Scoliosis and Bracing Treatment I Physiotherapy Ampang

Type of scoliosis 

Idiopathic scoliosis is diagnosed when all other potential causes are ruled out and accounts for approximately 80% of all cases. In adults over the age of 25, the prevalence of scoliosis exceeds 8%, escalating to 68% in individuals over 60 years old due to degenerative changes in the aging spine. Additionally, in the general population, the prevalence of scoliosis with a Cobb angle larger than 10 degrees is approximately 2.5%. Adolescent idiopathic scoliosis is the most common form, typically diagnosed during puberty. It is further classified into subgroups:

1. Infantile scoliosis: Developing between 0 to 3 years of age, infantile scoliosis has a prevalence of 1%.
2. Juvenile scoliosis: Emerging between 4 to 10 years of age, this form comprises 10-15% of all idiopathic cases in children. Left untreated, curves may lead to serious cardiopulmonary complications, with approximately 95% of patients requiring surgical intervention for curves of 30 degrees or more.
3. Adolescent scoliosis: Manifesting between 11 to 18 years of age, this type accounts for around 90% of idiopathic cases in children.

Congenital scoliosis results from embryological malformations of one or more vertebrae and may occur at any location along the spine. These abnormalities cause curvature and other spinal deformities as one area of the spinal column grows at a slower rate than the rest. The progression of scoliosis in magnitude is influenced by the geometry and location of these abnormalities, and since they are present at birth, congenital scoliosis is typically detected at a younger age than idiopathic scoliosis.

Neuromuscular scoliosis encompasses scoliosis secondary to neurological or muscular diseases, including cerebral palsy, spinal cord trauma, muscular dystrophy, spinal muscular atrophy, and spina bifida. This type often progresses more rapidly than idiopathic scoliosis and frequently necessitates surgical intervention. Additionally, injuries and infections to the spine can also contribute to the development of scoliosis.

Sign and symptoms 

Scoliosis typically doesn’t present noticeable symptoms, but when they do occur, they may include back pain, difficulty standing upright, core muscle weakness, and leg pain, numbness, or weakness. Signs of scoliosis can manifest as uneven shoulders, protruding shoulder blades, a head that doesn’t center above the pelvis, an uneven waist, elevated hips, constant leaning to one side, uneven leg length, and changes in skin appearance or texture such as dimples, hair patches, or skin discoloration along the spine. If any of these signs are observed, it’s advisable to seek a healthcare provider for a screening. Over time, further indicators of scoliosis may become evident, such as height loss and uneven alignment of the pelvis and hips.  

Complication 

Complications stemming from untreated scoliosis can lead to various issues, including the progression of deformity(s). This progression may result in back pain, lumbar radiculopathy, cosmetic concerns, nerve damage, and in severe cases, cardiac and pulmonary restriction. Individuals with untreated scoliosis, particularly those with a curve exceeding 80 degrees in the coronal plane, may experience increased shortness of breath due to compromised lung function. 

Diagnosis

Confirmation of scoliosis typically involves various diagnostic methods, including a physical examination, x-ray imaging, spinal radiograph, CT scan, or MRI. These diagnostic tools allow healthcare providers to visualize the curvature of the spine and assess its severity. The primary method for measuring the curvature is the Cobb Method, which quantifies the angle of deviation from the normal alignment of the spine. The severity of scoliosis is diagnosed based on the number of degrees measured using the Cobb Method. This comprehensive diagnostic approach enables healthcare professionals to accurately assess and monitor scoliosis, guiding appropriate treatment strategies tailored to the individual’s needs.

Treatment

Observation 

For mild cases of scoliosis, especially in children who are still growing, observation may be the initial course of action. Regular monitoring through physical exams and X-rays allows healthcare providers to track any changes in the curvature over time. 

Role of physiotherapy 

The role of a physical therapist in scoliosis management encompasses three pivotal tasks: informing, advising, and instructing. Providing clear and comprehensive information to patients and/or parents about the individual’s specific situation is essential. This includes elucidating the nature of scoliosis, its potential progression, and available treatment options, which may include recommending braces, such as the Milwaukee brace, to prevent scoliosis from worsening. Another significant focus for physical therapists is guiding patients in performing tailored exercises suited to their condition. Numerous studies highlight the beneficial effects of exercises for individuals with idiopathic scoliosis. Moreover, physiotherapists address biopsychosocial factors, particularly in adolescents experiencing chronic low back pain, by assessing and managing additional factors such as insomnia, depression, anxiety, stress, and daytime sleepiness. Recognizing and addressing these contributing factors is crucial for comprehensive care, addressing both the physical and psychosocial aspects of the patient’s experience. 

A highly effective approach in scoliosis management is the use of physiotherapeutic scoliosis-specific exercises (PSSE). These exercises are customized for each patient based on scientific evidence and are aimed at achieving three-dimensional self-correction of posture, stabilization of corrected posture, patient education, and integration of corrective positions into daily activities. The frequency of PSSE physiotherapy varies depending on factors such as the complexity of the technique used and the patient’s ability to follow the prescribed program, typically ranging from 2 to 7 days per week. Long-term outpatient programs may occur two to four times a week if the patient is willing to cooperate. PSSE physiotherapy is typically performed by professionally trained instructors, as exercises are chosen based on the type and severity of scoliosis in each patient, and the methodology applied. 

Bracing

Bracing is often recommended for adolescents with moderate scoliosis curves (typically between 25-40 degrees) who are still growing. The brace helps prevent further curvature progression by providing external support to the spine. Bracing is usually worn for several hours each day or overnight, depending on the severity of the curvature.

When children are still experiencing growth and have moderate scoliosis, a doctor may recommend a brace. While wearing a brace won’t cure scoliosis or reverse the curve, it effectively prevents further progression. The most common type of brace is typically made of plastic and contoured to fit the body’s shape. It’s designed to be nearly invisible under clothing, fitting snugly under the arms and around the rib cage, lower back, and hips, as exemplified by the Milwaukee brace. Most braces are worn throughout the day and night, and their effectiveness increases with prolonged wear. Children who wear braces can generally participate in most activities with few restrictions and can remove the brace for sports or other physical activities if necessary. Braces are usually discontinued once the bones stop growing, which typically coincides with milestones such as girls beginning to menstruate, boys needing to shave daily, or when there are no further changes in height. However, it’s important to note that congenital scoliotic curves are often inflexible and resistant to repair with bracing. In such cases, braces are primarily used to prevent the progression of secondary curves that may develop above and below the congenital curve, thereby minimizing imbalance. Bracing may be continued until skeletal maturity in these cases.

To conclude, parents play a vital role in monitoring their children’s posture from an early age. Early prevention or timely detection of idiopathic scoliosis is crucial to prevent its progression. Seeking assessment from a qualified scoliosis practitioner ensures a thorough evaluation of your child’s condition. Synapse Physiotherapy offers comprehensive scoliosis assessment and treatment services, providing support and guidance for families in need. Don’t hesitate to reach out to us for assistance. By taking proactive steps towards early intervention, we can effectively address scoliosis and promote better spinal health for your child’s future.