There are multiple types of scoliosis, each caused by a variety of different factors. Scoliosis is diagnosed when there is a lateral curvature of the spine that is ten degrees or greater. However, the changes that occur in the spine are three-dimensional. The altered structure of each vertebra is what causes the spine to shift to the side, rotate and collapse when the scoliosis is severe.
The most common type of scoliosis is adolescent idiopathic scoliosis (AIS). AIS occurs in children ten years and older. This type of scoliosis is idiopathic, meaning that its cause is unknown. Adolescents who are diagnosed with AIS are often asymptomatic, and may not know they have a mal-alignment of their spine. The concern is the natural progression of scoliotic curves over time. It has been shown that curves often progress during a child’s growth spurt, which occurs in adolescence. This growth spurt happens between the ages of 11 and 16 years in boys, and between 8 and 14 years in girls.
Treatment of AIS in adolescence is recommended based on the degree of the curve, which is measured on x-ray. As mentioned, curves must be 10 degrees or greater to be diagnosed as scoliosis. Curves that are measured between 10 and 25 degrees are often monitored by a physician with regular visits. Curves between 25 and 45 degrees are typically managed with a spinal brace. Patients with curves greater than 45 degrees may be managed surgically.
There are well-established guidelines for the treatment of scoliotic curves of greater magnitude, but what about for the smaller curves? Although, a patient may not be a candidate for a brace or surgery, they may be appropriate for an exercise prescription. Physical therapists work with patients who have AIS to strengthen the musculature around the spine to maintain balance of the spinal musculature and help control the progression of scoliosis. Patients can also learn to re-educate their postural system and movement patterns to promote a more typical alignment of the spine.
It’s frustrating to receive a diagnosis of AIS, knowing that it has the potential to worsen. It is even more unsettling knowing that the majority of treatments are only recommended for more severe curves. Patients are beginning to take matters into their own hands and are seeing positive results with exercise prescriptions.
Several clinicians at HSS Rehabilitation are using the Schroth method as a treatment approach to AIS. The Schroth method is a progression of postural exercises that strengthen the spinal musculature to support a more neutral spine. The practice consists of muscle activation and postural holding along with volumetric breathing techniques used in a variety of positions. This is one approach that patients can use to improve their postural support system and actively work to improve the stability their spine.
Karen Resnik is a doctor of physical therapy, Certified Kinesiotape Practitioner, and Certified Schroth Therapist at the CA Technologies Rehabilitation Center at the Lerner Children’s Pavilion at Hospital for Special Surgery.