Do you have a child, but the doctor determined scoliosis by the child? You don’t know what to imagine under that? What awaits you? How to help the child? So that its development would be healthy? Would you like to read more about it than what you could read in article Formation of scoliosis and how to determine it and how to treat it? I would like to explain you in this article options of therapy by children with scoliosis.
Treatment of scoliosis in childhood age is conducted according to the angle of curvature of the spine. By an angle evaluated according to Cobb, which is lower than 20 degrees, we focus on active exercising, which helps to strengthen the muscles and straighten the curve in the spine. If the angle is above 20 degree, doctors lean towards using a corset, and by a angle above 40 degree, the child is recommended a surgery.
The opinion whether to choose or not the corset therapy by a higher degree scoliosis is differing a lot even among medical specialists. Doctors with specialization in orthopedy are leaning towards the opinion that the corset is necessary by a curvature above 20 degrees according to Cobb, so that there would be no progression of the scoliosis and the curve could be passively straightened.
Several studies conducted on this topic, used as an objective assessment X-ray images, it showed straightening of the curve by 50-60% of children after using the corset. Studies that took several years however showed, that the initial correction is only temporary.
Long term studies showed that the average improvement of the curve during a therapy with corset is after 5 years of wearing only about 2-4 degrees from the original curve of the spine. The effectivity is therefore very low. During the therapy it is important to take in count also the fact that corsets affect as well the psychosocial development of the child, which can make the child feel unnatural among his peers. The corset restricts the child in movement, and affects also breathing, even though it was proved that breathing and function of the diaphragm has a provable and significant role in a natural treatment of scoliosis.
Because of these reasons physiotherapist do not prefer this conservative method, and they are standing behind the opinion that the skeleton should be supported against the gravity by increased activity of the muscles. If it’s supported by a passive support of the corset, the muscles lose their function. As a result the condition doesn’t improve, on the other hand there is regression (worsening) of the curve in the spine, which is supported by some recent studies as well.
From a position of an educated physiotherapist we definitely lean towards the therapy led on the basis of a movement regime, when the postural system is correctly stimulated and activated.
It is necessary to exercise daily, and positively motivate the child. The exercise has to be interesting and entertaining for the child, because the movement activity will be part of the daily life.
We recommend exercises with neurophysiological basis, using techniques in which is the activity of the muscles or muscle chains equipped on the basis of the movement patterns - programs that are saved in the central nervous system and they are genetically conditional. Among these methods can be for example Vojta method, concept according to Dr. Brügger, DNS according to Kolář, method according to Roswitha Brunkow, sensory motor exercises on unstable surfaces, exercising on a gym ball, Kabat method, but also riding on a horse known as hippotherapy. There is a big amount of ideal techniques and it depends only on the therapist, how can he combine the techniques, and effectively apply them, so that the result of the therapy would be the best possible.
WHAT KIND OF SPORT TO CHOSE
Therapy should be supplemented with extracurricular movement activity. From the courses for girls and boys I recommend dancing, especially ballet or traditional dance, where can children learn how to keep a correct body posture. As inappropriate dance I consider to be hip hop, street dance etc. in whose choreographies is big amount of jumping and bending in the spine and keeping the head in unnatural positions. Gymnastics are also ideal along with rock climbing…
Exercising should not burden the spine one sidedly (such as tennis, lacrosse, golf…), but should also stimulate the so called „crossed movement patterns” and deep stabilizing system. Insufficient function of the deep muscles on the spine causes incorrect body posture and scoliosis. These muscles can be very well activated during a dynamic movement. Therefore ideally chosen activities can be considered as a supplement to the therapy.
As a prevention against the formation of or its treatment I can recommend normal type of exercising in a gym, where the child can naturally develop the its movement patterns. For preschool children and babies, it is ideal to exercise with parents and children (organized for example by kindergartens or family centers).
Among ideal sports is also swimming. Today it is already fairly known what are the advantages of about the option of swimming for children already from the infantile age. Older children need to be taught correct swimming technique. By the breaststroke style, the child needs to learn how to hold breath and exhale under the water, and not being afraid of sinking the head below the water. By a crawl stroke is important to learn to breathe in when the arm which is above is at the peak of the spine curvature, that will lead to straightening of the curve. Backstroke and crawl stroke are without doubt the most ideal swim strokes.
INAPPROPRIATE MOVEMENT COURSES
We do not recommend activities where the child has to sit for a long period of time (art course, ceramics etc…) and where the spine of the child is exposed to static burdening, when there is minimal postural activity in the deep stabilizing system.
In case you are not entirely sure whether your child is exercising in accordance with physiotherapy, you can ask physiotherapist whether he would be willing to come and observe the child during the course and evaluate the quality and accuracy of performed movements/exercises.
Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: Clinical experience from a private practice in a physiotherapeutic field, FYZIOklinika