Tag: scoliosis

Kyphosis Vs Hyperkyphosis

Posted on February 28, 2022 by - Blog

While Scoliosis is the main focus of our clinic, we also treat associated spinal conditions such as Hyperkyphosis – it’s a lesser-known condition, not least because Hyperkyphosis is often a progression of “regular” kyphosis, a common condition that can often be managed through approaches targeting postural adjustments, such as chiropractic or physiotherapy.

 

What is HyperKyphosis

Scoliosis is a condition of the spine that, ideally should not exist (or should be very small in a healthy individual)  whereas Kyphosis, in and of itself isn’t a problem as a kyphosis is essential for a healthy spine!

The spine is made up of three main sections: cervical, thoracic, and lumbar. When viewed from the front or back, the spine should appear straight (however in scoliosis it appears curved), and when viewed from the side, it has a slight ‘S’ shape.

This S shape is actually a critical characteristic of the spine which allows it to perform its job. The natural curves of the cervical spine (neck) and lumbar spine (lower back) bend outwards and are referred to as ‘lordosis’. The thoracic spine (middle and upper back) features a curve that bends inwards, and this type of curve is referred to as ‘kyphosis’ – so, kyphosis is in fact, a totally normal condition for the spine to exhibit.

So, if kyphosis is a normal inwards bending of the spine, Hyperkyphosis is said to exist when the kyphotic curve becomes excessive, leading to a rounded appearance of the upper back, a “hunched” posture and often, back pain. We are all individuals with a slightly different spinal and physical makeup, it’s therefore hard to say what an “ideal” kyphotic curve is – for most people a healthy figure is between 20 and 45 degrees, but when a curve falls beyond that healthy range, problems can occur.

When a kyphotic curve exceeds approximately 50 degrees, this is referred to as ‘Hyperkyphosis’ – in many circles, the word “kyphosis” is also often used to mean “Hyperkyphosis” which is unhelpful!

 

 

Types of Hyperkyphosis

There are three main types of Hyperkyphosis – broken down by cause, these are postural, congenital and Scheuermann’s

Postural kyphosis is the most common type and is associated with the “hunched” posture we often expect in adolescents. While it’s not true that the use of electronic devices actually causes Hyperkyphosis, the terrible posture this tends to promote most certainly can. Postural kyphosis is the simplest diagnosis to treat, since the condition is caused by poor posture and weakened muscles resulting from it – any treatment approach which aims to address this problematic posture will generally resolve postural Hyperkyphosis.

Congenital Kyphosis is more complex – whereas, in postural kyphosis an individual is born with a normal spine that develops an issue through misuse, a person with congenital kyphosis is born with the condition. There are a number of malformations in the spine which fall under the category of congenital Kyphosis – these include vertebrae not forming properly, or multiple vertebrae fusing together into one solid bone, rather than forming separate and distinct vertebrae.

Some congenital Kyphosis cases may benefit from bracing, but the best treatment will vary considerably depending on the individual.

Finally, Scheuermann’s Kyphosis is a structural condition which affects the way that vertebra develop. In a person with a “normal” spine, vertebrae are rectangular in shape – thus, they sit on top of each other in a fairly level alignment. In patients with Scheuermann’s kyphosis, a number of consecutive vertebrae are more triangular in shape, meaning that they naturally want to curve irrespective of the health of surrounding supporting muscle.

Abnormal spinal curvatures caused by this type of kyphosis are often angular, stiff, sharp, and rigid, which is why this form is more complex to treat and can’t simply be corrected with a change of position. Scheuermann’s is more common in boys and is progressive during growth, which is why proactive treatment is so important.

 

 

Kyphosis, which treatment is right for me?

The vast majority of Hyperkyphosis cases tend to be postural in nature, so, while expertise is required to provide a suitable treatment there are many approaches that can help. Chiropractic and physiotherapy are two approaches we utilise at the UK Scoliosis Clinic, but any approach which alters the problematic posture will, over time tend to resolve this condition. It’s also true that many kyphosis cases which are visible, or cause pain do not reach the threshold for Hyperkyphosis – you should, however, look to treat the condition as early as possible, since it will tend to progress without intervention -, even if that only means getting some professional advice on improving your workspace to promote good posture.

Congenital cases and Scheuermann’s kyphosis can often benefit from more specialist treatment through a spinal clinic, like the UK Scoliosis clinic. Spinal bracing, similar to that used for Scoliosis can be appropriate in some circumstances – in others, the best approach may still be a manual therapy coupled with postural work although for more complex cases it’s often worth coordinating this through a specialist centre.

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]

 

Vibration Based Therapy for Scoliosis

Posted on September 29, 2021 by - Blog

Scoliosis researchers are nothing if not creative, and today we’re looking at a lesser-known, but interesting additional approach published in 2017.

In the field of physiotherapy in general, there has recently been a trend to incorporate vibration platforms into routines designed both for prevention and rehabilitation. Whole-body vibration (WBV) is a reflex-based neuromuscular form of training, and Side-alternating WBV (sWBV) is a special form of WBV which uses a “side to side” type of motion. It’s already known that this kind of vibration platform can be of use of physiotherapy, with studies reporting increased muscle force and power as well as effects on neural activity.[1][2][3]

The study authors point out that vibration-assisted exercises have the advantage of short training periods with a high number of muscular contractions/ repetitions, while the increasing availability of these kinds of vibration platforms make a home training program a real possibility. A home program also has the advantage of possible better compliance compared to frequent visits for supervised therapy programs. With these benefits in mind, this study sought to investigate the possibility of incorporating vibration therapy with Schroth based exercise and bracing for Scoliosis patients.

 

Study details

The study[4] was a randomised controlled trial, with assessments performed at month 0 and moth 6. The participants were randomly assigned to either a scoliosis specific exercise program on a vibrating platform or “treatment as usual” – here, normal Schroth exercise.

40 participants were recruited through the Paediatric Rehabilitation Centre, UniReha GmbH, University of Cologne, Germany in collaboration with the Department of Orthopaedic and Trauma Surgery, University of Cologne, Germany. Included were girls with moderate AIS (according to the SOSORT criteria) aged 10 to 17 years. Further inclusion criteria were: experience with auto-corrective physiotherapy (specifically Schroth) and use of a Chêneau brace at least 16 hours per day.

Participants of the intervention group received an introduction to the sWBV system and the exercises before the start of the home-training program. They received an exercise program including four different exercises: standing (16-20 Hz), sitting (18-25 Hz) and two different kneeling positions (10-20 Hz). Exercises were designed to incorporate auto-correction and stabilising physiotherapy. Each exercise was performed at home for three minutes (4×3 minutes) five times per week.

Each participant received an exercise folder containing photos of the exercises and individual adaptations according to the severity of curvature and a training schedule. Each participant documented the home-training program in a training log. For six weeks the participants received a weekly in-patient check; then the check-up frequency was reduced to bi-weekly. Serious unexpected events were recorded at each visit.

The participants of the control group were instructed to continue with their usual auto-corrective physiotherapy. This usually contains bi-weekly training under the supervision of a physical therapist and a daily home-training program. Schroth exercises focus on strengthening of the spinal musculature and elongating shortened muscles on the concave side of the spinal curvature.

 

Results

The results from the study were certainly positive – and suggest that further research and experimentation with this method may well be worth considering. The major scoliosis curve in the sWBV group decreased significantly by -2.3°, compared to the difference in the control group of 0.3°. In the sWBV group 20% (n=4) improved, 75% (n=15) stabilized and 5% (n=1) deteriorated by ≥5°. In the control group 0% (n=0) improved, 89% (n=16) stabilized and 11% (n=2) deteriorated. The authors also observed that the clinically largest change was observed in the ‘before menarche’ sub-group.

While it’s important always to remember that a single study is not enough evidence to make a firm conclusion, this line of research is of great interest to us at the UK Scoliosis clinic, since we already utilise vibration-based therapy in treating other (non-scoliosis) conditions, and have observed results (in terms of speed of outcome) which are broadly consistent with these findings. We’ll be keeping this option under close review!

 

[1] Matute-Llorente A, Gonzalez-Aguero A, Gomez-Cabello A, Vicente-Rodriguez G, Casajus Mallen JA. Effect of whole-body vibration therapy on health-related physical fitness in children and adolescents with disabilities: A systematic review. J Adolesc Health. 2014;54:385–96.

[2] Cochrane DJ. The potential neural mechanisms of acute indirect vibration. J Sports Sci Med. 2011;10:19–30.

[3] Rittweger J, Mutschelknauss M, Felsenberg D. Acute changes in neuromuscular excitability after exhaustive whole body vibration exercise as compared to exhaustion by squatting exercise. Clin Physiol Funct Imaging. 2003;23:81–6.

[4] Sina Langensiepen et al. Home-based vibration assisted exercise as a new treatment option for scoliosis – A randomised controlled trial J Musculoskelet Neuronal Interact. 2017 Dec; 17(4): 259–267.

Physiotherapy may improve functional capacity in younger scoliosis patients

Posted on September 13, 2021 by - Blog

It’s been established (and we’ve written several times about it) that scoliosis can impact both quality of life, and functional capacity – that is to say, the ability of a patient to live without pain and move around normally without struggling. While not all patients are affected, a large number report either pain reduced functional capacity or both. A recent study suggests that a targeted, 12-week physiotherapy intervention can result in significant improvement where this is the case.

 

Scoliosis and functional capacity

While the primary issue with scoliosis is the spinal deformation, the conditional can also cause decreased spinal movement, weakening of muscles near the spine, chronic pain, psychological suffering, reduced pulmonary function, and respiratory dysfunction.[1] Typically, more significant scoliosis cases are associated with more severe symptoms, however abnormal ventilatory patterns and respiratory muscle involvement have been reported in patients even with asymptomatic mild scoliosis who may be free of any respiratory dysfunction at rest.[2] Impaired exercise tolerance and physical deconditioning can also be early manifestations in patients with mild scoliosis.[3]

The majority of research in this field, has to date, been focused on larger curves however – With this in mind, a recent study[4] sought to explore the pulmonary function and functional capacity in school children and adolescents with mild or moderate idiopathic scoliosis who were included in a rehabilitation programme

 

Study information

The study included 49 school children and adolescents with idiopathic scoliosis. The patients were selected from those who visited the Rehabilitation Department of Paediatric Surgery, Louis Turcanu Children’s Hospital Timisoara, Romania. For each participant, the study authors recorded their demographic characteristics (age, sex, weight, and height) and physical activity behaviours (hours of time spent at a desk and at a computer per week, and hours of competitive and non-competitive practice of exercise per week). The patients were assessed clinically by the same orthopaedic surgeon. An X-ray examination of the spinal column in the standing anterior–posterior view was then performed. The X-ray examination and Cobb angle measurement were performed by a single investigator who was a radiologist. Mild scoliosis was defined by a Cobb angle <20° and moderate scoliosis was characterized by a Cobb angle between 21° and 35°.

Study participants were assessed before beginning rehabilitation and then again at 12 weeks after an exercise-based rehabilitation programme. Each evaluation consisted of spirometry (breathing) tests and functional capacity testing (6-minute walk test). Assessment of pulmonary function and the 6MWT were performed by the same investigator who was a specialist in physical medicine and rehabilitation. At each assessment, the participants were also assessed for back pain – an issue which is increasingly being recognised as a feature of Scoliosis.

 

Physical therapy

The patients performed a 12-week exercise programme that consisted of three sessions per week in the Outpatient Rehabilitation Department. The goals of the rehabilitation treatment were to improve awareness of body alignment, axial elongation, de-rotation and stabilization of the spine, increase chest expansion, and enhance exercise capacity. The exercise programme consisted of stretching exercises on the concave side of scoliosis, strengthening exercises on the convex side of scoliosis, and breathing exercises. Some specific exercises for core stabilization were performed, including spider (patients faced the wall, leaned forward and walked with fingers up the wall rising to their toes, and after full extension, walked with the fingers back down), pelvic tilt, cat-camel pose, and basic trunk curl (crunch) exercises using a ball (back extensions, opposite arm, and leg rise), and quadriceps strengthening exercises, which are important in increasing work capacity. Patients used rotational breathing respiratory exercises, such as contraction of convex areas of the trunk and directing inspired air in the concave areas. In each case, the specific core stabilization programme was established according to the individual spinal characteristics.

Patients with moderate scoliosis also had the indication to wear a corrective orthosis (Chêneau brace) for 20 hours per day

 

Results

Overall, the study concluded that in the participants, pulmonary parameters and functional capacity were improved after 12 weeks of supervised physical therapy. Results from the spirometry tests, as well as the 6-minute walk test, showed improvement – although the authors did note that the study participants still lagged behind their non-scoliosis counterparts in terms of respiratory factors.

Also of interest, especially given other recent findings in this area, was that approximately three-quarters of the patients had back pain at the beginning of the study, whereas at the final evaluation, only 50% still had back pain.

Based on the results, the authors suggest treating scoliosis as soon as possible after diagnosis in a rehabilitation centre under medical qualified supervision. They also note that the Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment currently recommends physiotherapeutic scoliosis-specific exercises as the first step for treating idiopathic scoliosis to prevent or limit the progression of the deformity and bracing and stress that Scoliosis-specific exercise programmes should also be designed by specifically trained therapists – further, they stress (as do we) that These programmes must be individualized and performed regularly throughout treatment.

 

[1]  Weinstein, SL, Dolan, LA, Spratt, KFet al. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA 2003; 289: 559–567.

 

[2]  Durmala, J, Tomalak, W, Kotwicki, T. Function of the respiratory system in patients with idiopathic scoliosis: reasons for impairment and methods of evaluation. Stud Health Technol Inform 2008; 135: 237–245.

 

[3] Koumbourlis, AC. Scoliosis and the respiratory system. Paediatr Respir Rev 2006; 7: 152–160.

[4] Elena Amăricăi et al. Respiratory function, functional capacity, and physical activity behaviours in children and adolescents with scoliosis. Journal of International Medical Research Volume: 48 issue: 4,

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

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

Posted on July 23, 2021 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:

 

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 medial professionals were simply taught that the best approach to scoliosis is to “wait and see” if the curve becomes bad enough for treatment. The problem is that scoliosis almost never resolves on its own[1] so 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.

 

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.

 

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

Why Scoliosis screening is important!

Posted on July 13, 2021 by - Blog

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

 

Why screening matters

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

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

 

So why aren’t we all screening?

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

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

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

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

 

Why we should screen

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

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

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

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

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

 

What you can do

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

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

 

 

 

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

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

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

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

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

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

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

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

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

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

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

5 Celebrity Scoliosis Stories

Posted on July 2, 2021 by - Blog

While the main focus of our blog is on treating, preventing and correcting Scoliosis, it’s always worth taking a moment to acknowledge the great things that many people with scoliosis have done. Scoliosis no matter how you opt to treat it (or not) does not have to ruin a life – and indeed, for some people, it can even give them a unique kind of strength. This week we’re taking a look at 5 interesting and diverse people who have or have had scoliosis, and what it means to them.

Please note that the UK Scoliosis clinic does not endorse (or cities) any of the views, nor the treatments (or lack of) discussed here.

 

1 – Usain Bolt

Usain Bolt is a Jamaican superstar sprinter and a five-time World and three-time Olympic gold medallist. He is the world record and Olympic record holder in the 100 meters, the 200 meters and the 4×100 meters relay – in short, he’s pretty good at what he does.

He is the reigning Olympic champion in these three events and is one of only seven athletes to win world championships at the youth, junior, and senior-level of an athletic event. He is also famously known as the ‘World’s Fastest Man’, after the 2012 London Summer Olympics where he won the 100 meters gold medal with a time of 9.63 seconds, setting a new Olympic record for that distance.

Bolt also suffers from scoliosis – which is believed to have been a factor in a serious injury that led to him cutting short his season in 2010. Of the condition, bolt says:

 “Scoliosis is not as serious as it sounds but for me, as a track athlete, it can be serious; I work really hard to keep it away but it’s still there.”

Bolt reportedly receives treatment from a homoeopathic German sports doctor a couple of times a year. He also has a masseuse who never leaves the sprinter’s side, travelling all over the world with him, warming him up before and after training and at every race  – although to be fair, this isn’t uncommon for athletes of his calibre! [1]

 

2 – Kurt Cobain

Music legend and cult figure Kurt Cobain suffered from Scoliosis – like many he experienced pain from the condition, but sadly this was long before we understood the link to pain, and well before effective non-surgical treatments were widely available.

Cobain’s story is interesting because, according to an interview with MTV – pain from the scoliosis actually became an important influence for him. He said:

    “… I have scoliosis. I had minor scoliosis in junior high, and since I’ve been playing guitar ever since, the weight of the guitar has made my back grow in this curvature. So when I stand, everything is sideways. It’s weird. ”

 

    “I go to a chiropractor every once in a while….. [scoliosis] gives me a back pain all the time. That really adds to the pain in our music. It really does. I’m kind of grateful for it.” [2]

 

3 – General Douglas MacArthur

Well known to history buffs and our friends in the US, General Douglas MacArthur was a critical figuring during the battle for the Pacific during WWII who served as supreme commander for the southwest pacific area and won the medal of honour for his defence of the Philippines.

Did you know, however, that this great military mind almost missed out on entrance to West Point – the prestigious officer school? He had the grades to qualify for entrance to West Point, but when he went for his preliminary physical examination, he received shocking news. The doctor informed MacArthur that he had curvature of the spine and was medically unfit to enter West Point.

McArthur, not being one to give up easily, consulted with Dr. Franz Pfister, a well-respected surgeon in Milwaukee, Wisconsin. Dr. Pfister told Douglas there was a possibility he could cure his spinal problem, as long as Douglas was prepared to do special scoliosis exercises everyday and follow all of his instructions for one year. Douglas jumped at the opportunity and made plans to move to Milwaukee, where he worked at his prescribed exercises every day.

After one year, he attempted the physical examination again – the doctor who conducted the exam saw that while he made great improvement – but his spine still wasn’t straight enough to pass. Undeterred, he continued on with the scoliosis specific exercises until in May of 1899 he finally passed his physical exam into West Point.[3]

 

4- Liza Minnelli

Liza May Minnelli was born in Hollywood, California. She is an American actress, singer and Broadway performer – you’ve probably seen her in something! Liza is the daughter of Judy Garland and film director Vincente Minnelli. Though her first appearances were with her superstar mother, Liza has established a substantial career as a performer. She is among the few entertainers who have won an Oscar, Emmy, Grammy, and Tony Award. She has also received two Golden Globes, a Grammy Living Legend award and induction into the Grammy Hall of Fame and numerous other awards and honours.

It has been speculated that Judy Garland herself may have had scoliosis, but it’s certain that Liza Minnelli has scoliosis. She has mentioned in interviews that her scoliosis forced her to move on stage in ways that didn’t affect her breathing or cause her pain.

In recent years, Liza has made appearances in various films and in television, perhaps most notable was her role on the TV comedy Arrested Development. Over the years, Liza has served and supported various charities and causes.

 

Of her condition, Minnelli says “I’ve got two false hips, a wired-up knee, scoliosis, which I’ve always had, and three crushed disks, but I feel great. I dance every day.”[4]

 

5 – King Tutankhamun

Perhaps the most famous figure from ancient history, King Tutankhamun may well have had Scoliosis. What’s more interesting, evidence also showed that one of Tut’s children (who was buried with him, having died in infancy) may have also had Scoliosis. This provides some ancient evidence for the purported genetic aetiology of scoliosis.

A 2010 article by the Journal of the American Medical Association outlined a study of the Egyptian king that estimates his death at around 17-19 years of age. Based on tests conducted on the remains of Tut, it is believed he died at such a young age of conditions including malaria and complications from a leg fracture.

The researcher’s CAT scanned King Tut’s mummy and also discovered he had “severe kyphoscoliosis an abnormal curvature of the spine in both coronal and sagittal planes”. They also found that he had oligodactyly, a toe malformation. They speculated that the condition would have made his left foot swell and would have caused excruciating pain when he walked[5].

Ancient drawings depict Tut shooting arrows sitting in a chariot, which researchers say is unusual. 130 walking sticks were found in Tut’s tomb. They were originally thought to merely represent power but now are thought to be ancient forms of crutches or canes. It is believed that Tut may have used them because he had difficulty walking and standing. Paintings, like the one below, found in Tut’s tomb show him leaning on such canes/crutches with his legs crossed awkwardly underneath him.

[1] https://usainbolt.com/

[2] http://www.mtv.com/news/1572103/kurt-cobain-about-a-son-from-beyond-by-kurt-loder/

[3] Douglas MacArthur: What Greater Honor. Pages 25-33

[4] https://www.timeout.com/newyork/film/that-70s-show

[5] Zahi Hawass, PhD; Yehia Z. Gad, MD; Somaia Ismail, PhD; et al, Ancestry and Pathology in King Tutankhamun’s Family,  JAMA. 2010;303(7):638-647. doi:10.1001/jama.2010.121

Scoliosis awareness month – Adolescent Scoliosis

Posted on June 14, 2021 by - Blog

Most of the Scoliosis cases we treat at the clinic – and indeed, most of the scoliosis cases discovered are categorised as adolescent idiopathic scoliosis (often called AIS) That’s to say, scoliosis in a person older than 10, but who has not yet reached skeletal maturity, and a case without obvious cause, such as congenital or syndromic issues, or trauma.

Whereas infantile and younger Juvenile scoliosis cases are common in boys, 80% of all AIS cases are girls. It is usually noticed around 11-12 years of age in girls and slightly later when diagnosed in boys.  AIS is estimated to affect between 3 and 4% of teenagers. In most cases, AIS begins to develop noticeably at the initial onset of puberty and becomes more apparent as it worsens during growth spurts. AIS can be highly progressive, so it is important that the right sort of monitoring and treatment is sought as soon as the condition is noticed. When not appropriately treated it may result in significant deformity, physical disability and psychological issues – but when treated with effective modern approaches, the prognosis – as showed by the BrAIST study, is good – with as many as 90% of patients who comply with bracing prescriptions avoiding surgery[1]

 

What causes AIS?

Like all forms of idiopathic scoliosis, the exact cause of AIS is unknown. Like other forms, there have been a large number of possible causes suggested – one of the leading theories is a genetic link, although more research is required before we are able to make a definitive conclusion.

There is also some evidence that AIS may be associated with certain activities which stress and pull the spine away from its normal aligned position – for example, research indicates a higher incidence of scoliosis in ballet dancers and gymnasts, although it’s important to note that this does not necessarily mean that these activities cause Scoliosis, only that more cases are being detected (this could feasibly be simply because we’re looking for them more frequently).

It’s also worth clarifying that while scoliosis does cause postural issues, poor posture does not cause scoliosis, and nor (so far as the current research suggests) does diet.

 

What is the prognosis for AIS Scoliosis?

The prognosis for an AIS case depends on a number of key factors – the significance of the curve at the time of discovery, the flexibility of the curve, the age of the patient and the ability of the patient to comply with ongoing treatment.

The larger a curve is at discovery, the more work needs to be done to correct it – Bracing has been shown to be effective up to 60 degrees, but an ideal candidate is in the 20-40 degree range. Closely tied to this is the rigidity of the curve – that is to say how flexible the spine is, and therefore how likely we are to succeed with an approach such as bracing, which aims to gently guide the spine back to a correct alignment. A flexible curve is much easier to treat than a rigid one.

The age of the patient is important for two reasons – firstly, while scoliosis development does not always stop in adults, where it does continue it tends to slow and become predictable – developing at about 1 degree per year. Therefore a small curve in an individual close to adulthood has less time to progress to a significant degree, than does a large curve in a younger child. What’s more, research suggests that curves that are still small at adulthood do not continue to develop[2]

Secondly, it’s also long been thought that scoliosis worsens faster around growth spurts[3] – hence an older adolescent who has almost reached their full growth has less exposure to this potentially aggravating factor.  More recently, however, we have come to understand aspects such as the Risser sign (an indication of skeletal maturity) and the onset of menstruation are closely correlated with the potential for curve increase regardless of “growth spurts”. Immature children (Risser sign 0 or 1) with larger curves (20–29°) at initial diagnosis demonstrated a 68% risk for curve progression, whereas mature children (Risser 2–4) with similar curves at initial presentation had a 23% risk for curve progression. Conversely, immature children with smaller curves (5–19°) demonstrated 22% chance for curve progression, while mature children with smaller curves had only a 1.6% risk for curve progression.[4]

In both cases, we would like to detect and control curves in patients at the earliest possible opportunity, as this allows us to stabilise curves, and prevent progression throughout growth, and maximise the chance for curve correction and the avoidance of future issues in adulthood.

It’s for this reason that early screening and detection is so important in scoliosis cases – it’s too simplistic to say that cases that are detected early are guaranteed a better outcome, but by spotting cases as early as possible, you certainly allow the maximum number of options for treatment.

 

How can we treat AIS?

The best treatment for a scoliosis case depends on all of the above factors – but for simplicity, let’s take the question just by curve size. It’s important to remember that factors such as age and curve flexibility may modify this rough outline.

In curves between 10-20° scoliosis, specific exercises – a physiotherapy based approach to treatment – are typically recommended as an initial approach, while bracing may also be used as a preventative measure in the long term, or as a more convenient alternative to exercise-based approaches.

In curves over 20-25° with a moderate to high risk of progression, scoliosis bracing is typically considered and often will be used in conjunction with scoliosis specific exercise. As we discussed a the beginning of the month – bracing was shown to be effective in reducing the progression to the surgical threshold of 50° by the end of growth in 72% of cases compared to 48% of those who were purely observed. What is important to remember, is that those who wore the brace for more than 13 hours per day actually had a 90% success rate[5].

In curves 45-50°, conservative non-surgical treatment becomes more difficult. In older adolescents when a curve is less likely to rapidly progress, bracing may be used and combined with intensive scoliosis specific exercise. This may help to improve body aesthetics and reduce the curve size when surgery is not recommended.

In large curves in younger adolescents with a high risk of progression, or a high rate of curve development bracing may be used to slow curve development. This way surgery can be delayed until growth has finished so multiple surgeries are not required.

When curves are large and the risk of progression is high, surgery may be the only option. Surgery is recommended not purely on curve size, but also on curve location, future progression, loss of postural balance and when bracing has been unsuccessful.

 

What does Adolescent Scoliosis look like?

The below X-ray shows an example AIS case. It’s usually not possible to tell how severe scoliosis is without taking an X-ray, although external signs can suggest that the condition may be present. This is why regular screening is so important!

 

 

[1] Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. Effects of Bracing in Adolescents with Idiopathic Scoliosis, N Engl J Med 2013; 369:1512-1521

[2] 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.

[3] Duval-Beaupere G: Pathogenic relationship between scoliosis and growth. In Scoliosis and Growth Edited by: Zorab P. Edinburgh, Scotland: Churchill Livingstone; 1971:58-64.

[4] Bunnell WP: The natural history of idiopathic scoliosis before skeletal maturity. Spine 1986, 11:773-776.

[5] Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. Effects of Bracing in Adolescents with Idiopathic Scoliosis, N Engl J Med 2013; 369:1512-1521