Article by John Miller
What is Scoliosis?
Scoliosis is a medical condition where your spine is curved from side to side. The spine of an individual with typical scoliosis may look more like an "S" than a straight line. Approximately 2% of the population will have a scoliotic curvature in their spine and approximately 10% of these are severe.
A scoliosis is named according to where the apex of the curvature of the spine occurs. Most commonly these curves occur in the thoracic (mid-back) and thoracolumbar (junction between the thoracic and lumbar) areas of the spine. Scoliosis does not commonly occur in the neck.
Early adolescence, specifically between 11 and 14 years of age is the ideal time to screen your spine for scoliosis. Scoliosis can progress during adulthood if not treated during youth. Therefore, being checked and treated at any stage can greatly improve your comfort, muscular strength and mobility.
What Causes Scoliosis?
Several types of scoliosis exist:
Structural (Idiopathic) scoliosis has genetic roots. A family history of scoliosis, particularly along the female side can increase your likelihood of having it by up to 20%. Idiopathic scoliosis usually develops in early adolescence between the ages of 11-14, with a higher incidence occurring in females than males (10:1). Progression of scoliosis is also more common in females than males. If left undiagnosed and untreated in adolescence, the curvature of the spine can progress.
Functional scoliosis can develop in adulthood, often in response to an injury or repetitive practice of asymmetrical activities (i.e. tennis, golf swing etc). It is a curvature of the spine that has formed from overuse of muscles on one side of the side and underuse of muscles on the reciprocal side. Since it is muscular based, it can reverse with appropriate treatment and exercise.
Pathology-related scoliosis can arise in people with a neuromuscular disease such as muscular dystrophy or in response to a severe injury to the spinal cord such as quadriplegia.
What are the Symptoms of Scoliosis?
Physical signs in children after the age of 8 that parents should suspect is scoliosis:
Contrary to common belief, scoliosis does not result from poor posture. However, it can progress to a more severe curve as a result of a poor posture of weak spinal muscles.
How is Scoliosis Diagnosed?
Checking for scoliosis is normally undertaken during a routine clinical examination by your physiotherapist or doctor.
Your physiotherapist will examine your spine, shoulders, rib cage, pelvis, legs and feet for abnormalities and asymmetry. If they suspect significant scoliosis, they will arrange for X-rays to confirm your cobb angle - or severity of scoliosis.
A significant curvature in the spine detected in adolescence will require a review from an orthopaedic spine specialist.
What are the Treatment Options for Scoliosis?
PHASE I - Pain Alleviation
While not all scoliosis sufferers experience pain or discomfort a percentage do. In these patients the provision of pain relief does assist with patient compliance with corrective or prevention exercises.
Pain relief can be achieved through a variety of techniques:
In this phase your physiotherapist may also introduce gentle exercises to maintain mobility in your spine as well as enhance your posture while your pain settles.
PHASE II - Rectifying Imbalances (Strengthening and Stretching!)
As your pain and inflammation settles, your physiotherapist will turn their attention to optimising the strength and flexibility of your muscles on either side of the scoliosis. They will also include adjacent areas such as the hip and shoulder region that may impact upon your spinal alignment.
The main treatment aims will include restoring normal spine range of motion, muscle length and resting tension, muscle strength, endurance and core stability.
Taping techniques may be applied until adequate strength and flexibility in the targeted muscles has been achieved.
PHASE III - Restoring Full Function
This scoliosis treatment phase is geared towards ensuring that you resume most of your normal daily activities, including sports and recreational activities without re-aggravation of your symptoms.
Depending on your chosen work, sport or activities of daily living, your physiotherapist will aim to restore your function to safely allow you to return to your desired activities.
Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon. Your physiotherapist will tailor your back rehabilitation to help you achieve your own functional goals.
PHASE IV - Preventing a Recurrence
Since scoliosis in many cases is a permanent structural change in the skeleton, ongoing self-management is paramount to preventing re-exacerbation of your symptoms. This will entail a routine of a few key exercises to maintain optimal strength, flexibility, core stability and postural support. Your physiotherapist will assist you in identifying which are the best exercises to continue in the long-term.
In addition to your muscle control, your physiotherapist will assess you hip biomechanics and determine if you would benefit from any exercises for adjacent muscles or some foot orthotics to address to correct for biomechanical faults. Some scoliosis results from an unequal leg length, which your therapist may address with a heel rise, shoe rise or a built-up foot orthotic.
Rectifying these deficits and learning self-management techniques is key to maintaining function and ongoing participation in your daily and sporting activities. Your physiotherapist will guide you.
What Results Can You Expect?
If you have mild to moderate scoliosis, you can expect a full return to normal daily, sporting and recreational activities. Your return to function is more promising when you are diagnosed and treated early.
Individuals with more moderate to severe spinal curvatures may need to be fitted for orthopedic braces in order to halt curve progression. In some severe cases during adolescence, surgery is indicated. Both of these latter two pathways are overseen by an orthopaedic specialist who may require monitoring the progress of the curve with routine x-rays.
If you have any concerns or questions regarding your scoliosis, please ask your physiotherapist or doctor.
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Nerve-related / Referred Pain
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