Tag: scoliosis treatment

Does poor posture cause Scoliosis?

Posted on January 17, 2024 by - Blog

Scoliosis is a medical condition that affects millions of people worldwide. It is characterised by an abnormal curvature and twist of the spine, which can result in physical limitations and discomfort. While the exact cause of scoliosis is not fully understood, it is believed to be the result of a combination of genetic and environmental factors.

 

Can poor posture cause Scoliosis?

One of the environmental factors that is often associated with scoliosis is poor posture – people with scoliosis are often perceived as having poor posture, and many parents worry that poor posture can cause Scoliosis – but can it? The bottom line is no – poor posture does not cause Scoliosis. Poor posture is a common problem that affects many people worldwide – and it can be a painful issue though. Poor posture can be caused by a variety of factors, including muscle weakness, joint stiffness, and poor ergonomics – but while Scoliosis might cause someone to appear to have poor posture, there’s no evidence to show that poor posture will lead to Scoliosis.

When we have poor posture, our bodies are not in alignment, which can lead to a variety of health problems, including back pain, neck pain, and headaches. Poor posture can also cause our muscles and joints to work harder than they should, leading to fatigue and discomfort. That “hunched” appearance which used to be associated with teens but seems to apply to almost everyone these days is more characteristic of Kyphosis, rather than Scoliosis – and in extreme cases, poor posture might be caused by Kyphosis, but not Scoliosis.

 

Is there any relationship between Scoliosis and Poor posture?

Most Scoliosis research focuses on establishing the true cause of Scoliosis, and the best ways to treat it, so there hasn’t been much research into whether poor posture might contribute once the condition already exists. Therefore, while poor posture is not a direct cause of scoliosis, it might be a factor which could contribute to the progression of the condition. When we have poor posture, our spines are not in the proper alignment, which can cause our muscles and ligaments to become strained and weakened, it’s feasible that this might make it more possible for scoliosis to progress.

Many aspects of a Scoliosis treatment plan are aimed at creating balance and strength in the core muscles which support the spine, so while maintaining good posture is important for everyone, it’s fair to say that focusing on good posture is especially important for those with scoliosis. Good posture can help to alleviate some of the painful symptoms which some people experience with scoliosis at the very least.

 

Maintaining good posture

Scoliosis or not, you can only do yourself a favour by maintaining good posture – Here are some tips:

  1. Stand up straight: When standing, make sure your weight is evenly distributed on both feet, and your shoulders are relaxed.
  2. Sit up straight: When sitting, make sure your back is straight, and your feet are flat on the ground.
  3. Use proper ergonomics: Make sure your desk and chair are at the proper height and distance to promote good posture.
  4. Exercise regularly: Regular exercise can help to strengthen the muscles and ligaments that support the spine, helping to prevent the progression of scoliosis.
  5. Stretch regularly: Regular stretching can help to alleviate the symptoms of scoliosis and improve flexibility.

 

Treating Scoliosis

Treating Scoliosis is about much more than altering postural imbalances – Scoliosis treatment requires a focus on good nutrition, exercise, and healthy lifestyle habits as well as a proactive approach such as Bracing. In this regard, there’s a lot we can do to help patients support treatment plans – and much of the advice would be beneficial to almost anyone!

For example, regular exercise can help to strengthen the muscles and ligaments that support the spine, and eating a balanced diet that is rich in calcium and vitamin D can also help to promote strong bones and a healthy spine.

So, while poor posture is not a direct cause of scoliosis, it’s not impossible that it might contribute to the progression of the condition. This being said, maintaining good posture is important for everyone, and might even help with pain relief in those with Scoliosis. By focusing on good nutrition, exercise, and healthy lifestyle habits, we can care for our spines, with, or without Scoliosis!

 

 

 

When Is It Too Late To Correct Scoliosis?

Posted on October 3, 2023 by - Blog

Scoliosis is a 3-Dimensional alteration to the structure of the spine, involving a sideways bend and twist it affects millions of people worldwide. While it is commonly associated with adolescence, scoliosis can develop at any age. Early detection and treatment are crucial for managing the condition effectively. However, many people wonder, “When is it too late to correct scoliosis?” In this blog, we will explore the possibilities of treating scoliosis at different stages of life and shed light on the importance of timely intervention.

 

Childhood and Adolescent

Scoliosis often manifests during childhood and adolescence, as the rapid growth spurts during these stages exacerbates spinal deformities. Detecting scoliosis early, allows for conservative treatment options such as observation, bracing, or specialised exercise systems. In most cases, correcting scoliosis is easier during this period, as the skeletal system is still growing and flexible and it is easier to control the growth of the spine. Non-surgical interventions can help prevent the progression of the curvature and minimize its impact on the individual’s quality of life. Therefore, it is vital for parents, educators, and healthcare professionals to be vigilant and screen children for scoliosis regularly.

 

Adulthood

But what happens if scoliosis goes undetected or untreated during childhood? Is it ever too late to correct the condition? While it is true that the optimal time for intervention is during childhood, scoliosis treatment can still be beneficial in adulthood. The goals of treatment shift slightly, focusing more on pain management, improving function, and preventing further curvature progression. Conservative approaches such as physical therapy, chiropractic care, and exercise can help alleviate discomfort and strengthen the surrounding muscles. In some cases, orthotic devices or spinal braces may also provide support and stability. By the time a person has reached adulthood, their spine is probably too rigid to actually correct the Scoliotic curve – however, it’s usually possible to stop the curve from progressing and getting any worse.

 

Later Life

Scoliosis – Specifically a form known as “de-novo” or “degenerative” scoliosis occurs frequently in the over 65’s. This is different from adult cases of Scoliosis since here the scoliosis starts to develop where it did not previously exist. The chances for correcting De-novo Scoliosis are low since the degeneration of the spine which causes the condition is due to ageing and sadly that cannot be prevented!

Intervention with bracing or exercised-based therapy can slow progression considerably, and in many cases will give people the ability to remain upright, independent and active, whereas they may otherwise struggle.

 

Conclusion

In summary, it is never too late to address scoliosis, although early detection and intervention are ideal.

Timely treatment during childhood and adolescence can prevent progression and reduce the need for more invasive measures later in life. However, even in adulthood, conservative treatments and, if necessary, surgical interventions can provide relief, improve function, and enhance the quality of life. The key lies in seeking professional help, staying informed, and embracing the support available to manage the physical, emotional, and psychological aspects of scoliosis. Remember, it’s never too late to take control and seek the best possible outcomes for a life with scoliosis.

 

Can Scoliosis Be Cured?

Posted on June 30, 2023 by - Blog

For those who are diagnosed with scoliosis, the first question is almost always “can scoliosis be cured?”.  Scoliosis is a complex condition – and so is the answer to this question.

 

What is Scoliosis anyway?

Before we can address the issue of a cure, we first need to properly understand the problem.

Scoliosis is a complex condition which consists of several issues occurring all at once. While a normal spine will appear straight when viewed from behind, in Scoliosis a 3-dimensional shift in the spine takes place, most notably causing a curvature to one side or the other, but it also tends to lead to rotation of the spine itself. Over time, scoliosis affects the balance of the body, leading to muscle imbalances, postural problems and issues with range of movement.

Scoliosis, especially in the early stages, can be hard to spot – scoliosis has typically progressed for some time before there are visual signs – however, once signs have appeared:

  • From the back, the spine may have a C or S shape curve rather than that of a straight line, this can make the waistlines uneven or one shoulder lower than the other.
  • From the side view, the normal spinal curves are often straightened, which makes the mid-back appear flat. Shoulder blades may be prominent.
  • While looking from the head down to the feet, there is a rotation or twist which can cause ribs or one side of the lower back to appear humped or more prominent.

Scoliosis is typically divided into two main categories – adult, and childhood scoliosis. Adult scoliosis is caused either by the degeneration of spinal discs with age or as a result of childhood scoliosis which was not treated. Childhood scoliosis (affecting infants through to young adults) has several known causes, but in 80% of cases, the exact cause 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.

 

Can Scoliosis be cured?

It’s important to be clear about what we mean when we talk about a “cure”. Scoliosis, depending on the type is (probably, according the current research) either genetic (idiopathic), or the result of denegation in the spinal discs (de-novo). Neither of these underlying issues can be “cured” per se.

Therefore, while some symptoms can be alleviated, addressing the root cause, especially when unknown or age-related (as in de-novo scoliosis), looks more like management rather than a definitive cure.

In young people, Scoliosis which is spotted early may be possible to correct to an extent that the spine is considered “normal” – but the individual will still have the underlying genetic factors which predispose them to developing Scoliosis. Ongoing monitoring will be required to stop the curve from coming back, at least until adulthood is reached.

In order people, it’s not possible to reverse the ageing process or reduce the damage which may have already occurred to vertebra – however, it is possible to support the spine and prevent it from worsening quickly, and complementary treatments may well be able to reduce any associated pain and greatly improve mobility.

At the UK Scoliosis Clinic, our aim is to allow people to live a normal life with Scoliosis.

 

 

[1] ‘A population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening’
Fong DY, Cheung KM, Wong YW, Wan YY, Lee CF, Lam TP, Cheng JC, Ng BK, Luk KD, Spine J.  2015 May 1;15(5):825-33. doi: 10.1016/j.spinee.2015.01.019. Epub 2015 Jan 20.

[2] 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.

 

 

 

Can people live a normal life with Scoliosis?

Posted on June 17, 2023 by - Blog

Scoliosis is a condition that affects the spine’s shape, causing it to twist and bend sideways. It affects approximately 2-3% of the adolescent population, and as much as 30% by the time we reach 60. While scoliosis can be a debilitating condition that affects a patient’s quality of life, it is possible to live a normal lifestyle with scoliosis.

 

Causes of Scoliosis

Scoliosis can have different causes, including genetic factors, congenital disabilities, and neuromuscular conditions. In some cases, the cause of scoliosis is unknown, and it’s referred to as idiopathic scoliosis. Different forms of Scoliosis include:

  1. Congenital scoliosis: This type of scoliosis is caused by spinal abnormalities that occur during fetal development.
  2. Neuromuscular scoliosis: This type of scoliosis is caused by conditions that affect the muscles and nerves that control the spine, such as cerebral palsy, muscular dystrophy, or spinal muscular atrophy.
  3. Degenerative scoliosis: This type of scoliosis occurs in older adults due to wear and tear on the spinal discs, causing them to weaken and collapse.
  4. Idiopathic scoliosis: This is the most common type of scoliosis, and it occurs in adolescents aged 10-18 years old. The cause of idiopathic scoliosis is unknown, but it’s believed to be genetic.

 

Symptoms of Scoliosis

The symptoms of scoliosis vary depending on the severity of the curvature. The main symptom is of course the curvature of the spine – although this isn’t typically what most people think of as it relates to quality of life. In fact, mild scoliosis may not cause any noticeable symptoms, while severe scoliosis can cause pain, discomfort, and breathing difficulties. Symptoms, depending on curve severity, can include:

  1. Uneven shoulders or hips: A visible curve in the spine can cause one shoulder or hip to be higher than the other.
  2. Back pain: Scoliosis can cause back pain
  3. Difficulty breathing: Severe scoliosis can compress the lungs and reduce lung capacity, making it difficult to breathe.
  4. Fatigue: Scoliosis can cause fatigue due to the strain on the back muscles and lopsided posture requires more energy to keep upright.
  5. Reduced mobility: In severe cases, scoliosis can limit a patient’s mobility and ability to perform daily activities.

 

Can Patients Live a Normal Lifestyle with Scoliosis?

The good news is that patients with scoliosis can live a normal lifestyle with the right treatment and management. Ideally, Scoliosis will be detected early on – giving the best possible treatment chances at any age. For children diagnosed with Scoliosis, a proactive treatment program involving exercise-based therapy and bracing can often allow them to reach adulthood with no more issues from Scoliosis than the rest of the general population.  For those who develop Scoliosis in adulthood, or have a childhood case which is not detected, it’s not usually possible to reduce the curve – but improving torso appearance, stopping progression and managing any associated symptoms is certainly possible.

Those living with Scoliosis can also make lifestyle choices which help to make living with Scoliosis easier – actually, most of these points are good advice for anyone! You should:

  1. Exercise – Regular exercise can help strengthen the back muscles and improve mobility. Low-impact exercises such as swimming, yoga, pilates and walking can be beneficial for patients with scoliosis.
  2. Maintain a healthy weight – Having a low Body Mass Index (BMI) or being underweight is linked with a increased risk of scoliosis due to softening of bones and weakening of muscles and ligaments. While excess weight can put a strain on the back muscles, exacerbating scoliosis symptoms. Maintaining a healthy weight can help to strengthen the spine and alleviate the stress on the back muscles and improve overall health.
  3. Wear proper footwear – Wearing shoes with good support and cushioning can help reduce the strain on the back muscles and improve balance and stability.
  4. Seek out scoliosis specific physical therapy – scoliosis specific physiotherapy such as Schroth, SEAS & Side shift methods, can help patients with scoliosis learn exercises to strengthen the back muscles and improve posture.
  5. Find a chiropractor, osteopath or physiotherapist who can help the body to feel and move better.
  6. Practice good posture – Maintaing more upright posture can help reduce the constant strain on the back muscles and ligaments reducing the likelihood of the scoliosis worsening slowly over time.
  7. Manage pain – Patients with scoliosis may experience back pain, and it’s important to manage the pain to improve quality of life. While over-the-counter pain relievers may be required at times, it is better in the longer term to use hot or cold therapy, acupuncture or massage to manage symptoms.
  8. Periodic check-ups – Patients with scoliosis should attend check-ups over the years with their healthcare provider to monitor the condition for progression and adjust the treatment plan as necessary.

 

Need help with Scoliosis?

If you’re living with Scoliosis or have recently been diagnosed, don’t wait – get in touch with the UK Scoliosis Clinic today and let our expert staff guide help you live your best life with Scoliosis!

 

 

Disadvantages of Scoliosis-Specific Exercise

Posted on March 19, 2023 by - Blog

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

 

Scoliosis Specific Exercise

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

 

Limited impact on larger curves

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

 

Requires commitment and consistency

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

 

Requires supervision

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

 

Can lead to muscle imbalances

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

 

Does not address underlying issues

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

 

Is Scoliosis specific exercise right for me?

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

 

 

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

 

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

 

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

 

Scoliosis: Should I seek treatment abroad in the UK?

Posted on March 4, 2023 by - Blog

When it comes to Scoliosis treatment, the simple fact is where you live has a big impact on the kind of treatment available to you and how you can best access it. The best place to seek treatment also depends on the kind of treatment you’re looking for, of course. Sometimes this might mean travelling abroad to a clinic is the best option for you. The option to see a specialist who has experience working with a specific co-existing condition might also be a factor to consider, even where others are available closer to home.

At the UK Scoliosis Clinic were thrilled to welcome patients from all around the world who are seeking non-surgical treatment approaches based around bracing. While many of our Clients are UK based, we can and do see many people from all around the world each year – of course, since the COVID 19 pandemic many people have been asking whether it’s a good idea to seek treatment with us in the UK, so this week we look at the pros and cons of travelling to the UK Scoliosis Clinic.

 

COVID

Firstly, let’s address the elephant in the room – COVID-19 – while largely under control in the UK, the disease is still prevalent – does this mean you shouldn’t travel? Of course, this is a decision for each of us to make individually, however, at this point in time, the vast majority of covid restrictions in the UK have been rescinded with items such as mask-wearing now optional based on your personal preferences. Covid levels in the UK remain broadly similar to most developed countries. At the UK Scoliosis Clinic, we’ve kept up with common sense measures such as enhanced cleaning and improved ventilation to help keep the spread of covid to a minimum.

 

The Economy and Pricing

In case you’re not a follower of global finance (we can forgive you for that) we’ll let you know that the UK Economy isn’t exactly doing fantastically at the moment… while this isn’t great for those of us living here it can be a significant advantage for those looking to travel for treatment. The weakness of the UK Pound means that our services, including consultations and braces, are now more affordable than ever before once you take the exchange rate into account.

We’re easy to get to

While travelling internationally often seems like a daunting prospect, the UK Scoliosis Clinic is very easy to get to – and much less complicated than many clinics based in London. Our Chelmsford Clinic is positioned close to both London Stansted (STN) and London Southend (SND) airports the trip from the airport is an easy one. Getting from the airport to the clinic is straightforward, and we have Bus, Cab or Train stops literally within 10 minutes’ walk of our door.

If you’re coming to the UK on a long-haul flight, you may want to stay in Chelmsford overnight, but many of our European-based patients can and do fly in, attend the clinic and return home at the end of the day. Direct flights to both airports are available from most major European destinations, from a wide variety of budget and national carriers – Flights at less busy times can be very inexpensive indeed.

If you’re travelling from Europe It’s also easy to reach our clinic via the Eurostar train service. The Eurostar will set you down at Kings Cross St. Pancras international station in London, from where you can easily connect to Chelmsford station, which is just a few minute’s walk from the clinic

We understand that international patients can often be subject to delays in arriving at the clinic due to situations beyond their control, thus we make all possible efforts to accommodate this – however if you are intending to conduct part of your journey by public transport, please leave at least an extra hour in your planning in case of delays – UK Public transport rarely runs on time!

 

It’s easy to enter the UK

Although it’s true that European citizens do now face slightly more paperwork when travelling to the UK than before Brexit, the process of acquiring the relevant visa for travel (a tourist visa is perfectly acceptable for visiting the UK Scoliosis Clinic) is straightforward for citizens of the vast majority of countries.

 

We’re Flexible!

As a Clinic, we want to provide fantastic treatment options to everyone, regardless of where they happen to live. We take a flexible approach to provide options for those who need to travel further to the clinic and we’ll go out of our way to make arrangements that work for you whenever possible. This starts right from the consultation stage with our new web-based consultation option – which is ideal for those living abroad.

 

Scoliosis Treatment in the UK

If you’re thinking about Scoliosis treatment in the UK, a web-based consultation is an excellent way to start – this will give us an opportunity to speak to you about what we might be able to offer in your specific case, as well as what the cost of treatment would be, before you leave your own home. Follow up and review appointments may also be able to be conducted online when required and we can work with your local x-ray imaging facility if necessary. In fact, if you have been thinking about treatment in the UK, there may never have been a better time!

 

Bracing Scoliosis over 45 degrees

Posted on July 25, 2022 by - Blog

For many years it was considered to be the case that surgery was the only option for reversing Scoliosis – while Scoliosis braces did exist, their primary function was simply to stop Scoliosis from progressing. The best outcome available from bracing was therefore to slow Scoliosis down enough that a patient reached adulthood with a tolerable curve.

Today, modern Scoliosis braces have the ability not only to stop the progression of Scoliosis but also to reverse the condition. Such “over corrective” braces, such as the ScoliBrace we offer at the UK Scoliosis Clinic do this by applying gentle pressure to the scoliotic curve in the opposite direction to the curvature – over time, this can gradually help the spine to return to proper alignment. The success of bracing treatment depends on several factors – one of the most important being the flexibility in the spine, however, it’s possible for patients with Scoliosis up to around 60 degrees[1] to see excellent correction when they are young and flexible enough.

Nonetheless, the “wait and see” followed by surgery approach is still common today, which means Scoliosis patients should always do their research and explore their options before committing to a specific course of treatment.

 

When to brace

When to brace a Scoliosis curve is a tricky question, and one of the major benefits of seeing a Scoliosis specialist – very small curves may not need bracing, with an exercise methodology being enough to control the condition. Larger curves, but those under roughly 30 degrees could benefit from either bracing or exercise-based approaches, so the patient’s lifestyle factors and preferences start to play an important role in treatment selection. For curves over 30 degrees Cobb (Cobb angle being the way in which Scoliosis is measured), bracing is usually the best way forward – however many patients with curves over 45 degrees are often recommended a surgical approach, is this the only option?

 

Bracing curves over 45 degrees – study results

A 2011 study[2] looked specifically at treating Scoliosis patients who were recommended surgery but declined it. The purpose of the study was to verify if it was possible to achieve improvements of scoliosis of more than 45° through a complete conservative treatment – in most cases, this means a combination of bracing and exercise. Specifically, the methods comprised full-time treatment (23 or 24 hours per day) for 1 year with Risser cast, Lyon, or Sforzesco brace; weaning of 1 to 2 hours every 6 months; with strategies to maximize compliance through the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) management criteria applied and specific scientific exercises approach to scoliosis exercises (SEAS) performed.

Out of 1,148 idiopathic scoliosis (IS) patients at the end of treatment, the sample comprised 28 subjects older than 10 years, still growing, with at least one curve above 45°, who had continually refused fusion. The group comprised 24 females and four males, including 14 in which previous brace treatments had failed; at the start of treatment, the age was 14.2±1.8 years and Cobb degrees in the curve were 49.4° (range, 45°-58°). Subgroups considered were gender, bone age, type of scoliosis, treatment used, and previous failed treatment.

After the course of treatment, two patients (7%) remained above 50° Cobb but six patients (21%) finished between 30° and 35° Cobb and 12 patients (43%) finished between 36° and 40° Cobb. Improvements were therefore found in 71% of patients, with only a single 5° Cobb progression observed in one patient. As such, the conclusion was that bracing can be successfully used in patients who do not want to undergo operations for Scoliosis, with curves ranging between 45° and 60° Cobb, given sufficient clinical expertise to apply good braces and achieve great compliance.

 

Is bracing always the right choice for larger curves?

Weather bracing is the right choice for any given curve depends very much on the patient – as studies like this show it’s certainly possible to achieve great results without undergoing surgery – however, the spine needs to be sufficiently flexible and there needs to be time before skeletal maturity is reached still remaining so that treatment has time to work. A consultation with a Scoliosis specialist is always the best way forward when dealing with a suspected or confirmed Scoliosis case, but today it’s certainly true that there are far more tools we can use to prevent and treat Scoliosis than ever before.

 

 

 

[1] Maximum indicated cobb angle for ScoliBrace

[2] Stefano Negrini  1 , Francesco Negrini, Claudia Fusco, Fabio Zaina, Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements Spine J. 2011 May;11(5):369-80.doi: 10.1016/j.spinee.2010.12.001. Epub 2011 Feb 2.

Do curves continue to grow after bracing?

Posted on July 15, 2022 by - Blog

Scoliosis Bracing is one of the most effective ways to treat Scoliosis – today it’s the preferred method used by Scoliosis specialists, and increasingly it’s seen as a worthwhile methodology even by some spinal surgeons. Bracing works by gently applying pressure to the spine while the brace is being worn – this slowly guides the spine back into the correct position, correcting Scoliosis over time. A natural question which often comes up is, therefore, what happens after bracing? Will the curve return?

 

Scoliosis progression

Scoliosis itself is a progressive condition – this means it tends to get worse over time. In children and young adults it worsens very quickly, especially around growth spurts. Once the body reaches Skeletal maturity (which is usually a bit later than the point at which someone is legally considered an adult) the progression of Scoliosis tends to stop, or at least slow. Research suggests that the size of  a Scoliotic curve a person carries into adulthood is a major factor in determining wheather their cure continues to grow. Larger curves (approximately 30 degrees or more) which are carried into adulthood tend to progress throughout life – about 1 degree per year is a commonly cited figure[1] – conversely, curves which are less than 30 degrees often don’t progress.

Scoliosis also commonly impacts older individuals – the prevalence of scoliosis increases with age, so that roughly 30% of the population over 60 have adult scoliosis, although in older people the cause is slightly different – most cases are age-related due to wear and tear on the spine, although having Scoliosis already can make this kind progress more quickly.

What we can take away from this is that the core objective of Scoliosis bracing should be to get people to skeletal maturity with a curve as small as possible, and below 30 degrees wherever viable. This gives a person the best chance of living the rest of their life with minimal or no impact from Scoliosis.

 

Curves after bracing

While most of the research being carried out in the Scoliosis field relates to treating curves in the first place, some studies have looked at the issue of loss of correction. One recent study aimed to evaluate the

loss of the scoliotic curve correction in patients treated with bracing during adolescence and to compare patient outcomes of under and over 30 Cobb degrees, 10 years after brace removal.

As part of the study, researchers reviewed 93 (87 female) of 200 and nine patients with adolescent idiopathic scoliosis (AIS) who were treated with the Lyon or PASB brace at a mean of 15 years (range 10–35). All patients answered a simple questionnaire (including work status, pregnancy, and pain) and underwent clinical and radiological examination.

The patients underwent a long-term follow-up at a mean age of 184.1 months (roughly 15 years) after brace removal. The pre-brace scoliotic mean curve was 32.28° (± 9.4°); after treatment, the mean was 19.35° and increased to a minimum of 22.12° in the 10 years following brace removal. However, there was no significant difference in the mean Cobb angle between the end of weaning and long-term follow-up period. The curve angle of patients who were treated with a brace from the beginning was reduced by 13° during the treatment, but the curve size lost 3° at the follow-up period.

The groups over 30° showed a pre-brace scoliotic mean curve of 41.15°; at the end of weaning, the mean curve angle was 25.85° and increased to a mean of 29.73° at follow-up; instead, the groups measuring ≤ 30° showed a pre-brace scoliotic mean curve of 25.58°; at the end of weaning, it was reduced to a mean of 14.24° and it increased to 16.38° at follow-up.

The basic conclusion was therefore that Scoliotic curves did not deteriorate beyond their original curve size after bracing in both groups at the 15-year follow-ups.  Interestingly, there was also no significant difference in the mean progression of curve magnitude between the ≤ 30° and > 30° groups at the long-term follow-up, which tends not to support the traditional thinking that larger curves progress more through adulthood.

 

Preventing loss of correction

From the above, we can conclude that a small amount of curve increase is likely when discontinuing bracing treatment – however, It’s important to keep in mind that rather than simply weaning off of a brace, it’s possible to be more proactive about the end phases of treatment. One option, for example, is to continue with a Scoliosis specific exercise regimen – research demonstrates that doing so can help to prevent loss of correction after treatment.[2]

While we are not aware of any specific studies which have looked at this issue, one other factor to consider is a possible weakening of muscles which can take place during bracing. A brace takes much of the load off of the musculature which surrounds the spine, so that after a period of years wearing a brace a person may be less able to support themselves and maintain good posture. Studies have shown, however, that Scoliosis specific exercise can be effective in reducing muscle stiffness and loss of strength during bracing[3] suggesting again that a “proactive” end to bracing may help to reduce the risk of loss of correction even further.

 

 

 

 

[1] 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.

 

[2] 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

 

[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

 

Gamifying scoliosis treatment – could it work?

Posted on May 17, 2022 by - Blog

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

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

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

 

Gamifying Treatment

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

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

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

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

 

Further research

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

 

 

 

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

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

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

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

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

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

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

Posted on April 14, 2022 by - Blog

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

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

 

1 – Be passive

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

 

2 – Ignore the costs

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

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

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

 

3 – Forget about mental health

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

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

 

Getting help

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

 

 

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

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