therefore, avoiding such activities probably won’t do anything to prevent or avoid scoliosis.

 

Isn’t exercise good for everyone?

At the risk of providing a very simplistic answer, yes. Almost all scoliosis clinicians agree that those with scoliosis should actively take part in sport and physical activities[6]. This is not least because the psychological and social aspects of exercise are shown to be related to the patient’s self-image in a positive way[7] – indeed, it has also been reported that persons with scoliosis who exercise regularly, show higher self-esteem and have better psychological outcomes from treatment[8]. Therefore, SOSORT also recommends that patients with scoliosis should remain active in sports activities[9], especially since, as outlined above, participation does not seem to directly affect the occurrence or degree of scoliosis[10].

 

Can exercise cure scoliosis?

Tired out girl

Specialised forms of exercise can treat scoliosis, but most forms of exercise still make a positive contribution to health !

It was once thought that a range of everyday exercises may be beneficial for scoliosis suffers – today the picture s more refined. For example, it was once widely reported that popular forms of general exercise, such as swimming (which has traditionally been recommended as a good sports activity for scoliosis and even prescribed by some physicians as a treatment),could be a possible corrective approach. Now we know that swimming does not seem to have any positive effect on scoliosis, although its certainly a great low-impact form of exercise, and a lot of fun!

To return to the point about causation and correlation, there is also at least one older study from 1983, which screened 336 competitive adolescent swimmers for scoliosis and found the prevalence of scoliosis to be 6.9%[11], which is more than double the average. Despite this, there is no evidence to suggest that swimming is a causative factor of scoliosis.

If general exercise does not seem to improve scoliosis, is there an approach that can? In fact, there are several forms of specialised exercise which have now been developed with the sole aim of reducing and controlling scoliosis – these are the Schroth and SEAS approaches, both of which have proven to be successful alone, and far more successful when combined with bracing. You can learn much more about both approaches on our site – but for more information please don’t hesitate to get in touch!

 

 

[1] Prevalence and predictors of adolescent idiopathic scoliosis in adolescent ballet dancers’

Longworth B., Fary R., Hopper D, Arch Phys Med Rehabil. 2014 Sep;95(9):1725-30. doi: 10.1016/j.apmr.2014.02.027. Epub 2014 Mar 21

[2] Tanchev PI, Dzherov AD, Parushev AD, Dikov DM, Todorov MB. Scoliosis in rhythmic gymnasts. Spine. 2000;25(11):1367–72.

[3] Warren MP, Brooks-Gunn J, Hamilton LH, Warren LF, Hamilton WG. Scoliosis and fractures in young ballet dancers. Relation to delayed menarche and secondary amenorrhea. N Engl J Med. 1986;314(21):1348–53.

[4] Meyer C, Cammarata E, Haumont T, Deviterne D, Gauchard GC, Leheup B, et al. Why do idiopathic scoliosis patients participate more in gymnastics? Scand J Med Sci Sports. 2006;16(4):231–6.
Meyer C, Haumont T, Gauchard GC, Leheup B, Lascombes P, Perrin PP. The practice of physical and sporting activity in teenagers with idiopathic scoliosis is related to the curve type. Scand J Med Sci Sports. 2008;18(6):751–5.

[5] Kesten S, Garfinkel SK, Wright T, Rebuck AS. Impaired exercise capacity in adults with moderate scoliosis. Chest. 1991;99(3):663–6.

[6] Liljenqvist U, Witt K-A, Bullmann V, Steinbeck J, Völker K. Empfehlungen zur Sportausübung bei Patienten mit idiopathischer Skoliose. Sportverletz Sportschaden. 2006;20(01):36–42.

[7] Fällström K, Cochran T, Nachemson A. Long-term effects on personality development in patients with adolescent idiopathic scoliosis. Influence of type of treatment. Spine. 1986;11(7):756–8.

[8] Liljenqvist U, Witt K-A, Bullmann V, Steinbeck J, Völker K. Empfehlungen zur Sportausübung bei Patienten mit idiopathischer Skoliose. Sportverletz Sportschaden. 2006;20(01):36–42.

[9] Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, et al. Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal deformities. Eura Medicophys. 2005;41(2):183–201.

[10] Kenanidis E, Potoupnis ME, Papavasiliou KA, Sayegh FE, Kapetanos GA. Adolescent idiopathic scoliosis and exercising: is there truly a liaison? Spine. 2008;33(20):2160–5.

[11] Becker TJ. Scoliosis in swimmers. Clin Sports Med. 1986;5(1):149–58.

There’s an app for that – why technology can’t replace clinicians just yet!

A number of the conditions we treat here at the clinic (but most commonly Scoliosis and Kyphosis) are often treated at least in part with an exercise program. In some cases, the exercise program might be a primary line of treatment, whereas in other instances it is used as a support mechanism.

Here at the clinic, we will usually provide an exercise prescription which patients should then undertake each day at home. Sometimes this is the correct approach, but one of the most significant problems posed by this approach is exercise adherence. The simple fact is that programs such as Schroth or SEAS do not work if they are not performed every day and for the correct amount of time.

At the UK Scoliosis clinic, we work to avoid this problem by staying in touch with our patients and scheduling regular check-up appointments, but exercise adherence is still a significant factor in determining treatment success.

In recent years, it has often been argued that either an app or computer program might replace the role of the clinician in encouraging exercise adherence. It’s certainly an attractive idea, however as yet, the research indicates this approach is not practical.

 

There’s an app for that

There’s no question that augmenting face to face treatment with software-based approaches has great promise, and it certainly stands to reason that apps could have the potential to play an essential role in promoting exercise adherence in the future. Apps can monitor patients remotely, are cheap, can provide reminders, and can enable feedback to patients. Many of us also now use apps for fitness purposes, either as exercise trackers, heart rate monitors or in place of a traditional personal trainer. Despite this, app-based exercise programs have not been widely incorporated in rehabilitation for adolescents with musculoskeletal disorders[1]

So far, research has not suggested that apps have been particularly effective as a replacement for traditional contact with professionals more generally –  a recent systematic review showed limited evidence regarding the effectiveness of using apps to increase physical activity in adolescents[2]. Furthermore, apps aimed at increasing physical activity in adolescents were not effective[3].

 

Exercise adherence in Hyperkyphosis

Scoliosis and Kyphosis can both be disruptive conditions

One of the conditions we treat at our clinic is Hyperkyphosis. While hyperkyphosis is sometimes seen as less serious than Scoliosis, research shows that adolescents with hyperkyphosis have decreased quality-of-life (particularly the self-image and appearance components[4]. Hyperkyphosis is also associated with back pain in long-term follow-up studies[5]. Hyperkyphosis is often treated with an exercise prescription, either in advance of bracing or as a complementary approach.  Milder cases of Hyperkyphosis have been shown to respond well to exercise-based programs – although the biggest issue is ensuring that patients adhere to their exercise plan.

 

 

A Kyphosis case study

Given that few attempts have been made to use apps specifically to treat musculoskeletal conditions, a recent study was set up to assess the potential of an app-based exercise program for adolescents with Hyperkyphosis and back pain[6].

App usage was not impressive in the study

The study focused on 21 participants, between 10 and18. All of the participants were given an initial one-time exercise treatment session and were instructed to continue using an app provided for the study to track and guide their home-based exercise over  a period of 6 months.

After participants logged in to the app, they were shown their prescribed exercises by image and exercise name. To perform an exercise, users only had to click on the exercise, which shows the same picture and written instructions on how to perform the exercise. The prescribed amount of time counts down similar to an interval timer while the participant performs the exercise.

Although the format was relatively simple, and the exercise sessions prescribed only lasted approximately 15 minutes a day, the study shows that most participants did not use the app. One participant did not have a Smartphone or tablet, this participant did participate in the exercise program, and logged exercise adherence on a sheet of paper. One participant complied with the program 100%, but the remaining participants either did not use the app or used it less than once per week. When investigators questioned the participants about their usage, they also indicated themselves that they used the app less than weekly.  Unsurprisingly, the patient’s quality of life scores (measured with the SRS-22 form) did not significantly improve over the 6 months.

 

What can we learn from these results?

These results serve mainly to confirm what has been suspected for some time – many users just do not stick to their exercise program, absent encouragement and mentorship from scoliosis or kyphosis professional.  For parents of children with kyphosis or scoliosis, the critical question is therefore whether exercise-based approaches are the most suitable treatment, given that adherence to the program is so important. In some instances, parents may prefer to opt for a kyphosis or scoliosis brace, which does not suffer from these same issues.

Does this mean apps are useless in the treatment of musculoskeletal disorders? Almost certainly not  – some apps, such as our ScoliScreen allow users to perform an initial diagnosis of their scoliosis, and monitor their conditions. The study discussed here did also show that the app had a positive effect on the study participant who fully committed to the exercise program, which suggests that a combination of an app and personal encouragement from a clinician may be a superior way forward.  At the UK Scoliosis clinic, we are always researching the best way to give a superior experience to our patients, and apps are a field that we are investigating with interest!

 

[1] Madden M, Lenhart A, Cortesi S, Gasser U. Teens and mobile apps privacy. Washington, DC: Pew Internet & American Life Project; 2013. [2015-04-21].

[2] van Sluijs EMF, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ. 2007;335(7622):703.

[3] Direito A, Jiang Y, Whittaker R, Maddison R. Apps for IMproving FITness and increasing physical activity among young people: the AIMFIT pragmatic randomized controlled trial. J Med Internet Res. 2015;17(8):e210.

[4] Petcharaporn M, Pawelek J, Bastrom T, Lonner B, Newton PO. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument. Spine (Phila Pa 1976). 2007;32(20):2226–31.

Lonner B, Yoo A, Terran JS, et al. Effect of spinal deformity on adolescent quality of life comparison of operative Scheuermann’s kyphosis, adolescent idiopathic scoliosis and normal controls. Spine (Phila Pa 1976). 2013;38(12):1049–55.

[5] Murray P, Weinstein S, Spratt KF. Natural history and long-term follow-up of Scheuermann kyphosis. J Bone Joint Surg Am. 1993;75A(2):236–48.

Ristolainen L, Kettunen JA, Heliövaara M, Kujala UM, Heinonen A, Schlenzka D. Untreated Scheuermann’s disease: a 37-year follow-up study. Eur Spine J. 2012;21(5):819–24.

[6] Karina A. Zapata, Sharon S. Wang-Price, Tina S. Fletcher and Charles E. Johnston Factors influencing adherence to an app-based exercise program in adolescents with painful hyperkyphosis Scoliosis and Spinal Disorders 201813:11

New research – Scoliosis impacts functional capacity

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