What’s New in Nonsurgical Scoliosis Treatment?
Has Conservative Management of Scoliosis Changed?
If you or a loved one have been diagnosed with scoliosis you may be wondering what new treatments are out there to address it. Scoliosis refers to an abnormal curvature of the spine and depending on its severity can range from a minor cosmetic annoyance to a severe deformity that causes pain and can affect breathing and movement. In this article we will examine some of the advances in nonsurgical scoliosis treatment so you can feel informed about the decisions you are making about your care.
WHY IS SCOLIOSIS A PROBLEM?
When you observe a model of a healthy spine from the front or the back you will notice the vertebrae are stacked on top of one another in a straight line. When you move to the side, however, you will notice that it curves gently from back to front changing direction as the neck or cervical spine transitions into the thoracic spine, or mid back, and again as the mid back transitions into the lumbar spine, or low back. With scoliosis, the most noticeable change is often the presence of one or more curves from left to right forming a “C” or an “S” when you look at the spine from behind. It might not be as obvious, but scoliosis often involves some degree of abnormal spinal rotation and increase in the front to back curvature also making it a three dimensional problem.
It can be present at birth but is most often diagnosed in early adolescence. Scoliosis can be congenital, meaning it is present before birth (usually caused by abnormal formation of spinal bones)--or idiopathic, in which case it develops after birth. The cause of a scoliosis can typically be identified as one or more of three causes. A functional scoliosis develops in response to a skeletal or movement abnormality elsewhere in the body. For example, a discrepancy in length between the legs could cause a functional scoliosis to develop because the hips are not even. A scoliosis can also be neuromuscular in origin meaning it is associated with a condition that affects the nerves or the muscles. Finally degeneration of the vertebral bodies and weakening of their supporting ligaments can cause scoliosis to develop in adults.
Stopping progression of the curve is a primary goal of scoliosis treatment. Without treatment scoliosis curvature can progress leading to changes in appearance, difficulty walking or moving, pain, and can even restrict heart and lung function if the scoliosis compresses the ribcage. When treated during skeletal immaturity there is the greatest likelihood of stopping the progression and sometimes even improving the scoliosis as the skeletal system is more adaptable at this time. To better understand the current recommendations for the treatment of Scoliosis we reviewed the second edition of The Harms Study Group Treatment Guide published in 2021. The Harms Group is a worldwide cohort of surgeons, with over twenty years of productivity, who perform comprehensive, multi-center, prospective research studies focused on pediatric spinal deformity.
CONSERVATIVE TREATMENT:
Scoliosis treatment that is nonsurgical in nature is considered to be conservative. The most recent guidelines published by the International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) list the goals of nonoperative intervention for Adolescent Idiopathic Scoliosis as stopping curve progression at puberty, preventing or treating respiratory dysfunction, preventing spinal pain, and improving aesthetics via postural correction. In adults, the primary goal is to treat pain and improve function. The use of spinal bracing and physiotherapeutic scoliosis-specific exercises will be discussed here.
Bracing: Despite advances in medicine, bracing of curves greater than 25 degrees is still the first line treatment in skeletally immature patients because of the likelihood of continued progression of the scoliotic curve even after reaching skeletal maturity (usually achieved by 25 years of age). Smaller curves should be carefully monitored on a regular basis, typically every six months. Curves greater than 45 deg will often be treated surgically.
Customized bracing made from a mold of the person’s torso, evidence shows, can not only prevent progression, but in some cases improvements, in larger scoliotic curves. Generally bracing is worn between 12 and 23 hours a day until skeletal maturity is reached. Additionally, nighttime bracing of smaller curves may prevent progression in up to 25% of people. While adjusting to brace-wearing can be difficult for young persons, getting to choose the color and pattern of the brace and picking out clothing that is fun and comfortable to use while wearing it, can help.
Physiotherapeutic scoliosis-specific exercises (PSSE): Physical therapy has long been considered an important form of conservative treatment for scoliosis. In recent years the physical therapy community has been studying the effectiveness of PSSE versus conventional physical therapy. The Harms Study Group further defines PSSE:
PSSE consists of very specific exercises developed based on a detailed assessment of the patient’s curve pattern characteristics in all three planes. Patients are trained to“autocorrect” or “self-correct” their alignment in all three planes: coronal, sagittal, and axial. This corrected alignment is then incorporated into stabilizing exercises as well as balance, coordination, and proprioceptive training to automatize the more centered alignment. Patients are taught to incorporate the corrected alignment into activities of daily living. Although PSSE and general or conventional physical exercise both work on core and posture strengthening, conventional therapy does not take into consideration the individual’s specific scoliotic curve pattern, and conventional therapists have not undergone specific education and certification in scoliosis assessment and management.
While research will continue to be done to assess who will benefit most from this type of physical therapy, you can learn more about these types of exercises by working with a therapist trained in the Schroth Method of PSSE. This treatment method focuses on achieving elongation of the spine and derotation of the vertebrae to improve breathing function and posture by individualizing treatment to each person’s unique curvature. It can also help relax stiff muscles, promote better pelvic alignment, and address pain.
EARLY TREATMENT IS OPTIMAL
If you or your child have been identified as having scoliosis, early management is optimal to prevent progression of the curve when possible and address symptoms of pain, breathing difficulties, and losses of function. If you are interested in learning more about the Schroth approach to scoliosis and how physical therapy can help, call and schedule a physical therapy evaluation at Evolve.
Click here to find out more information about physical therapy for Scoliosis.
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