Tag: scoliosis treatment

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

What is the most common treatment for Scoliosis?

Posted on March 14, 2022 by - Blog

If you look around online, you’ll quickly see that lots of people are looking for advice on what the most common treatment for scoliosis is – in fact, “what is the most common treatment for scoliosis” is one of the most popular asked questions on google search!

 

 

The problem with “common” treatment as a concept…

We understand why this is – but for us, this question speaks to a real problem with most people’s understanding of Scoliosis! It’s essential to understand that Scoliosis is a highly individualised condition – yes, it has common hallmarks whenever it is present, but almost every aspect of the condition will, in fact, vary between patients. Because of this, treating scoliosis successfully requires a treatment approach which is personalised, rather than common or generic.

Usually, it’s not even enough to describe a broad treatment pathway when treating a Scoliosis case – simply saying that an exercise-based approach is used, for example, does not mean much – since a scoliosis specific exercise routine will be (or should be!) designed from the ground up to counteract the specific scoliosis which the patient is experiencing.

Furthermore, it’s rare that only one approach will be used in treating scoliosis. Surgery is a possible exception to this, but even in this case, most surgeons do recommend some form of physiotherapy post-surgery to speed recovery and promote health after the operation. It’s therefore much more helpful to think about the possible components of scoliosis treatment and to speak to a scoliosis professional about your specific case and how a treatment plan can be put together.

 

Components of scoliosis treatment plans

With that said, let’s look at a high level, at some of the most common options for treating scoliosis.

 

Wait and see

Wait and see used to be a common refrain amongst GP’s encountering scoliosis cases – for many years, surgery was thought to be the only option for correcting scoliosis (it’s now been shown that this is not the case), therefore the only real option was to watch a scoliosis case and see if it got bad enough to require surgery. It goes without saying that this is not a treatment, and today there is almost no circumstance where “wait and see” is truly a good approach.

 

Surgery

Spinal fusion surgery is the most common surgical treatment for severe scoliosis in adolescents. Using metal rods, hooks, screws, and wires (known as instrumentation), the procedure straightens the spine and solidifies the bone to prevent further abnormal curving. Such a procedure will stop scoliosis from progressing and can typically straighten the spine to a considerable degree. The main downside is the risk of complications from surgery as well as the longer-term issues associated with living with a fused spine. For those with large scoliotic curves, however, these issues are often far preferable to living with severe scoliosis.

 

Bracing

Scoliosis bracing has come a long way over the last 10-20 years. Once thought of as a way to potentially slow scoliosis progression, modern “over corrective” scoliosis braces can be effective in reducing and even totally eliminating scoliosis cases given the right conditions. For bracing to be effective, the patient typically needs to be young enough for their spine to remain flexible and have not yet reached spinal maturity. Luckily, this window aligns perfectly with the 10-15 age range where the majority of scoliosis cases are first spotted. Modern scoliosis braces are relatively comfortable to wear, low profile and effective when used as prescribed. Today, bracing is the best option for those with scoliosis cases over roughly 30 degrees and under 60 degrees. Larger curves may still be treated with bracing, but the degree of correction possible is likely to be less.

 

Exercise-based approaches

Also commonly used today, exercised based approaches utilise specialist disciplines within physiotherapy to allow a patient to actively oppose scoliosis with their own body – exercise-based approaches require commitment to show results, but can be effective in reducing smaller scoliotic curves when applied diligently. Exercise is very often used alongside bracing, as it has an especially noticeable effect on muscular strength and tends to oppose some of the muscular weakening which can occur with bracing.

 

Complementary approaches

There are many other complementary approaches which have been shown to have supportive benefits for scoliosis sufferers – these include disciplines such as massage, yoga or Pilates. None of these approaches have been shown to actively correct scoliosis, but they may play a valuable role in helping to reduce pain or discomfort associated with the condition.

 

Experimental methods  – more research required

Scoliosis treatment is an area where a great deal of research has been taking place recently, and there are a number of other approaches being investigated with a view to determining their effectiveness as scoliosis treatments. Some approaches, such as vibration-based therapy show promise in augmenting existing methodologies – at least one study has suggested that combining a vibration plate with scoliosis specific exercise may improve results.

Other areas not currently seen as effective treatments for scoliosis, such as chiropractic, are being actively investigated by organisations such as CLEAR. Indeed, some of these experiments have published promising results. Programmes such as CLEAR have not yet met the bar in terms of demonstrating efficacy for scoliosis treatment, but may do so in the future. At the UK Scoliosis Clinic, we stay on top of many developing methodologies and will be open to incorporating new ones if and when the literature supports this step.

 

Which scoliosis treatment is right for me?

This article is intended as a quick overview of some of the approaches which can go to make up the unique course of scoliosis treatment that all patients deserve. The critical thing is to find a clinic that has the breadth and depth of experience to provide the treatment which best fits you. At the UK Scoliosis clinic, we provide all of the non-surgical options listed above (except the experimental ones) and work closely with expert and highly respected spinal surgeons to refer those cases which would not benefit from non-surgical intervention.

For more information about any of these approaches, please browse our website and articles, or feel free to get in touch.

 

 

 

 

Bracing vs Exercise – Which Scoliosis Treatment is Cheapest?

Posted on March 1, 2022 by - Blog

When it comes to treating scoliosis, you shouldn’t just be trying to find the cheapest option – it’s critical to consider the likely outcome of treatment over the long term, and to remember that in many cases the cost of treatment will be spread out over many years. Quality treatment is always going to be more expensive, and the sad fact is that “cheap” treatment may not have any positive impact at all. This being said, it’s also only right that you do consider cost as part of your treatment selection process. Let’s look at some of the considerations to keep in mind when choosing between exercise-based, or bracing based treatment.

 

Bracing

Scoliosis bracing is the most effective way to treat Scoliosis, in terms of Cobb angle, without undergoing surgery. Bracing has the best chance of any treatment to not only stop the development of scoliosis but also to reverse the condition. Bracing is typically recommended for curves between about 30 and 60 degrees, but certainly can be used to treat smaller curves.

Scoliosis braces (at least ones worthy of the name) are custom made for the wearer and are expensive – the average brace will cost anywhere between 3000 and 4000 Uk Pounds. Some braces, such as the ScoliBrace we offer at the UK Scoliosis Clinic are adjustable within a certain degree, meaning you can get more life out of the brace.

While bracing does come with a high upfront cost it should be kept in mind that a brace will, in the vast majority of cases, last for many years. In adolescents with larger curves, more than one brace may be needed, since eventually, the scoliosis could improve to a point where a new brace would need to be fitted in order to keep up the reduction, but in many cases an adjustable brace such as ScoliBrace can cover an entire course of treatment. In younger children requiring bracing either to correct scoliosis or prevent a relapse multiple braces will be needed, but this will still be spread out over 10-15 years. On the other hand, when buying a brace as an adult, you can (assuming you do not go through significant weight loss or gain) essentially consider it as a lifetime investment.

Bracing also has the benefit of incurring next to no ongoing costs – it’s advisable to have check-up appointments at scheduled intervals, but other than this the treatment is paid for.

In real terms then, the cost of bracing in those not having reached skeletal maturity should be considered as between £1000 and £2000 per year. For those buying a brace as an adult, the cost would be considerably less when annualised.

Exercise-based approaches

Scoliosis specific exercise approaches are often offered alongside bracing as additional support but are mostly used to treat smaller scoliotic curves, at or below 20 degrees. There are essentially two ways to approach this – either through a “Bootcamp” style intensive course, which seeks to teach the patient how to establish and maintain an exercise program or through regularly scheduled appointments over the period of treatment.

Bootcamp style classes can be an attractive prospect – lasting only a few weeks to a month, however, they do not address the need for scoliosis specific exercises to be constantly evaluated and adjusted to keep the correction going. For those looking simply to prevent a small scoliotic curve getting worse, a Bootcamp may work well – but for longer-term treatment, regular appointments with a therapist are usually preferable.

A critical factor to consider with exercise-based approaches is the ability of the patient to perform the exercises correctly – either SEAS or Schroth exercises are not easy, and require physical strength, this means this many younger children may struggle to perform the techniques correctly, even if their compliance with the schedule is 100%.

Scoliosis specific exercise boot camps can cost anywhere from £2000-£5000, depending on the location and whether accommodation is included. Individual sessions range from £50 to £100 per session, based on 1 session per month this comes out to roughly £600 – £1200 per year, plus ongoing travel costs.

As you can see, in real terms, the annualised cost of bracing compares favourably with a Bootcamp style approach and bracing is likely to be only slightly more expensive than a session-based approach to treatment. Taking a Bootcamp type introduction to scoliosis specific exercise, and then following up with periodic appointments with a specialist to review will probably cost more than bracing.

 

Which should I choose?

Although the figures above represent rough guides  (the cost of any treatment will always be individualised and could be more or less than this) it’s hopefully clear to see that there is not likely to be a huge difference in cost when considered over a period of years.

The main factor to consider should, therefore, be the most appropriate treatment for your case. Certain situations are easy to determine – very large curves in young people require bracing in order to have a chance of avoiding surgery, Small curves in adults with a stable spine, without any pain can be easily managed with an exercise approach and curves of say, 45 degrees in young people require bracing for the fastest possible reduction before skeletal maturity is reached and the spine is too ridged to correct.

Often, convenience is more of consideration – for example, the parents of a young teen with a small curve may consider wearing a brace part-time a better investment than paying for ongoing exercise therapy, given that it’s much more effort to comply with an exercise prescription and almost no effort at all to put on a brace. Similarly, an older person might prefer to treat a smaller scoliotic curve which is not too bothersome with the session-based exercise approach, since raising a large amount of cash up-front for the purchase of a brace may not be justifiable.

Unfortunately, there is no easy answer as to which treatment ends up being the cheapest since treatment for scoliosis is always as individual as the patient, but in many cases, you will find that the real terms cost between the two isn’t that great.

 

 

Do I need to treat my Scoliosis?

Posted on February 21, 2022 by - Blog

Scoliosis, in most cases, is a progressive condition – this means it gets worse with time. For this reason, we recommend most people (and all young people who have not reached skeletal maturity) treat, and try to correct Scoliosis as soon as possible. There are, however, some circumstances where treatment of Scoliosis may not be required – let’s take a look.

 

Scoliosis in children – does it need to be treated?

We started out by saying that for young people, scoliosis should always be treated – the reason is simple – Scoliosis tends to progress over time, and in a very young person there is a lot of time for scoliosis to continue to progress. It’s true that once a person reaches adulthood the development of scoliosis slows considerably – and below a certain cobb angle the curve may stop completely, but sadly most young people will reach a surgical threshold before this.

Research has demonstrated that cases of Juvenile scoliosis greater than 30 degrees tend to progress quickly – studies suggest that as much as 100% of these patients will progress to the surgical threshold. Juveniles with curves from 21 to 30 degrees are more difficult to predict in terms of progression but can frequently end up requiring surgery, or at least are left living with a significant disability.[1]

There is always a chance that scoliosis may not progress as much as predicted, and an individual who experiences scoliosis at a young age may make it to adulthood without requiring surgery. There are, however, still many common symptoms that scoliosis sufferers will experience throughout their life without treatment. Some of the most common include pain, physical deformity, limited mobility and difficulty breathing during exercise.[2] Some recent research has also suggested that even a small cobb angle can have a significant negative impact upon a person’s ability to be active and keep fit and healthy.[3] Since we understand how important staying fit and active is to long term health, it is also fair to say that left untreated scoliosis could be a predictor for longer-term health problems.

Since, with modern, active, bracing there is an excellent chance of not only preventing scoliosis development but actually reversing it. So there are almost no circumstances where active treatment of scoliosis isn’t worth at least investigating.

The only significant exception here would be in the case of an individual who is certainly going to require surgery regardless of attempts to slow or reduce scoliosis through a non-surgical method such as bracing. Bracing can sometimes be used in severe cases as a way to try to delay surgery, but this is not always a net benefit in the long term.

 

How about in adults?

There are two types of scoliosis in adults – these are adolescent scoliosis in adults (ASA) (Essentially, scoliosis carried over from childhood) and de-novo scoliosis. De-novo scoliosis will be discussed in a moment, so let’s consider ASA first.

The rate of progression of scoliosis in adults varies – but is certainly slower than in children. As a rough figure, about 1 degree per year can be expected. There is, however, quite some variation in the actual worsening experienced by an individual – with research suggesting that this may be correlated to the degree of scoliosis on reaching adulthood – those with larger curves tend to progress more in adulthood, those with smaller curves progress less and many not progress at all.

This is the first case in which there are a large group of people who probably do not need to treat scoliosis – although they should have regular check-ups to ensure that the condition has not started to worsen. An adult with a relatively small curve, which does not cause pain or discomfort and is not progressing, does not stand to gain significantly from Scoliosis treatment. Although it is not impossible to slightly reduce a scoliotic curve in an adult, any correction will be much smaller than in a child hence, if there are no other symptoms, monitoring scoliosis is probably the best approach.

Adults with a curve which does seem to be progressing, or who are experiencing pain or other symptoms from scoliosis may want to consider either an exercise-based approach or bracing as a method to manage Scoliosis. Both approaches are suitable for adults since there is less concern about adherence to an exercise regime (a common problem with children). The appeal of bracing for adults is likely to be ease of use, and, although bracing is expensive, it’s worth keeping in mind that an adult brace will likely last a lifetime if well cared for.

While we often associate scoliosis with younger people – especially girls (certainly, these are the group we most often think about treating today) this stereotype is somewhat unhelpful. In fact, the group most often impacted by Scoliosis are the over 60’s – here, as much as 30% of the cohort suffer from degenerative or “de-novo” scoliosis, a condition caused by spinal degeneration induced by ageing which can cause pain and discomfort. [4]

In older adults, the decision to treat scoliosis is more nuanced – although de-novo scoliosis does progress, cases tend to do so more slowly, hence the main issue to be addressed is often pain. Approaches such as bracing can be an excellent option here, but they do come with a cost – for some older adults with only mild discomfort from their scoliosis the cost of bracing base treatment may therefore be too high to justify, although an exercised based approach can be an excellent compromise between cost and results.

 

 

[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] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041

[3] SARAIVA, BA; et al. “Impact of Scoliosis Severity on Functional Capacity in Patients With Adolescent Idiopathic Scoliosis”. Pediatric Exercise Science. 30, 2, 243-250, May 2018

[4] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

‘The prevalence and radiological findings in 1347 elderly patients with scoliosis‘
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.,  Journal of bone and joint surgery 2010 Jul;92(7):980-3

 

How is scoliosis treated in 2021? – Part 2

Posted on November 20, 2021 by - Blog

Last week we began looking at how we can best treat Scoliosis in 2021 – this week we’re continuing to look at treatments, this time in terms of exercise and physiotherapy based approaches.

Schroth Therapy

Schroth therapy is a well-established and easy to use exercise methodology which some experts consider to be the best exercise-based approach for treating Idiopathic Scoliosis. [i]

As an independent treatment, some studies have shown a reduction of cobb angle of 10-15 degrees over the course of a year[ii] – however Schroth therapy combines particularly well with bracing. When Schroth is combined with bracing superior results can often be achieved more quickly.[iii]

The Schroth method itself is comprised of more than 100 individual exercises, which are chosen and organised individually for each patient. A Schroth program usually consists of 6-8 core exercises which are specifically targeted for the curve in question. This is because the Schroth method recognises that what’s appropriate for the common 3-curve, right thoracic scoliosis, for example, would not work for the 4-curve variety.

At the UK Scoliosis clinic, we adhere to the guidelines of the Schroth Best Practice program, the most up to date development of the methodology based on recent evidence by Dr Hans-Rudolf Weiss, Grandson of Katharina Schroth and son of Christa Lehnert-Schroth. Schroth best practice incorporates the latest evidence-based approaches and includes several new methods for treating specific conditions common to scoliosis sufferers more directly than the original version.

 

SEAS

SEAS is the acronym for “Scientific Exercise Approach to Scoliosis”.

SEAS is an approach to scoliosis exercise treatment with a strong grounding in the most modern approaches in physiotherapy. SEAS treatment programs are usually constructed by a practitioner, who will then teach the patient their individual routine. After this, SEAS can be performed at home.

The objective of SEAS exercise is to promote self-correction of the scoliotic posture, using exercises which are often incorporated into a broader exercise program designed to improve overall function and lessen the symptoms of scoliosis.

Unlike other therapies, the SEAS methodology is constantly evolving, so seeking out a practitioner who demonstrates familiarity with the latest research is especially important.

SEAS is also used alongside bracing treatment and is especially useful for avoiding a loss of correction after the conclusion of treatment with a brace. A 2008 study showed that post-brace patients treated with SEAS experienced no loss of correction after 2.7 years.[iv]

 

So….Which treatment is best for me?

In most cases, the best treatment for scoliosis will be bracing – be this part time, full time or night-time based bracing. Whichever treatment you choose, be sure to opt for a clinic which offers customised one to one treatment – If you suspect scoliosis you should seek a professional consultation, but as a rough guide we would suggest:

For small curves, less than 20 degrees a scoliosis exercise program based on SEAS or Schroth might be sufficient, especially if there is a low risk of progression.

For curves over 20 degrees, or curves with a high risk of progression, bracing is the best option. Today, it is fair to say that specialised scoliosis bracing when prescribed for high-risk patients can prevent the need for surgery in most cases.[v] Research indicates that non-surgical treatment with a brace is highly effective in treating juvenile idiopathic scoliosis, whereas part-time bracing in adults significantly reduces progression of curvatures and improves quality of life.[vi]

Often exercise is combined with bracing as part of an overall treatment program – but research shows that in head to head comparison bracing is the most effective treatment in most cases. A recent study showed that over 12 months, bracing led to a mean reduction in cobb angle of 5.88 degrees, whereas exercise reduced curves by just 2.24 degrees.[vii]

 

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

[ii] Kuru T, et al. The  efficacy  of  three-dimensional  Schroth  exercises  in   adolescent idiopathic scoliosis: A randomised controlled clinical trial,

Clinical  Rehabilitation,  30(108); (2015)

[iii] Marinela, Rață;Bogdan, Antohe, Efficiency  of the Schroth and Vojta Therapies in Adolescents with Idiopathic Scoliosis. Gymnasium, Scientific Journal of Education, Sports, and Health Vol. XVIII, Issue 1/2017

[iv] Fabio Zaina et al. Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients (Winner of SOSORT’s 2008 Award for Best Clinical Paper) Scoliosis 2009 4:8

[v] Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs. ‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’ [Results of the BrAIST Clinical Trial] N Engl J Med 2013; 369:1512-1521

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

[vii] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine [Publish Ahead of Print]

 

What is Schroth best practice?

Posted on August 20, 2021 by - Blog

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

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

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

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

 

Recent studies

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

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

 

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

 

Is Schroth best practice the way forward?

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

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

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

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

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

How is scoliosis treated in 2021?

Posted on May 1, 2021 by - Blog

Scoliosis treatment has come a long way since treatments for conditions first emerged at the start of the last century. Today there are more options for scoliosis sufferers than ever before, so a common question we often get is simply – “how should I treat scoliosis in 2021”? Over the next couple of articles, we’ll try to answer this as simply as possible.

Historically, it was thought that surgery was the only way to treat scoliosis – but today there are a number of non-surgical approaches which, when applied by a specialist scoliosis clinician, can treat scoliosis.

The two main treatment methodologies used are exercise-based approaches and bracing. Bracing is the most effective way to reduce a cobb angle (cobb angle is the measurement of scoliotic curve) and avoid surgery. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[i] Results vary by brace – but some studies have shown success rates with bracing as high as 100%.[ii]

Scoliosis specific exercise can be effective in treating smaller curves (generally below 20 degrees) where there is a lower risk of progression, but is probably best used in support of bracing, as a method to address muscular imbalances and postural problems which can often result from scoliosis.

Although the “wait and see” or “observation” approach to scoliosis management is now outdated, it is often still recommended by GP’s and is sadly still the favoured approach within the NHS. Unfortunately, the vast majority of scoliosis cases will progress, so it is better to seek advice from a scoliosis professional wherever possible.

 

This week, let’s compare the options which are most often known to patients – observation and bracing.

 

Observation (Wait and see)

Observation is not a treatment for scoliosis, it is simply the act of watching and waiting – however, scoliosis almost never resolves without treatment.

Research has demonstrated 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.[iii]

Because observation is not a treatment, it most often leads to the patient requiring surgery. By contrast, today, through modern bracing technology, it has 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.[iv]

 

Bracing

Scoliosis braces are the most effective non-surgical method for reducing cobb angle[v] There are many different kinds of scoliosis brace and many work slightly differently, however broadly speaking braces can be classified as active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position).

Results vary by brace – but some studies have shown success rates with bracing as high as 100%.[vi]

Scoliosis bracing in children and adolescents is recommended when Cobb angles over 20° are observed and there is a risk of progression as the child grows. For cobb angles under 20°, bracing might still be a preferred treatment option, since (unlike exercise) no conscious effort is necessary from the wearer.

Night-time braces are also an attractive option for single curves not exceeding 35 degrees in magnitude.[vii]

 

(This article continues next week!)

 

 

 

[i] ‘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

[ii] 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, and 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.

[iii] 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.

[iv] ‘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

[vi] 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, and 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.

[vii] Grivas TB, Rodopoulos GI and Bardakos NV, ‘Biomechanical and clinical perspectives on nighttime bracing for adolescent idiopathic scoliosis‘ Stud Health Technol Inform. 2008;135:274-90.

What is the fastest way to treat Scoliosis?

Posted on February 1, 2021 by - Blog

When you or a family member is diagnosed with Scoliosis, it’s only natural to want to know what the fastest way to treat the condition is. At the UK Scoliosis Clinic, we always stress the need to get a quick diagnosis, as Scoliosis can progress quickly – so acting early makes treatment much easier. But once Scoliosis is diagnosed, how long does treatment take and what’s the fastest option?

 

What do we mean by treatment anyway?

Before we explore the fastest possible option for treating Scoliosis, it’s important that we first understand what “treatment” means here. There are two main aspects which Scoliosis treatment is broken down into – firstly, there’s the Cobb angle, this is how much the spine is “curved” away from the position in which it should ideally sit. Secondly, there are the associated factors which arise from scoliosis or are exacerbated by it. These include physical factors such as muscle weakness, as well as psychological factors associated with deformity, anxiety etc.

 

Treating the Curve

Research shows clearly that Scoliosis bracing is the fastest possible way to reduce cobb angle – longer daily bracing periods will reduce curves faster than shorter periods, with patient adherence to wear-time being the main aspect for success. Choice of brace is also of critical importance here – an active brace, like ScoliBrace, must be used, since a passive brace is not designed to correct the Cobb angle, only to hold it in place.

 

The best possible option in terms of speed is, therefore, full time bracing with an active brace, such as ScoliBrace. A recent study which compared the two main treatment pathways, scoliosis bracing and scoliosis exercise showed that bracing yielded an average reduction in Cobb angle at 6 months of 3.13 degrees, and at 12 months of 5.88 degrees.  This compared favourably with another trial group using an exercise-based approach –  here, the 6 months mean reduction was just 0.66 degrees, and at 12 months was 2.24 degrees.[1]

This figure is somewhat misleading, however, since it also factors for subjects who did not wear their brace as instructed or for the time required – nor was the brace use in the study the ground-breaking new ScoliBrace which we offer. While our results depend to a large degree on the individual case, below are some case studies using the ScoliBrace – all of which achieved better than 25-degree curve correction in roughly 2 years.

 

 

Treating associated factors

While scoliosis bracing is clearly the fastest way to reduce cobb angle, it’s also important to strengthen the muscles around the spine, and improve the posture overall to equip the patient for life after Scoliosis. Indeed, treating the cobb angle alone may even lead to increased muscle weakness in the future, due to the supportive work being taken up by the brace, rather than the appropriate muscles.

Scoliosis specific exercise is a highly effective approach for heading off these issues – having been shown to be effective in improving overall quality of life scores, as defined by the SRS 22 questionnaire, a standard tool used to gauge the impact scoliosis has on a persons life. In the study mentioned above, the group treated with scoliosis specific exercise showed improvements in all the SRS-22 quality of life scores, and a significant improvement in terms of the functional score, a measure of physical impact on daily life from scoliosis. [2]

 

While any form of exercise (and the sense of control and ownership it can bring) will have a positive psychological effect, the same study also noted a significant improvement in self-image amongst the bracing group – especially after the 12 months follow up. Simply put, the reduction in deformity seemed to translate to a tangible improvement in self-image – which, coupled with exercise, can go a long way to beating the psychological issues caused by Scoliosis. [3]

 

The fastest way to treat Scoliosis

Put simply, the fastest way to treat scoliosis is Active bracing – with a brace like ScoliBrace. Scoliosis specific exercise will reduce scoliosis over time, but only at a much slower rate. This makes it applicable for small curves where a large correction is not required, however, if the goal is to correct a small curve quickly, bracing is still a better choice. This being said, it’s only half the story – beating scoliosis means leaving a patient with a reduced, or eliminated Cobb angle and ensuring that they are physically fit, functionally capable and psychologically ready to move on and leave Scoliosis behind.

It’s for this reason that the UK Scoliosis clinic prefers a multifaceted approach to Scoliosis, making use of bracing, exercise and complementary approaches to provide a treatment plan which aims to address all aspects of scoliosis – in the short, and the long term.

 

 

[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] 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]

[3] 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]

What is Night Time Bracing?

Posted on April 1, 2020 by - Blog

Today, Scoliosis bracing is recognised as the most effective non-surgical scoliosis treatment to reduce cobb angle in scoliosis cases – and to do so relatively quickly. This isn’t to say that bracing is a total solution – scoliosis also creates muscle and posture imbalances which are best addressed by methods such as scoliosis specific exercise, however, we now understand that Bracing is far more effective than exercise in reducing cobb angle itself. [1]

Research also shows that the longer scoliosis braces are worn, the more quickly the underlying cobb angle can be corrected[2] – this means that typically, bracing will be almost full time with a view to achieving rapid change. However, for some smaller curves night time bracing, a part-time bracing option, maybe a viable way to go – so what’s the evidence for night time bracing?

 

Night time bracing

Whereas most scoliosis bracing takes place on a nearly full-time basis, night time bracing is a part-time approach – which, as you may have guessed, takes place in the evening and at night.

Night time bracing is one approach which has been considered as a way of addressing concerns relating to poor patient compliance, which is often noted with the use of full-time bracing. Night time braces will, by their nature, tend to correct a curve more slowly than a full-time brace – however, based on the clinical results available, a recent study concluded that night time braces constitute an attractive option for single-major lumbar/thoracolumbar curves not exceeding 35 degrees in magnitude. [3]

Like all approaches, night time braces have some pros and cons, however, and it’s a decision that should be discussed with a scoliosis professional. Some factors to consider are:

 

Advantages of night-time braces

More attractive wear time – many patients find that wearing a brace in the evening or at night is easier for them to manage from a social point of view, and it’s an attractive option for parents who are worried about bracing their children during school hours.

Higher compliance – Compliance with prescribed brace wear time is one of the most critical aspects of scoliosis treatment, and with young children and adults, in particular, maintaining compliance is perhaps the most difficult part of treatment. Higher compliance rates, even at a slower correction speed, may prove better in the long term than a full-time brace which is not worn properly.

Ideal for maintaining results – Night time braces represent an excellent option for preventing scoliosis returning in patients who have successfully completed treatment, but need to maintain curve correction until skeletal maturity has been achieved. Unlike an exercise-based approach, a night time brace requires very little effort from the user.

Suitable for early intervention – Night time braces may be a good choice for patients who have a curve unsuitable for exercise-based treatment, or for those who are too young or weak to be able to perform exercise properly.

 

Disadvantages of night-time braces

Slower curve correction – cobb angle correction correlates with brace wear time, so a lower wear time means a longer duration of treatment. In some situations, a shorter course of more intensive bracing may be preferable.

Not suitable for large curves –  larger curves require full time bracing, meaning that night time braces are not likely to be effective for more serious scoliosis cases. Our ScoliNight brace is recommended for curves less than 25 degrees.

Less cost-effective –  night time braces achieve less correction over the same course of time than a full-time brace. In growing children, this may mean multiple braces need to be purchased, rather than just one full-time brace.

 

In most cases, we recommend a full time (or near full time) brace for scoliosis treatment, especially for larger curves. In most cases, correcting the curve as soon as possible is the main concern – however as suggested above, night time bracing could be an excellent option for correction maintenance over the longer term.

It’s also important to stress that modern scoliosis braces do go quite some way to alleviate the main issues associated with low compliance – the model we prefer, the ScoliBrace, is designed using a fully individualised CAD/CAM process to fit the wearer snugly but comfortably. ScoliBrace comes in a wide variety of colours and can be virtually invisible under clothes if this is the look you prefer. Similarly, it’s flexible enough to allow the wearer to participate in sporting activities and normal play with no significant hindrance.

 

Want more information about night time Bracing?

To find out if night time bracing might be the right option for you, book a consultation today! The UK Scoliosis Clinic offers consultations at our clinic, or online, via webex

 

 

[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] ‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

[3] Grivas TB, Rodopoulos GI, Bardakos NV. Biomechanical and clinical perspectives on nighttime bracing for adolescent idiopathic scoliosis. Stud Health Technol Inform. 2008;135:274-90. PMID: 18401098.