What is scoliosis?

Scoliosis refers to a spinal curvature different to the normal spine. The curve can be found either in the lower, middle, and/or upper back. These abnormal curvatures are described as looking like a “S” or “C” shape.

There are different types of scoliosis and different causes for this condition. Because the severity of each type of scoliosis can vary and it can be a highly complex condition. Additionally, the progression of scoliosis is different for each individual. And it depends on the age of diagnosis, severity, the initial treatment process chosen as well as the treatments completed.

It affects 2 – 4% of young individuals and predominantly females. Generally, the malformation in the spine occurs in a 3D manner and affects the alignment of the vertebrae. Which in turn, changes the function (biomechanics) of the entire body. The function of the back muscles and the rest of the body is abnormal and painful. Your back is also not be as strong as it should be, thus generating pain during certain postures or activities. Imagine the building blocks of a wall. If anything happens to anyone of the bricks, the top and bottom bricks are negatively impacted. The entire structure of the wall changes and can collapse if it is not corrected.

Diagnosis

Scoliosis is usually diagnosed when symptoms develop. Radiologists use diagnostic tests such as, X-rays, Magnetic Resonance Imaging, and Computed Tomography to confirm the diagnosis. So they measure the Cobb-angle of your spine, which indicates the severity of scoliosis. And, if the degree of the sideways curvature exceeds 10 degrees (Cobb-angle), it is diagnosed as scoliosis.

Severity according to the Cobb angle diagnosis:

Light: 10 to 20 – 25°
Moderate: 25 to 40 – 45°
Severe: greater than 40 – 45°:

Scoliosis X-ray

Treatment options

The two main options for scoliosis treatment is either conservative treatment or corrective surgery. Conservative treatment includes exercise therapy and or bracing. The type of treatment you choose to undergo, depends on the severity of your scoliosis curve, age at which you are diagnosed, the risk of disease progression and the best viable option for you and your family.

Exercise therapy include various methods and protocols that have been researched and confirmed to assist in the management of scoliosis. The main methods that we use in our exercise therapy is:

  1. The Schroth method
  2. The Scientific Exercise Approach to Scoliosis (SEAS) method

Most patients benefit from conservative treatment even if they choose to undergo corrective surgery. Because, conservative treatment like exercise therapy treats the muscles that stabilize and move the spine. Even if you have a straight and normal spine, you need to exercise the surrounding muscles in the correct manner in order for them to function at their best. Who doesn’t want strong and healthy muscles!

Bracing is a form of conservative treatment that may be introduced to a scoliosis patient if the specialist thinks it will help. In most cases bracing is done by an orthotist or prothetist. They will take measurements and make a brace specific to you. Normally, bracing is very effective in young people, because it can still manipulate your bones to grow in a certain manner. Bracing prevents further spinal column deviation. Thus, the older you are, the less effective bracing becomes.

Bracing requires the patient to wear it most of the day. With the exception of taking the brace off during sport practice and other physical activities. The option of taking the brace off during sport activities might be declined by the specialist in severe cases.

Surgical interventions is definitely the most effective manner to correct the scoliosis curve. However, it is the most invasive and expensive way to correct the spinal curvature. Although corrective surgery is very successful in correcting spinal deformities, the procedures are not without risk.

In many cases, surgical intervention is the last resort. In some cases, if the Cobb-angle is severe (> 50 -degrees), corrective surgery is the only option. Even then, exercise therapy must be introduced post surgical procedures to ensure that the surrounding muscles and structures are strong enough to allow proper stability and movement.

Conservative treatment like exercise therapy might take longer to manage or stop the spinal curvature progression. But it does not come with the risks associated with corrective surgery.

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More on exercise therapy

1. Schroth method

By using this method we focus on strengthening and lengthening uneven muscle groups around your spinal column. The primary aim when using the Schroth method is to improve posture and spine alignment.

How do we do this?

Exercise therapy is the tool that we as biokineticists use to manage your scoliosis curve and ultimately stop the abnormal curvature form progressing. In the beginning, each new session is monitored by us and you will receive exercises for homework. We show you how to maintain a better posture by teaching you which muscles to activate and which ones to relax. We call this posture correction exercises.

Some of the exercises include external aids or equipment that assists you to perform the exercises in the correct manner. Such as small pillows, exercise balls, therabands or an exercise stick.

Each posture correction exercise has to be practiced by you many times during the session, but also many times at home. Often, we use a mirror so that you can monitor yourself and see how you can change your posture with the exercises. You are taught how to visualize your abnormal posture in to a better posture. How to lengthen or contract your ‘collapsed’ area. Exercise repetition with precision is the key to managing your curve progression.

What else?

In addition to the posture correction exercises, we teach you how to change your breathing pattern during the exercises. The breathing assists in the posture correction by allowing additional lengthening to occur. These exercises allows us to teach you a new normal posture. The more you practice this new normal posture, the better your scoliosis curve looks.

Over time, your weak muscles get stronger and your tight muscles more flexible. The imbalances in your spinal muscles is corrected and your spinal curve has improved stability. Your back feels like it can move more freely and without the pain it used to experience. In the end, all these posture correction exercises and repetition of them will help you manage and stop the curve progression.

2. SEAS method

SEAS (Scientific Exercise Approach to Scoliosis) method focuses on specific exercises that require active self-correction techniques. These exercises are performed without any external aids and is incorporated into daily activities.

How do we do this?

We can think of the SEAS method as an extension of the Schroth method. During the Schroth method we teach you how to activate the right muscles in different postures and exercises and how to breathe during these exercises. After you master the activation of the correct muscles, we use many exercises to strengthen your muscles in various ways. We apply similar principles but challenge the body and muscles to a greater extent. Treatment sessions are conducted at least twice a week for 40 – 60 minutes each. Unlike the Schroth method these exercises are mostly performed at home.

Primary goals include:

  1. Increasing patients awareness of deformity
  2. Independent 3D self-correction by patient
  3. Subconscious self correction in daily life postures and tasks
  4. Spinal stabilisation
  5. Enhanced posture control – improved look of the body
  6. Use of exercises in which balance reactions are elicited
  7. Possible wearing of brace while performing rehabilitation program
  8. Not focused on repetitive precision of exercises but rather variability of exercises

Ultimately, we aim to reduce the scoliosis curve progression with the exercises, manage pain and posture during everyday activities.

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Scoliosis in upper or lower back pain

Pain

Your pain might be during simple tasks such as:

Standing, walking, or lifting objects.

You also feel like you have less movement on the one side when compared to the other side.

Minimize curvature progression

Primary aim

Primary aim of conservative treatment – exercise therapy and or bracing –

Assists in the management to stop or minimize curvature progression.

Physiotherapist Pretoria East, Discovery Physiotherapist - Physio Pretoria, Discovery network physiotherapist, Medical Aid Physiotherapist

Why choose conservative treatment?

1. Fewer risks compared to corrective surgery
2. Less expensive
3. Spinal curvature less than 50-degrees encouraged to try conservative treatment first
4. In many cases, conservative treatment produces just as successful patient outcomes as corrective surgery
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Why come to us?

Yes, we give professional and friendly service.. But we give you so much more. You get the option to see your progression from beginning to end. You decide if you want pictures and videos taken before, during and after your exercise therapy period. This gives a clear indication of posture and movement improvement.

We may provide progress reports if required by you or any other health care provider.

Continuous evaluations and supervision

Your posture and ability to use your muscles is evaluated at your first consultation and we keep evaluating this through your exercise therapy journey. You get better with each session because you complete the therapy exercises with us at the biokinetics centre AND at home. Additionally, you receive videos to remind you how to do each exercise.

You may decide to send us videos of you doing your exercise therapy at home – And we love this! We want to see you actively striving to improve your scoliosis curve with the exercises we give you! The videos have explanations and demonstration – which make it easy and fun to complete your therapy at home.

What structures are affected?

The back is made up of many different structures i.e. muscles, nerves, tendons, ligaments, discs, joints, and vertebrae. Together there is 33 vertebrae which forms the spinal column. The spinal column is divided into 5 sections: Cervical, Thoracic, Lumbar, Sacral and Coccygeal. Your spine is the primary bony structure that is affected by scoliosis, however not the only structure. Muscles, ligaments, tendons and fascia in the back attach to the spinal column and as the vertebrae change in shape and direction, these other structures change with them.

What do the structures do?

The spinal column has a few important functions: Firstly, it protects the spinal cord on the inside of the spinal column. It also serves as a place of attachment for soft tissues structures such as muscles, ligaments, tendons and fascia. And the soft tissues provide stability for the spine during static and dynamic movements such as sitting or walking. It allows movement to occur in an efficient manner. Also, the lumbar spine provides stability and mobility for the upper body. So it helps to transmit the forces between the upper & lower parts of the body. In essence, the spine connects the upper body and lower body and allows for efficient movement to occur.

Normal standing posture, side view

What happens to these structures when you have scoliosis?

Scoliosis, which is an abnormal spine curvature, has many different causes. There are many types of scoliosis but each one causes an abnormal loading within the spine. Because of the progressive overload, there is a decrease in the spine’s ability to maintain stability. And your spine then continues to grow in an asymmetrical manner, leading to the worsening of the spinal curves.

The vertebral bones experience more pressure on the one side. The tendons and ligaments shorten on the one side of the spinal column and it lengths on the other side of the spinal column. Which means these structures (muscles, ligaments, tendons) around the vertebral column cannot maintain their physiological alignment.

When these structures cannot maintain their alignment they cannot perform their original function. And stability and mobility in the spine is not optimal. Additionally, the forces you expose your back to is not properly transmitted between the upper and lower parts of the body. As a result, your body is not able to move as efficiently as it is supposed to and it limits you during normal and sport related movements.

Types of scoliosis

Early onset scoliosis

  • Present prior to the age of 10
  • Because they are still growing, it can affect more than just the spine
  • It can cause the ribs to be malformed, which may affect lung development
  • Minimal outward signs of spinal problems in the case of mild severity
  • Importance of treatment is crucial
  • No treatment may lead to heart and lung problems
  • Symptoms & signs may include:
    • Tilted head
    • Uneven shoulders
    • Asymmetric waistline
    • Uneven hips

Adolescent Idiopathic Scoliosis

  • Most common form of scoliosis, diagnosed between the ages of 10 and 18
  • No single cause has been identified
  • Spinal curvature may continue to progress into adulthood
  • Possible causes include hormonal imbalances or asymmetric growth
  • 30% of diagnosed adolescents have a family history of scoliosis
  • Most patients don’t experience pain or neurological abnormalities
  • May appear normal in side view
  • Symptoms may include:
    • Uneven shoulders
    • Protruded rib on one side
    • Leaning torso
    • Lower back pain may be experienced at times

Congenital

  • Fairly rare
  • Spinal abnormalities that develop in the womb
  • A spinal defect will be present at birth
  • Possibilities of additional curves in the opposite direction
  • Detected at an earlier age than other condition or diseases
  • Symptoms may include:
    • Tilted shoulders
    • Uneven waistline
    • Protruded rib on one side
    • Tilted head
    • Body leaning to one side

Degenerative Scoliosis (De Novo Scoliosis)

  • Also referred to as adult onset scoliosis or late onset scoliosis
  • People over the age of 60 has a 60% chance of having degenerative scoliosis
  • No prior history of scoliosis
  • Sideways curvature of the spine that develops slowly over time
  • Age-related degeneration of the spine
  • Spinal curvature to become more pronounced on one side
  • Commonly develops in the lumbar spine (lower back)
  • Normally a C-shape curvature
  • Symptoms may include:
    • Mostly associated with some sort of pain, especially in the lower back
    • Might include a dull ache or stiffness in the lower back
    • A burning / tingling / numbing or radiating pain that is felt down the legs
    • Sharp pain in the leg that is felt during walking but goes away during rest
    • Decrease in balance abilities
    • Muscle fatigue
    • Poor posture

Neuromuscular scoliosis

  • Type of idiopathic scoliosis
  • Develops secondary to various disorders of the brain, spinal cord and muscular system (i.e. cerebral palsy, muscular dystrophy, myelodysplasia, Duchenne muscular dystrophy)
  • Spinal curvature occurs when the disease affects the nerves and muscles. Which then are unable to maintain the proper alignment and balance of the spine and body
  • May progress into adulthood
  • Progression of scoliosis is more rapid than other forms of scoliosis
  • People in wheelchairs who struggle to sit upright may develop neuromuscular scoliosis
  • Symptoms may include:
    • Normally not painful
    • Pain if the spinal curvature is very severe
    • First sign of neuromuscular scoliosis is a change in posture
    • Leaning forward or to one side while standing or sitting

Scheuermann’s Kyphosis

  • A type of kyphosis (rounding or abnormal curve in the upper back)
  • Normally diagnosed during adolescence
  • Secondary to another structural deformity in the vertebrae
  • Symptoms may include:
    • Muscle fatigue
    • Poor posture
    • Back pain
    • Stiffness
    • Normally the symptoms do not get worse over time, except in severe cases

Syndromic Scoliosis

  • Secondary to another syndrome
  • Common linked syndromes include Muscular dystrophy, Rett’s syndrome, Beale’s syndrome, osteochondrodystrophy & multiple soft tissue disorders
  • Screening is possible at an early age
  • Symptoms may:
    • Vary because of the different conditions linked to it
We are here to assist in the management of your scoliosis.. whichever type it may be!