Scoliosis is medical condition of the spine, which is usually occurring by children and adolescents. It is a pathological sideways curvature of the spine, which is fixed. Human spine is not straight as a rod. On the other hand, if we look from the side on the human spine, we will see that in the area of the neck is a slight drop in the spine, thoracic area is slightly protruding, and lumbar area is again curved. That is a healthy (physiological) curvature of the spine, its goal is to dampen the impacts during walking and running. The curvature can be also visible if we look from the back. Scoliosis can form in any age, but it’s a question how fast can it be recognized and how far can we affect the progression of scoliosis with physiotherapy.
Spine, and the vertebrae can be imagined as a tower of bricks. In case where this tower is not straight, and one of the bricks is deflecting to the side, we can talk about scoliosis (if the shape of the vertebrae didn’t change) or something that is close to scoliotic posture (if the shape of the vertebrae is still correct, but the muscles around are pulling or rotating the vertebra in an incorrect direction). The difference is, that the scoliotic posture, can be treated more easily than scoliosis alone.
Dividing the illness according to the age
If the scoliosis is diagnosed by children to 3 years, we talk about infantile scoliosis, to 10 years it is juvenile scoliosis and to 20 years adolescent scoliosis.
APPEARANCE OF SCOLIOSIS
Scoliosis is affecting about 6% of population. Scoliotic posture is more common. Incorrect posture, to which both diseases have close is appearing by preschool children up to 30%. Scoliosis affects more often girls than boys. The reason is higher amount of water in body and higher elasticity of the ligamentous fibres. Progression of the scoliosis happens usually in time of accelerated growth of the children, because the bones grow faster than muscles, and muscles are not able to keep the bony apparatus straight.
CAUSE OF SCOLIOSIS
The cause of the formation of scoliosis is unknown in nearly 80% of cases. It is presumed that there are more factors (genetic predisposition, muscle imbalance, effect of central nervous system, disorder of growth apophysis of the vertebrae, disorder of collagen etc…). By very small children is the cause usually incorrect psychomotor development already during the first months of life. Rotating or crawling and leaning more to one side than the other is by scoliosis a common manifestation. Especially if the scoliosis was already diagnosed by a relative.
With development of molecular medicine, there have been such theories about the effects of metabolic disorders. With development of genetic engineering people started to talk about autosomatic dominant gene with unfinished penetration (Ťupa. 1998). Other theories talk about mistakes in the formation of the embryonal development, or about incorrect position of the fetus in the uterus. Other authors talk about hypovascularization of the given segments of the spine.
Evaluating the condition based on the X-ray examination, is focused on the angle of the curvature in the spine. The length of the legs should be measured. In case of uneven leg length it is recommended to cushion the shorter leg to elevate the tilt in the pelvis, which has an effect on the curvature of the spine. Kinesiological examination by a physiotherapist reveals rotation and shift in the vertebrae, alternatively rotation of the ribs, muscle dysbalance in the trunk area, pelvic area, legs and arms, based on the correct diagnosis can physiotherapist offer you to keep movement regime and recommend you some compensating exercises, which has to be controlled in case there would be some adjustments given to the development of the scoliosis and growth of the child.
From a biomechanical point of view there is an anteversion of the pelvis (tilt of the pelvis forward) to lower the range of lordosis in the lumbar spine, but at the same time rotation of the lumbar vertebrae (Otáhal, 2000). Bending spine is always joined with rotation and vice versa, if the vertebrae are rotated, the spine is always bending (Lewit, 2000).
Treatment is differing according to the degree of severity of scoliosis. By a scoliosis to 20 degree angle according to Cobb, conservative treatment is applied - physiotherapy. That is focused on the reduction of scoliotic curve. Ideal are also methods, which strengthen (activate) the muscles alongside the spine, because they may be weak, and at the same time shortened muscles or muscles in higher tension will be stretched. The offer of therapeutic methods is wide and it depends on the physiotherapist how well can he apply and choose the best one for the client. The cooperation with children and adults is crucial, because good results can be achieved only during regular exercising. The effect of exercising can be increased by kinesio tape.
Within the range of 20 - 40 degrees according to Cobb, doctors usually recommend to wear the corset. For correct effect is important that the children would wear corset whole day or even during night. Corset for night is different than the one worn during the day, therefore it is important to talk about the options with the doctors and when should the child wear the corset. Unfortunately the corset is not accepted by children in adolescence with much enthusiasm. They have a psychological barrier because of mocking from classmates. The spine is in period of adolescence collapsing even more because of the accelerated growth.
If the scoliosis is bigger than 40 degrees, surgical treatment is recommended. During such type of scoliosis there is a risk of oppression and subsequent damage to the internal organs. Keep in mind that it is fairly difficult operation. The scoliotic curve is fixed with titanium rods. Finished growth of the spine is basic assumption for operation, otherwise it would be necessary to repeat the surgery. Furthermore, it is not ideal to undergo operative treatment in period of growth and by by girls/women it is recommended after pregnancy and planned births. All these reasons show how important it is to stop further development of scoliosis.
The needed movement regime is led under the supervision of physiotherapist with combined techniques that are stimulating the correct coordination of the muscles and lower the muscle tension in the hypertonic muscles. Ideal is also mobilization or manipulation of the spine and soft tissues around the spine, pelvis, but also legs and arms. Well educated physiotherapist with interest in the field knows a wide spectrum of effective methods.
In the following article Physiotherapy of scoliosis in childhood age you can read whether it is good to choose corset therapy, how should normal physiotherapy look, how to adjust daily movement regime of the child with scoliosis and what sports and courses are ideal in combination with physiotherapy.
Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: Clinical experience from a private practice in a physiotherapeutic field, FYZIOklinika