Tag: scoliosis

Scoliosis awareness month – Early-onset Scoliosis

Posted on June 7, 2021 by - Blog

Early-onset Scoliosis is an umbrella term used by many organisations (including the scoliosis research society) to include scoliosis cases that present under the age of 10. Within this bracket, there are really two further categories of scoliosis we need to understand.

The first is Infantile scoliosis – which is the name given to scoliosis cases that are diagnosed in children between the ages of 0 to 3 years. Infantile Scoliosis is at least as common in boys as girls, which is worth bearing in mind since adolescent cases (which comprise the majority of overall cases) are predominantly female cases[1].

Juvenile scoliosis is therefore diagnosed when scoliosis of the spine is apparent between the ages of 4 and 10. It is less common than adolescent scoliosis and comprises about 10-15% of total idiopathic scoliosis cases.  It is found more often in boys between the ages of 4-6 and curves tend to be left-sided, while in older children it is more common in girls and curves are right-sided and similar to adolescent scoliosis.[2]

 

What causes early-onset Scoliosis?

There are several main categories that comprise early-onset scoliosis cases – these are:

  • Idiopathic – Curves for which there is no apparent cause – this is probably the kind of scoliosis you are most familiar with, as it forms the bulk of scoliosis cases, especially in teens.
  • Congenital – Here the cause is incorrect development of the Vertebrae in-utero. It is sometimes associated with cardiac and renal abnormalities.
  • Neuromuscular – In children with neuromuscular disorders including spinal muscular atrophy, cerebral palsy, spina bifida and brain or spinal cord injury.
  • Syndromic – Certain syndromes, such as Marfan’s, Ehlers-Danlos and other connective tissue disorders, as well as neurofibromatosis, Prader-Willi, and many bone dysplasias may be associated with EOS.

At the UK Scoliosis clinic, we mainly focus on the treatment of the idiopathic variety – which, as the name implies, is currently without defined cause. There are two main theories that explain the development of idiopathic infantile scoliosis – the first postulates that some children are simply born with a spine that is already curved, while the second suggests that the curvature occurs after birth and may be linked to the way a baby is handled. Much more research is required to clarify this, however.

 

What is the prognosis for early-onset Scoliosis?

The Scoliosis research society notes especially for early-onset cases, that early Scoliosis carries a risk of heart and lung problems in childhood which may become increasingly problematic in adult years[3] – but it’s worth noting that other research has shown that scoliosis can negatively impact the heart and lungs as the deformity increases in other age categories[4]. When untreated, severe EOS may be associated with an increased risk of early death due to heart and lung disease – the term Thoracic Insufficiency Syndrome (TIS) is commonly used to describe the potential combined spine and lung problems in EOS.

Idiopathic scoliosis has a number of possible treatment pathways, both non-surgical and surgical, whereas congenital and syndromic cases are more complex, and require in-depth evaluation to determine the best pathway. In all instances, it is important that suspected cases in infants should be investigated with a complete neurological examination and MRI or CT scan. This will serve to rule out any underlying neurological condition or disease process and allow the best treatment to be given as soon as possible.

 

How can we treat early-onset scoliosis?

Bracing may be an effective approach in idiopathic cases with good flexibility in the curve – however, rigid curves are less likely to benefit from this approach. Casting (which is a similar approach, using a plaster cast rather than a brace) is also a possible approach here.

Early-onset scoliosis is, however, the only broad category of scoliosis where the “wait and see” approach may have some value. The Scoliosis research society guidelines suggest that Idiopathic early onset scoliosis with curves greater than 30-35 degrees are most likely to progress and some studies have suggested the progression to surgical threshold for this group may be as high as 100%[5] – however, children younger than age 2 with infantile idiopathic curves less than 35 degrees stand a chance of the condition resolving without further treatment.

 

What does early-onset Scoliosis look like?

The below X-ray shows an example early onset Scoliosis 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] https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/early-onset-scoliosis/infantile-idiopathic-scoliosis

[2] https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/early-onset-scoliosis/juvenile-idiopathic-scoliosis

[3] https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/early-onset-scoliosis

[4] 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

Sperandio EF, Vidotto MC, Alexandre AS, Yi LC, Gotfryd AO, Dourado VZ. Exercise capacity, lung function and chest wall shape in patients with adolescent idiopathic scoliosis. Fisioter Mov. 2015;28(3):563–72. doi:10.1590/0103-5150.028.003.AO15

Barrios C, Pérez-Encinas C, Maruenda JI, Laguía M. Significant ventilatory functional restriction in adoles- cents with mild or moderate scoliosis during maximal exercise tolerance test. Spine. 2005;30(14):1610–5. doi:10.1097/01.brs.0000169447.55556.01

 

[5] 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.

Scoliosis awareness and the BrAIST study

Posted on May 27, 2021 by - Blog

Scoliosis awareness month is almost upon us, and as usual, we’d like to take the opportunity to draw attention not only to the condition but also to the importance of ongoing research. Scoliosis awareness month, for those who don’t know, takes place in June each year – with International Scoliosis Awareness Day on the last Saturday of each June.

While Scoliosis awareness day is a great opportunity for fund and awareness-raising events, National Scoliosis Awareness Month runs throughout June and aims, in particular, to highlight the growing need for education, early detection and awareness to the public about scoliosis and its prevalence within the community.

According to the scoliosis research society, the organisers of National Scoliosis Awareness Month, its official objectives are:

  • Using the results from the BrAIST Study, highlight the importance of early detection and the effectiveness of bracing as early, non-operative care.
  • Increase public awareness of scoliosis and related spinal conditions through educational and advocacy campaigns of local activities, and community events during the month of June.
  • Unite scoliosis patients, families, physicians, and clinicians in a collaborative partnership that educate, and advocate, for patient care, patient screening, patient privacy, and patient protection
  • Build networks of community collaborations and alliances to help sustain and grow the campaign[1]

 

It’s the BrAIST study – an important landmark for scoliosis research and treatment which we’d like to discuss today.

 

The BrAIST study

The BrAIST study, overseen by Dr Stuart Weinstein and published in 2013, was perhaps the most impactful study showing the efficacy of bracing in treating scoliosis cases.  In short, the study proved that bracing of adolescents with moderate scoliosis was an effective treatment in the reduction of the number of patients who advance to the need for surgery. In addition, a dose-response was found between the number of hours of brace wear and the success rate of bracing – which is to say, there’s a strong relationship between how long a brace is worn, and how effective the treatment is. Both are critical points when considering the value of scoliosis bracing as a whole.[2]

Unlike many of the smaller studies which inform our understanding of scoliosis and best practice in treating it, the BrAIST study was coordinated between several medical centres, and allowed the highest level of medical study, a randomized clinical trial, to be undertaken. To answer the question of whether bracing is effective in growing children and adolescents with curves.

During the study,  242 patients with curves between 20 – 40 degrees participated.  Patients in the bracing group were assigned to wear a brace 18 hours per day (a typical bracing prescription).  A special monitor was embedded in the brace to keep track of how long it was used per day.  Patients in the observation-only group received no additional treatment.  The endpoint of the study was “treatment failure” defined as progression of the scoliosis to 50 degrees or “treatment success” when skeletal maturity was reached without progression to 50 degrees.

Across the survey group, 72% of brace wearers avoided surgical recommendations, but only 48% of patients in the observational group did the same. Furthermore, however, it was also shown that patients who complied fully with their bracing instructions, and wore the brace for 13 hours or more was greater than 90%, showing both that the amount of time the brace is worn is very important and that the results we can expect with solid compliance are fantastic indeed. The study, therefore, provided strong evidence to the value of brace treatment for those adolescents at high risk of progression of surgery.

 

Why the BrAIST study matters.

The BrAIST study was notable due to its size – a large sample set, its nature – a fully randomised clinical trial and the credentials of its authors – a range of expert Doctors. The impact of the BrAIST study was therefore to provide solid evidence not only for non-surgical treatment but also against the “wait and see” attitude which has existed towards scoliosis for decades.

In the past, the value of a screening examination for scoliosis has been debated due to inconclusive evidence of the success of non-operative treatment for scoliosis – simply put, without strong evidence to show it’s possible to avoid surgery, why screen, and why bother?

Thanks to the BrAIST study, this is no longer true.  It shows that early screening and non-surgical treatment may reduce the number of patients who progress to surgery and, therefore, could serve as a potential cost saving for the health care system and of great benefit to patients. According to the study, Policy statements from professional organizations and governmental agencies regarding scoliosis screening in school programs and primary care settings will need to be reassessed in order to identify at-risk patients who will benefit from bracing for scoliosis[3].

And it’s this final point that highlights why scoliosis awareness month and the BrAIST study now matter more than ever – it’s 2021, and there’s no sign of the UK government even considering screening in schools for scoliosis, and, despite many organisations best efforts, the majority of people are still unaware of scoliosis, and it’s possible treatments.

That’s why this scoliosis awareness month, we invite you to help us spread the word – and, for your own knowledge, take just a moment to read the conclusions from the BrAIST study – you can find it here and read the abstract in about 3 minutes.

Over the next month, we’ll be posting articles about different kinds of scoliosis, how to spot them and what the treatment options could be – keep an eye out and help us to raise awareness throughout June!

 

[1] https://www.srs.org/patients-and-families/additional-scoliosis-resources/scoliosis-awareness-month

[2]     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

[3] 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

Does scoliosis always get worse with time?

Posted on February 10, 2021 by - Blog

One of the first questions which many people ask when they are diagnosed with scoliosis is “will it get worse?” There’s also a lot of misconceptions around this issue to deal with. It’s true that some scoliosis cases do simply stop developing – but despite what you might read on the internet, this is very rare. Today, we understand scoliosis much better than ever before, and so while we can’t fully explain the condition, we can now make some very sensible assumptions about its likely progression.

This week, let’s look at some of our current best information on this question.

 

Scoliosis development

Firstly, it’s important that we outline exactly what we mean by “worse” in this situation.  Scoliosis is a condition which causes a host of unpleasant symptoms, ranging from physical deformation to problems breathing and, perhaps most impactful for most people, a drastic impact on self-confidence. While these are all perfectly valid ways of understanding how” bad” scoliosis is, in a clinical setting we tend to focus on an accepted measurement called cobb angle. Cobb angle measures the deviation of the spine from normal, such that a more pronounced scoliotic curve is said to have a greater cobb angle, or be of a greater magnitude. It is generally true that as cobb angle increases, symptoms will also become more severe. So, what do we understand about the factors which seem to predispose individuals to a greater increase in this regard?

 

Growth potential

Growth potential – that is to say, how much growing a skeleton has already done, and (roughly) how much more it has to do has been strongly correlated with curve progression.  This has been established since the early ’70s , when it was predominately believed that scoliosis progression was fastest during adolescent growth spurts.[1] More recently, however, we have come to understand that in fact, 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.  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. [2]

 

Size of curve

Perhaps intuitively to most of us, the size of the curve at the point of discovery is also a factor in predicting its growth. Much research has examined the relationship between age and curve magnitude – for example, Nachemson et al, and Weinstein et al, correlated curve progression with age and curve magnitude,[3] however, today we also understand that curve magnitude can be an independent predictor of curve progression – that is to say that generally speaking, larger curves tend to get larger, and can also progress after skeletal maturity. Weinstein et al. and Ascani and colleagues reported that children with curves < 30° at skeletal maturity did not demonstrate curve progression into adulthood, while the majority of curves > 50° progressed at approximately 1° per year[4]

 

Family History

A family history of scoliosis is a major indicator for the development of scoliosis – research indicates that those with a family member who has scoliosis go on to develop scoliosis in between 11.5 and 19% of cases – considerably more than the 2-3% average in the population as a whole. Research also suggests that those who have family members with severe curves are likely to develop more severe curves themselves, although the correlation is not total.[5] Other factors clearly influence scoliosis, which can also impact the severity of a curve, but those with family members with larger curves should be especially aware.

 

Gender

On average, girls are up to 5 times more likely than boys to develop scoliosis and hence you must also consider that many activities which are popular with young women and girls, such as gymnastics, have scoliosis rates up to 12.4 times as high as the general population. [6] While this is a complex area, since boys can, and do, get scoliosis – it’s important to note that 70% of scoliosis cases are girls. If you perform a home screening, or someone mentions that your child may have scoliosis, you should be especially cautious of that child happens to be a girl.

 

And here’s the key takeaway

We now know a lot about the progression of scoliosis – far more than we ever did in the past. This means that we are far better able to predict the outcome of a case and to treat it appropriately. The keyword here is treat – since there’s one common theme which runs through each of these points – most of the time, scoliosis will progress, and often, it will progress quickly. While there is a chance that some curves may stop growing, it’s highly unlikely – research shows that juvenile cases, for example, almost never resolve spontaneously.[7]

Today, scoliosis treatment is highly advanced – if caught early, surgery can be avoided and most cases can be corrected quickly and in a non-invasive way. The longer cases are left to progress, however, the more difficult they are to treat, and the longer this will take.

At the UK scoliosis clinic, we see far too many young people in particular who have developed scoliosis and which has been allowed to progress. Sometimes the curve progression is sadly just too large for us to help – but each of these cases would have started out as a relatively small curve which, while certainly not desirable for a young person, would have been relatively simple to treat.

Please, do not wait to screen for scoliosis – do it today and if you have concerns get in touch!

 

[1] Duval-Beaupere G: Pathogenic relationship between scoliosis

and growth. In Scoliosis and Growth Edited by: Zorab P. Edinburgh,

Scotland: Churchill Livingstone; 1971:58-64.

[2] Bunnell WP: The natural history of idiopathic scoliosis before

skeletal maturity. Spine 1986, 11:773-776.

  1. Lonstein JE, Carlson JM: The prediction of curve progression in

untreated idiopathic scoliosis during growth. J Bone Joint Surg

(Am) 1984, 66:1061-1071.

[3] Nachemson AL, Peterson LE: Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg (Am) 1995, 77:815-822.

 

Peterson LE, Nachemson AL: Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society. J Bone Joint Surg (Am) 1995, 77:823-827.

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.

 

[4]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.

[5] ‘ Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’
Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

[6] ‘ Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’
Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

 

[7] Charles YP, Daures JP, de Rosa V, Diméglio A,  Progression risk of idiopathic juvenile scoliosis during pubertal growth‘ Spine (Phila Pa 1976). 2006 Aug 1;31(17):1933-42. DOI:10.1097/01.brs.0000229230.68870.97

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]

14 Myths about Scoliosis, Revisited!

Posted on January 7, 2021 by - Blog

Nearly three years ago we posted an article entitled “14 Myths about Scoliosis” – and by all accounts, it’s one of our most-read articles of all time. Perhaps there’s something about myth-busting, which is especially needed in the scoliosis world. Three years ago, we pointed out that much of what we know and understand about scoliosis is based on emerging research, or out of date information – scoliosis treatment is a rapidly advancing field, in which the best clinics need to stay on top of the technological and research developments.

After just a few years, this week, we revisit the 14 myths to see what we can add.

 

Myth 1 – Scoliosis causes pain

In 2017 we wrote that “while Scoliosis may be associated with pain as it develops, typically, scoliosis in the early phases does not cause pain. This is why scoliosis screening is so important, and why we provide the scoliscreen app. In Children especially, the early onset of scoliosis might go completely unnoticed.”

This has been perhaps the biggest change on the list – really, this no longer belongs on a list of “Myths” – to be clear, research now suggests that scoliosis does cause pain, at least in some cases. Certainly, we can no longer assume that the presence of pain means scoliosis is not a factor to consider.

This view was mostly based on older research, which had gone mainly unchallanaged for decades. Since then there has been a great deal of study on pain in scoliosis, so that today, we’re of the view that pain is, in fact, often a symptom of scoliosis. Research has now shown that Spinal pain is a frequent condition in AIS patients, further supporting the need for early detection and screening to minimise potential pain and suffering[1] –  that In patients under 21 treated for back pain, scoliosis was the most common underlying condition[2] and that in one study of 2400 patients with AIS, 23% reported back pain at their initial contact[3].

Studies have also shown that s coliosis patients have between a 3 and 5 fold increased risk of back pain in the upper and middle right part of the back[4] , that Chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[5] and that patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[6]

 

 

Myth 2 – “Watchful waiting” is the best approach

In 2017 we wrote: “In the UK and many other parts of the world a “wait and see” approach is often favoured when it comes to scoliosis. The condition is monitored to see if it gets worse, with a view to undertaking a surgical fusion of the spine if the situation becomes bad enough.

In the past, this might have been the best approach, but today we have the know-how and technical ability required to create a scoliosis specific exercise program and a customised bracing solution, which can serve to correct the problem before it progresses to the point where surgery would be required. It is easier to improve a more flexible and smaller curve with bracing and scoliosis specific exercise than it is to change a large more rigid curve – so early diagnosis and appropriate treatment make a big difference.”

Since 2017 we’ve discussed the cost benefits of early screening on a number of occasions – bracing and treatment costs have come down meaning that early detection and treatment makes all the more sense financially.

Earlier this year, we reported that many specialists still take the view that scoliosis can only be treated surgically (this is false!), in many cases you may not be seen by a specialist until scoliosis has developed beyond 45 degrees, which is typically considered the threshold for surgery. Bracing and other non-surgical methods are certainly still possible in curves up to 60 degrees depending on the individual case and risk of future progression.

Recent research by the British Scoliosis Society (BSS) has now illustrated just how long “wait and see” can go on, even after getting an appointment for a consultation. They showed that most patients face another long wait for treatment during which scoliosis tends to progress. Their 2018 study specifically looked at scoliosis progression whilst waiting for a consultation and eventual surgery. In the study, 41 females and 20 males with a mean age of 11.8 years with a mean Cobb angle (curvature) of 58° were followed –  Average waiting time to be seen in the clinic for an initial consultation was 16 months – thereafter, the average waiting time for surgery was 10 months. Rapid curve progression was seen in twelve patients, of which 10 required more extensive surgery than originally planned. Their mean Cobb angle at presentation was 48° which increased to a mean of 58° at surgery[7]. Many of those cases could have been treated non surgically before the “waiting” – but probably not after.

 

 

Myth 3 – Scoliosis screening doesn’t help scoliosis sufferers

In 2017 we wrote: “Current UK policy does not support mass screenings due to the cost, potential of false positives, belief that bracing doesn’t work and that if the curve is severe enough family or other adults will notice it.

As we mentioned above, since scoliosis does not always cause pain (and most people don’t know how to recognise scoliosis anyway) it’s entirely possible that the condition can go unnoticed in many cases. The earlier the detection, the more appropriately the right treatment can be given at the right time.”

Research continues to support the need for early screening, although we do now recognise pain as a symptom. Newer online screening tools (including our own, which will be released soon) are helping to make screening faster, and easier than ever before – the scoliosis treatment community will probably resolve this issue through technology long before government takes any action.

 

 

Myth 4 – Scoliosis doesn’t progress into adulthood

In 2017 we wrote “Historically, scoliosis was most strongly associated with growth – from this it was assumed that when an adolescent stops growing, scoliosis would not progress. It is now known that it often will progress into adulthood – in addition, the bigger the existing curve the more likely it is to progress.

The major reason for progression is the weakening of the ligaments in the spine as we age. As the ligaments weaken, the spine loses stability and the spinal deformity worsens. This means that appropriate exercises and chiropractic care are highly beneficial for us all as we age – but can make a huge difference to a scoliosis sufferer.

The weakening of ligaments causes 30% of the population over the age of 60 years to have scoliosis versus only 3% of adolescents!”

 

Since 2017, we’ve successfully treated many older adults suffering from degenerative scoliosis – and we’ve seen first hand the positive effects such as a reduction in pain, even from part-time bracing – in this sense, our results are in line with the research which was emerging back in 2017.[8]

 

Myth 5 – Swimming will help reduce scoliosis

In 2017 we wrote “Over many years children have been told to swim to treat scoliosis. While swimming is a great form of exercise in general, there is no evidence to support this idea – although there actually has been some research which suggests that scoliosis can be worsened after swimming. This research is not strong enough to suggest that scoliosis patients should avoid swimming, but we can now say that swimming alone is not an effective treatment.”

Since then, we aren’t aware of any studies which have specifically looked at swimming – and this is mainly because there is much greater focus on scoliosis specific exercises which can help to control or reduce Scoliosis in a significant way.

 

 

Myth 6 – Bad posture causes scoliosis

In 2017 we wrote that “You might think that telling your child to sit upright will stop scoliosis – this makes sense since often adolescents will have slumping posture, however, the slumping posture itself is not necessarily linked to the development of scoliosis.

In fact, for children with scoliosis, the spine will often be straighter than is observed in the average population. Typically, the thoracic kyphosis in adolescent idiopathic scoliosis will be reduced and sometimes even bend in the opposite direction!

Often children’s shoulder blades will lift off the thorax (aka winging of the scapula) due to weakness of the serratus anterior muscle which will give the appearance of hunching.”

The only point we would add here today is that the advances in research around pain and scoliosis are significant for teens and young adults – if your child is complaining of back pain, we now advise that you seek the help of a spinal professional, at least to rule out scoliosis. A consultation with a scoliosis practitioner is ideal – but most professional chiropractors will be able to provide you with an X-ray which could show early signs of scoliosis. If your child shows any kind of unusual posture, we recommend scoliosis screening as soon as possible.

 

Myth 7 – You can correct scoliosis by just sitting up straight

In 2017 we wrote “Scoliosis is more than just twisting of the spine, it causes is often multi-factorial thus a multi-factorial treatment must be given.  Sitting up straight might help a little since postural exercises might well be an effective element of a treatment program, but the right treatment will be different for every patient – that’s why we take time to go through a detailed consultation process with each patient.”

It’s still true that you can’t correct scoliosis by changing your sitting patterns – but with higher than ever levels of young people coming into our clinic with neck problems, it’s worth keeping in mind. Long term postural problems could predispose you to the development of de-novo scoliosis later in life – so a focus on posture now may pay dividends later.

 

Myth 8 – Spinal braces don’t work in correcting scoliosis

In 2017 we wrote that “Spinal bracing has been the subject of intense research over the past 15-20 years. Far from the myth that they are ineffective, spinal braces have been shown to reduce progression in 70 to 80% of cases compared to those who aren’t braced.

Among some healthcare professionals, the notion that scoliosis braces don’t work does still exist however this is most usually because there is confusion about the kind of bracing being discussed. Bracing technology itself has come a long way in the last few years.  Traditional medical braces are designed to hold the spine in the patient’s scoliotic position, which might halt progression, but it actually does nothing to improve the curve.

In contrast, our Scolibrace braces are an active over-corrective brace which works to shift the spine in the opposite, direction back towards normal posture. In addition, they help to shift the mechanical loading of the spine to stimulate normal spinal growth. This not only helps to reduce the likelihood of progression but also improves the potential correction.

Traditional braces, therefore don’t work in correcting scoliosis (although they might stop it getting worse) Scolibrace braces, however, actively work to correct the position of the spine, and have been shown to be highly effective in doing so.”

In recent years there has been yet more improvement in bracing technology, with research to further explore its effects being published regularly. Since 2017, it’s been established that Bracing is far more effective than exercise in reducing cobb angle. In one study, the 6-month reduction in Cobb angle from a bracing group was 3.13 degrees and at 12 months the mean reduction was 5.88 degrees.  In the exercise group, the 6 months mean reduction was just 0.66 degrees, and at 12 months was 2.24 degrees[9] There’s no question that the exercise approach still have value – not least because they address the muscular imbalances that bracing does not – but today, we recommend bracing to most of our clients, either full time or part-time.

 

Myth 9 – Scoliosis only affects girls

In 2017 we wrote “Scoliosis is more common in girls than boys, but boys can and do develop scoliosis.

Scoliosis is particularly common in ballet dancers and gymnasts, which might be at the heart of this misconception, but there is no doubt the boys and girls can both develop scoliosis.”

Our experience since then shows this to be true – more girls than boys experience scoliosis, but we have seen many male patients of all ages at the clinic. To be a little more specific on the Gymnastics question, research has shown that Gymnasts (and ballet dancers) are as much as 12 times more likely to develop scoliosis than non-gymnasts[10] however, we still urge caution with this statistic – we’ve discussed this issue a few time since 2017, and each time we’ve noted the awareness of scoliosis in these fields, which doubtless leads to higher reporting.

 

Myth 10 – Spinal manipulation can reduce scoliosis

In 2017 we wrote that “Spinal adjustment and manipulation can often help to improve spinal mobility and ease areas of aches and pains in those who have scoliosis, just as it can for those who don’t – but spinal manipulation alone will not reduce scoliosis.

While chiropractic adjustments can form a valuable part of an overall treatment regime, there is no evidence from the scientific literature to support the assertion that spinal manipulation and adjusting techniques alone can reduce scoliosis. Where adjustments may be highly beneficial is in support of an exercise and lifestyle regime, as a method of increasing range of motion, and reducing pain in some cases.”

Over time, serious research into chiropractic based treatment as an approach to reducing scoliosis has been coalescing around the CLEAR institute, who have certainly published some interesting research. In a sample of 140 patients using the prospective CLEAR technique, (and according to the CLEAR institute themselves) improvement in Cobb angle was documented in all 140 cases. The average amount of reduction in Cobb angle was 37.7% after an average of 12.3 visits. 23 patients were no longer classified as having scoliosis after their treatment (e.g., the Cobb angle was reduced to below 10 degrees).

While the study results were published[11], they were not peer-reviewed and therefore do not currently meet the standard of proof for us to consider this technique at the UK Scoliosis Clinic – we will keep this under review, however, should independently reviewed research become available.

 

Myth 11 – Physiotherapy exercise reduces scoliosis

In 2017 we wrote: “Just like chiropractic care, physiotherapy can help to improve mobility and function for scoliosis patients and might form part of an overall program – however again there is no evidence to show that generalised exercise, massage, mobilisation or core stability will improve a scoliotic curve.  Bracing and scoliosis specific exercise are currently the only non-surgical methodologies which is clinically indicated as effective in treating scoliosis.”

As outlined above, this still holds true – we believe that scoliosis specific exercise is a solid approach for treating small curves, and for addressing issues around muscular imbalance and some kinds of pain associated with scoliosis. Research continues to show that a combination of both approaches is greater than the sum of its parts. Interestingly, research since 2017 has demonstrated that exercised based approaches tend to yield a slightly higher quality of life scores (SRS Questionnaire-based) than bracing alone[12].

Our view is now that Bracing is the primary tool for reducing Cobb angle – exercised based approaches are an invaluable “force multiplier” in this regard.

 

Myth 12 – Heavy backpacks cause scoliosis

In 2017 we wrote that “Heavy backpacks cause uneven loading and are never good for children’s spines and posture… but they don’t cause scoliosis. If it was the case every child would have scoliosis!”

This is still the case – but please do be kind to you child and think about their spine health overall, not just scoliosis!

 

Myth 13 – Scoliosis worsens in pregnancy or will stop me having children

In 2017 we wrote that “Current research knowledge shows that women are not at an increased risk of progression in pregnancy, however carrying a baby will produce more stress upon the body and the spine which will increase the likelihood of pain and discomfort as for all women in pregnancy.

At birth, it is important for the anaesthetist to be aware that a mother has scoliosis, as it will affect the position of the spine if they need to give an epidural injection. It will not however affect the woman’s ability to carry a child or give birth.”

Again this position I unchanged – Scoliosis will not affect your fertility.

 

Myth 14 – Surgery is the only treatment for scoliosis

In 2017 we wrote that “Surgery is sometimes the only option for large curves at high risk of progression.  50 degrees is the typical indicator for surgery as the curve is at a high risk of progression into adulthood.

Scolibrace with scoliosis specific corrective exercise has been shown to be clinically effective in reducing curves between 20 and 60 degrees, whereas curves between 10 and 20 degrees with a low risk of progression can sometimes be treated by scoliosis specific exercise alone.

As previously mentioned early diagnosis is key, as the chances for arresting and correcting a relatively small angle are very good.”

Since 2017, we’ve helped patients from all backgrounds, ages and genders beat scoliosis – and in the vast majority of cases, we have been able to help them avoid surgery. Where this hasn’t been possible, it is almost always because they sought treatment too latte – had scoliosis been caught sooner, a non-surgical option would almost always have been open to them.

As always, screen regularly – and if you have questions get in touch – don’t wait and see!

 

 

[1] ‘Back Pain and Adolescent Idiopathic Scoliosis: A Descriptive, Correlation Study’,
Theroux Jean, Le May Sylvie, Labelle Hubert [University of Montreal, Quebec, Canada; Murdoch University, Perth, WA, Australia], Spine Society of Australia 27th Annual Scientific Meeting (8-10 April 2016)

‘Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis A Cross-sectional Study’
Jean Theroux, DC, MSc, PhD, Sylvie Le May, RN, PhD, Jeffrey J. Hebert, DC, PhD,and Hubert Labelle, MD : SPINE 153607

 

[2] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

 

[3] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

 

[4] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

 

[5] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

 

[6] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

 

[7] H V Dabke, A Jones, S Ahuja, J Howes, P R Davies, SHOULD PATIENTS WAIT FOR SCOLIOSIS SURGERY?  Orthopaedic ProceedingsVol. 88-B, No. SUPP_II

[8] Scoliosis bracing and exercise for pain management in adults—a case report
Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407

[9] 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]

 

[10] ‘Prevalence and predictors of adolescent idiopathic scoliosis in adolescent ballet dancers’
Longworth B., Fary R., Hopper D, Arch Phys Med Rehabil. 2014 Sep;95(9):1725-30. doi: 10.1016/j.apmr.2014.02.027. Epub 2014 Mar 21.

 

[11] Woggon D, Woggon A, and Chong S: Developing a scoliosis-specific chiropractic protocol: preliminary results from 140 consecutively-treated scoliosis cases. The American Chiropractor, Dec 2013; 35(12):16-22.

[12] 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]

 

Do Boys Get Scoliosis?

Posted on July 8, 2020 by - Blog

Do boys get scoliosis? It’s a good question – and it’s one which we don’t hear people ask enough. While it’s certainly true that the majority of scoliosis cases which you’ll hear about in the news are females – and if you know someone with scoliosis, they’re more likely to be female, Males, can, and do get scoliosis.

 

Scoliosis and Gender

It’s a generally stated fact that scoliosis affects girls more than boys, or, more broadly, it’s frequently noted that about 75% of adolescent idieopathic scoliosis cases are females. Both statements are true – but adolescent idiopathic scoliosis is not the only kind of scoliosis, and 25% is still a large number of people!

To be a little more specific, let’s break the question down – first, scoliosis in children.

Idiopathic scoliosis is a 3-dimensional distortion of the spine and trunk that occurs in otherwise healthy children. 80% of scoliosis cases in this age group are considered to be “Idiopathic” or “of unknown cause” – scientists are fairly sure that genetics can play a role, but the exact onset of scoliosis Is still not fully understood.

A well-recognised theory about how scoliosis develops in adolescence revolves around asymmetrical growth of the vertebrae which de-stabilises the spine and makes the vertebrae prone to becoming wedged. Wedging of the vertebrae then creates a lateral spinal curve which places uneven loading on the vertebrae and precipitates further asymmetrical growth and progression. It is then thought that spinal cord tension develops as the spine bends and twists and brain function and growth is altered as muscle asymmetry develops.

We break idiopathic scoliosis down further into age groups – and here’s where the numbers get interesting.

Infantile idiopathic scoliosis is the name given to idiopathic scoliosis cases which are diagnosed in children between the ages of 0 to 3 years. Statistically, it is the least common of all forms of idiopathic scoliosis and comprises about 1% of all idiopathic scoliosis in children – while the numbers of overall cases are smaller about 60% of patients are boys.

Juvenile idiopathic scoliosis is diagnosed when scoliosis of the spine is apparent between the ages of 4 and 10. It is less common than adolescent idiopathic scoliosis but more common than infantile. In total, it comprises 10-15% of idiopathic scoliosis cases.
Juvenile scoliosis is also found more often in boys between the ages of 4-6, whereas between 6 and 10 it becomes more common in girls.

Adolescent idiopathic scoliosis is the type which we most frequently hear about – and here is where between 75% and 80% of 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 is worsens during growth spurts.

While it’s clear that when taken as a whole, girls will tend to make up the majority of scoliosis cases, there are substantial age groups where boys are the most common patients. It’s also critical to understand that while all scoliosis cases should be considered as potentially debilitating, the time available for scoliosis to progress (it typically stops at skeletal maturity) is a huge factor in determining risk.  Scoliosis discovered in a 5-year-old boy has considerably more time to progress, than in a 16-year-old girl.

Finally, there’s another common form of scoliosis to consider – affecting a very different age group. Older adults are at considerable risk of another common form of scoliosis, known as “de-novo” (degenerative) scoliosis. De-novo scoliosis is caused by wear and tear to the spinal discs as we age, and is therefore quite common – research suggests that as many as 30% of the over 60’s suffer from scoliosis. Although de-novo scoliosis progresses much more slowly than childhood or adolescent scoliosis it can still have a major impact on quality of life, if not properly treated.[1] De-novo scoliosis affects both males and females – and since such a large percentage of older people can suffer from this condition, there’s a very real argument to be made suggesting that taken over a lifespan, the rates of male and females scoliosis are much closer together than it might seem at first glance.

 

If you think you may have scoliosis

If you think you may have scoliosis, the advice is simple – regardless of gender, see a scoliosis specialist sooner rather than later. At the UK Scoliosis clinic, we offer in-person consultations at our Essex clinic, as well as online consultations from the comfort of your own home.

 

 

 

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

‘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

 

I Have Back Pain… Is it Scoliosis?

Posted on June 30, 2020 by - Blog

Back pain is probably the single most troublesome and common condition for people to suffer from today – our changing lifestyles as well as more time spent at a desk (or a home desk.. perhaps even worse) mean that BUPA now estimates that a many as 2 in 3 of us will suffer from back pain in our lives.[1] I began my career in spine care as Chiropractor, and proudly practice to this day. Each and every week I treat hundreds of patients for all kinds of back pain – most often it’s a common symptom, stemming from a common problem with a clear treatment pathway. Sometimes, however, back pain can be a symptom of something more serious – like scoliosis. So, could your back pain be due to scoliosis, and should you see a professional?

 

Does scoliosis cause back pain?

The issue of scoliosis and back pain has been somewhat contentious – many organisations will still tell you that back pain is not a symptom of scoliosis, or that scoliosis is “painless”. Today, however, these views are out of date – there’s a growing body of research that shows that while pain may not be the main symptom of scoliosis, it can certainly be a factor.

One recent study concluded that “Spinal pain is, in fact, a frequent condition in AIS patients, further supporting the need for early detection and screening to minimise potential pain and suffering”[2] and at the UK Scoliosis clinic, we support this view.

Research has also shown that in patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[3] while another, involving 2400 patients with adolescent idiopathic scoliosis showed that 23% reported back pain at their initial contact[4]. Estimates suggest that scoliosis patients have between a 3 and 5 fold increased risk of back pain in the upper and middle right part of the back[5] – and support the view that chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[6] It’s also been shown that patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[7] – and finally, more positively, that part-time bracing in adult scoliosis cases can improve chronic pain[8]

So, can scoliosis cause back pain? Yes it can.  Does that mean your back pain is caused by scoliosis? Possibly – let’s explore more.

 

Back pain in adults

Back pain is incredibly common in adults – as stated above, 66% of us at least will suffer from it. The vast majority of these cases will not be scoliosis. Scoliosis progression is lowest in adulthood, and the incidence of new cases is almost nil amongst the general young and middle aged adult population. It’s certainly possible that undiagnosed, untreated childhood scoliosis is the source of your pain – but there are any number of common conditions which are far more likely. If you’re aged 25 – 60, it’s highly unlikely that scoliosis will be your problem.

As we age, the picture starts to change, however – mainly due to the presence of a condition known as “de-novo” or degenerative scoliosis. De-novo scoliosis is caused by wear and tear to the spinal discs as we age, and is therefore quite common – research suggests that as many as 30% of the over 60’s suffer from de-novo scoliosis. Although de-novo scoliosis progresses much more slowly than childhood or adolescent scoliosis it can still have a major impact on quality of life, if not properly treated.[9]

To the core point of this article, while most forms of scoliosis are detected at a scoliosis specific screening,  De-novo scoliosis is most often discovered as the result of a back-pain investigation. Patients with degenerative De-Novo scoliosis typically present for treatment with complaints ranging from debilitating back or lower extremity pain to spinal imbalances, as well as as a response to incidental findings on lumbar radiographs.

Counter-intuitively, the pain caused as a result of adult scoliosis is not related to the size of the curve. Several good studies show there is little to no relationship between the size of the curve and the intensity of pain – therefore a 20 degree and a 55 degree curve have the same chance of causing pain in an adult. Pain in adults is more commonly linked to the degree to which vertebrae individually shift to the side in what is called ‘lateralisthesis’ and their ‘postural balance’ or degree to which their trunk or upper body is shifted to the side or forward over their pelvis This means that a visual observation is not always sufficient to rule out scoliosis in adults, and a professional consultation is the best approach. Put simply, if you’re over 60, and suffering with new back pain – a scoliosis consultation isn’t at all a bad idea.

 

Back pain in Children and Young people

Finally, let’s look at the youngest population – children and teens. While we often associate back pain with older populations, this is a bit of a misconception – One meta-study from 2013 (nearly 7 years ago now) suggested a rate of low back pain among adolescents aged 9–18 years of about 12% at any given moment, whereas the number who would experience an episode of pain during a 12 month period was 34%.[10] This number certainly will not have improved!

It’s important to note that this headline figure is an average too – and the studies used in this broad-spectrum analysis showed great variation in the estimates of prevalence. For example, estimates from the Nordic countries showed a weekly occurrence of spinal pain in young people at around 20%[11], and a small Danish study showed a lifetime prevalence of spinal pain of 86% in a population of adolescents aged 11–13 years, with neck pain being the most prevalent.[12]

Scoliosis, whilst statistically less common in the young than the older, is far more risky for the young – since the opportunity for the condition to progress to the surgical threshold is greatest. Scoliosis is also known to develop rapidly and unevenly during growth spurts, making this a time for real concern. As an average figure, 3-4% of teens will develop scoliosis. Left untreated in young people, Scoliosis can be a life-limiting condition –  but treated early, its impact can be almost entirely mitigated. Back pain won’t always be present in a scoliosis case – so if you have concerns about the shape of a young persons back (this is the most common way scoliosis is detected) do not be dissuaded from seeking a consultation due to the absence of back pain – but, if presented with a young person with new back pain, a scoliosis consultation may be a wise approach.

 

 

[1] https://www.bupa.co.uk/health-information/back-care/back-pain

[2] ‘Back Pain and Adolescent Idiopathic Scoliosis: A Descriptive, Correlation Study’,
Theroux Jean, Le May Sylvie, Labelle Hubert [University of Montreal, Quebec, Canada; Murdoch University, Perth, WA, Australia], Spine Society of Australia 27th Annual Scientific Meeting (8-10 April 2016)
Jean Theroux, DC, MSc, PhD, Sylvie Le May, RN, PhD, Jeffrey J. Hebert, DC, PhD,and Hubert Labelle, MD : SPINE 153607

[3] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[4] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

[5] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

[6] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[7] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[8] Scoliosis bracing and exercise for pain management in adults—a case report
Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.

[9] ‘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

[10] Calvo-Munoz I, Gomez-Conesa A, Sanchez-Meca J (2013)  Prevalence of Low Back Pain in Children and Adolescents: A Meta-analysis  BMC Pediatr. 2013 (Jan 26); 13: 14

[11] Torsheim T, Eriksson L, Schnohr CW, Hansen F, Bjarnason T, Valimaa R (2010)
Screen-based activities and physical complaints among adolescents from the Nordic countries.
BMC Public Health 10:324

[12] Aartun E, Hartvigsen J, Wedderkopp N, Hestbaek L (2014)  Spinal Pain in Adolescents: Prevalence, Incidence, and Course:
A School-based Two-year Prospective Cohort Study in 1,300 Danes Aged 11-13
BMC Musculoskelet Disord. 2014 (May 29); 15: 187

Scoliosis and Kyphosis, what’s the difference?

Posted on May 1, 2020 by - Blog

Given our name being the UK Scoliosis clinic you would expect or focus to be on the non-surgical treatment of scoliosis, however, we also work with many patients suffering from another common spinal condition – Kyphosis. But what’s the difference between Scoliosis and Kyphosis?

 

Kyphosis

Kyphosis is the condition which causes what’s sometimes called a “hunchback”, people with this condition tend to hunch forward, and, as you may have already realised, it’s getting far more common today than ever before.

But isn’t the spine supposed to bend forward slightly? – yes, it certainly is, however, when this forward bend becomes too pronounced it can become an issue. As a general guide,  it’s normal to have a mid-back kyphosis (backward c-shape curve) at approximately 40 degrees. Above this, unpleasant symptoms may result.

Typically, patients complain of aching and stiffness in their mid-back and lower back. It worsens when weight-bearing, especially when doing activities that require repeated bending such as gardening. Often, teenagers are noticeably hunched from spending hours on their phones, tablet’s or PC’s – a trend which often worsens into adulthood. Most age groups are at risk of Kyphosis, although there is probably a stronger link with lifestyle than with age per se.

 

Causes of Kyphosis

Like scoliosis, there can be different underlying causes of kyphosis, but unlike scoliosis, we understand these potential causes well. There are 4 main underlying issues which can lead to Kyphosis, these are:

 

Postural Kyphosis – is the most common form and the one which is increasing faster than ever before. Postural kyphosis is noticeable, in that it will appear when standing and sitting and disappear when laying face down. Postural kyphosis isn’t a structural problem caused by an abnormal shape of the vertebra that make up the spine, but rather by the supporting muscles and tissues. Over time, as we remain in a slouched position (such as sitting at a desk all day or hunched forward gaming for hours on end) certain muscles become too tight, others become weak and loose, leaving us with a “hunchback” look. Postural kyphosis, disappears when laying face down as the spine is able to return to its normal position, without the need the need for the surrounding muscles muscles to work and support the spine against the force of gravity.

 

Scheuermanns kyphosis

Scheuermann’s disease – is far less common, and results in an increased kyphosis throughout the teenage years whilst growth is occurring. It is a growth plate disorder in the vertebrae themselves, which causes them to become more wedged and compressed at the front, hence the increase in kyphosis. This will result in structural deformity as the bone formation is altered. Scheuermann’s cannot be “cured” or reversed, however, the right treatment at the right time, can help to significantly reduce the progression of the deformity. Bracing in the right cases has been shown to be a very effective treatment when combined with specific posture exercises.

 

 

 

 

 

Osteoporatic fracture, and kyphosis

Osteoporosis of the spine – is a common cause in older individuals – here, the fundamental cause is vertebrae undergoing compression fractures due to a loss of bone strength. Osteoporosis of the spine can cause a large increase in the kyphosis in people over 60. It will often continue to progress with age, thus it is vital that patients keep their posture upright and keep their bones strong for as long as possible. While again, this condition is not “curable” the right management can make a huge difference to the quality of life.

 

 

 

 

 

 Spinal malformations & birth defects – account for the majority of the remaining Kyphosis cases – there are a number of conditions which can cause the vertebra to not develop properly. Depending on the underlying condition and the severity, it may need surgical intervention.

 

Treatment Of Kyphosis

In most cases of Kyphosis, the condition can be treated effectively with specific postural correction exercises & stretches, postural traction and kypho-bracing when necessary. Advanced manual approaches such as Chiropractic Biophysics can be highly effective in resolving Kyphosis cases. Beyond initial treatment, the same approach can be used to manage and reduce the severity of symptoms, often so that the impact on daily life is very little. Only in very severe cases is surgery typically required, and this is usually due to the risk of progression and further complications. Many cases of postural kyphosis can be improved or resolved.

The pictures below show the correction in an adult male with hyper-kyphosis, through the Chiropractic Biophysics technique. The pictures are approximately 1 year apart.

Scheuermann’s disease, and cases related to osteoporosis in particular, can often benefit from part-time bracing with a specialised Kyphosis brace, such as Kyphobrace – in these cases, a “cure” is not possible, but with proper management, it is entirely possible to live a normal and healthy life with Kyphosis.

In senior’s with kyphosis, caused by underlying osteoporosis, further compression fractures become more likely as the spine becomes progressively more hunched. Hence, treatment & exercise programs need to be gentle and designed to help keep patients more upright, improve balance to resist falls, and include nutritional support to help maintain bone strength. Gentle supportive bracing in senior’s can also be effective in helping them stay upright when whey are standing and walking.

 

 

Scoliosis

Whereas Kyphosis causes “forward hunching” posture, related to an excessive forwards bend in the spine, scoliosis causes a side to side curvature of the spine resulting in a distinctive scoliosis profile.

Unlike Kyphosis, Scoliosis tends more often to be a serious condition which, in most cases, progresses (sometimes rapidly) without proper treatment. While Scoliosis can cause pain, it does not always, and in many cases it is only detected through screening or is noticed by friends of family members during a trip to the beach or when changing clothes. Whereas Kyphosis is quite easy to spot. Scoliosis can progress to a significant degree without any obvious signs, so screening is a very good idea to enable early detection.

 

Causes of Scoliosis

Whereas the causes of Kyphosis are well understood, and (with a bit of planning) you can reduce your risk through targeted exercise and fitness approaches, most cases of scoliosis have no known cause – in a large number of cases, the condition is described as ”idiopathic” – literally meaning “without known cause”.  The underlying pathologies are therefore:

 

Idiopathic scoliosis – Idiopathic scoliosis is most commonly found in younger teenagers, with the most at-risk group thought to be between the ages of roughly 11 and 16. Girls are affected more often than boys, but boys can and do develop scoliosis.  While the cause is not currently known, research suggests that genetics may play an important role. It’s also believed that participation in some activities such as ballet or gymnastics, in which there is a contortion of the spine, may hasten or promote the development of scoliosis.

 

Degenerative Scoliosis – Degenerative scoliosis is a condition typically seen in people over the age of 60. In this case, we do know the cause – degenerative or “de novo” scoliosis is simply caused by wear and tear as we age, involving changing in the shape of the vertebrae and weakening of the spinal ligaments and muscles enabling the vertebrae to twist and turn.

 

Scoliosis from other causes – Other, less common causes of scoliosis include congenital deformities and problems with the formation of the spine such as hemi-vertebra or butterfly vertebra, and are usually present from birth. Other cases may be caused by underlying neurological and syndromic conditions that may or may not have already been diagnosed.

 

Treatment for scoliosis

Scoliosis in older individuals (de novo scoliosis) cannot be “cured”, in the same way as kyphosis in older individuals cannot be “cured” – however, similar approaches can be used to significantly reduce the impact of scoliosis on one’s life, and in some instances, it is also possible to reduce the scoliotic curve itself. Scoliosis bracing can be highly effective as a means to achieve this and has also been shown to reduce pain where it exists.

Scoliosis in younger individuals is almost invariably a case of idiopathic scoliosis – the treatment for this depends on the severity of curve at time of diagnosis, but in all cases, the objective is to straighten the spine as much as possible. In cases which are caught very early, when the curve is still small, scoliosis can sometimes be corrected using scoliosis specific exercises – a regime of scientifically based movements and stretches designed to counteract the scoliotic curve. In very young patients (who are not able to perform scoliosis specific exercise) or in larger curves, scoliosis bracing is the preferred method of treatment. While bracing results vary according to the brace type that is used, today a very high number of cases treated with corrective bracing achieve a reduction of the curve down to a “normal” scoliosis value.

 

Is it Scoliosis, or Kyphosis?

If you’re unsure about an unusual posture or spinal issue you have noticed, an excellent place to start is a professional consultation at the UK Scoliosis Clinic, just get in touch!

Can scoliosis get worse as you age?

Posted on March 2, 2020 by - Blog

Scoliosis is a progressive condition – it does tend to get worse as you age. However, scoliosis is somewhat unusual in that it does not have what we might call a “predictable trajectory” – this is to say that you cannot simply assume that after X years, scoliosis will have increased by X degrees. Rather, it often accelerates during growth spurts – and even outside of this develops at an unpredictable rate. It’s for this reason that we encourage people never to “wait and see” when it comes to scoliosis – a year waiting may see very little change in the condition, or it might be a lot…

It is possible to predict the rate of growth to some extent – and indeed, in cases of adult scoliosis (that is to say scoliosis which began in childhood and was carried into adulthood), we can estimate the increase in curvature to be approximately 0.82° per year.[1] By contrast,  the rate at which scoliosis increases in young patients depends more upon risk factors such as the severity of scoliosis considering age, the rigidity of curve, and family history. What we do know, is that Juvenile scoliosis greater than 30 degrees tends to increase rapidly and left untreated presents a 100% prognosis for surgery, whereas curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[2]

With scoliosis, there is therefore a very real need to act quickly and proactively if the condition is to be halted and the curvature corrected before either surgery is required, or full correction is no longer possible.

 

Rapid progression in scoliosis cases

While we know that scoliosis is subject to rapid and unpredictable changes in severity, most of the research in this regard has only targeted more serious cases – however, it’s likely that the same basic principles apply to smaller curves, again underpinning the need for fast action when scoliosis is suspected.

Recent research by the British scoliosis society[3] has shown that in patients already waiting for scoliosis surgery, curve progression can be considerable just during the consultation process. Their 2018 study specifically looked at scoliosis progression whilst waiting for a consultation and eventual surgery. In the study, 41 females and 20 males with a mean age of 11.8 years with a mean Cobb angle (curvature) of 58° were followed –  Average waiting time to be seen in the clinic for an initial consultation was 16 months – thereafter, the average waiting time for surgery was 10 months. Rapid curve progression was seen in twelve patients, of which 10 required more extensive surgery than originally planned. Their mean Cobb angle at presentation was 48° which increased to a mean of 58° at surgery.

Perhaps the saddest part about the study from the British scoliosis society was the specific data on the curves of the participants at the beginning of the research. While the study sought to examine curves which were already at the “surgical threshold”, the range of curves studied was actually between 17°–90°[4], and while a 90-degree curve would certainly be likely to require surgery, a 17-degree curve would almost certainly have not – indeed, a 17-degree curve would be an excellent candidate for the kind of conservative, non-surgical treatment we offer at the UK scoliosis clinic.

By the end of the study, however, after such a short time, the smallest curve was  30°and the largest was 120°. While it is certainly easier to treat a smaller curve,  a 30-degree curve still has a good prognosis with modern conservative treatment through active bracing, such as scolibrace.  This study goes to show that the right information at the right time makes a significant difference in scoliosis cases.  Indeed –  in stark contrast to the above – one recent study of 113 scoliosis patients treated with non-surgical approaches showed that vast majority achieved a significant curve correction and only  4.9% of patients needed surgery.[5]

 

Older adults

As we already mentioned, adult scoliosis cases – that is to say, childhood scoliosis which is carried into adulthood – does tend to progress at a more predictable rate, however as we age, there is an additional risk from Scoliosis.

Older adults are at considerable risk of another common form of scoliosis, known as “de-novo” (degenerative) scoliosis. De-novo scoliosis is caused by wear and tear to the spinal discs as we age, and is therefore quite common – research suggests that as many as 30% of the over 60’s suffer from scoliosis. Although de-novo scoliosis progresses much more slowly than childhood or adolescent scoliosis it can still have a major impact on quality of life, if not properly treated.[6]

Patients with de-novo or degenerative scoliosis, will often experience constant back and leg pain which makes it difficult for them to walk or stand for any period of time. They may become aware that they cannot stand up straight and lean towards one side, this becomes more noticeable the longer they are upright. Frequently they don’t find relief with standard conservative treatment such as chiropractic or physiotherapy and they are not suitable for surgery due to osteoporosis ie bone weakening. These patients often respond well to a gentle supportive brace, which helps to keep them upright and less tilted thus they can walk or stand more comfortably for longer periods of time.

 

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

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

[3] H V Dabke, A Jones, S Ahuja, J Howes, P R Davies, SHOULD PATIENTS WAIT FOR SCOLIOSIS SURGERY?  Orthopaedic ProceedingsVol. 88-B, No. SUPP_II

[4] H V Dabke, A Jones, S Ahuja, J Howes, P R Davies, SHOULD PATIENTS WAIT FOR SCOLIOSIS SURGERY?  Orthopaedic ProceedingsVol. 88-B, No. SUPP_II

[5] ‘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

[6] ‘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

 

Can scoliosis be cured?

Posted on February 20, 2020 by - Blog

For those who are diagnosed with scoliosis, the first question is almost always “can scoliosis be cured?”.  Scoliosis is a complex condition – and so is the answer to this question, but this week we’ll try to make it easy to understand!

 

What is scoliosis anyway?

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

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

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

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

Scoliosis is typically divided into two main categories – adult, and childhood scoliosis. Adult scoliosis is caused either by the degeneration of spinal discs with age or as a result of childhood scoliosis which was not treated. Childhood scoliosis (affecting infants through to young adults) has several known causes, but in 80% of cases, the exact cause is unknown. This is termed “Idiopathic” scoliosis. The remaining 20% of cases are typically caused by congenital or genetic conditions, spinal malformations, underlying neuromuscular conditions, metabolic conditions or trauma.

 

Can Scoliosis be cured?

It’s important to be clear about what we mean when we talk about a “cure”. As we’ve described, scoliosis isn’t a single issue condition. Whereas something like a throat infection is unpleasant, it has a single root cause and once correctly identified it’s easy for your GP to provide you with some appropriate medication – over a couple of weeks you can expect your condition to have fully resolved, or been “cured”.

In most cases, the underlying cause of scoliosis is unknown – and in some which are known (such as de-novo scoliosis), the underlying cause (here ageing) cannot be cured, but can certainly be managed.

Let’s look at an example – In an idiopathic cases (which typically affects children and teenagers) an initial diagnosis typically involves an existing scoliotic curve, and often some pain or muscle weakness. It’s possible to correct the scoliotic curve using approaches such as modern “active” bracing, as long as it is caught soon enough[1]. Muscle imbalances can be eliminated with appropriate physical therapy approaches, such as Schroth therapy, or Scoliosis specific exercise. Pain associated with scoliosis may be helped with complementary therapy such as massage in the short term, whereas evidence suggests that approaches such as bracing also reduce pain over the longer term.[2]

In many ways then, the symptoms of scoliosis can be cured – however, ongoing treatment is required to prevent the scoliosis from returning, since the underlying condition itself cannot be fully overcome. This being said, once a patient has reached skeletal maturity, scoliosis progression typically halts, and any further development can be prevented with appropriate exercises.

So, overall, it is more realistic to say that while scoliosis cannot be fully “cured” it’s entirely possible for the patient to live the rest of their life “scoliosis free” –  as long as the curve is caught early enough to be corrected.

 

Scoliosis requires ongoing monitoring.

One of the most notable aspects of scoliosis is its tendency to develop at a varying pace – and with a fairly unpredictable rate of progression, so it’s critical for anyone who has been diagnosed with scoliosis to continue to be monitored, at least until they reach skeletal maturity. Modern approaches to treatment do have a very high success rate, and research is now helping us to understand how we can best avoid any reduction in curve correction after a treatment plan has concluded[3] but ongoing monitoring is the simple and effective way to address any problems which may develop along the way to skeletal maturity.

At the UK Scoliosis Clinic, we’re keen to ensure all of our patients feel supported right from their initial consultation, through to skeletal maturity.

 

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

 

[2] Scoliosis bracing and exercise for pain management in adults—a case report
Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.

 

[3] 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