SCOLIOSIS



08.06.22



By Free Motion Physiotherapy





WHAT IS SCOLIOSIS?



Scoliosis is an abnormal lateral curvature of the spine (backbone). It is most often diagnosed in childhood or early adolescence. In a healthy person there is a natural, forward-and-backward curve to the spine. These natural curves occur at the cervical, thoracic and lumbar regions in the “sagittal” plane (The sagittal plane divides the body into right and left halves).


These natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress evenly during movement. With scoliosis, the spine rotates and develops a side-to-side curve.



What Does The CAUSES & SYMPTOMS



WHAT CAUSES SCOLIOSIS?



Scoliosis can be classified as idiopathic, congenital, or neuromuscular.


Idiopathic scoliosis:


• Idiopathic scoliosis is when you are diagnosed with scoliosis as all other causes are excluded and comprise about 80 percent of all cases.

• Adult scoliosis has a prevalence of more than 8 % in adults over the age of 25 and rises up to 68 % in the age of over 60 years. The most common cause of adult scoliosis is degenerative changes in the aging spine (spine curves as you age).

• Adolescent idiopathic scoliosis is the most common type of scoliosis and is usually diagnosed during puberty.


Congenital scoliosis

• Results from embryological malformation of one or more vertebrae and may occur in any location of the spine.

• The vertebral abnormalities cause curvature and other deformities of the spine because one area of the spinal column lengthens at a slower rate than the rest.

• The geometry and location of the abnormalities determine the rate at which scoliosis progresses in magnitude as the child grows.

• As these abnormalities are present at birth, congenital scoliosis is usually detected at a younger age than idiopathic scoliosis.


Neuromuscular scoliosis

• Encompasses scoliosis that is secondary to neurological or muscular diseases.

• Includes scoliosis associated with cerebral palsy, spinal cord trauma, muscular dystrophy, spinal muscular atrophy, and spina bifida.

• This type of scoliosis generally progresses more rapidly than idiopathic scoliosis and often requires surgical treatment.

• Injuries and infections to the spine can also contribute to the cause of scoliosis



WHAT IS THE INCIDENCE OF SCOLIOSIS?



• Worldwide prevalence, including all forms of scoliosis, is said to be 1% of the population.

• Scoliosis can develop in infancy or early childhood.

• The primary age of onset for scoliosis is 10-15 years old, occurring equally among both genders.



WHAT ARE THE SYMPTOMS OF SCOLIOSIS?



There are several signs and changes in the body that may indicate the possibility of scoliosis.

• Sideways curvature of the spine

• Sideways body posture

• One shoulder raised higher than the other

• Uneven alignment of the pelvis and hips

• Clothes not hanging properly

• Local muscular aches

• Local ligament pain

• Height loss


Scoliosis itself does not cause symptoms although some back pain may develop. This is usually a result of the inability to stand upright, muscle weakness, and loss of conditioning.



HOW IS SCOLIOSIS DIAGNOSED?



Before your doctor can suggest a treatment plan, if scoliosis is suspected, they will need to take a history. This may include questions about:


• Family history • Date when you first noticed a change in your spine

• Curve progression (determined from earlier X-rays, if available)

• Presence and location of pain

• Any bowel, bladder, or motor dysfunction.


Scoliosis is usually confirmed through a physical examination, an x-ray, spinal radiograph, CT scan, or MRI.


The aim of the functional physical examination is to distinguish between faulty posture and actual idiopathic scoliosis. In a physical exam, your doctor will examine your back to check the shape of your spine and see how you move around. Your nerves may also be tested through reflex, sensation, and muscle-strength checks.


If needed, your doctor may order X-rays or other scans to show a full picture of your spine. Your doctor can then determine if you have scoliosis and if so, to what degree. The curve is measured by the Cobb Method and is diagnosed in terms of severity by the number of degrees.



MANAGEMENT



Medical Management



Patients with early-onset scoliosis, defined as a lateral curvature of the spine under the age of 10 years, are offered surgical treatment when the major curvature remains progressive despite conservative treatment (Cobb angle 50 degrees or more). Spinal fusion is not recommended in this age group, as it prevents spinal growth and pulmonary development.



Conservative Treatment



Most cases of adult scoliosis can be managed non-operatively through regular observation by a doctor, over-the-counter pain medications, and core-strengthening exercises to strengthen the muscles which support the back and to improve flexibility.


Children who have mild scoliosis may need regular checkups to see if there have been changes in the curvature of their spines as they grow.



Your doctor will recommend some forms of physiotherapy, to both maintain strength and relieve pain. These may include:

• Working to improve posture

• Doing low-impact exercises, such as swimming

• Daily stretching

• Staying active


If pain is not relieved by oral medications or physiotherapy, your doctor may recommend epidural (given around the spinal cord) or nerve block injections for more effective relief.



Bracing



When children's bones are still growing and he or she has moderate scoliosis, the doctor may recommend a brace. Wearing a brace won't cure scoliosis or reverse the curve, but it usually prevents any further progression of the curve.


Most braces are worn day and night. A brace's effectiveness increases with the number of hours a day it's worn. Children who wear braces 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 activities.



Surgical treatment



Surgery is necessary in some cases of adult scoliosis. This treatment is only considered as a last resort because of the risks of complications from spinal surgery. Surgery may be suggested for considerable pain, a spinal imbalance or to improve quality of life.



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