Physiotherapy in Action

Physiotherapy In action: Idiopathic Scoliosis

by: - February 3, 2017
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By: Dr Lucia Corriette
Physiotherapist

Overview

Scoliosis is a condition that causes the spine to curve sideways. There are several different types of scoliosis that affect children and adolescents. The most common type is “idiopathic,” which means that there is no known cause.

Idiopathic scoliosis tends to occur between age 10 and the time a child is fully grown. Scoliosis is not usually painful and small curves are not usually seen by children and their parents. Instead, they may be discovered during a school screening or at a regular check-up with the pediatrician. In some cases, complaints of back pain lead to a doctor’s visit where a diagnosis is made.

Scoliosis causes the bones of the spine to twist or rotate so that instead of a straight line down the middle of the back, the spine looks more like the letters “C” or “S.” These curves are more often seen in the upper and middle back (thoracic spine); but they are also present in the lower back (lumbar spine), and occasionally, in both the upper and lower parts of the spine.

Idiopathic scoliotic curves form in different sizes and mild curves are seen more often than larger ones. In children, a curve can worsen rapidly during a growth spurt.

Although it can develop in toddlers and young children, idiopathic scoliosis usually begins during puberty. It is seen in both boys and girls, but girls are more likely to develop larger curves that require medical care.

Causes

• Usually unknown
• May be a genetic component; 30% of patients with adolescent idiopathic scoliosis have a family history of the condition
• Congenital – present at birth
• Neuromuscular – due to abnormal muscles or nerves and conditions such as cerebral palsy
• Degenerative – due to bone collapse from trauma or osteoporosis
• Not due to activities such as carrying a heavy bag to school
• Not due to poor posture

Signs and Symptoms
• Tilted, uneven shoulders, with one shoulder blade protruding more than the other
• Prominence of the ribs on one side
• Uneven waistline
• One hip higher than the other

Medical Management

Diagnostic tests
X-rays will provide clear images of the bones in the spine. The doctor will be able to see the exact location of the curve and to measure how severe it is. The more serious curves are greater than 25 degrees and may need treatment. Curves that are more than 40 degrees may require surgery.

Nonsurgical Management
Observation: Curves are monitored through observation and use of x-rays every 4-6 months by the attending physician.
Bracing: For adolescents who have curves between 25-40 degrees, use of a brace may be warranted. This is important because at this age, there are some years of growth remaining and the curve can increase in size during this time.

Surgical Management
Surgery may be recommended if the curve is greater than 45-50 degrees or if bracing did not stop the curve from increasing to 45- 50 degrees. This is important because severe curves that are not surgically corrected could affect lung function.

The surgery performed is usually spinal fusion. Its purpose is to straighten the curve and fuse the vertebrae (spinal bones) together. This way, they become one single, solid bone. Following this procedure, there will be no further growth of the part of the spine affected by scoliosis. The bones are kept in position with the use of metal rods until they become fused.

Only the curved part of the spine is fused during surgery. Therefore, the other bones of the spine will be free to assist with motion.

Surgical correction of scoliosis

Physiotherapy
Adults with scoliosis suffer from spinal pain, which is experienced more in this group than in adults without scoliosis. Adolescents with mild scoliosis also experience back pain. This can be addressed effectively during a course of physiotherapy treatment that includes pain relieving techniques along with exercises.

Specific exercises are a big part of the treatment for scoliosis. They are not viewed as an alternative to bracing or surgery (in those who have moderate-severe scoliosis), but as a form of treatment that can be used alone, or along with bracing or surgery. In non-progressive scoliosis, these exercises could result in a reduction of the curve. Scoliosis specific exercises can also improve back asymmetry, secondary muscle imbalance and related pain. In more severe cases of thoracic scoliosis, they can also improve breathing function.

In the ideal setting, the physiotherapist works as part of a team that includes the orthopaedic doctor, the orthotist (responsible for making braces), and the mental health care provider. Mental health is an important aspect of medical care for those patients with significant curves. This is because of the psychological issues associated with body image perception among adolescents as a result of the spinal curve and the need to wear a brace for most of the day.

Take Away

Pay close attention to complaints of back pain in adolescents; particularly regular complaints. Seek medical attention in such cases.

References
1. American Academy of Orthopedic Surgeons. Idiopathic Scoliosis in Children and Adolescents. http://orthoinfo.aaos.org/topic.cfm?topic=A00353 Accessed January 10, 2017
2. Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al. Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools. Scoliosis and Spinal Disorders. 2016;11:20. doi:10.1186/s13013-016-0076-9.
3. CHOC Children’s. Scoliosis. http://www.choc.org/orthopaedics/spine-center/scoliosis/ Accessed January 10, 2017
4. Fitnesspedia. Scoliosis-Rehabilitation: Exercise Therapy. https://fitnesspedia.wordpress.com/2012/08/19/scoliosis-rehabilitation-exercise-therapy/ Accessed January 10, 2017
5. Massage Education Guide. Scoliosis and the Benefits of Massage Therapy. http://www.massage-education.com/scoliosis.html Accessed January 10, 2017
6. Mayo Clinic. Scoliosis. http://www.mayoclinic.org/diseases-conditions/scoliosis/home/ovc-20193685 Accessed January 10, 2017
7. Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012;7:3. doi:10.1186/1748-7161-7-3.