Scoliosis is an abnormal lateral curvature of the spine, often diagnosed in childhood or early adolescence. Rather than a straight line, the spine exhibits more of a “S” shape, curving side to side. Often, this occurs in the mid-back (thoracic) or a bit further down (junction between thoracic and lumbar).
How common is it?
Scoliosis typically affects 2-3 percent of the population, often developing in infancy or early childhood. However, females are up to 8 times more likely to progress to a point where surgery may be required.
Anatomy
The vertebral column (Spine) consists of 24 separate vertebrae, and 5 fused vertebrae forming the sacrum and 4 fused vertebrae that form the coccyx. It provides attachments to muscles, supports the trunk, protects the spinal cord and nerve roots.
The cervical region has a gentle inward curve, thoracic spine has an outward curve, and the lumbar spine curves inward again, providing the spine with the strength and qualities to absorb shock.
What are the causes?
Scoliosis can be further broken down into different categories depending on the cause. Understanding the classification can also aid us in how we treat the scoliosis.
Idiopathic
This is the most common type of scoliosis, accounting for up to 80% of cases. The cause is unknown, and typically presents during adolescence, but can also start earlier.
Congenital
This type of scoliosis results from a spinal defect present at birth. It is a rare condition, affecting 1 in 10,000, and surgery may be required to correct the alignment.
Neuromuscular
This type of scoliosis often develops due to a form of disease, such as muscular dystrophy or cerebral palsy.
How is scoliosis diagnosed
Scoliosis is usually confirmed through a physical examination, an x-ray, spinal radiograph, CT scan or MRI. Based on the image, the curve is then measured using the Cobb Method, and diagnosed in terms of severity. The greater the angle, the more severe.
In the clinic, the Adam’s Forward Bend Test is often used to identify potential curvatures, and any asymmetries, as the client is directed to bend forward and touch their toes.
How is scoliosis managed?
Medical Management
Individuals with early-onset scoliosis under the age of 10 years are often offered surgical treatment when a major curvature (cobb angle ≥ 50 degrees) still presents, even after conservative management.
Conservative management
Most cases of scoliosis with mild curvatures, do not require treatment, surgery or braces. Children with mild scoliosis may require regular check-up to monitor any changes in the spine as they grow.
Braces
When children are still growing, and they have moderate scoliosis, a brace is sometimes recommended. Although it doesn’t fix the scoliosis, a brace can help prevent further progressions of the curve.
Physical Therapy Management
Primarily used to treat milder forms of scoliosis to improve the condition, maintain appearance and avoid surgery. May consist of the following:
physical exercises
bracing
manipulation
electrical stimulation
Insoles
Exercise
Exercise is often used to help return the spinal curvature to a more neutral position. This may consist of:
Restoring muscular symmetry and alignment of posture
Breathing into the rounded side of the body
Education around body awareness
Helping to derotate, deflex and to correct the spine, while elongating the spine
Key Points
Management is based on the current condition of the individual, the severity and type of scoliosis.
Treatment should be specifically tailored, with consideration of the individual's physical and mental challenges.
Although bracing and surgical treatment can be an effective treatment, acceptance of such treatments can be tough.