Scoliosis

Scoliosis is a regularly treated condition at Trimetrics where we use evidence based integrated approach: manual therapy, Schroth and Pilates based exercise.

Scoliosis is a three-dimensional change in the spine. It is a change in the shape and the position of the spine, thorax and trunk. It involves fixation of the vertebrae having moved into extension, lateral deviation and rotation. The majority of Scoliosis cases (80-90%) are idiopathic meaning that there is no known cause. The most recent evidence suggests that it is potentially genetic and multifactorial.

Scoliosis occurs during periods of most growth. Generally, this occurs during puberty with most change occurring at the beginning of puberty. Scoliosis is also most likely to progress during other periods of change through the lifespan e.g. post menopause. Degenerative Scoliosis can start in the postmenopausal period and is often accompanied with low back pain, instability and osteoporosis.

Commonly, girls are more likely to have Scoliosis than boys. Scoliosis can have major psychological implications to those affected as a chief factor is the esthetic change. It can majorly affect body image especially as it often occurs at a very important age of development. Initially, signs of scoliosis are mainly visual but generally between the ages of 20-30 years’ onset of pain occurs. Evidence indicates that early treatment will decrease the chance of pain.

What to look out for (Signs and Symptoms)

• Scoliosis will appear as a lateral curve of the spine when viewing a person from behind. It can appear as an “S” or “C” shape and opposed to a straight line.
• 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.

Assessment and diagnosis

Adam’s Forward Bend Test
This is a tool that can be used by anyone suspecting a Scoliosis in another individual.

Imaging
X-ray is typically used to measure the Cobb angle of the curve. It can also be used to measure The Risser sign and congenital spine/rib abnormalities. Other tests, which may be used, include Chest X-ray and on occasion cardiac and pulmonary 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.

Postural analysis
A trained eye is required to identify abnormalities in each of the different body blocks (Shoulder, Thoracic, Lumbar, Hip and Pelvic block). This allows for a systematic Scoliosis type to be identified and classified to aid the treatment plan.

Scoliometer
A simple tool used externally to measure the angles on the curves. Not as reliable as imaging but can be used as an objective measure.

Every Scoliosis is different and for this reason it is essential to undergo individual assessment for an appropriate treatment plan to be prescribed. In some cases, bracing or surgery may be advised or required.

Treatment

Schroth method
This is a system of assessment and exercise therapy developed in Germany in 1973.
Schroth exercises are customized for each unique spinal deformation. The technique is very successful since it elongates, de-rotates and medially deviates the spine. The method teaches the individual how to correct their spinal rotation incorporating a rotational breathing technique which increases lung capacity. The Schroth method restores normal spinal position through pelvic corrections, breathing techniques, and stabilizing isometric contractions.
The exercises are neuromuscular aiming to reprogram posture affected by scoliosis. Pelvic corrections are used to help patients to consciously correct their posture.  www.schrothmethod.com
The method places a large emphasis on improved posture during routine daily living. The exercises are performed in a variety of different positions to correct abnormalities during treatment sessions and to carry over into normal daily routine.

Clinical Pilates Exercise
Clinical Pilates exercises (Pilates exercises tailored to meet an individual spine’s needs, delivered by or under medical supervision of our Registered Physiotherapists) can decrease the degree of scoliosis, increase the flexibility and function of the posterior muscular chain and reduce pain. We have a full suite of Balanced Body Pilates equipment: we typically use the Reformer, Trap table (Cadillac), Chair, Core Align, as well as, mat exercises.
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.

Postural re-education
Through hands-on, verbal and visual cues.

Education
Having a better understanding of Scoliosis empowers the individual to develop pro-active coping strategies.

Photos to measure change
Photos taken during the initial assessment and then monthly follow-up photos allow for visual change to be followed and identified. This provides motivation and a better body awareness.

Breathing exercises
Scoliosis hugely affects the functioning of the rib cage and the lungs. Specific breathing exercises help to counteract this.

Assessment and treatment of secondary symptoms
Due to the spinal imbalances other changes can occur over time. The Therapist will also assess this and attempt preventative measures. Any changes will be observed and targeted throughout the rehabilitation journey.

Manual Therapy
As needed, specific hands on spine and pelvic mobilization techniques can be used to assist with de-rotation, medial deviation and flexion of the spinal levels.

Functional Dry Needling/Intramuscular Stimulation
Secondary symptoms can appear as tension in certain groups of muscles. FDN/IMS can be used to release old, tight, painful muscles, so that the spine is free to move where it did not before, and both brain and spine are free to receive new postural training to maintain corrections.
For treatment to be effective it is vital that the patient commits to the program with absolute compliance to the home exercises and use of the props in every day settings.