Sign and Symptoms 

Several signs may indicate the possibility of scoliosis, including a sideways curvature of the spine, sideways body posture, one shoulder being higher than the other, clothes not hanging properly, local muscular aches, and local ligament pain. A major concern in progressive severe scoliosis is decreasing pulmonary function. In one study, about 23 percent of patients with idiopathic scoliosis presented with back pain at the time of initial diagnosis. Idiopathic scoliosis may also affect pulmonary function due to changes in the shape and size of the thorax. Recent reports on pulmonary function testing in patients with mild to moderate idiopathic scoliosis showed diminished pulmonary function, with greater impairment observed in severe cases of spinal deformity, proximally-located curvature, and older patients.

Diagnosis 

Scoliosis diagnosis in children and teenagers often occurs during routine medical examinations due to the absence of noticeable symptoms. Scoliosis chiropractors undertake a comprehensive diagnostic approach, starting with a thorough review of the child’s medical history and family background, which may uncover potential underlying medical conditions contributing to spinal curvature. Some cases are even identified through school screenings. Following this, a physical examination assesses the child’s posture, checking for any asymmetry in the trunk or shoulders. When the child bends forward, the doctor looks for signs such as one side of the rib cage appearing higher than the other, which can indicate possible scoliosis. The most definitive diagnostic tool, however, is x-ray imaging, providing detailed insights into the extent and severity of the spinal curvature. By evaluating these x-ray images, practitioners can accurately determine the severity of the condition and devise appropriate treatment strategies tailored to each individual case.

Management 

Management of scoliosis depends on the severity of the curvature, measured by the Cobb angle, and the age of the patient.

Observation 

For mild scoliosis, which is defined as a Cobb angle of less than 20 degrees, observation is typically recommended, especially in growing children and adolescents. Regular follow-up visits every 4-6 months are essential to monitor the progression of the curve. If the curve does not worsen, no further treatment may be necessary.

Physiotherapy 

Physiotherapy can be particularly beneficial for managing mild to moderate scoliosis, defined as a Cobb angle of less than 20 degrees, or in some cases, up to 30 degrees. Physiotherapy aims to manage symptoms, improve posture, and strengthen the muscles that support the spine. Specific exercises tailored to the individual’s condition can help reduce the progression of the curve and enhance overall spinal function. By focusing on muscle balance, flexibility, and core strength, physiotherapy not only addresses the curvature but also promotes better posture and alignment, contributing to the patient’s overall well-being and quality of life.

Brace 

For moderate scoliosis, especially in growing children and adolescents, orthotic specialists provide braces designed to prevent further curvature. These braces are tailored to fit each patient and are regularly adjusted to ensure effectiveness. By applying gentle pressure to the spine, braces help to maintain proper alignment and minimize the progression of the curve during periods of rapid growth. Regular monitoring and adjustments by healthcare professionals ensure that the brace continues to fit correctly and functions as intended, promoting optimal outcomes in scoliosis management.

The most common type of brace used for scoliosis is made of plastic and is contoured to conform to the body, such as the Milwaukee brace. This type of brace is designed to be nearly invisible under clothing, fitting snugly under the arms and around the rib cage, lower back, and hips. Most braces are worn day and night, and their effectiveness increases with the number of hours worn each day. Children who wear braces can usually participate in most activities with few restrictions. If necessary, the brace can be removed for sports or other physical activities.

Braces are typically removed once bone growth has ceased, which usually happens around two years after girls start menstruating, when boys begin shaving daily, or when there are no further changes in height. In general, congenital scoliotic curves are not flexible and are resistant to correction with bracing. Therefore, braces are mainly used to prevent the progression of secondary curves that develop above and below the congenital curve, which can cause imbalance. In these cases, braces may be worn until skeletal maturity is reached.

Surgery 

Severe scoliosis typically progresses over time, and a specialist may suggest scoliosis surgery to reduce the severity of the spinal curve and prevent further worsening. The most common type of scoliosis surgery is spinal fusion. In this procedure, two or more vertebrae are fused together so they cannot move independently. Pieces of bone or a bone-like material are placed between the vertebrae, and metal rods, hooks, screws, or wires are used to hold that part of the spine straight and still while the old and new bone material fuses together. This stabilizes the spine and corrects the curvature to a more manageable degree.

Acute injuries 

These injuries typically result from abrupt trauma to the tissue, and their symptoms manifest almost immediately. The underlying principle in such cases is that the force applied to the tissue at the time of injury—whether it involves muscles, tendons, ligaments, or bones—exceeds the inherent strength of that tissue. Forces contributing to acute injuries can be either direct or indirect in nature.

The classification of acute injuries can be based on both the site and type of injury. Regarding the site, injuries may affect various anatomical structures such as bones, cartilage, ligaments, muscles, bursae, tendons, joints, nerves, or skin. On the other hand, the type of injury categorisation includes conditions like fractures, dislocations, sprains, or strains, providing a comprehensive framework for understanding and addressing the diverse range of acute injuries.

Acute injuries can be further divided into 2 which is direct and indirect injury.

Direct Injury: 

A direct injury occurs when there is direct contact with an external force or blow, known as extrinsic causes. This type of injury involves a physical impact on the body from an external source. Two common scenarios illustrating direct injuries include collision with another player. This often happens in contact sports such as rugby or football when players tackle each other. The force from the collision can lead to injuries to various body parts. Then, it can be struck by an object. For instance, in sports like basketball or hockey, a player may be struck by a basketball or a hockey stick, causing direct trauma to the affected area.

Indirect injury:

 Indirect injuries can manifest in two primary ways, both stemming from intrinsic causes. The first way is injury occurring some distance from the impact site. In this scenario, the actual injury doesn’t happen at the point of impact but at a location further away. An example is falling on an outstretched hand, which can result in a dislocated shoulder. The force generated by the fall is transmitted through the limb, leading to an injury in a different area.

The other way is injury resulting from internal forces built up by the performer’s actions. These injuries don’t arise from direct physical contact with an external object or person. Instead, they result from internal forces generated by the individual’s movements. Factors such as overstretching, poor technique, fatigue, and lack of fitness contribute to these injuries. Examples include muscle strains or ligament sprains, where the damage is caused by the internal stresses placed on the tissues during physical activity..

Repetitive activities carry the potential to lead to overuse injuries, which develop gradually over time due to prolonged and repetitive loading of the tissue. Symptoms of overuse injuries typically emerge gradually, and in the early stages, individuals may experience little or no pain. Unfortunately, athletes often continue exerting pressure on the affected area, hindering the necessary healing process. Unlike acute injuries, the causes of overuse injuries are often less obvious. The underlying principle in overuse injuries is that repetitive microtrauma overwhelms the tissue’s capacity to repair itself (Clarsen, 2015). 

To gain a deeper understanding of overuse injuries, it is helpful to consider the microscopic changes occurring in tissues subjected to repetitive stress during workouts. During exercise, various tissues such as muscles, tendons, bones, and ligaments undergo significant physiological stress. Following the activity, these tissues adapt to become stronger, better equipped to withstand similar stress in the future. Overuse injuries occur when the tissue’s adaptive capacity is surpassed, resulting in actual tissue damage.

In the overzealous athlete, insufficient time is allowed for proper adaptation before the next workout. Cumulative tissue damage eventually surpasses a threshold, leading to pain and dysfunction. Excessive repetitive forces, often influenced by one or a combination of risk factors, contribute to the exceeding of the tissue’s adaptive capability. These risk factors may include factors such as improper biomechanics, inadequate rest periods, overtraining, or pre-existing structural vulnerabilities.

Common type of sport Injuries

Soft tissue injury: 

Ligaments 

Ligaments are made up of closely packed collagen fibers. They play a significant role in providing passive stability to the joint.Load is transferred in the direction of the ligament from bone to bone. Injuries occur when a ligament is under excessive load.

Ligament injuries are classified into three grades .A Grade I sprain involves some stretched fibers, but clinical testing reveals a normal range of motion when stressing the ligament. In a Grade II sprain, a significant proportion of the fibers are affected, leading to increased laxity. Stressing the joint and ligament results in noticeable laxity, but there is still a definite endpoint. A Grade III sprain indicates a complete tear of the ligament, resulting in excessive joint laxity with no firm endpoint. While Grade III sprains are often painful, it’s noteworthy that they can also be pain-free, as sensory fibers may be completely severed during the injury.

For grade I and grade II sprains, treatment aims to promote tissue healing. prevent

joint stiffness, protect against further damage and strengthen muscle to provide additional joint stability.The management of a Grade III sprain provides options for both conservative and surgical approaches. For instance, a torn medial collateral ligament of the knee or a torn lateral ligament of the ankle may be treated conservatively. This conservative approach often involves full or partial immobilisation of the affected joint. On the other hand, a surgical intervention may be considered, wherein the two ends of the torn ligament are surgically reattached. Following the surgical procedure, the joint is typically fully or partially immobilised for a duration of approximately six weeks. (Brukner et al., 2017)

Physiotherapy interventions for ligament sprains typically commence with a multifaceted strategy. Initial priorities involve pain management and the reduction of swelling. Subsequently, the rehabilitation process shifts towards restoring the affected joint’s functionality and addressing various aspects:

• Range of Motion (ROM): Physiotherapy aims to gradually restore the normal range of motion in the injured joint, ensuring that flexibility is regained without compromising stability.
• Strength: Strengthening exercises are crucial for enhancing the support and stability of the ligaments.
• Proprioceptive Training: Proprioception, or the body’s sense of spatial orientation, is often compromised in ligament injuries. Physiotherapy includes exercises to restore proprioceptive deficits, enhancing the individual’s awareness of joint positioning and movement.
• Performance Improvement: As the rehabilitation progresses, the focus broadens to improve overall performance, whether it be in returning to sports, work-related activities, or daily life. Specific exercises and drills are tailored to the demands of the individual’s activities.
• Biomechanical Corrections: Physiotherapists work to identify and correct any biomechanical faults that may contribute to abnormal movement patterns or predispose the individual to future injuries. This may involve assessing and modifying movement techniques to ensure optimal joint function and reduce the risk of re-injury.

Tendon

Healthy tendons are composed of tightly packed, parallel bundles of collagen fibers. 

• Tendon rupture 

Injuries to tendons typically occur at points with minimal blood supply, such as the Achilles tendon, usually around 2 cm (0.75 in.) above the insertion point, or at the musculotendinous junction.Tendon ruptures often happen unexpectedly, especially in older athletes without a prior history of injury to that specific tendon. The Achilles tendon and the supraspinatus tendon of the shoulder are the two tendons most frequently affected by ruptures. 

• Tendinopathy 

Tendinopathy refers to a chronic tendon injury, and it does not inherently imply a specific cause (aetiology). This term is widely adopted by leading researchers in the field of tendon science. Tendinopathy is frequently observed in overuse injuries, where repetitive loading of a tendon leads to strain and tissue deformation. As this process continues, some tendon fibers begin to fail, eventually resulting in macroscopic tendon failure. In overuse tendon injuries, characteristic degenerative changes occur, including altered fibril organisation, reduced cell count, occasional vascular in-growth, and local necrosis. These changes signify the impact of prolonged and repetitive strain on the tendon structure, contributing to the chronic nature of tendinopathy.

Athletes with overuse tendon pain may exhibit pain occurring after exercise or the following morning, potentially painful at rest. Athletes may find that they can “run through the pain,” and the discomfort tends to decrease as they warm up. Clinical examination may reveal localised tenderness and thickening of the affected tendon. Swelling and crepitus may be present; however, crepitus is often a sign of associated tenosynovitis or may be attributed to the water-attracting nature of collagen disarray. The main objective of the treatment of tendon injuries is to restore full motion and function.

Muscle 

Muscle injuries stand out as one of the most prevalent issues in sports, accounting for a frequency ranging from 10% to 55% of all sustained sporting injuries. These injuries encompass muscle strains/tears and contusions.

Strain/Tear:

Muscles undergo strain or tearing when some or all of the fibers fail to withstand the demands imposed on them. Commonly affected muscles include the hamstrings, quadriceps, and gastrocnemius—muscles that span two joints, making them more susceptible to injury. Muscle tears often occur during sudden acceleration or deceleration. Muscle strains are categorised into three grades. A grade I strain involves a small number of muscle fibers and causes localised pain but no loss of strength. A grade II strain is a tear of a significant number of muscle fibers with associated pain and swelling. Pain is reproduced on muscle contraction. Strength is reduced and movement is limited by pain. A grade III strain is a complete tear of the muscle. 

Several factors contribute to an increased predisposition to muscle strains. Inadequate warm-up routines before engaging in physical activity can leave muscles unprepared for the stress they may encounter. Insufficient joint range of motion, characterised by limited flexibility, increases the risk of muscle strains, particularly during dynamic movements. Excessive muscle tightness can make muscles more prone to strain, especially when subjected to sudden or intense stress. Fatigue resulting from overuse, inadequate rest, and insufficient recovery periods heightens the likelihood of muscle strains. Muscle imbalances, where certain muscle groups are stronger or more flexible than others, create vulnerabilities to strains. Additionally, individuals with a history of previous muscle strains are at an elevated risk of experiencing recurrent injuries in the same or adjacent muscle groups.

The acute management of muscle strains is crucial for optimal recovery and minimising complications. This involves several key components: initiating early ice and compression to reduce swelling and inflammation, considering a brief period of immobilisation, particularly in the initial days post-injury and depending on severity. Additionally, early and cautious mobilisation, incorporation of range of motion exercises within pain limits, is recommended, while aggressive stretching techniques should be avoided. Gentle massage of the affected muscle can be beneficial but might be best postponed for the first 24-48 hours, depending on the severity of the strain. This comprehensive approach aims to address immediate symptoms, promote healing, and prevent further damage to the injured muscle (Brukner et al., 2017). 

Hard tissue injuries 

Joint 

Dislocation of a joint occurs when trauma produces complete dissociation of the articulating surfaces of the joint. Subluxation occurs when the articulating surfaces remain partially in contact with each other. Dislocation and subluxation present with distinct signs and symptoms that collectively indicate joint instability. A notable feature is the loss or severe impairment of joint movement, accompanied by an evident deformity in the affected area. The presence of swelling and tenderness around the joint signifies the trauma associated with the dislocation or subluxation. Pain, often intense, is a consistent symptom experienced at the site of the joint displacement.

Dislocated joints, in most cases, can be reduced relatively easily. After reduction, the joint needs to be protected to aIlow the joint capsule and ligaments to heal. Where possible, early protected mobilisation is encouraged. Subsequent muscle strengthening gives the joint increased stability.

Articular cartilgae 

The ends of long bones are endowed with articular cartilage, a crucial component that furnishes a low-friction gliding surface. This cartilage not only acts as a shock absorber but also diminishes peak pressures on the underlying bone. Although these injuries are common, improper management poses an elevated risk of long-term, premature osteoarthritis. Articular cartilage is susceptible to damage, particularly through shear injuries like dislocations and subluxations. Osteochondral injuries, which involve both cartilage and underlying bone, may coincide with soft tissue conditions such as ligament injuries (e.g., ACL injuries). Articular cartilage injuries fall into three classes: disruption of the deep layers with or without subchondral bone damage, disruption of the articular surface only, and disruption of both the articular cartilage and subchondral bone

Bone fracture 

A bone is a rigid organ integral to the vertebrate skeleton, serving multiple essential functions in the human body. Not only do bones provide structural support, but they also play a crucial role in safeguarding vital organs. Additionally, bones contribute to the production of red and white blood cells, essential for bodily functions like oxygen transport and immune response. Furthermore, bones serve as mineral reservoirs, storing important minerals such as calcium and phosphorus. Beyond these fundamental roles, bones enable mobility and act as a framework, offering support for the body’s overall structure. The tissue composing bones is categorised as dense connective tissue, emphasising its strength and durability in facilitating these diverse physiological functions.

Fractures can result from various causes, including direct trauma like a blow or indirect trauma such as a fall on an outstretched hand. They may manifest as closed or open (compound) fracture, the latter involving a bony fragment penetrating the skin. 

Classifications of fractures include transverse, oblique, spiral, or comminuted, with avulsion fractures being common in athletes, particularly children, where a piece of bone attached to a tendon or ligament is torn away.

Clinical features of a fracture encompass pain, tenderness, localised bruising, swelling, and, in some cases, visible deformity and restricted movement. Management involves anatomical and functional realignment. Non-displaced or minimally displaced fractures can be treated with bracing or casting, while displaced fractures necessitate reduction and immobilisation. In cases of displaced, unstable fractures, surgical stabilisation may be required to ensure proper healing and prevent complications (Brukner et al., 2017).

Physiotherapy plays a pivotal role in the rehabilitation of bone fractures, addressing both the physical and functional aspects of recovery. The treatment approach is tailored to the type and location of the fracture, as well as the stage of the healing process. Pain management is an essential aspect of physiotherapy, and modalities like ice, heat, or electrotherapy may be employed to alleviate pain and reduce inflammation during the initial stages of rehabilitation. Physiotherapists will also focus on promoting gentle mobilisation to prevent joint stiffness. They guide patients through range of motion exercises designed to maintain flexibility while ensuring the safety of the healing bone. As the fracture stabilises, progressive weight-bearing exercises are introduced, starting with non-weight-bearing or partial weight-bearing activities to rebuild strength and bone density. Muscle strengthening is a key component of physiotherapy for bone fractures. Targeted exercises aim to enhance the strength of the muscles surrounding the fractured area, providing crucial support and stability during the healing process. Additionally, balance and proprioception training play a significant role, particularly if the fracture affected a weight-bearing joint. These exercises help restore stability and reduce the risk of falls.