11/05/2023
SCOLIOSIS
Definition:
Scoliosis is an abnormal lateral curvature of the spine. It is most often diagnosed in childhood or early adolescence.
The spine's normal curves occur at the cervical, thoracic and lumbar regions in the so-called “sagittal” plane. These natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement. Scoliosis is often defined as spinal curvature in the “coronal” (frontal) plane. While the degree of curvature is measured on the coronal plane, scoliosis is actually a more complex, three-dimensional problem which involves the following planes: Coronal plane, Sagittal plane, Axial plane
The coronal plane is a vertical plane from head to foot and parallel to the shoulders, dividing the body into anterior (front) and posterior (back) sections. The sagittal plane divides the body into right and left halves. The axial plane is parallel to the plane of the ground and at right angles to the coronal and sagittal planes.
Scoliosis is also defined by the Cobb's angle of spine curvature in the coronal plane and is often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane.
These abnormalities in the spine, costal-vertebral joints, and the rib cage produce a ‘convex’ and ‘concave’ hemithorax.
The rotation component starts when the scoliosis becomes more pronounced. This is called a torsion-scoliosis, causing a gibbus.
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.
Females are eight times more likely to progress to a curve magnitude that requires treatment.
Scoliosis can be classified by etiology: idiopathic, congenital or neuromuscular.
Idiopathic scoliosis
The diagnosis when all other causes are excluded and comprises about 80 percent of all cases.
Adolescent idiopathic scoliosis is the most common type of scoliosis and is usually diagnosed during puberty.
Classified into the following subgroups:
Infantile scoliosis: Infantile scoliosis develops at the age of 0–3 years and shows a prevalence of 1 %.
Juvenile scoliosis: Juvenile scoliosis develops at the age of 4–10 years, comprises 10–15 % of all idiopathic scoliosis in children, untreated curves may cause serious cardiopulmonary complications, and curves of 30 and more tend to progress, 95 % of these patients need a surgical procedure.
Adolescent scoliosis: Adolescent scoliosis develops at the age of 11–18 years, accounts for approximately 90 % of cases of idiopathic scoliosis in children.
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
There are several signs that may indicate the possibility of scoliosis.
>Sideways curvature of the spine
>Sideways body posture
>One shoulder raised higher than the other
>Clothes not hanging properly
>Local muscular aches
>Local ligament pain
>Decreasing pulmonary function, major concern in progressive severe scoliosis.
Due to changes in the shape and size of the thorax, idiopathic scoliosis may affect pulmonary function. Recent reports on pulmonary function testing in patients with mild to moderate idiopathic scoliosis showed diminished pulmonary function. Impairment of function was seen in more severe cases of spinal deformity, proximally-located curvature and older patients.
Scoliosis is usually confirmed through a physical examination, an x-ray, spinal radiograph, CT scan or MRI.
The curve is measured by the Cobb Method and is diagnosed in terms of severity by the number of degrees.
Conservative Treatment
Most people with scoliosis have mild curves and probably won't need treatment with a brace or surgery. 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.
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 further progression of the curve.
In general, most congenital scoliotic curves are not flexible and therefore are resistant to repair with bracing. For this reason, the use of braces mainly aims to prevent the progression of secondary curves that develop above and below the congenital curve, causing imbalance. In these cases, they may be applied until skeletal maturity
Physiotherapy Management
Physical therapy and bracing are used to treat milder forms of scoliosis to maintain cosmesis and avoid surgery.
Scoliosis is not just a lateral curvature of the spine, it’s a three dimensional condition.
Conservative therapy consists of:
*physical exercises
*bracing
*manipulation
*electrical stimulation
*insoles.
The physiotherapist has three important tasks, to:
Inform, advise and instruct.
Some physiotherapists recommend a brace to prevent the worsening of scoliosis. eg Milwaukee brace.
There is evidence that exercises have beneficial effects on patients with idiopathic scoliosis.
Physiotherapists may also address biopsychosocial factors.
Adolescents who are presenting with idiopathic scoliosis and chronic low back pain symptoms may also have other factors such as insomnia, depression, anxiety and stress, and daytime sleepiness that need to be assessed and addressed as contributing factors to a chronic low back pain experience.
The aims of physical therapy are usually:
>Autocorrection
>Coordination
>Equilibrium
>Ergonomical corrections
>Muscular endurance/ strength
>Neuromotor control of the spine
>Increase of ROM
>Respiratory capacity/ education
>Side-shift
>Stabilization
>Exercises
It’s important to note that not all patients with scoliosis are actually suffering from this spine deformation.
Every patient is different and deserves attention to deploy the appropriate treatment
Coping with scoliosis is difficult for a young person in an already complicated stage of life. Teens are bombarded with physical changes and emotional and social challenges. With the added diagnosis of scoliosis, anger, insecurity and fear may occur.
Culled from:
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