How to detect a Scoliosis and what to do if you identify one?
Scoliosis is a lateral curvature of the spine greater than 10 degrees. When we look at a spine from behind the person it should appear that the spine runs in a straight line up and down. When a person has a scoliosis this straight line will instead be curved. The curve can appear as either an “S” or a “C” shape.
There is no formal screening for Scoliosis in schools in Canada. Parents need to be extra vigilant and aware of the warning signs. It is often overlooked as it may not be painful. If you suspect that you or someone you know may have a scoliosis The Adams Forward Bend Test can be used as an identification tool.
Stand behind the person and have them flex their body forwards. If there is a notable hump on one side (if one side is raised) this is indicative of a scoliosis and the individual should seek advice from a medical professional.
Other signs and symptoms to look out for:
- Asymmetrical ribs, shoulders or pelvis – clothes may not fit correctly or you may notice that clothes hang unevenly.
- Decreased flexibility of the spine.
- Back pain and muscle spasms – One third of Scoliosis patients complain of back pain, often located in the thoracic (mid-back) or lumbar (low back) regions of the spine. Inflammation can develop around stressed areas of muscles and joint along with degenerative change occurring at a faster rate.
- Issues with cardiopulmonary (heart and lungs) function – only with severe curves. It may feel difficult to take a deep breath.
- Gait abnormalities – Change in walking pattern. One foot may not strike the ground for as long as the other foot. You may notice that one hand grazes the hip but the other does not.
Types of scoliosis:
Idiopathic – This is the most common type of Scoliosis and simply means that there is no known cause. Despite having no known cause, it may be linked to genetics and is most often multifactorial. It usually presents during the ages of 10-15 or following a growth spurt.
Degenerative – The most common form of adult scoliosis is degenerative. Older patients are more likely to have newly diagnosed scoliosis secondary to degenerative diseases e.g. osteoporosis.
Functional – Causes include but are not limited to leg length discrepancy and muscle spasm. Functional Scoliosis is reversible.
Congenital – Include malformation of the vertebrae. Congenital scoliosis is associated with abnormal development in the embryo and may occur in association with developmental abnormalities in other organ systems.
Neuromuscular – occurs in patients with neurologic or musculoskeletal disorders.
Diagnosis and imaging:
When a Scoliosis is suspected the usual tests for this condition include X-Ray (Cobb Angle, Risser sign, congenital spine and rib abnormalities), Chest X-ray and on occasion Cardiac and Pulmoary function Tests (only if curve is greater than 60° or when there are signs and symptoms consistent with respiratory problems present)
MRI is not routinely performed but may be done in patients with neurological symptoms or when there has been rapid progression of the curve angle.
The curve severity and progression, skeletal maturity, sex, and age of the patient are used to determine the method of treatment. Once the Cobb angle has been determined a treatment plan can be created for the individual.
Surgery: Cobb Angle > 40-45° surgery is likely indicated.
The goal of surgical intervention is to reduce the severity of the curve as able and prevent further progression.
Bracing: Cobb Angle 30-40° – bracing is indicated and must occur immediately.
The goal of bracing is to slow progression of the curve angle and to attempt to better align the individual.
Physiotherapy: Physiotherapy treatment of scoliosis consists of advice and education, decision guidance, breathing retraining, mobility and strengthening exercise. Scoliosis specific exercises have been proven to prevent further increase in curve angles and also to reduce the curve angles in some individuals. Scoliosis specific exercise has been proven to reduce the need for bracing. The forms of exercise with the best evidence base for Scoliosis management are Pilates and The Schroth technique.
Pilates and Scoliosis
Pilates exercises significantly decrease the degree of scoliosis, increase the
flexibility of the posterior muscular chain and reduced pain in the individual.
Scoliosis-specific exercises can reduce spine curvature and prescriptions for braces in adolescents with idiopathic scoliosis through Pilates exercise combining
flexibility, muscular contraction, body awareness and posture correction, using
equipment such as the reformer, Cadillac and Chair. Pilates-based de-rotational
exercises focusing on core activation and isolation of Transverse Abdominus are
used to effect more balanced alignment and as a result decrease the curve angles.
The Schroth Techinque for Scoliosis– Coming soon to Trimetrics…
Schroth exercises are customized for each unique spinal deformation. The technique elongates and de-rotates the spine.
The method teaches the individual how to:
Correct their spinal rotation.
To increase lung capacity with a rotational breathing technique.
To restore normal spinal position through pelvic corrections, breathing techniques, and stabilizing isometric contractions.
Improve posture during routine daily living.
The Schroth exercises are neuromuscular exercises that aim to reprogram posture affected by scoliosis. Pelvic corrections are used to help patients to consciously correct their posture.
The exercises are performed in a variety of different positions to not only correct abnormalities during treatment sessions but to carry over into normal daily routine.
Specific Benefits of Physiotherapy Treatment
- Prevent progression of the curve through postural training.
- Decrease levels of pain and teach coping strategies for pain.
- Improve strength
- Teach a home exercise program for self-management.
- Improve appearance and in turn enhance self-esteem.
- Provide information to support the decision-making process.
- Proactive spinal corrections to avoid surgery.