Scoliosis, which is when the spine is curved abnormally, affects 2-3 percent of the U.S. population, or an estimated 6-9 million individuals.1 Gradually developing in infancy or early childhood, scoliosis fully emerges by around 10-15 years of age and affects individuals over the course of their entire lives. Each year, scoliosis patients visit physicians over 600,000 times, 40,000 patients undergo spinal fusion surgery, and 30,000 children are fitted with a corrective brace. Among scoliosis patients, women are eight times more likely to suffer from severe scoliosis which requires treatment.2 This article will discuss the physical function of patients with scoliosis and standard management of the condition.
Scoliosis can be classified according to its cause – idiopathic, congenital, or neuromuscular. While idiopathic scoliosis remains of unknown cause, congenital scoliosis results from a malformation of one or more of the spine’s vertebrae in the embryo. Neuromuscular scoliosis, in contrast, results from a neurological or muscular disease.
Several signs may reflect the presence of scoliosis in an individual. These include but are not limited to a head which is not fully centered above the pelvis, uneven shoulders, rib cage, or waist, unusually high hips, and the entire body seeming to lean to one side. Deformities can specifically be observed in different views of the body. Clinically, a diagnosis of scoliosis is generally confirmed by a physical examination, X-ray, spinal radiograph, or CT or MRI scan.
The physical function of patients with scoliosis can be compromised depending on the severity of an individual’s condition. Scoliosis can result in decreased spinal movement, weakened spinal muscles, chronic pain, and reduced pulmonary function.3 In addition, patients also tend to suffer from a decreased tolerance for exercise and a decline in their physical conditioning.4
Several options exist for the treatment of scoliosis. These include but are not limited to observation, physical therapy, bracing, and surgery.
In children, if the spinal curve seems to be growing increasingly accentuated, a physician may wish to examine a child every four to six months through adolescence. In adults, in contrast, unless symptoms are worsening, X-rays are usually recommended infrequently. In many individuals, the spinal curve is mild enough not to require comprehensive treatment.
In severe enough cases which warrant treatment, scoliosis can often be treated by physical therapy. Physical exercises, manipulation, electrical stimulation, insoles, and bracing (as detailed below) constitute a comprehensive physical therapy treatment regimen. Physical therapy exercises may include targeted physical positions which stretch the spine, breathing exercises, and soft stretching activities such as pilates.5 Recent research has shown that in adolescents with scoliosis of unknown origin, combining both resistance and aerobic training improves an individual’s functional and respiratory health far more than a similar training regimen using aerobic training only.6
Braces are effective in patients with moderate scoliosis who have not reached skeletal maturity. Indeed, a brace may be recommended if a child is still growing and has a spinal curve between 25 and 40 degrees.
Finally, the most severe cases of scoliosis may require surgical intervention. Specifically, surgery is recommended when the spinal curve exceeds 40 degrees and there are signs of progression. The two primary goals of surgery are to reduce spinal deformities and prevent their progression into adulthood.
Despite its prevalence and effect on physical function, proper management of scoliosis can improve quality of life.
References
1. Scoliosis – Symptoms, Diagnosis and Treatment. Available at: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Scoliosis. (Accessed: 15th September 2022)
2. Scoliosis – Physiopedia. Available at: https://www.physio-pedia.com/Scoliosis. (Accessed: 15th September 2022)
3. Weinstein, S. L. et al. Health and Function of Patients with Untreated Idiopathic Scoliosis: A 50-Year Natural History Study. JAMA (2003). doi:10.1001/jama.289.5.559
4. Koumbourlis, A. C. Scoliosis and the respiratory system. Paediatric Respiratory Reviews (2006). doi:10.1016/j.prrv.2006.04.009
5. Negrini, S., Zaina, F., Romano, M., Negrini, A. & Parzini, S. Specific exercises reduce brace prescription in adolescent idiopathic scoliosis: A prospective controlled cohort study with worst-case analysis. J. Rehabil. Med. (2008). doi:10.2340/16501977-0195
6. Xavier, V. B., Avanzi, O., de Carvalho, B. D. M. C. & Alves, V. L. dos S. Combined aerobic and resistance training improves respiratory and exercise outcomes more than aerobic training in adolescents with idiopathic scoliosis: a randomised trial. J. Physiother. (2020). doi:10.1016/j.jphys.2019.11.012