Tag: scoliosis treatment

A scoliosis Journey – Week 3

This week, we round out our journey with Patient X – having correctly diagnosed scoliosis and chosen an appropriate treatment methodology, it’s now time to explore her progress and eventual results using the Scolibrace system.

 

5. Treating scoliosis with scolibrace – the results

As you will remember from previous instalments of this series, there are two main categories of scoliosis brace – active correction and “passive” braces. Active correction braces are the type now used by most scoliosis specialist clinics, and have been shown to be highly effective in treating scoliosis.[1] While scolibrace is certainly not the only active correction brace on the market, we firmly believe it is the best available today.

There are two main reasons we believe this – firstly, scolibrace is highly user-friendly. Unlike some braces, scolibrace can be put on and taken off by the wearer without any assistance, it’s also easy to secure, requiring just a couple of Velcro straps to hold it in place. Scolibrace also has a low form factor, meaning it can be worn under clothes without being visible in most cases – and a wide variety of colour choices goes to make this even easier. Being made from the latest materials, and fabricated using CAD/CAM technology scolibrace is also lightweight and so easy to move in that many wearers even leave their brace on to participate in sports activities. Taken as a whole this makes life during bracing very much more comfortable (and far preferable to surgery!).

Perhaps more important in the long term, however, are scolibrace’s results. In the case of patient X (who began treatment with a 33-degree Cobb angle), a one-month in-brace x-ray showed that the curve had reduced to 13 degrees. At the 3 month out of brace x-ray, the curve had reduced to 26 degrees. In just three months the out of brace curve had reduced by 7 degrees.

At this point, the flexibility of the scolibrace design was once again important since, where other systems may require a whole new brace, scolibrace allows extra corrective padding to easily be added to the brace to increase the 3-dimensional corrective action and keep up the progress. At the 12-month mark, an out-of-brace x-ray was taken – The results of which showed that the spine was down to just 11 degrees without using the brace – a reduction of 22 degrees which brought patient X within one degree of “normal” measurement.

The final x-ray for patient X was taken 22 months after the start of treatment after a period of weaning off the brace. This x-ray was an out-of-brace x-ray where the patient was required to be out of the brace for at least 6 hours. The results of the final X-ray showed her spine to have a 6-degree curvature, which according to definition (greater then 10 degrees cobb) cannot be classified as a scoliosis.

The combination with scoliosis specific exercise assisted in speeding the correction of the Cobb angle[2], but also made a substantial contribution to the overall postural correction which scoliosis treatment also provides. Postural assessments showed continuous improvement of her posture with her body showing good balance after 4 months of treatment, with improvements continuing so that she was visually symmetrical by the 12-month mark. The postural improvements were then maintained throughout the treatment period.

One potential risk of scoliosis bracing which has been highlighted is the potential for loss of mobility or deterioration of fitness, however the incorporation of exercises in the program also assisted in this regard[3], such that a functional assessment of fatigue ability and strength of her core muscles, together with the flexibility of her spine showed no deterioration of strength, endurance or flexibility at the end of treatment.

 

6. After scoliosis

After just 22 months of treatment, patient X no longer suffered from scoliosis – an unmitigated success for scolibrace, but what about in the future, could scoliosis reoccur?

While a patient is continuing to grow, there is always the chance that scoliosis could begin to develop again – scoliosis patients should, therefore, be monitored until they have reached adulthood and their skeleton has finished growth. Having said this, recent research has indicated that continuing with some targeted scoliosis specific exercises after bracing can be effective in preventing any loss of correction[4].

So what now for patient X? Having completed her treatment and with a handful of ongoing exercise to keep her on track she’s free to get on with the rest of her life, scoliosis free!

 

scoliosis braces

Scoliosis braces have come a long way!

Could ScoliBrace be right for you?

We hope that this series of articles has been informative and has given you an outline as to the path that a typical non-surgical scoliosis treatment can take. If you have concerns about scoliosis, or would like to find out if ScoliBrace might be right for you, why not get in touch today, and arrange a one to one consultation with our specialists.

 

 

 

 

 

 

[1] ‘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

 

[2] 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.

 

[3] Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, Tedeschi C, Venturin A: Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal deformities. Eura Medicophys 2005, 41(2):183-201

[4] 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

 

Happy New Year from the UK Scoliosis Clinic

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

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

 

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

Scoliosis specific exercise prevents loss of correction after bracing

When we think about scoliosis treatment we tend to focus on there here and now – normally this means concentrating on getting the correct diagnosis and making sure the right treatment program is put in place. What’s often less discussed however, are plans for going forward after you have completed your treatment.  This is especially the case when bracing – we know that bracing can offer a significant reduction in cobb angle, but what happens when it’s time to stop wearing the brace?

 

Does the end of bracing mean the return of scoliosis?

At our clinic we often encounter clients who wonder whether the end of bracing means a reversal in the correction achieved – will scoliosis start to develop again after bracing?  It’s a fair question – but thankfully research shows that a scoliosis specific exercise program – exactly the same kind of program which is usually used to support bracing – can actually be highly effective in reducing loss of correction after bracing.[1] The results of the study suggest that simply continuing with a scoliosis specific exercise program can, in fact, prevent any loss of correction.

Scoliosis specific exercises are already recommended not only as a compliment to bracing, but also as a means to avoid some of the pitfalls associated with wearing a brace – the most common issues being muscular stiffness loss of strength.[2] In fact, it’s common to use scoliosis specific exercises for a period before beginning bracing – as some research suggests this may promote a quicker correction.[3]

It’s therefore not surprising that exercises may have a valuable role to play during the weaning phase of treatment too. Brace weaning itself is a critical phase of treatment which can vary in both its nature and duration according to the patient. In some instances, clinicians reduce the daily hours of brace in a somewhat rapid way, shifting from full-time wearing (18 or more hours per day) to the point that the patient is totally free from the brace within a period of six to 12 months. Others progressively and slowly reduce the hours of brace use, with a mean reduction of two to three hours every six months.[4]  Researchers currently believe that a failure to properly support and train the trunk muscles during this period may be responsible for the loss of correction which sometimes accompanies the end of treatment – however, scoliosis specific exercises can be used to address this specific problem.

 

What does the research say?

Scoliosis SEAS treatment

SEAS exercises can reduce loss of correction in scoliosis cases

The results of one of the few studies on this specific issue were certainly encouraging– in the 2008 study, sixty-eight patients were monitored throughout their process of brace weaning. The patients were divided into two groups according to whether or not exercises were performed during the weaning period. The exercise group included 39 patients and was further divided into two sub-groups: a SEAS group, who performed SEAS exercise programs, and an “other” group – who performed a variety of other forms of scoliosis specific exercise.  29 patients were placed in the non- exercise group.

The study followed the patients for 2.7 years – at the end of treatment, Cobb angle had increased  in the non-exercise group (by approximately 3.5 degrees) – however both the SEAS and other exercise groups saw their cobb angles remain stable – no change was detected.

 

So does the end of bracing mean the return of scoliosis?

In short, it certainly does not have to! From a patient’s perspective it’s important to find a clinic which also provides a solid aftercare plan however. At the UK Scoliosis clinic, we take great care to plan a course of treatment which includes appropriate brace weaning support, so that maximum correction can be maintained. As new research becomes available in this regard, we’ll apply it to our programs wherever appropriate.

 

 

 

[1] 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

[2] Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, Tedeschi C, Venturin A: Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal

deformities. Eura Medicophys 2005, 41(2):183-201

[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] Negrini S: The Evidence-Based ISICO Approach to Spinal Deformities. 1st edition. Milan, Boston: ISICO; 2007.

Scoliosis Treatment – Scoliosis exercise Vs. Bracing, which is best?

Today the two main methodologies involved in the non-surgical treatment of scoliosis are Bracing, and Specialist exercise methodologies. In most cases we use both approaches throughout the course of treatment with our patients since both approaches have their strengths. We are however, often asked which treatment methodology is best – so let’s consider the latest research on this question.

 

Bracing vs Exercise – New research

The first thing to realise when comparing scoliosis treatment is that while many patients often want to know “which is best”, this question is often less explored in the scientific literature. For the most part, scoliosis practitioners want to focus their time and attention towards improving their methodologies of choice, rather than on making comparisons with other approaches. Because of this, few studies have tried to directly compare bracing and exercise approaches – although a recent 2017 study has done just this[1].

In the study conducted in China, 53 patients (age of 10 – 17 years, Cobb angle ≥ 20 – 40 degrees,) were randomly assigned to either a bracing group or exercise group. Twenty-four patients (19 females) were placed in the bracing group and 29 patients (22 females) in the exercise group.

Patients in the bracing group were provided with a rigid thoracolumbosacralorthosis (a Scoliosis brace – TSLO) and asked to wear their brace 23 hours a day, while patients in the exercise group were treated with the Scientific Exercise Approach to Scoliosis (SEAS) protocol. Data regarding angle of trunk inclination, Cobb angle, shoulder balance, body image, quality of life (QoL)[2] were collected every 6 months.

At the first visit, patients assigned to the bracing group were prescribed with a rigid (TLSO) and received an initial pre-treatment evaluation to allow for brace fabrication. To achieve optimum correction, patients were invited to the scoliosis clinic to check the fit and modify (if necessary) the brace after the first month of intervention and then every three months as recommended by SOSORT[3].

The SEAS patients took part in a session of 1.5 hours at which they learned and practiced the core content of their program every two to three months, in which they learnt their personalised exercise protocol. The patients continued treatment at the clinic once a week (40 minutes) plus one daily exercise session at home (10-15 minutes)[4].

 

 

Study Results

At this stage, it’s important to mention that while this study represents an important beginning in this comparative project, the results available at this time reflect only a year of treatment. It is likely that the trends illustrated here will hold good over a longer period, and thankfully we will be able to verify this since the study is still ongoing.

 

Cobb angle 

A 54 Degree Cobb angle (X-ray)

The bracing group achieved a significantly larger reduction in Cobb angle – at 6 months, the mean reduction of cobb angle in the bracing group was 3.13 degrees, and at 12 months the mean reduction was 5.88 degrees.  In the exercise group, the 6 months mean reduction was just 0.66 degrees, and at 12 months was 2.24 degrees.[5]

 

Quality of Life

The SRS-22 form used for gauging quality of life factors consists of a number of subsets of data, each of which was individually evaluated during this study. These include a score for pain, function, mental health and self-image. Taken as a whole, the results showed that for the bracing group, the SRS functional score (a measure of the impact of scoliosis on everyday life) as well as the total score (a broader measure of quality of life factors) all showed significant improvement between the initial consultation and 12-month evaluation as well as between the 6-month and 12-month evaluations.  The one exception to this was pain level, which did not differ significantly across the three evaluations.

The researchers also noticed that self-image was significantly improved in the bracing group, especially at the 12 months follow up, this was interesting given the negative self-image association which is sometimes linked to bracing.  Participants did report an increase in their overall satisfaction levels (taking all factors into account), although this was most apparent after passing the 6-month mark.

For the exercise group, all the SRS-22 quality of life subsets showed a slightly larger improvement across the three visits than bracing – especially in terms of the functional score. The exception here again was pain, where no significant change was detected[6].

 

 

Overall comparison

In comparing the two treatment groups, the study investigators noted it was interesting to find that the overall improvement of quality of life was more significant in the exercise group. Although the quality of life scores improved in both groups, at all three visits, the average scores of most subsets in the SRS-22 were higher in the exercise group.  By contrast, the improvement in cobb angle was significantly greater in the bracing group, although the exercise group did also show an improvement at the 12-month mark.

 

 

So which is better?

At this stage, it seems fair to suggest that the results of the study reflect what many scoliosis clinicians are already aware of – Scoliosis Bracing is by far the most effective way to reduce a cobb angle – Indeed, the authors note how “There is no doubt that bracing has proven efficacy in halting the progressive nature of the deformity and reducing the need for surgery”.

At the same time, scoliosis specific exercise has a more positive impact on functional capacity – this comes as no surprise to scoliosis practitioners, since scoliosis specific exercise is intended to reduce muscular imperfections and promote better everyday posture. Exercise approaches also seem to correlate with a greater improvement in quality of life factors than bracing, although this is also to be expected since it is almost universally accepted that any form of exercise serves to boost quality of life in most individuals.

Taking these two points, its easy to see how a combination approach is often the best possible option – by pursuing both treatment methodologies it is possible to achieve functional improvement, cobb angle correction and an improvement in quality of life in a flexible way which works for the patient.

More results from this particular study, as well as further research can be expected in this area and we will report it to you as soon as it becomes available!

 

scolibrace results

An example of successfull bracing 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 [Publish Ahead of Print]

[2] The SOSORT SRS-22 Form was used for this data collection.

[3] Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 2012;7:3.

[4] Romano M, Negrini A, Parzini S, et al. SEAS (Scientific Exercises Approach to Scoliosis):a

modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis 2015;10:3.

[5] 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]

[6] 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]

Scoliosis bracing is becoming more effective

For some time now, scoliosis clinicians have broadly accepted the view that scoliosis bracing is an effective way to halt the progression of scoliosis, and (with the use of the correct brace) is also an effective way to reduce the curve.

The outlook for bracing was not always a positive as it is today – historically, studies suggested that bracing was only as effective as observation. Over time however, research has tended to show bracing to be more effective than was once thought, so that today the rates of success with bracing are very high.

In 2005, the Scoliosis Research Society (SRS) attempted to standardize the inclusion criteria and outcome measurements for bracing studies, to enable comparison among studies. In the guidelines, it was suggested that a curve progression of less than 5 degrees should be regarded as success. At the time, SRS did not even consider that bracing might actually serve to improve a curve – although it was quickly realised that this was possible. For this reason, the criteria for “improvement” (being a reduction of curve of at least 6 degrees) was established in 2009.

Despite some scepticism in the mid 2000’s however, some bracing studies today have demonstrated rates of surgery prevention as high as 100%[1][2] and the field is one of the major areas of study and advancement – so what caused such an improvement in the prognosis?

 

Braces are getting better

scoliosis braces

Scoliosis braces have come a long way!

One of the major reasons for the improvement in bracing effectiveness has been the improvement in braces themselves.  A recent review study conducted in 2016, attempted to explore this issue by examining 53 studies published between 1990 and 2016[3]. It showed that when comparing the percentage of patients eventually requiring surgery and the improvement rate in the past 26 years, we find that there is a trend towards reduction in surgical rate and an increase in improvement rate. Yet, close inspection showed that the change is strongly related to the type of brace used.

Key factors in bracing outcome are the amount of in-brace correction and comfort for the wearer. In the study, it was shown that large in-brace correction in excess of 50% would be accompanied by improvement at skeletal maturity[4][5] and hours of brace wear are positively associated with the rate of treatment success[6]. Simply put, an active correction brace which is also comfortable to wear is a key factor in significantly reducing surgical requirement[7]. This is why so much effort has been expended in ensuring that our ScoliBrace is the most comfortable brace available!

The study also showed that the effectiveness of a brace depended on the quality of its construction, not just its design[8]. In 2007 Danielsson et al pointed out the importance of the skill and dedication of the orthotist in creating a brace as a critical factor in the eventual success of treatment and similar views have been forwarded by other authors[9]. Today, advancements in technology mean that a higher quality of brace design and manufacture than ever before is available to us. Indeed, at the UK scoliosis clinic we use the latest laser scan and computer aided manufacture processes to create a brace for each client, which fits their needs perfectly.

 

Combination treatment is most effective

Today we also appreciate that in most instances an individualised treatment plan based on a number of complementary methods provides the best chance for a significant reduction of the curve. In fact, today it is generally accepted that bracing should not be employed alone in the management of Adolescent Idiopathic Scoliosis in particular – instead individualised scoliosis specific exercises should also be incorporated. This is because Scoliosis specific exercises improve the muscle strength of the trunk and the postural awareness of the patients. More importantly perhaps, when combined with bracing, evidence suggests the results are an improvement in curve reduction[10]. Properly tailored exercise programs may also help to reduce the loss of correction which frequently accompanies the end of brace treatment if not properly managed.[11]

 

Scoliosis clinicians are working hard to improve bracing technology.

scolibrace

Modern scoliosis braces are highly effective

At the UK scoliosis clinic, we respect and value the work that surgeons can do in correcting very serious cases of scoliosis which are unsuitable for conservative treatment. However, the 2016 review study has suggested that a conflict of interest in bracing development might be a negative factor for patients[12].

One of the lest effective forms of brace is the Boston brace – yet these are often favoured by orthopaedic surgeons (especially in the US)[13]. The Boston brace is at least outdated, and in some situations may complicate scoliosis treatment unnecessarily. Boston braces also encourage thoracic flat back, which has been shown to be detrimental to the correction of curves[14].

Why are these braces sometimes favoured then?  –  This maybe because in the event that the brace fails to achieve the objective, the surgeon can go on to treat the patient using surgery, although this might not be the patient’s preference. Conversely, the kinds of modern braces we use at our clinic and which are widely implemented throughout Europe today are predominantly used by physicians who treat patients conservatively. In this instance, failure of the brace requires an external referral for surgical treatment[15] – hence it is in the interest of non-surgical clinics to constantly develop and improve their braces, which results in highly advanced modern braces, like ScoliBrace.

 

 

 

 

[1] De Giorgi S, Piazzolla A, Tafuri S, Borracci C, Martucci A, De Giorgi G. Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery? Eur Spine J.2013;22(6):S815–22.

[2] Aulisa AG, Guzzanti V, Perisano C, Marzetti E, Falciglia F, Aulisa L.Treatment of lumbar curves in scoliotic adolescent females with progressive action short brace: a case series based on the Scoliosis Research Society Committee Criteria. Spine (Phila Pa 1976). 2012;37(13):E786-E791.

[3] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[4] Landauer F, Wimmer C, Behensky H. Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up.

[5] Appelgren G, Willner S. End Vertebra Angle – A roentgenographic method to describe a scoliosis. A follow-up study of idiopathic scoliosis treated with the Boston brace. Spine (Phila Pa 1976) 1990;15(2):71- 74.

[6] A large number of studies are cited in Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[7] Wiley JW, Thomson JD, Mitchell TM, Smith BG, Banta JV. Effectiveness of the Boston brace in treatment of large curves adolescent idiopathic scoliosis. Spine. 2000;25(18):2326–2332.

[8] Rigo MD, Villagrasa M, Gallo. A specific scoliosis classification correlating with brace treatment: description and reliability. Scoliosis. 2010;5(1):1. doi:10.1186/1748-7161-5-1.

[9] For example see Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner- Bonneau D. Ameta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am. 1997;79(5):664-674.

[10] Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S. Active self-correctionand task-oriented exercises reduce spinal deformity and improve quality of life insubjects with mild adolescent idiopathic scoliosis. Results of a randomized controlled trial. Eur Spine J. 2014;23(6):1204-14. doi:10.1007/s00586-014-3241-y.

[11] Goldberg CJ, Dowling FE, Hall JE, Emans JB. A statistical comparison between natural history of idiopathic scoliosis and brace treatment in skeletally immature adolescent girls. Spine. 1993;18(7):902-9088.

[12] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[13] Wynne JH. The Boston brace and TriaC system. Disabil Rehabil Assist Technol2008; 3(3):130-135. doi:10.1080/17483100801903988.

[14] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[15] Ibid.

June is Scoliosis awareness month

Scoliosis is a serious condition which can cause discomfort, disability and eventually require major surgery if left untreated. Catching scoliosis early makes it much easier to treat, so this week please take a moment to read this quick primer on scoliosis and pass it on to those you care about.

 

What is scoliosis?

Scoliosis is a disorder in which there is a sideways curve of the spine. Curves are often S-shaped or C-shaped. In most people, there is no known cause for this curve, although those who have a family history of scoliosis do seem to be at greater risk.

 

What are the signs and symptoms of scoliosis?

In the absence of formal screening programs scoliosis is often first discovered by parents when they see an obvious curve or hump on their child’s back, especially when bending forwards.

Occasionally scoliosis might be detected through a complaint of back pain, but scoliosis is frequently present without pain.

Typical symptoms include:

  • Uneven shoulders
  • Head appears to be off centre
  • Uneven waist
  • One side of the rib cage is higher than the other when bending forward

 

 

How common is scoliosis

Scoliosis is much more common than most people think. The latest research suggests that between 2 and 3% of children aged 10-15 years will develop scoliosis. This might seem like a small number, but 3% would be 3 in every 100 – which would be one in every 30. Therefore, about one child in each school class will develop scoliosis.

Girls are more likely to develop scoliosis than boys (about 75% of scoliosis patients are girls) but boys can and do develop scoliosis too. Research suggests that some sports and activities are associated with a higher risk of scoliosis – the most notable example are ballet dancers and gymnasts, where the condition is us up to 12 times more prevalent[1][2].

 

How is scoliosis treated

If scoliosis is not diagnosed early, or if the scoliotic curve is left to develop unchecked then surgery to fuse the spine may eventually be required. It was once thought that this was the only effective means of treating scoliosis – which is one of the reasons why a screening program was not put into place. [3]

Today there are a wide variety of approaches which can be used to treat scoliosis non-surgically. These methods are far less physically invasive and much less emotionally disturbing, especially for young people. Evidence strongly indicates that non-surgical treatment can be highly successful in reducing the chance that surgery will eventually be required.[4]

Often, more than one approach can be used to develop a treatment program – the two main approaches used at our clinic are scoliosis specific exercise and scoliosis bracing, however we may also complement these approaches with evidence-based Chiropractic treatment or postural correction programs. While these additional tools do not directly reduce scoliosis, they can often assist the sufferer in terms of pain relief, or with regards to improving body symmetry.

 

What can I do?

The biggest single factor in ensuring a good outcome for scoliosis patients is early diagnosis – a very small curve is much easier to stabilise and correct than a larger one. June is Scoliosis Awareness Month. Throughout the month, our aim is to raise awareness about scoliosis screening and the importance of early detection -you can help by raising the issue of scoliosis with your child’s school, local clubs or youth groups.

This month, we are offering free scoliosis screening sessions and informational talks to schools. So if you know anyone who might be interested, please ask them to get in touch!

You can screen for scoliosis yourself, at home, using our scoliscreen tool – available at  (https://scoliosisclinic.co.uk/scoliscreen/) if you’re a parent please feel free to use this tool to screen your own children.  It’s an excellent idea to screen all children, but those between 10 and 15 are at the highest risk. If you do have a child who participates in a high-risk activity, please take a moment to screen them if you possibly can.

If you have concerns about a young person, please don’t worry – simply get in touch to book a free professional screening here at our clinic.

 

[1] Tanchev, Panayot I. MD; Dzherov, Assen D. MD; Parushev, Anton D. MD; Dikov, Dobrin M. MD; Todorov, Miroslav B. MD, Scoliosis in Rhythmic Gymnasts, Spine: June 1st, 2000 – Volume 25 – Issue 11 – p 1367-1372

[2] Longworth, Brooke et al. Prevalence and Predictors of Adolescent Idiopathic Scoliosis in Adolescent Ballet Dancers Archives of Physical Medicine and Rehabilitation , Volume 95 , Issue 9 , 1725 – 1730

[3] R 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.

[4] 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.