What is Scoliosis?
A normal spine has three main curves: cervical lordosis, thoracic kyphosis, and lumbar lordosis. These curves occur in the frontal plane, meaning they curve front to back. A scoliotic curve curves to the side.
Therefore, a scoliosis refers to when the vertebrae in the spine do not follow a straight line but are curved sideways. Sometimes they can also rotate, or twist, like a corkscrew.
A small scoliotic curve may be barely noticeable by eye, or it might be so slight that an X-ray (or MRI) would be needed to measure it. In those cases, the scoliosis is unlikely to cause any issues.
However, when a scoliosis is present in children, the curve may continue to grow until their skeleton is fully developed. This means that if the curvature becomes significantly large, it can cause more than just bad posture.
It can lead to headaches and back pain, loss of normal range of motion, digestive issues, affect breathing, and eventually cause early arthritis due to the unusual pressure on some of the joints, etc.
Observable symptoms of Scoliosis
- The head is not centered with the rest of the body
- Uneven shoulders
- Constant leaning to one side
- Difference in hip height
- Difference in shoulder blade height or position
- Uneven arm position as the arms hang on both sides of the body when the child is upright
- A sideways curvature of the spine when the child bends forward
Causes of Scoliosis
Most commonly (80-85% of the time), scoliosis is idiopathic, meaning the cause of it is unknown. In some cases, the development of idiopathic scoliosis can be due to a genetic predisposition.
While it can be diagnosed at any age, it is usually diagnosed in kids 10 and older.
There may be a correlation with poor posture as well. This is where we can differentiate if a scoliosis is functional or structural.
- A functional scoliosis develops due to certain postures and compensations that are likely due to muscle tightness and imbalance. In those cases, the spine appears to be curved but is not actually.
- A structural scoliosis originates in the spine and cannot be corrected by correcting posture and muscle imbalance
Less commonly, scoliosis can be:
- congenital, meaning that there were problems in the spine before a baby is even born. Usually, the spinal bones are either not fully formed or are fused in ways they should not be.
- neuromuscular, meaning that conditions that affect the nerves and/or muscles of the body (such as cerebral palsy or muscular dystrophy), will affect their ability to support the spine, leading to the development of a scoliotic curve
Severity of Scoliosis
Mild – Curve is less than 25 degrees, and risk of progression is 22%
Moderate – Curve is between 26-40 degrees, and risk of progression increases to 68%
Severe – Curve is above 40 degrees, and risk of progression is quite high at 90%
What to do about scoliosis?
In mild cases, if there are no symptoms or cosmetic concerns, then often the course of action is nothing.
However, until the child or adolescent is fully grown, the risk of progression is there. This means that the scoliosis should be monitored regularly (usually annually) and a referral to physiotherapy might be appropriate for preventative strategies and education.
In moderate cases symptoms are more likely, such as headaches, back pain, digestive issues, and fatigue with activity. A brace is often recommended to reduce the risk of progression and give the organs more room.
Physiotherapy and sometimes other disciplines, such as registered massage therapy and chiropractic, may also be an effective adjunct to bracing to help with symptoms and postural correction / education.
In severe cases, especially if a curve is above 50 degrees, a brace is not going to be able to able to slow progression, and surgery is likely to be recommended. Surgery usually involves spinal fusion to realign the vertebrae.
There have been many advances in surgical correction of scoliosis so the kind of surgery required will depend on the type of misalignment, the severity of symptoms, and the location of the scoliosis.
Overall, surgery has good outcomes.
What can Physiotherapy do about my child’s scoliosis?
In mild cases, treatment is preventative:
- Postural correction and education
- Postural exercises to correct muscle imbalances that have developed due to the scoliosis
- Manual therapy (soft tissue release, joint mobilizations) to help improve flexibility and restore range of motion that have been impacted by the scoliosis
- Postural taping to give proprioceptive feedback to the body and provide awareness to the child so they can better self-correct as they become aware of how their body is sitting in space
In moderate cases, treatment also helps to eventually wean off bracing while managing any associated symptoms.
In severe cases, physiotherapy might be helpful post-operatively to correct the muscle imbalances that had developed pre-operatively.
If you have questions, don’t hesitate to contact us for more information!
Can my child still play sports?
Yes, exercise and sporting activities (especially ones that focus on core strength) are encouraged!
In the severe cases, there may be some sport restrictions following a surgery. This is usually because after a fusion there will be some permanent loss of overall range of motion. However, kids often are able to return to sporting activities within 6 to 9 months after surgery.