Scoliosis

  • January 27, 2020
Scoliosis Rehabilitation

Scoliosis is the sideways or lateral curvature of the spine in the upright position which occur most often during the growth spurt just before puberty. The lateral curvature is usually accompanied by some rotational deformity.

Scoliosis is also termed as a three-dimensional deformative abnormality of the spine. Its defines by the cobb’s angle of spine curvature in the coronal plane and often accompanied by the vertebral rotations in the transverse plane. Less than 40% of the curvature can be treated by physiotherapy more than 40% requires surgery.

Scoliosis is caused by conditions such as cerebral palsy and muscular dystrophy; the cause of most scoliosis is unknown. About 3% of adolescents have scoliosis.

Scoliosis can affect any part of the spine, but the most common regions are at the level of the chest and the lower back. It often appears in children most. In many cases, treatment is not necessary as the curve corrects itself with growth. However, based on the age of the child and on the degree of curvature, a combination of bracing and physical therapy is often recommended.

Many cases of scoliosis are mild, but some specific spinal conditions continue to get more worsen as the children grows. Severe scoliosis can be disabling. More the spinal curve, the greater the reduction in chest cavity making it difficult for the lungs to function properly.

A very small number of individuals with scoliosis may require surgery. Children’s who have mild scoliosis are monitored closely, usually with an X-ray, to see if the case is getting worse or not. Some children’s will have a need to wear a brace to stop the curve from worsening more further while others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.

Causes

Most of the times the cause for scoliosis is unknown so it’s termed as idiopathic scoliosis.

  • In children age 3 and younger, it’s called as infantile scoliosis.
  • In children age 4 through 10, it’s called as juvenile scoliosis.
  • In children age 11 through 18, it’s called as adolescent scoliosis.

Scoliosis most often affects girls. Some people are likely to have curving of the spine. During growth spurt the curve usually gets worsen.

Other types of scoliosis are:

  • Congenital scoliosis can also be termed as birth defect scoliosis which affects the development of the bones of the spine.
  • Neuromuscular scoliosis such as cerebral palsy or muscular dystrophy.
  • Any spinal infections or injuries.

 Symptoms

Signs and symptoms of scoliosis may include:

  • Uneven shoulders or hips.
  • The affected shoulder blade appears more prominent than the unaffected shoulder blade.
  • Uneven waist.
  • One hip higher than the other.
  • In infant’s scoliosis include a bulge on one side of the chest.
  • It’s more common in females than in males.
  • Spine curves more to one side.
  • Backache or low-back pain that goes down till legs.
  • Weakness in the spine after sitting or standing for a long time.
  • Head is slightly off center.
  • Uneven leg lengths.
  • Person or individual may lean to one side.

Risk Factors

  • Age: Signs and symptoms typically begins during growth spurt that occurs just prior to puberty.
  • Gender: Both boys and girls develop scoliosis at the same rate but girls have a much higher risk compare to boys for the curve to worsen and even requires treatment.
  • Family history: Scoliosis can run in families but children with scoliosis don’t have a family history of the disease.

Complications

 Many individuals suffering from scoliosis will tend to have a mild disorder, scoliosis may cause some complications including:

  • Lung and heart damage: In severe scoliosis, the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump
  • Back problems: Adults who had scoliosis as children are more likely to have chronic back pain than are people in general population.
  • Appearance: As scoliosis worsen it causes more noticeable changes such as prominent ribs, uneven shoulders and hips, shift of the waist and trunk to the side. People with scoliosis become more self-conscious about their appearance.
  • Chronic pain.
  • Respiratory deficiencies.
  • Decreased exercise capacity.
  • Low back pain.
  • Lower self-esteem.
  • Spinal infections after surgery.
  • Leakage of spinal fluid.
  • If the wear and tear of the spinal bones occurs there will be persistent pain.
  • Due to an uncorrected curve or spinal surgery there will be damage to the surrounding spine and nerve.

Investigations

  • X-ray of the spine to detect the actual curving of the spine.
  • MRI of spine.
  • CT scan of spine to rule out the bony changes.
  • Spinal curve measurement (scoliometer screening)

Treatment

It depends on many factors:

  • Cause of scoliosis
  • Where the curve is the spine
  • How big is the curve?
  • Is your body still growing?

Many individuals with idiopathic scoliosis need not require any treatment, but should have a routine checkup with the doctor for every six months.

If you are still growing your doctor may advise you to use a back brace to support your spine due to which you can avoid further curving of the spine, theses brace work best in individuals over 10 years of age.

Braces due not work for individuals who have neuromuscular scoliosis and congenital scoliosis.

Surgery may be required if the spine curve is getting worse very quickly. The treatment should also include emotional support and physical therapy.

Casting

Casting instead of bracing is sometimes used for infantile scoliosis to help the child’s spine to go back to its normal position as it grows. This can be done with the help of plaster of Paris. The cast are attached to the individual’s body and will be worn throughout the day. As the child grow regularly the cast is changed frequently.

Bracing

If the individual as mild to moderate scoliosis and the bones are still growing the doctor may recommend you to use a brace to prevent the further curvature but it will not cure or reverse the scoliosis.

They are two types of braces used for scoliosis:

  • Thoracolumbosacral orthosis (TLSO).
  • Milwaukee brace.

Physical Therapy Management

  • Reduce pain and stiffness of the effected areas and focus on strengthening of the week muscles.
  • Cold and hot pack to reduce the pain.
  • Strengthening and isometric exercises to improve the week muscles.
  • Ergonomical corrections.
  • Neuromotor control of the spine to increase the strength.
  • Stretches to elongate the shortened muscles on the effected side.
  • Patient education about the knowledge of stretches and exercises are important.

Prevention

Routine scoliosis screening is now done in schools and such screening has helped many individuals to detect early scoliosis.

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