Frequently Asked Questions About Scoliosis and Non-Surgical Treatment
Stokes, I.A.F.: Hueter-Volkmann effect.
Spine: State of the Art Reviews (modified from Stokes)
What is scoliosis?
Historically, scoliosis was defined a lateral or sideways curve in the spine with a Cobb angle greater than 10 degrees 1. We now know that scoliosis is a 3-dimensional deformity of the spine, involving forward, sideways, and rotational movement of the involved vertebrae 2. If the scoliosis is structural, boney changes will show on x-ray films. These skeletal changes along with soft tissue imbalances cause a change in the shape of the trunk. Scoliosis is classified by the age at which it is found. It is described as infantile at less than 3 years; juvenile from 3 to 10 years; adolescent greater than 10 years.
What causes scoliosis?
There are many causes for scoliosis, but most scoliosis (80-90%) is described as idiopathic, meaning "of one's own" or as having a cause which it not well understood. See our references for current research. However, once the curve has begun a vicious cycle occurs, with uneven loading gravitational forces on of the spine causing more changes in the bone shape and orientation. The curve can lose some flexibility and over time, changes in the shape of the trunk occur. This leads to more uneven loading of the spine, and more progression of the curve and deformity. This vicious cycle was described by Ian Stokes, PhD 3.
How can curve progression be predicted?
Because we don't know the cause of idiopathic scoliois, curve progression prediction is not fully possible at this point in time. Studies looking at the genetics of scoliosis have identified genes that are partially responsible and now, physicians are beginning to test patients using a diagnostic test called the SCOLISCORE AIS (www.axialbiotech.com/company/find/press/2009/16). Correlations between the test results and probability of curve progression are at a fairly early stage. As more data are collected, we will understand better which individuals are likely to progress. At this point, we know that:
- Curves are more likely to progress in females4.
- If curves progress, they are more likely to progress during periods of growth4.
- Most curves do not progress beyond 20 degrees Cobb4.
- Curves that reach beyond 30 degrees Cobb at the end of growth are more likely to progress as adults5. This progression is probably related to mechanical forces (vicious cycle theory).
How do you cure scoliosis?
People have been looking for a cure for idiopathic scoliosis since at least the time of Hippocrates. We don’t mean to sound discouraging, but there is no cure for scoliosis; no way to “fix” it. Scoliosis is a chronic condition. The only practice that comes close to “fixing” the curves is surgery. An orthopedic surgeon can utilize titanium rods and screws to mechanically straighten a spine to a greater or lesser degree depending upon the 3-dimensionality of the curve.
When indicated, braces can help to stabilize a curve (see the brace study in our references) ; although, there are some curves that progress in even a well-constructed, properly fit brace. There are no machines or vitamins that will straighten the curve.
We believe that the best outcomes are achieved when your primary care physician or an orthopedic surgeon works as part of a team with an orthotist (when bracing is indicated) and a physical therapist trained in the Schroth-based BSPTS method to manage your condition over the course of your life.
What if I've had surgery?
Scoliosis is a chronic condition, just like diabetes or osteoporosis. So, if you've had surgery, you still need to care for your back. You need to be aware of your alignment above and below the rods and watch the way you move. You'll need to retrain your body and change the way you do things, like getting out of bed, for instance. The rehabilitation training we provide at Scoliosis Rehab will help you to understand your curve pattern in 3-D and will teach you how to move so as to minimize the negative effects that surgery and scoliosis can have on your joints and muscles.
How can Physical Therapy exercises and treatment help with scoliosis?
The basis for physical therapy intervention for scoliosis is the vicious cycle theory (see Question 2 above). Our specially trained staff knows how to assess and classify curve patterns and teach individuals how to proactively impact the vicious cycle by doing curve-specific scoliosis exercises designed to decrease the influences of gravity and uneven muscle pull. As a person begins to understand the corrected alignment, he or she will perform strengthening and breathing exercises in a specific corrected position. The scoliosis exercises require frequent repetition throughout one's lifetime, in order to "reprogram" the body in the more symmetrical posture. The goal of physical therapy treatment for scoliosis is to develop the ability to incorporate these corrections into daily activities at home, school and work.
Why hasn't this method been used in the US before?
There has been in the United States, a general, yet unsupported, consensus for the past century that exercises are not effective in the treatment of idiopathic scoliosis. The “nonspecific” back exercises which were prescribed probably did have little or no impact. Sadly,there have not been many high quality physiotherapy research studies performed in the US. Please refer to "Scoliosis and the Human Spine", by Martha Hawes, Ph.D. 2nd edition, 2003, available through the National Scoliosis Foundation (www.scoliosis.org/store/books.php).
Physical therapists are degreed, licensed medical professionals specializing in the evaluation and treatment of musculoskeletal problems. At this time, US physical therapist training, in general, usually includes several lectures on general types of scoliosis, non-specific exercises, pain control, general bracing, surgical techniques and rehabilitation after surgery.
It is time for Physical Therapist education to offer more specialization in training for conservative, pro-active intervention for scoliosis rehabilitation. We invite interested physical therapists and physical therapy educators to contact us about educational opportunities.
For whom are the Schroth scoliosis exercises recommended?
The Schroth-based BSPTS Method is recommended for people with idiopathic scoliosis who are willing to make the commitment to learn the scoliosis exercises and change their movement patterns. The scoliosis exercises can be started after a Cobb angle of 15 degrees is noted. Because of the level of commitment required, exercises usually start after age 10 years in girls and 12 years in boys. The Schroth-Based Method can also be used for adults, but due to long standing movement patterns and soft tissue tightness in adults, the scoliosis exercises generally progress more slowly. The specific exercises, if taught and performed correctly, should create no pain, but produce a sense of increased mobility and balance.
The exercises require frequent repetition throughout the patient's lifetime, in order to "reprogram" the body in an optimal symmetric posture. Remember, there is no cure for scoliosis.
How does the Schroth based BSPTS Method interface with the current standard of care for idiopathic adolescent scoliosis in the United States?
The Schroth-based BSPTS Method can be used to support the current treatment approach in the USA. The exercises can begin after a 15 degree Cobb angle is noted after age 10 for girls, and age 12 for boys. Usually in this country, observation only is recommended for curves with Cobb angles of 10-25 degrees. Teaching these scoliosis patients about a more symmetrically, aligned posture equips them to make choices about their movement habits throughout the day impact their spine.
A brace is usually recommended for adolescents if the curve progresses to more than a 25 degree Cobb angle. The exercises can be used to help keep the muscles of the torso strong and more balanced even while the individual wears a brace. Specific braces are recommended to support this optimal posture. The exercises are especially important as the spine matures, growth stops and the person is weaned from his or her brace. Continuing to perform the exercises as the individual comes out of the brace will train the person to maintain a more upright, balanced posture, decreasing the effects of the vicious cycle (see question 2).
In this country, many Doctors recommend surgery for people having curves with Cobb angles of greater than 45 degrees. The Schroth-based BSPTS Method exercises can be used to maximize the neutral alignment of the spine if surgery is rejected by the patient or family for medical or other reasons. Schroth teaching advocates conservative management of scoliosis, but recognizes the fact that in some cases, surgery is the best option. These specific scoliosis exercises can also be used before surgery to decrease the secondary soft tissue tightness and after recovery from surgery to facilitate more even muscle pull on the spinal correction.
How do I find a brace-maker (orthotist) who can make a Rigo Cheneau Type Brace?
The Rigo Cheneau Type Brace requires specific training and years of practice with a master brace-maker. There are very few such orthotists in the United States. Please contact Align Clinic & Align Clinic WI for more information on the WCR brace or feel free to contact us for further information.
What about bracing for adults?
There is evolving data indicating bracing can be helpful in reducing pain and improving function in adults. Please contact Align Clinic or Align Clinic WI or go to:
Does my insurance cover this type of Physical Therapy?
The physical therapy treatments associated with the Schroth based Method are billed under standard physical therapy codes. Individual insurance plans may vary in their reimbursement terms.
We recommend that you check on your insurance coverage for physical therapy services.
- Moen KY and Nachemson AL 1999 Spine 24: 2570-2575, Treatment of scoliosis: an historical perspective.
- Deacon et al, 1984 J Bone and Jt Surgery-Br 66: 509-512. IS in three dimensions: a radiographic and morphometric analysis.
- Matsumoto et al, 1997 Spinal Disorders 10:125-131. Flexibility in the scoliotic spine: three dimensional analysis.
- Stokes et al, 1996 Spine 21: 1162-1167. Mechanical modulation of vertebral body growth. Implications for scoliosis progression.
- Lonstein J.E., 1987 Spine: State of the Art Review, vol. 1, No. 2., p184-187. Editor Jesse H. Dickson. “ The Risk of Progression of Idiopathic Scoliosis in Skeletally Immature Patients”.
- Weinstein S.L., 1987 Spine: State of the Art Review, vol. 1, No. 2, p. 203. Editor Jesse H. Dickson. “The Natural History of Scoliosis in a Skeletally Mature Patient”.