Understanding Scoliosis

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Like many medical terms, such as scoliosis, we recognize the word, but aren’t always sure what it exactly means, the symptoms of it or how it’s treated. Scoliosis is a condition that affects 5 to 7 million people in the United States, and knowing the details of a diagnosis and treatment options available can help you make a more informed decision on your treatment or that of a loved one.

There are three main treatment options of those suffering from Scoliosis; physical therapy, bracing and surgery. The American Physical Therapy Association (APTA) has worked with the Scoliosis Research Society (SRS) to develop resources and training especially for Physical Therapists in recent years to help provide care throughout treatment.

What is Scoliosis?

Scoliosis is a sideways curvature of the spine that occurs most often during a growth spurt and just before puberty. It’s most common in girls.

If a curvature of the spine is larger than 10 degrees, it’s deemed scoliosis—curves less than 10 degrees are considered postural changes. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most cases of scoliosis are unknown.

When considering what treatment is right for you or your child, keep these scoliosis treatment options in mind:

  • Severity of curve—larger curves are more likely to worsen over time.
  • Curve pattern—double curves, also known as S-shaped curves, tend to worsen more than C-shaped curves do.
  • Location of curve—curves located in the center section of the spine worsen more often than curves in the upper or lower sections of the spine.
  • Maturity—if a child’s bones have stopped growing, the risk of curve progression is low. That also means that braces will have the most effect in children whose bones are still growing.

Treatment Options

For the majority of patient diagnosed with scoliosis, treatment options consist of braces or surgery. If you have a child with scoliosis, and their bones are still growing, it’s likely that your doctor will recommend wearing a brace. It won’t cure scoliosis, or reverse the curve, but it usually prevents any further progression of the curve. Surgery is another option.

Physical Therapy

Physical therapy treatments can offset the effects of scoliosis and help improve the shape and look of the body. Some evidence indicates that physical therapy can help patients appear straighter and improve breathing.

A physical therapist will consider various aspects of a patient’s condition but in accordance with recommendations of the APTA, may recommend any combination of the following:

  • Range-of-Motion Exercises. Your physical therapist will design a gentle range of motion treatment program to prevent limitations or to increase the body’s range of motion, if movement limitations are present.
  • Strength Training. Your physical therapist will design a treatment program to strengthen any muscles surrounding the spine or in other parts of the body that have been weakened by the change in the spine’s position, such as the hips, shoulders, or even the head and feet.
  • Manual Therapy. Physical therapists are trained to gently restore motion to joints and muscle tissue that may have become restricted due to scoliosis. They may use their hands to help guide and retrain movement patterns.
  • Modalities. Several additional treatments, such as ice, heat, electrical stimulation or ultrasound may aid in achieving physical therapy goals. Your physical therapist will choose the most appropriate modalities for your particular case.
  • Functional Training. Physical therapists are trained to be experts in assessing movement patterns, providing education on proper movement patterns, and retraining the body for optimal movement.
  • Education. Your physical therapist will provide information about scoliosis and the effects on the body and movement.

Braces

Most braces are worn during the day and at night because a brace’s effectiveness increases with the number of hours that it’s worn. Children who do wear a brace can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activity.

Braces are discontinued after the bones stop growing. This typically occurs:

  • About two years after girls begin to menstruate
  • When boys need to shave daily
  • When there are no further changes in height

The two main types of braces are:

  • Underarm or low profile brace—This type of brace is made of modern plastic materials and is contoured to conform to the body. Also called a thoracolumbosacralorthosis, this closefitting brace is almost invisible under the clothes. It fits under the arms and around the rib cage, lower back and hips. Underarm braces are not helpful for curves in the upper spine or neck.
  • Milwaukee brace—This brace is a full-torso brace with a neck ring with rests for the chin and for the back of the head. Because they are more cumbersome, Milwaukee braces are usually only used in situation where an underarm brace won’t help.

Surgery

In most cases, surgery won’t be suggested until after a child’s bones have stopped growing. If the scoliosis is progressing rapidly at a young age, surgeons can install a rod that can adjust in length as the child grows. The growing rod is attached to the top and bottom sections of the spinal curvature and is usually lengthened every six months.

However, if surgery does become a treatment option, your doctor will have suggested it to reduce the severity of the spinal curve to prevent it from getting worse. Surgery for scoliosis is called “spinal fusion.”

In spinal fusion, surgeons connect two or more of the bones in the spine (vertebrae) together. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight and still while the old and new bone material fuses together.

Regardless of what treatment option is chosen, physical therapy can help ease discomfort.

Many of the physical therapists at Tidewater Physical Therapy Inc. hold Direct Access Certification through the Virginia Board of Physical Therapy allowing them to evaluate and treat patients without a prescription. As part of your healthcare team, a physical therapist will make an assessment of your condition and create a plan to start you on the road to wellness. Our team will communicate with your physician of record and obtain a referral, if necessary, for your continued treatment. We will also work with your insurance carrier to make sure services are covered by your plan. To make your own appointment, find a clinic near you.

Sources:

http://www.mayoclinic.org/diseases-conditions/scoliosis/basics/treatment/con-20030140

http://www.acatoday.org/content_css.cfm?CID=2189

http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=44c972bb-9690-4505-99f2-0a4c6d1a41a4#.VJMCzpBE4