Tag: Scoliosis screening

Adult Scoliosis – How to Screen

Posted on June 18, 2022 by - Blog

This month, the UK Scoliosis clinic is raising awareness about Scoliosis in adults, as part of our work for Scoliosis awareness month. Over the last few weeks, we’ve looked at the kinds of scoliosis that impact adults, and older adults in particular. This week, we’ll take a look at how you can recognise the signs and symptoms of Scoliosis, as an adult.

 

Recap : Scoliosis in adults

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life. While many Scoliosis cases which are carried into adulthood progress very slowly (and may not progress at all for some time if they are small enough at skeletal maturity)[1] cases can begin to worsen again as we age and the spine (particularly the intervertebral discs) start to degenerate. Accordingly, worsening scoliosis in an ASA case is often referred to as Adult Degenerative Scoliosis.

The second type is Degenerative De-Novo Scoliosis (sometimes noted as DDS) – this is the development of a new scoliosis case, usually as a result of spinal degeneration – the cause is essentially the same as degeneration in ASA, however, we usually refer to De-Novo separately, since there is no prior history of Scoliosis. This being said, it may not always be possible to disambiguate a De-Novo case from an ASA case, since the lack of detection of a scoliosis case does not equate to the absence of scoliosis itself!

 

Adult Scoliosis – General signs

Not all signs of Scoliosis, especially in adults, are of the specific kind which tend to be noticed in children and younger teenagers – in fact, many adult scoliosis cases are discovered as a result of an investigation for back pain rather than concerns about Scoliosis.

Adults with scoliosis very often experience more generalised symptoms than younger people, due to the degeneration of the spinal discs and joints also taking place – this commonly leads to the narrowing of the openings for the spinal sac and nerves, a condition called spinal stenosis which can range from uncomfortable to extremely painful.

Many patients with adult scoliosis may adopt unusual postures in an attempt to avoid and reduce this pain – some patients with adult scoliosis may lean forward to try and open up space for their nerves. Others may lean forward because of loss of their natural curve (lordosis, sway back) in their lumbar spine (low back). The imbalance causes the patients to compensate by bending their hips and knees to try and maintain an upright posture.

Accordingly, back pain, and specifically Low back pain and stiffness are common issues for those with adult scoliosis. Numbness, cramping, and shooting pain in the legs due to pinched nerves, as well as fatigue resulting from strain on the muscles of the lower back and legs are all common issues.

Finally, while not a diagnostic indicator, it is worth noting that many older adults may also experience arthritis, which commonly affects joints of the spine and leads to the formation of bone spurs.

 

Adult Scoliosis – Traditional symptoms

The more traditional, physical symptoms associated with scoliosis of course also apply to adult cases, and it’s these which are easiest to screen for.

Degenerative Scoliosis linked to ASA can often occur in the thoracic (upper) and lumbar (lower) spine, with the same basic appearance as that in teenagers, such as shoulder asymmetry, a rib hump, or a prominence of the lower back on the side of the curvature.

De-Novo cases are typically seen more in the lumbar spine (lower back) and are usually accompanied by straightening of the spine from the side view (loss of lumbar lordosis).

 

Home Screening for Scoliosis

While the more general, painful symptoms are best investigated by a spinal professional (whether scoliosis is the cause or not), a basic home screening for the physical signs of scoliosis is easy to do. Simply follow the steps here!

 

 

 

 

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

Scoliosis Screening – For Older Adults!

Posted on June 8, 2022 by - Blog

Scoliosis screening is a topic which we regularly write about on our blog – in our view (and safe to say, in the view of most of the scoliosis treatment community) screening represents a relatively inexpensive way to detect scoliosis as early as possible. In young people, early detection is particularly important – the majority of scoliosis cases progress (at least to come extent) without treatment, whereas early intervention allows for relatively simple, non-surgical approaches to be used in preventing and correcting curve progression. Studies have shown that a large percentage of scoliosis cases are detected between the ages of 11 and 14[1] although the young people outside of this bracket certainly can and do develop scoliosis.

Young people, with their whole life ahead of them, have the highest risk of progression from scoliosis –  however, when the condition is caught early, they also have some of the best prognoses. These two factors together mean that younger patients tend to attract the attention of most medical studies. It’s essential however, that we also recognise the importance of screening in older adults – as many of 1 in 3 of whom will develop the condition in later life.[2]

 

Why screening older people matters

No matter what the age of the individual concerned, spotting scoliosis early is always a benefit, and, put simply, since there are forms of scoliosis – such as “De-Novo” scoliosis –  which begin development later in life, scoliosis is a condition which we need to be vigilant for throughout life.

It’s true that Scoliosis cases (even more significant cases) tend to progress much more slowly throughout adulthood than they do in childhood (something around 1 degree per year is a commonly cited figure[3]) however we also have to keep in mind that one spends much more time as an adult than as a child! Since conditions such as De-Novo Scoliosis are related to the natural ageing process rather than the genetic factors which (as per the latest research available) looks to be the most likely culprit for adolescent scoliosis cases, it’s also possible for someone with no history of scoliosis at all to develop the condition in their 60’s or 70’s.

The good news is that even without public health provision, scoliosis screening is quick, easy and can even be done yourself at home (although it’s easier with someone to help).

It’s for this reason that scoliosis screening is considered a beneficial stage of treatment amongst the Orthopaedic community, as it is reported in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT).[4]

 

So why have I never heard about scoliosis screening?

At present, scoliosis screening isn’t widely provided in the UK – The latest review from the NHS concluded that screening for the condition isn’t worth doing – as a scoliosis clinic, you can well imagine that we disagree with this!

There are three main reasons which explain the lack of screening in the UK – unfortunately, they’re all pretty poor excuses!

The first is simply the fact that many health professionals have little or no training on Scoliosis, and the general public has even less. We don’t just mean GP’s here – while many professionals, such as Chiropractors, who specialise in spinal health can recognise a scoliosis case, most have not had the benefit of specialist training on how to treat the condition. As the UK Scoliosis clinic we’re thrilled to take referrals from concerned chiropractors from miles around, but not all healthcare professionals have a clear referral route for scoliosis cases. This is an issue for the healthcare community itself to work on as a major step toward improving outcomes for patients.

This raises a question – why are we so ignorant when it comes to scoliosis, especially in older people?  This is the second major problem – the belief held for much of history, that scoliosis is treatable only with surgery, or (often for older adults) that progression was inevitable and simply something one had to “live with” – therefore, it followed that screening to catch it early was of little value.

Until recently, this has been a valid point – but it’s critical to recognise that today there are far more options for scoliosis sufferers, and we’re now able to help many patients overcome scoliosis without ever thinking about surgery. Much of the evidence suggesting scoliosis can only be treated with surgery dates as far back as the 1940’s[5] so it makes sense for us to re-examine the evidence and technology we now have available.

This is all the more important given the results of more recent research which show that exercise[6] and bracing[7][8] based treatments can reduce pain and curve progression as well as improve quality of life in older people, even when used as a part time treatment.

The third reason is cost – and the cost-based argument against screening also flows from the same line of thought – if surgery is the only treatment option, why invest in screening? To be fair it has been true, even in the recent past, that accessing a scoliosis screening in the UK meant attending a specialist clinic, and inevitably that meant incurring a cost. Given that screening should be done yearly at least, and many older adults are working with a fixed income this clearly makes the proposition less attractive.

Today, however, screening need not be expensive – or actually cost anything at all. There are now several guided screening apps available, which, while not a substitute for a professional opinion, are a great initial screening tool. These include our own ScoliCheck app.

 

 

[1] ‘School Scoliosis Screening Programme – A Systematic Review’
Sabirin J, Bakri R, Buang SN, Abdullah AT & Shapie A 2010, Medical Journal of Malaysia, December issue, vol. 65, no. 4, pp. 261-7.

[2] ‘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

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

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

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

[4] TB Grivas, MH Wade, S Negrini, JP O’Brien, T Maruyama, M Rigo, HR Weiss, T Kotwicki, ES Vasiliadis, LS Neuhaus, T Neuhous, School Screening for Scoliosis. Where are we today? Proposal for a consensus. Scoliosis 2(1)  (2007) 17

[5] AR Shands, JS Barr, PC Colonna, L Noall, End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopedic Association.  J Bone Joint  Surg 23A  (1941) 963-977.

[6] ‘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

[7] 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.

[8] ‘Effects of Bracing in Adult With Scoliosis: A Retrospective Study‘
Palazzo C, Montigny JP, Barbot F, Bussel B, Vaugier I, Fort D, Courtois I, Marty-Poumarat C, Arch Phys Med Rehabil. 2016 Jun 22. pii: S0003-9993(16)30256-8. doi: 10.1016/j.apmr.2016.05.019

 

Why Scoliosis screening is important!

Posted on July 13, 2021 by - Blog

Although Scoliosis awareness month is now over, we wanted to take one last opportunity to highlight the importance of a subject which is dear to our heart at the clinic – scoliosis screening. It’s a simple step that we can all take to avoid the risk of serious scoliosis, yet it something that most people are still unaware of.

 

Why screening matters

Scoliosis screening is quick, easy – and in many countries, it’s done as standard by general health practitioners and in schools. Today, most scoliosis clinicians agree that school screening for scoliosis in the UK would be a positive step to take since, for relatively little cost, significant benefits can be obtained for the majority of patients. It’s not just schools either – Chiropractors and other health professionals could help by learning some basic screening steps, or even just by encouraging people to use a free screening app.

It’s for this reason that scoliosis screening is considered a beneficial stage of treatment amongst the Orthopaedic community, as it is reported in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT).[1]

 

So why aren’t we all screening?

There are three main reasons which explain the lack of widespread screening in the UK. The first is simply the fact that many health professionals have little or no training on Scoliosis, and the general public has even less. So why is this the case? It goes back to the second main reason – the belief held for much of history, that scoliosis is treatable only with surgery and, therefore, that screening was of little value.

Until recently, this has been a valid point – but it’s critical to recognise that today there are far more options for scoliosis sufferers, and we’re now able to help many patients overcome scoliosis without ever thinking about surgery. Much of the evidence suggesting scoliosis can only be treated with surgery dates as far back as the 1940s[2] so it makes sense for us to re-examine the evidence and technology we now have available.

This is all the more important given the results of large scale studies, such as the BRAiST study in 2013[3], in which 58% of untreated patients had curves greater than 50° at skeletal maturity, while only 25% of patients treated with a scoliosis brace reached curves over 50°. This meant there was a 56% reduction of relative risk to surgery levels in braced patients and treatment costs for braced patients were less than those requiring surgery.

The third reason is cost – and the cost-based argument against screening also flows from the same line of thought – if surgery is the only treatment option, why invest in screening? Recent research has shown that scoliosis can be treated non surgically, and, in actual fact, we do now know exactly what scoliosis screening in schools would cost on an individualised basis  – research carried out between 2000 and 2007 demonstrated that the direct cost for the examination of each child who participated in the program for the above period was just 2.04 €.[4] It is reasonable to suggest that costs today could be even lower!

 

Why we should screen

Aside from the fact that the arguments against screening no longer seem to stand up, it’s also clear that screening for scoliosis in schools, clinics and even through clubs and activities provides the best (sometimes only) opportunity for early diagnosis and therefore allows for non-surgical treatment, which is often not the case in the absence of screening[5].

In their most recently published joint information statement on scoliosis screening, the American Academy of Orthopaedic Surgeons, Scoliosis Research Society, Paediatric Orthopaedic Society of North America and American Academy of Pediatrics all agreed that there does not appear to be any significant medical reason not to screen for scoliosis[6].

Today there is significant evidence which shows that the number of scoliosis sufferers eventually requiring surgery can significantly be reduced where non-surgical treatment (such as scoliosis specific exercise, or bracing) is available on a high standard.[7] If we work from a modern viewpoint, rather than an outdated one, we can therefore see the real value of school screening. Indeed, school screening is often the only tool we have to detect mild and moderate spinal curves which can be easily treated with non-surgical methods.

The most recent research also confirms that this is more than just informed speculation – research does confirm that in areas where screening programs exist, fewer patients ultimately require surgery for scoliosis.[8]

In 2006, research from the University College Hospital and The London Clinic[9] assessed the severity of scoliosis presentation over 30 years. What the authors found was, that since mass school screenings were abandoned in the 1990s, in the year 2000 only 8% of patients had been identified at school compared to 32% in 1985 and that the number of patients presenting with curves greater than 40° had increased to 70%. This meant that for many of these patients non-surgical care would be less effective and the likelihood of requiring surgery was much greater. The author’s recommended that greater community awareness was required to enable earlier detection.

 

What you can do

The point of Scoliosis awareness month is to get people talking about scoliosis – but we shouldn’t let it end on June 30th – just by talking about scoliosis and raising the issue with people you interact with day-to-day, we can encourage more people to screen at home, more professionals to seek training on spotting scoliosis and perhaps even put pressure on the government to implement screening in schools. At Complete Chiropractic we screen all patients for scoliosis as part of our initial consultation, and we’d love to see other chiropractors do the same.

Thank you all for your support during Scoliosis awareness month 2021 – we hope next year to be able to do much more to support the event in a (hopefully) covid-free way!!

 

 

 

[1] TB Grivas, MH Wade, S Negrini, JP O’Brien, T Maruyama, M Rigo, HR Weiss, T Kotwicki, ES Vasiliadis, LS Neuhaus, T Neuhous, School Screening for Scoliosis. Where are we today? Proposal for a consensus. Scoliosis 2(1)  (2007) 17

[2] AR Shands, JS Barr, PC Colonna, L Noall, End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopedic Association.  J Bone Joint  Surg 23A  (1941) 963-977.

[3] BRAiST availible at: https://www.nejm.org/doi/full/10.1056/NEJMoa1307337

[4] TB Grivas, ES Vasiliadis, C Maziotou, OD Savvidou, The direct cost of Thriasio school screening program.  Scoliosis 2(1) (2007) 7.

[5] WP Bunnel, Selective screening for scoliosis. Clin Orthop Relat Res 434  (2005) 40-5.

[6] Information Statement: Screening for idiopathic scoliosis in adolescents. American Academy of Orthopaedic Surgeons (AAOS), Scoliosis Research Society (SRS), Pediatric Orthopaedic Society of North America (POSNA) and American Academy of Pediatrics (AAP), October 1, 2007.

[7] M Rigo, C Reiter, HR, Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil 6(3-4)  (2003) 209-14.

T Maruyama, T Kitagawa, K Takeshita, K Mochizuki, K Nakamura, Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment?  Pediatr Rehabil 6(3-4)  (2003) 215-9.

B Lee, The Correct Principles of Treatment of Angular Curvature of the Spine. 1872, Philadelphia, USA.

[8] T.B. Grivas et al.  “How to Improve the Effectiveness of School Screening for IS” The Conservative Scoliosis Treatment (2008) p 120

[9] Detection of adolescent idiopathic scoliosis, Muhammad Ali Fazal, Michael Edgar, Acta Orthopaedica Belgica, 2006, 72, 184-186

What is scoliosis anyway?

Posted on June 9, 2020 by - Blog

As you may – or may well, or well not ­– be aware, June is Scoliosis awareness month. Since so many of us are working from home, or simply having to take a break from normal life at the moment, you may well have noticed some talk about this online, so, what is Scoliosis, and why should be you be aware of it?

 

What is Scoliosis?

Simply put, scoliosis is a spinal disorder which causes the spine itself to be curved from side to side. A normal spine does indeed have a forwards and backwards curvature, so that viewed from the side it looks like an “S” shape – but in scoliosis, the spine also has a side to side curvature, so that viewed from the front or the back, it has an “S” or “C” shape. In fact, scoliosis is more complicated than this – there’s typically also a rotation of the vertebra (the spinal bones), but the general shape is what you might be able to notice in someone’s posture.

 

Can I see Scoliosis?

Scoliosis is sometimes possible to see, usually in more severe cases. In some individuals with very low body fat, it may be possible to notice the curvature of the spine – however, most common signs (like uneven shoulders and hips, or a rib hump when bending forward or one shoulder blade seeming to stick out more than another) tend to be the only noticeable change. It’s true that the worse a scoliosis case is, the more visible it will tend to be – but scoliosis can remain almost invisible for a long time before reaching this point.

Like all conditions, scoliosis is much easier to treat if it’s spotted early –  this is where scoliosis screening comes in. Scoliosis screening is a fast, painless and simple procedure which you can even try at home. In fact, many countries include scoliosis screenings as part of their public health measures, however, this isn’t the case in the UK.

 

Who can get Scoliosis?

Anyone can get scoliosis – on average, about 3% of children will develop scoliosis, whereas some forms of scoliosis, common amongst the older population can affect up to 30%.[1]

There are many different sub-types of scoliosis, but for ease of explanation we typically divide them into two groups – these are adult, and childhood scoliosis.

Adult scoliosis is caused either by the degeneration of the spinal bones, ligaments & discs with age or as a result of childhood scoliosis which was not treated. Childhood scoliosis (affecting infants through to young adults) is more of a mystery – right now the exact cause for about 80% of cases is unknown. This is termed “Idiopathic” scoliosis. The remaining 20% of cases are typically caused by congenital or genetic conditions, spinal malformations, underlying neuromuscular conditions, metabolic conditions or trauma.

Idiopathic scoliosis in children is typically classified according to the age that it is diagnosed. It is most common in adolescents (over 10 years) but also occurs in infants (under 3 years) and juvenile’s (3-10 years).

Approximately 3-4% of children are affected by scoliosis, that’s about one in each class at school. In adults over the age of 50, this figure increases to 30-40%.

The earlier scoliosis is detected, the more effective a treatment and management plan will be. This helps reduce the risk of progression and the potential need for surgery. If scoliosis specific exercise and/or bracing are used early enough in the development of scoliosis, curve progression can be stopped, and surgery avoided. In some cases, near-complete correction of the curve is possible.

 

How do I screen for scoliosis?

Screening for scoliosis is easy to do and takes less than 5 minutes – remember that early detection is the most important factor, so screen regularly and if you have concerns, get in touch with a scoliosis professional.

 

 

[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.

Why Scoliosis screening can save you money

Posted on March 22, 2020 by - Blog

When you’re dealing with scoliosis, the least important factor should be finances – you should always select a treatment plan based on it’s long term prospects and what’s best for you or your child. This being said, it’s true that the earlier Scoliosis is caught, the easier and (usually) more cheaply it can be treated. It’s for this reason that scoliosis screening can actually save you a great deal of money…..

 

Scoliosis screening is really cheap

It’s certainly true that scoliosis bracing and even exercise-based therapies are not cheap – the costs of treating scoliosis can be a burden and we understand this – however the first step on the ladder, a scoliosis screening, can be incredibly cheap, or even free. A scoliosis screening involves performing just a few simple movements and standing in a normal posture while you are observed from behind – you can even use our free scoliscreen app to guide you through the process.

For those who have a family history of scoliosis, or have concerns following an initial screening, the UK Scoliosis clinic offers inexpensive initial consultations both online and in person, which are an excellent way to get a professional opinion – not just on scoliosis, but also on the case of a complaint, even if it is not scoliosis related.

We cannot stress enough that knowing your “scoliosis status” early on, makes a huge difference to your prognosis, and to the cost of care, and this is because…

 

Scoliosis costs more to treat, the longer it is left.

Like most conditions, scoliosis is easier – and therefore usually cheaper – to treat when its caught early on. [1] In many counties, scoliosis screenings are provided to all children at school, since it’s public health benefit is well recognised. While there is some traction for the idea here in the UK, it does seem unlikely this will become normal procedure any time soon. This is a great shame, since scoliosis can often be noticeable via a simple screening well in advance of any of the usual “symptoms” becoming visible day to day.

All scoliosis cases are highly individual, which is one of the things which makes it a complex condition to treat correctly – but speaking generally, If scoliosis is caught early it is often possible to treat with exercise-based approaches which usually represent the cheapest way forward. Other options for a relatively mild case include night time or part-time bracing – which, while somewhat more expensive is easier for many families to manage.  Once scoliosis cases have progressed beyond approximately 30 degrees cobb, bracing will likely be the only form of treatment which is likely to succeed – while bracing is infinitely preferable to spinal surgery if at all avoidable, braces can be expensive. Innovative braces, such as our favoured model, the ScoliBrace, can help to reduce cost by extending the life of a brace through an adaptive design – but there’s no question that letting the case develop will raise the cost of treatment.

In serious cases, which have reached the surgical threshold of 50 degrees with time left for spinal growth ie curve progression, corrective bracing like Scolibrace can be used and is often successful in either reducing the curve or stopping the curve from progressing until growth has finished. This can mean that surgery can be avoided or that just one surgery can be perfomed rather than multiple surgeries that would be required as the spine grows. . Realistically, however, the costs of treating a larger curve will be higher again – often, multiple braces as well as complementary therapies will be required to achieve curve improvement.

What’s critical to remember here is that ALL scoliosis cases develop over time – all cases start out small, and therefore start out cheaper to treat. As time passes, the difficulty of treatment and the cost only rise.

 

So, Is surgery cheaper?

The UK is unusual, in that our NHS provides spinal surgery to those who need it – free of charge. The truth is that spinal surgery is immensely expensive – the cost of an operation to correct scoliosis would run to tens of thousands of pounds if purchased privately – but in the UK, we do not pay this cost directly. In an absolute sense then, yes, spinal surgery is cheaper – however, it’s critical to consider the social and emotional costs of allowing scoliosis to develop to the surgical threshold, as well as the possible financial implications of surgery in the long term. Especially for those who are already in work, or perhaps attending university – what would be the cost of 6 months to a year of recovery?

The other point to keep in mind here is that “opting for surgery” is not quite the same in the UK, as it would be in, for example, the US. While the NHS will provide scoliosis surgery for those in need, it will not do so for those who are not badly enough effected  – this is to say, those who have reached the surgical threshold. While scoliosis does generally tend to develop over time, the rate is not always uniform and is certainly possible that an individual “opting for surgery” by simply waiting for the scoliosis to reach the threshold may actually never reach it – meaning they are left with scoliosis forever.

 

Don’t wait, screen today!

Scoliosis screening is free with our ScoliScreen app – and for those with concerns, affordable consultations are available at our clinic, or now even online via a secure web chat. Please do not let worries about the cost of treatment prevent you from finding out the true cause of an issue as doing so will not save money – in the long term, it will cost far more, both financially and emotionally!

 

[1] Fong DY, Cheung KM, Wong YW, Wan YY, Lee CF, Lam TP, Cheng JC, Ng BK, Luk KD, ‘A population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening’ Spine J. 2015 May 1;15(5):825-33.

A Scoliosis Journey: Week 2

Posted on June 22, 2019 by - Blog

Last week we began to explore the case of Patient X – a scoliosis patient who, after successful treatment with a ScoliBrace, avoided the need for corrective surgery and now lives scoliosis free.  This week, we learn about her treatment prescription. If you missed week one, we suggest reading it here first.

 

3. The best treatment?

Having confirmed a scoliosis case and with that case being below the surgical threshold, it was possible to move forward with a non-surgical approach for patient x – but which is the best treatment methodology on offer?

In dealing with any scoliosis case, there are at least three elements to treatment which need to be considered – firstly, the Cobb angle (that is to say, the angle of the scoliotic curvature) needs to be reduced. Secondly the angle of trunk rotation (rib hump) and thirdly, muscular imbalances which have developed alongside the scoliosis, need to be addressed and balanced.

In terms of Cobb angle reduction, Scoliosis braces are the most effective non-surgical approach.[1] There are many different kinds of scoliosis brace and many work slightly differently. Broadly speaking braces can be classified as either active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position). Passive braces which are typically provided by hospitals, once the only option available, obviously do nothing to reduce cobb angle – so bracing with an active correction brace is the recommended approach.

The angle of trunk rotation or the “rib hump” is best addressed by a active scoliosis brace such as Scolibrace which addresses the scoliosis in a 3-dimensional manner, helping to de-rotate the spine to reduce rib hump progression, whilst preserving the spines natural curves in the low and mid-back.

The best approach to correcting the muscular and postural imbalances associated with scoliosis are specialised exercise methodologies which have been designed for scoliosis treatment. There are two main approaches to consider. The first is SEAS or the “Scientific Exercise Approach to Scoliosis”. SEAS consists of an individualised exercise program adapted for the purpose of treating an individual’s scoliosis. Different exercises are used to correct different types and elements of scoliosis, so by combining them in the correct way, an ideal exercise plan can be produced.

SEAS treatment is often used as a stand-alone approach when treating smaller curves and as a compliment to bracing with large curves and where there is a significant risk of progression.

The other main exercised based method, Schroth therapy, is a well-established and easy to use treatment methodology which some experts consider to be the best exercise-based approach for treating Idiopathic Scoliosis.[2]  As an independent treatment, some studies have shown a reduction of Cobb angle of 10-15 degrees over the course of a year[3] – however, Schroth therapy combines particularly well with bracing. When Schroth is combined with bracing superior results can often be achieved more quickly than either approach alone.[4]

Patient x’s scoliosis, being 33 degrees cobb, was already beyond the point where exercise alone would have been an ideal treatment. As the patient was still growing and the curve was already greater than 30 degrees, she was also considered a high risk for her scoliosis to worsen. While this specific combination of factors meant that hers was a high-risk case overall, she was an ideal candidate for correction with a highly advanced scoliosis brace – the ScoliBrace. (This is the brace we offer at the UK Scoliosis Clinic)

In this case, scoliosis specific rehabilitation exercises and use of a scoliosis orthotic device, a Scolibrace, were therefore recommended.

 

4. Treatment with ScoliBrace

ScoliBrace, unlike many braces, is a totally customised, 3D designed, rigid active correction brace. ScoliBrace isn’t just customised for your scoliosis case, you can also choose a colour or pattern which suits your style – or opt for something which matches your skin tone to blend in well.

A ScoliBrace is not like most braces which use 3 point pressure. It uses a 3D inverse correction of the spine ie it shifts the spine into the opposite direction by moving the spine towards the correct position

For Patient X, the scoliosis brace was initially to be worn full-time. This is 23 hours per day with up to a maximum of 4 hours out of the brace if the patient was actively participating in sports during those out of brace hours. Brace wear was started at 2 hours on the first day, followed by adding another 2 hours every subsequent day until the required full-time hours were attained. Time in brace is often adjusted throughout scoliosis treatment period -but is generally high at the start in order to arrest the curve development and begin to reduce it as soon as possible.

Patient X was also given a program of scoliosis specific exercises, which were initially taught in the clinic as twice a week for 3 weeks, followed by once per month. The patient was required to complete the exercises each day out of the brace, but this was easy to do at home and it was included as brace time wear.  A  ScoliRoll (scoliosis orthotic device) was also used daily for 20 minutes to stretch the spine into the opposite direction of the curve, to help improve the spines mobility back to a normal position.

Next week, we’ll focus on Patient X’s progress with ScoliBrace!

 

 

[1] 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 (2018) [Publish Ahead of Print]

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

[3] 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)

[4] 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

A Scoliosis Journey: Week 1

Posted on June 12, 2019 by - Blog

Welcome to this special series of articles from the UK scoliosis clinic. This month is scoliosis awareness month, and throughout June we will be covering a representational example of a scoliosis case, all the way from discovery to diagnosis, treatment to conclusion.  While this series necessarily presents a generalised view of scoliosis treatment as a whole, we hope it will provide a good overview of the treatment process, which will be similar for most cases.

It is scoliosis? It’s not always easy to tell without an x-ray

 

1 . Is that scoliosis?

Most people have never heard of scoliosis, although it’s much more common than you might think. Scoliosis affects about 3 or 4 per cent of children (about one in each class at school) and as many as 40% of the over 60s. Scoliosis is a condition of the spine which causes it to curve away from its natural (fairly) straight alignment when viewed from behind. When viewed from the side the spine does curve gently forwards and backwards – these curves are known as Kyphosis, and Lordosis, and are a normal and important part of the way your spine works. A small bend in the spine, less than 10 degrees is considered normal and not a cause for concern – but in cases which need treatment, curves can often exceed as much as 50 degrees, 5 times that “normal” figure.

While this is all great information, we can’t usually see our spines or our children’s spines – and unless you’ve had cause to have a chest x-ray or similar taken its unlikely that you ever would have, so how can we recognise scoliosis in the first place?

In many countries around the world, Scoliosis is a condition for which there is a national screening program. In the same way that many of our children receive immunisations through their school, if you happen to be born in the right country, you’ll also get a Scoliosis screening. Screening allows scoliosis to be spotted very early and therefore treated most effectively. In the UK however, there is no such program, so here most scoliosis cases are spotted by family members, friends, or (often in the case of teenagers) by the sufferer themselves.

Take our case here, patient X. Patient X is a 16-year-old female, who initially complained about what appeared to be poor posture. The ‘x’s marked on her back show exactly where each of her vertebrate is, but you can imagine that without these markings, it simply looks as if she is standing awkwardly, or, like many teenagers, has awful posture! As you can see from the X-ray on the right, however, this is, in fact, a fairly well-advanced scoliosis case.

 

So how do we spot scoliosis? The main points to ask yourself are –

  • Are the shoulder’s level or uneven?
  • Is the waist even on each side? Or is one side straighter and the other more rounded or prominent?
  • Does one side look like it’s folded down or have a large skin crease?
  • Are the shoulder blades level? Does one stick out more than the other?
  • With straight legs, bending forward from the waist and with the hands between the knees is one side of the rib cage higher than the other, or is the lower back more prominent than the other, if yes, this indicates scoliosis.

 

It wasn’t a scoliosis screening which highlighted this example – In-Patient X’s case, it was this poor posture, and some mild back pain which brought her in for a scoliosis screening – importantly, she also participated in ballet (research shows that ballet dancers have a higher incidence of scoliosis) and had a family history of scoliosis. While these facts probably didn’t seem relevant to her at the time, they sounded all too common to the scoliosis professionals. According to the patients’ mum, she had no major issues growing up and all major growth milestones passed without incident – but for the back pain and the fact that she noticed the poor posture, this case would have continued to progress. It’s hard to say when the case actually began, but it’s entirely possible it had been developing for several years, and early screening could have detected this.

 

2. So, its Scoliosis.

A scoliometer, which helps us to measure and understand a Scoliosis case

Thankfully, patient X was seen at a scoliosis clinic within just weeks of her initial diagnosis. A simple scoliosis screening, coupled with a measurement from a device known as a scoliometer revealed the presence of all the warning signs, and at her follow up appointment the above x-ray confirmed the presence of scoliosis.

But when we say “scoliosis” – what do we really mean? This is a complex question since each and every scoliosis case is different and occurs in 3D. While we typically define scoliosis as a curvature of the spine when viewed from the rear, the condition is always more complex than this explanation makes it sound. In addition to the curvature, the vertebra will usually be rotated to some extent and may also be subject to damage or malformations as a result, or even as a cause of the Scoliosis. Scoliosis cases can curve in different directions and the vertebra which is most displaced from the centreline will also vary. Some scoliosis cases consist of a single curve, whereas others consist of a major curve and an opposite “compensatory” or secondary curve.  Scoliotic curves can also develop in different regions of the spine, or more than one region.

Therefore, receiving the diagnosis of “scoliosis” is only the first step. Using a variety of sophisticated imaging technologies, it was possible to classify and understand patient x’s scoliosis – hers was a 33 degree, left thoracolumbar scoliosis with significant rotation of the vertebra in the lumbar spine, the condition was causing poor posture and had also become painful. There’s no question that this is a complex diagnosis and one which only 10 years ago would almost certainly have ended in surgery, but thanks to the advanced research in the field of scoliosis correction, it’s the kind of case that today we can successfully treat non-surgically.

What’s critical to appreciate, however, is the complexity of this and the vast majority of scoliosis cases. Patient X (as we will see in coming segments) was treated with great success, without surgery, and no longer suffers from scoliosis – but this result has been almost entirely attributable to the highly individualised, customised treatment plan she received. More about that, next week.

 

Why scoliosis should be examined by a trained professional

Posted on February 5, 2019 by - Blog

At the UK Scoliosis clinic, we are always campaigning for the widespread adoption of scoliosis screening in schools, clubs and anywhere else where young people gather! It’s not just younger people who need to be concerned about scoliosis either – as we recently wrote on this blog, adult onset or “de-novo” scoliosis now affects 1 in 3 people over the age of 60.

Screening is a vital first step, since spotting scoliosis early makes it easier to treat, no matter the age of the patient. What’s important to remember, however, is that screening is just that – a first step. This week, we take a look at why those who suspect scoliosis after initial screening should seek a consultation with a scoliosis professional as a soon as possible.

 

What is a scoliosis consultation, or a professional evaluation?

Screening and consultations are always available at the UK Scoliosis Clinic

Scoliosis screening is a simple process, designed to identify some of the most common signs and symptoms of scoliosis.  Screening (which takes just a few minutes and  can be done at home) allows you to spot scoliosis developing before it would necessarily become noticeable in everyday life. Once you have confirmed signs of scoliosis, the next step is to seek a professional opinion from a trained scoliosis practitioner.

Where screening can highlight potential signs of scoliosis, and make you aware of any risk factors you may have, only a professional consultation will allow a suitably trained practitioner to offer you a formal diagnosis of your condition. Often, a practitioner will be able to confirm that scoliosis is, in fact, present – however, some screening results can be “false positives”  and turn out to be the sign of a postural problem or other condition instead.

When scoliosis is confirmed, a scoliosis practitioner can offer you a tailored treatment designed to stop the development of scoliosis and reverse the trend as soon as possible.

What you should not do is seek advice from non-scoliosis professional. While there are many reputable professionals who work with the spine and associated conditions (chiropractors, physiotherapists, osteopaths etc.) these individuals must also be either trained scoliosis specialists or have at least received specialist instruction in diagnosing scoliosis in order for their diagnosis to be truly accurate. Scoliosis is a complex, 3D condition which requires a complex response, and that’s something only a trained professional can really deliver.

Accessing a scoliosis professional might mean travelling, and while that can certainly be inconvenient there are many good reasons why you should opt for the right clinic.

 

So why choose a scoliosis professional?

Scoliosis professionals offer a clear advantage

It’s hopefully already obvious that a scoliosis professional offers the best choice when investigating a potential case of scoliosis, but as opposed to non-specialists, those clinics who focus on the treatment of scoliosis offer many other benefits. Professional clinics who specialise in scoliosis can:

Offer a reliable diagnosis – based on years of training and experience, not only can scoliosis practitioners diagnose scoliosis at a fundamental level, they can measure and map the precise nature and magnitude of your scoliosis and recommend an ideal treatment on this basis. While many everyday practitioners may be able to notice scoliosis, only a scoliosis professional can gather the detailed information required to formulate  an effective, evidence based treatment plan which is individually tailored to your case.

Utilise the correct diagnostic tools – It cannot be stressed enough that without the correct diagnostic equipment it is almost impossible to correctly understand a patients scoliosis.  Reputable clinics should be able to provide and evaluate X-Rays to properly understand the nature of your scoliosis. Today, some clinics try to claim that “radiation free” methods of diagnosis (such as ultrasound or laser measurement) are suitable for diagnosing scoliosis. Unfortunately, this is just not the case – currently, only an X-Ray or MRI scan can provide enough detail for a professional to make an initial diagnosis. Other methods can be excellent ways to monitor the progress of treatment, but simply do not provide enough clarity for initial diagnosis.

Rule out congenital factors – Most cases of scoliosis will be either idiopathic (in younger patients) or de-novo (in older individuals). There are other causes of scoliosis, such as congenital or neurological factors which also need to be ruled out, however. In the event that scoliosis may be related to an underlying neurological or congenital condition, a patient should be referred to a specialist in these areas and should not be treated with traditional scoliosis correction methods without further investigation. Reputable, professional clinics can rule out such causes, and also help to refer you to the right person if need be.

Offer personalised treatment – Scoliosis, unlike some conditions, is truly unique in every patient. While there are certainly some common features and trends, each scoliosis treatment is as complex and varied as the patient themselves. What’s more, scoliosis treatment needs to be constantly re-evaluated and adjusted in order to achieve the best results as fast as possible.  All this means that the “standardised” treatment plans offered by some non-specialist clinics are far from ideal when it comes to scoliosis. In some cases, you may just end up with sub-optimal results, but the wrong treatment at the wrong time can actually worsen the condition in some patients.

Chose from multiple treatment methodologies – Clinics and professionals who specialise in scoliosis will certainly have a variety of approaches to treating scoliosis to draw from. Creating a treatment plan for a scoliosis patient will usually involve at least scoliosis specific exercise and some form of bracing but might also include a wide variety of complementary approaches such as chiropractic care or massage for short term management of discomfort. Today, it’s rare that a scoliosis case will be best treated with only a single approach, so a clinic which can offer a variety of treatments, all with scoliosis in mind, presents a clear advantage. Clinics who offer only a single treatment approach may do so with the best of intentions, but this is rarely the best option for the patient.

Offer advice based on the latest research – Scoliosis professionals who are members of a relevant body, such as SOSORT are required to stay up to date with the latest research in the field of scoliosis treatment. This means that a scoliosis professional will always be fluent with the latest thinking, but you’re far more likely to be treated with the most up to date approaches available at a specialist clinic.

Happy New Year from the UK Scoliosis Clinic

Posted on January 18, 2019 by - Blog

A happy new year from everyone here at the UK Scoliosis Clinic!

If you’re a scoliosis sufferer or know someone who is, you might be looking for some impactful new year’s resolutions which can benefit scoliosis sufferers. With that in mind, here are some scoliosis friendly New Years resolutions which we recommend you take on!

 

Number one – Don’t wait and see!!

“Wait and see” is not a treatment!

“Wait and see” or “observation” is the “old school” approach to scoliosis treatment. Observation simply means watching the scoliosis develop with the hope that it will not progress to the surgical threshold. Observation is therefore not a treatment, sadly observation almost always results in a negative outcome, since recent research has shown that scoliosis almost never resolves without treatment.[1] If you’re currently stuck with “wait and see” make this the year you take control!

Don’t just wait – Book a consultation with a scoliosis specialist! Observation once made sense, because it was thought that surgery was the only visible treatment option. Furthermore, it was also assumed that many cases of scoliosis would not process. Today was known that both are untrue – modern research has demonstrated, for example, that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery. Curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[2]

On the positive side, the latest work on scoliosis has also shown that modern bracing technology allows for highly effective treatment, such that it has now been demonstrated that conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[3]  As with all treatment, earlier action means better results so don’t wait! (or wait and see!)

 

Number two – Start screening your children

The gift of a scoliosis screening might be a life-changing one for your child. Two to three percent of adolescents between the age of 10 and 15 will develop scoliosis. That might seem like a small percentage, but in fact, it’s about one per class at school. Some studies have suggested a higher level, but two to three percent is an accepted figure.  The risk is highest amongst girls and appears to be greater in individuals who participate in activities such as gymnastics.

If scoliosis is noticed in its very early stages, it is far easier to treat, so screening can make a real difference. What’s more, 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 at home 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.

 

Number Three- Find balance in your physical activities

Scoliosis SEAS treatment

Specialist exercises can reduce the imbalances created by Scoliosis

Since asymmetrical strength and tension in the involved musculature is a common feature of scoliosis, it makes sense to try to avoid participating in activities which exaggerate this problem. That is to say since scoliosis often leads the muscles one side of the body to be stronger than the other, it makes sense to avoid making that worse with activities which build strength on one side of the body, but not the other. In fact, much of the work done with scoliosis specific exercise is aimed at correcting this imbalance.

Some practitioners suggest that activities which tend to asymmetrically load the body (most things with a bat or racket) should, therefore, be avoided – however, this approach is too broad in most cases and tends to cut off many of the most enjoyable sports!

The better solution is not to avoid these activities, but instead to carefully monitor growth and symmetry and perform targeted exercise on the non-playing side of the body (usually the non-dominant side) in order to balance out development. While this point is important to scoliosis patients, it’s actually good advice for anyone!

Once again, the best way to access professional monitoring and treatment is through a scoliosis specialist.

 

Number four – Raise awareness about scoliosis

Although scoliosis is a relatively common condition in young people (and actually a very common one in older people) scoliosis is also a mystery to many of us. This is partly because treatment options were limited for many years, but as we have shown this is not the case today.

In order to treat scoliosis more effectively and reduce the number of people eventually requiring surgery, most scoliosis clinicians now agree that school screening for scoliosis would be a positive step to take – for relatively little cost, significant benefits can be obtained for the majority of patients. Screening for scoliosis in schools and other groups, like classes or clubs is quick, easy and cheap. Using our ScolisScreen app, it’s also possible to pre-screen a friend or a family member at home in less than 10 minutes – but individual screening does little to raise awareness overall.

It’s no surprise that scoliosis screening is considered as a beneficial stage of treatment amongst the treatment community, and has been recommended by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Despite this, school screening is still not provided in the UK, although it is now common in many other countries.

Because of the misplaced belief in limited treatment options which is common not only amongst the general population but also amongst GP’s – as well as the lack of screening programs, many cases go undetected and therefore progress.

Despite this, there’s much you can do to raise awareness about scoliosis – if you have friends or family with children – especially those between about 10 and 15 – send them the link to our ScoliScreen tool and let them know about screening.  Be sure to let people know that today treatment is accessible and viable!

If you are active in a local school community, ask them about setting up a scoliosis screening program. The UK scoliosis clinic provides free school screening events for schools within a reasonable distance, and many other clinics will be happy to do the same.

Perhaps you’re involved in a larger community group or club – if you’re within a reasonable distance of our clinic get in touch and we’ll be happy to work with you on a group screening or awareness talk event.

 

 

[1] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42

[2] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[3] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

Is observation a treatment for scoliosis?

Posted on December 17, 2018 by - Blog

When first seeking treatment, many scoliosis sufferers are advised that they should “watch and wait” or  “wait and see” how their condition progresses, in the hope that their curve will remain small enough to avoid surgery.  Medically, this approach is known as “observation”.

 

Is observation ever the right choice?

The argument for observation was once much stronger than it is today – for much of recent history the consensus view has been that surgery was the only effective way to treat scoliosis and since surgery is obviously best avoided wherever possible, observation is the only other choice. Although surgical treatment was once the only option for scoliosis sufferers, this is no longer the case – today non-surgical approaches are highly effective, meaning that observation is probably never the right choice.

 

Avoiding surgery with non-surgical treatment

Today, non-surgical treatment from scoliosis consists of two major approaches, exercise-based and bracing. Scoliosis braces are the most effective non-surgical method for reducing cobb angle[1]. There are many different kinds of scoliosis brace and the way they work is different, however broadly speaking braces can be classified as active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position).

Exercise methods such as the Schroth method (remove comma) or SEAS focus on teaching the scoliosis sufferer to self-correct their scoliotic position. Schroth and SEAS can both be effective as a standalone treatment for smaller curves and is often paired with bracing for superior results.

In both cases, however, catching scoliosis early with screening, and then taking appropriate action to stabilise and correct the Cobb angle is the key to a successful outcome. Unfortunately, many medical professionals today are still unaware of the non-surgical options for treating scoliosis and how effective they can be – unlike 20 years ago, today the prognosis is a good one.

 

Why observation does not work

Simply put, Observation is not a treatment for scoliosis, it is simply the act of watching and waiting, hoping the condition does not worse – however recent research has shown that scoliosis almost never resolves without treatment.[2] While it was once thought that scoliosis would not always progress, modern research has demonstrated, for example, that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery. Curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[i]

Because observation is not a treatment, it most often leads to the patient requiring surgery and does not promise any improvement. By contrast, modern bracing technology allows for highly effective treatment, such that it has now been demonstrated that conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[ii]

 

What should I do if I have been prescribed observation?

If you have been diagnosed with scoliosis but have been advised that observation or “wait and see” is the best approach, the best option is to book a consultation with a scoliosis specialist. Even if your condition is not serious enough to merit bracing, some targeted scoliosis specific exercise can, at the very least, help to prevent the curve from developing further rather than simply allowing it to increase.

 

 

 

 

 

[1] 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 (2018) [Publish Ahead of Print]

[2] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42

[i] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[ii] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3