A regular spine, when viewed from behind, looks straight. However, a spine affected by scoliosis shows evidence of a lateral, or side-by-side curvature, with the spine looking like an ‘S’ or ‘C’ and a rotation of the back bones (vertebrae) looking like that the person is tilting to one side.
Scoliosis occurs most often in children aged 10 to 14, affecting females 7 times more frequently than males.
Scoliosis is not a disease. In simple terms, it just means that in an often otherwise healthy person the spine is curved or twisted. It does not develop because of anything a person did or did not do.
TYPES
There are four types of scoliosis:
- Idiopathic scoliosis
The most common type of scoliosis, idiopathic means of unknown origin. Depending on the age of onset, it may be infantile (birth to 3 years), juvenile (age 3 to 8), adolescent (age 9 to 18), or adult scoliosis (after age 18).
- Congenital scoliosis
A rare form of scoliosis, affecting one in 10,000 babies in utero.
- Neuromuscular or syndromic scoliosis
Developed by children who have neuromuscular disorders like muscular dystrophy or cerebral palsy.
- Degenerative scoliosis
Adult scoliosis, a degenerative condition that typically occurs after age 40.
DIAGNOSIS
When a Scoliosis is suspected the usual tests for this condition include X-Ray (Cobb Angle, Risser sign, congenital spine and rib abnormalities).
Diagnosing scoliosis is easy, but recognising it pre-diagnosis can be remarkably difficult. Most of the cases go unnoticed until the patient has gone through puberty and the curve becomes more noticeable.
Luckily, there are symptoms and signs that parents, teachers, and other adults can look out for in young patients. These signs may help recognise scoliosis at an early age when it is still most easily managed.
Here are five simple ways to check for scoliosis, looking for:
- Uneven shoulders: one tilted to the side or higher than the other
- Uneven hips: one tilted to the side or higher compared with the other
- Differences in the spine: With someone watching from behind and the patient bending over to touch his or her toes, ask: Does the spine curve to one direction? Is one rib higher than the rest, or one hip higher than the other?
- Uneven space between the arms and body, with one arm further from the body than the other arm is.
- Differences in walking: Does one leg look shorter than the other, or is there a noticeable limp?
HOW TO WORK ON IT
Determining the best course of treatment is based on the type and severity of the scoliosis, the patient’s age, and the guidelines established by the Scoliosis Research Society.
The variety of treatment options for scoliosis includes physical therapy, bracing, and surgery.
Surgery: Cobb Angle > 40-45° surgery is likely indicated.
The goal of surgical intervention is to reduce the severity of the curve as able and prevent further progression.
Bracing: Cobb Angle 30-40° – bracing is indicated and must occur immediately.
The goal of bracing is to slow progression of the curve angle and to attempt to better align the individual.
Physiotherapists can provide care during any of the phases of scoliosis treatment, including bracing or post surgery. They assess the posture and movement patterns of the whole body, noting any limitations caused by changes in the spine, and address other symptoms, such as pain and muscle imbalances. Your Doctor will continue to thoroughly monitor progress during the course of rehabilitation.
Physical therapy treatments may include:
Range-of-Motion Exercises;
Strength Training;
Manual Therapy;
Functional Training ; and
Good Posture Education.
The advice of a physiotherapist is vital in regards to exercise technique, advancing exercises, or increasing the weight used with any exercise that is used to treat a scoliosis. Doing incorrect exercises or using too much weight could make a scoliosis worse or cause compensatory pain. As the scoliotic bend causes an imbalance in the strength and length of the muscles of the body, don’t be amazed if your physiotherapist asks you to do more repetitions or use heavier weights when doing an exercise on one side versus the other in order to start shifting the imbalance back towards a more neutral position.
Thus, be proactive- get yourself or a family member with scoliosis assessed from an orthopaedic doctor and a physiotherapist for better management and rehabilitation.
[Ms DIPTI VASHISHT is Team Leader, Sports physiotherapist at AktivHealth]