SCOLIOSIS

Scoliosis is a complex 3-dimensional condition of the spine and trunk in otherwise healthy individuals that can be progressive.

Scoliosis is often initially diagnosed when a patient enters adolescence but can start at a younger age (infantile or juvenile scoliosis). When the curvature initiates or becomes evident as the patient goes through puberty, it is called Adolescent Idiopathic Scoliosis, or AIS.

It is not well understood what causes scoliosis to initiate. Research suggests it is multifactorial and can be related to genetic factors, family history, and joint mobility/connective tissue.  It tends to be more common in girls than in boys and affects approximately 3% of the population. Scoliosis can progress (worsen) during rapid periods of growth.

We can measure scoliosis curves to determine how big or small they are. We use degrees to define objectively how big or small a curve is. The larger the number of degrees, the greater the magnitude of the curve. The scoliosis curve measurement in degrees is called a “Cobb angle.” We can also measure the amount of rotation that is present with scoliosis curves using the x-ray, or we can measure the angle of trunk rotation (ATR) if the patient is in the clinic. This can be done painlessly using a scoliometer. Both the Cobb angle and the ATR are important measurements to determine scoliosis severity and prognosis.

Scoliosis can present in different ways but typically it looks like one of these patterns. A physical therapist who is a scoliosis specialist can look at your x-ray and how your body moves to classify your scoliosis curve type – this classification guides the treatment strategy.

When a child or teen grows, they may not grow symmetrically. This is normal! Often growth will occur in one bone (leg, foot, etc) and then the other side will catch up. This happens in your long bones (arms and legs) and in your other bones like your vertebrae bones (spine bones) and pelvis. What isn’t normal is when a bone grows longer or taller on one side, but the other side fails to catch up for a while. In the spine bones, if one side of the bone grows taller, but the other side stays short for a time, this can create a bone shaped like a trapezoid or wedge (abnormal – orange) instead of a rectangle (normal – blue).

The bony changes that are occurring are not limited to the wedging on the side of the spine bones. There are also bony changes that affect the shape of the bone from front to back. There is an increase in growth on the front of the bone relative to the back, causing the bone to be taller on the front than the back. This is why many patients with scoliosis have flattening in their midback (area between the shoulder blades).

Take this x-ray for example. The spine is bent like an “S” and the top curve is to the right and the bottom curve is to the left. The top curve is not only bent to the right, it is also twisting backwards on the right. As the spine curves, it pulls the ribcage with it. This person’s ribs will be rotated backwards in their right upper back and if they bend forward and you look at their back, you might notice the ribs on the right are higher than the ribs on the left. Also, when upright, this person’s right shoulder will likely be more forward than the left shoulder. These body changes occur because of the 3-dimensional nature of scoliosis.

Yes! If your growth is complete, your growth plates are closed so your bones can no longer grow more asymmetrically. However, scoliosis can still worsen once growth is complete. Scoliosis can be progressive in nature – meaning over time, with gravity, the curve can worsen due to the asymmetries, poor posture, muscle weakness, increased mobility in the joints, arthritis, hormone changes, and body mechanics. It is generally expected that scoliosis curves worsen by 1º every year as adults.

Yes! But not all “treatment” for scoliosis is equivalent – and not all “treatment” is effective. Traditional physical therapy has not been shown to be effective for patients with scoliosis. However, scoliosis specific physical therapy (PSSE) exercises have been shown to be effective; and these specialized types of exercises are backed by over 100 years of implementation and high-quality research studies. It takes a trained scoliosis specialist to teach scoliosis specific exercises. A physical therapist without this additional training is not able to teach these exercises in the same way that a spine surgeon wouldn’t operate on your knee, and you wouldn’t go to an orthopedic doctor to manage a heart condition. Scoliosis is a complex condition that requires additional training to safely and effectively manage.

At Align Physical Therapy, over 95% of our caseload is patients with scoliosis or kyphosis. We treat patients with scoliosis from 4 years old to octogenarians. We understand how scoliosis can be well managed across the lifespan. Patients travel from all over the country (and even a few other countries!) to seek the highly specialized treatment we can provide.

For more information about Physiotherapeutic Scoliosis Specific Exercises (PSSE) like the Schroth Method and BSPTS Rigo Concept and how this type of physical therapy is very different from standard physical therapy, click here.

For more information about the research that supports the use of PSSE, click here.