Nov 5

Scoliosis

Let’s go over some common myths, misconceptions and truths around scoliosis. What is Scoliosis?

Scoliosis is a curvature of the spine. This curvature can happen in various parts of the spine, including the mid-back and lower back. While scoliosis often develops during childhood, it can emerge at any stage of life.

What is the cause of Scoliosis?

Most cases of scoliosis are classified as "idiopathic," meaning they arise spontaneously without a known cause (Lowe et al., 2000). It is important to know that scoliosis can also stem from other factors, such as congenital conditions or neuromuscular disorders like cerebral palsy (Lee et al., 2022).

How common is Scoliosis?

It seems to affect 3.1% of children and adolescents (Li et al., 2024).

What are Cobb angles?

To assess the curve of the spine, healthcare professionals use something called the Cobb angle, which measures the curvature in a specific plane (the frontal plane)(Romano et al., 2024). This angle helps classify the severity of scoliosis:

Mild: less than 20°
Moderate: 21° to 35°
Moderate to Severe: 36° to 40°
Severe: greater than 40°

While the Cobb angle is the most widely used and recognized measure for assessing spinal curvature, it’s not the only method available. However, caution is advised when using these alternative methods, as they may not be as widely validated.

What are the consequences of Scoliosis?

The impact of scoliosis can vary between adults and children. For mild cases, there may be little to no impact on daily life. Additionally, curves less than 30 degrees in childhood do not seem to progress significantly once matured (Weinstein & Ponseti 1983). However, more severe scoliosis curvature can lead to a range of challenges, including decreased quality of life, increased disability, pain, cosmetic concerns, and functional limitations, although this significantly varies between individuals (Weinstein et al., 2003). In more serious instances, it can even affect lung function.

What is the relationship between Scoliosis and pain?

The relationship between scoliosis and pain isn't as straightforward as we might assume. While it’s easy to think that a curved spine would naturally lead to stress and discomfort in surrounding structures, the reality is more complex. Some individuals with scoliosis experience pain, while others may not feel any discomfort at all. However, overall there are higher rates of pain in people with Scoliosis vs people without Scoliosis (Topalis et al., 2017).

What can you do about Scoliosis?

Scoliosis doesn't always worsen over time however, it is believed to progress on average at approximately 1 degree annually in adolescents (Lee et al., 2022). There have actually been reports of complete spontaneous resolution in 9.5% of children in one study (Soucacos et al., 1998). While spontaneous (no treatment) improvements were seen in 27% (Soucacos et al., 1998). While treatments like surgery can lead to significant improvements in spinal curves, other options—such as exercise and bracing—are commonly used as well. Exercises specifically designed for scoliosis, known as physiotherapeutic scoliosis-specific exercises (PSSE). Bracing is typically recommended for curvatures greater than 25-30° (Romano et al., 2024). Bracing is thought to be able to slow down curve progression in adolescents (Lee et al., 2022). Surgery is often seen as a last resort option and reserved for more severe cases (>45 degrees) (Lee et al., 2022).

What can exercise do for Scoliosis?

Physiotherapeutic scoliosis-specific exercises (PSSE) focus on two main elements: self-correction and stabilization (Romano et al., 2024). A recent Cochrane review (Romano et al., 2024), which represents some of the highest evidence in research, examined whether specific scoliosis exercises are more effective than general therapeutic exercises in altering the Cobb angle. The findings showed that they didn't significantly outperform general exercises in changing the curvature and had only a slight positive effect on self-image and quality of life.

It's important to note that research isn’t always perfect. There were limited studies included in this review, each with its own limitations and biases. While research provides the best foundation for understanding these issues, anecdotal evidence can often lead us astray due to biases like confirmation bias (see “the importance of research” for more information on why research is important).

In summary, current evidence does not support the idea that exercise can correct the spinal curve in scoliosis. However, exercise still offers many benefits, particularly in pain management, with studies indicating overall improvements in pain for individuals with scoliosis (Romano et al., 2024). Staying active can play a vital role in our overall well-being.

What exercise method is most effective for Scoliosis?

The truth is, we don’t have a definitive answer yet. While we know that exercise can have a mild impact on the Cobb angle (Fan et al., 2020), research suggests that there isn’t a significant difference between scoliosis-specific exercises and general therapeutic exercises (Romano et al., 2024)(Thompson et al., 2019)(Gamiz-Bermudez et al., 2022). This highlights the importance of maintaining an active lifestyle, as any form of exercise can still contribute positively to our health!

What can manual therapy (e.g., manipulations, massage, mobilization and others) do for scoliosis?

The truth is, we don’t have definitive answers yet. While a few studies hint at potential benefits of manual therapy for scoliosis, they are of low quality, making it difficult to draw reliable conclusions (Sun et al., 2023).

The 10 key points from this blog:

Definition and Development: Scoliosis is a curvature of the spine that can occur in different areas, including the mid-back and lower back. It often develops in childhood but can emerge at any age.
Causes: Most scoliosis cases are classified as "idiopathic," meaning they arise spontaneously without a known cause. Other factors include congenital conditions and neuromuscular disorders, such as cerebral palsy.
Prevalence: Scoliosis affects approximately 3.1% of children and adolescents.
Cobb Angle Measurement: Healthcare professionals use the Cobb angle to assess the severity of scoliosis. It classifies curves into categories: mild (<20°), moderate (21°-35°), moderate to severe (36°-40°), and severe (>40°).
Consequences of Scoliosis: The impact of scoliosis varies. Mild cases may not affect daily life significantly, while more severe curvatures can lead to pain, disability, and cosmetic concerns, and may even affect lung function.
Pain Relationship: The connection between scoliosis and pain is complex. Some individuals experience pain, while others do not. Overall, those with scoliosis report higher rates of pain compared to those without the condition.
Progression and Treatment Options: Scoliosis doesn't always worsen, with an average progression of about 1 degree annually in adolescents. Treatments include surgery for severe cases, bracing for curvatures over 25-30°, and exercise.
Exercise Benefits: While current evidence does not support exercise as a means to correct spinal curvature, it offers benefits like pain management and improved quality of life. Staying active is crucial for overall well-being.
Manual Therapy: There is limited research on the effectiveness of manual therapy for scoliosis, and the studies available are of low quality, making it challenging to draw firm conclusions.
Importance of Research: Understanding scoliosis requires looking at high-quality research. Anecdotal evidence can be misleading, so it's essential to rely on scientific studies for accurate information and effective treatment strategies.

References

Fan, Y., Ren, Q., To, M. K. T., & Cheung, J. P. Y. (2020). Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review. BMC musculoskeletal disorders, 21(1), 495. https://doi.org/10.1186/s12891-020-03517-6
Gámiz-Bermúdez, F., Obrero-Gaitán, E., Zagalaz-Anula, N., & Lomas-Vega, R. (2022). Corrective exercise-based therapy for adolescent idiopathic scoliosis: Systematic review and meta-analysis. Clinical rehabilitation, 36(5), 597–608. https://doi.org/10.1177/02692155211070452
Lee, G. B., Priefer, D. T., & Priefer, R. (2022). Scoliosis: Causes and Treatments. Adolescents, 2(2), 220–234. https://doi.org/10.3390/adolescents2020018
Li M, Nie Q, Liu J, Jiang Z. Prevalence of scoliosis in children and adolescents: a systematic review and meta-analysis. Front Pediatr. 2024 Jul 23;12:1399049. doi: 10.3389/fped.2024.1399049
Lowe, T. G., Edgar, M., Margulies, J. Y., Miller, N. H., Raso, V. J., Reinker, K. A., & Rivard, C. H. (2000). Etiology of idiopathic scoliosis: current trends in research. The Journal of bone and joint surgery. American volume, 82(8), 1157–1168. https://doi.org/10.2106/00004623-200008000-00014
Romano, M., Minozzi, S., Bettany-Saltikov, J., Zaina, F., Chockalingam, N., Kotwicki, T., Maier-Hennes, A., Arienti, C., & Negrini, S. (2024). Therapeutic exercises for idiopathic scoliosis in adolescents. The Cochrane database of systematic reviews, 2(2), CD007837. https://doi.org/10.1002/14651858.CD007837.pub3
Soucacos, P. N., Zacharis, K., Gelalis, J., Soultanis, K., Kalos, N., Beris, A., Xenakis, T., & Johnson, E. O. (1998). Assessment of curve progression in idiopathic scoliosis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 7(4), 270–277. https://doi.org/10.1007/s005860050074
Sun, Y., Zhang, Y., Ma, H., Tan, M., & Zhang, Z. (2023). Spinal Manual Therapy for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. BioMed research international, 2023, 7928429. https://doi.org/10.1155/2023/7928429
Thompson, J. Y., Williamson, E. M., Williams, M. A., Heine, P. J., Lamb, S. E., & ACTIvATeS Study Group (2019). Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and meta-analysis. Physiotherapy, 105(2), 214–234. https://doi.org/10.1016/j.physio.2018.10.004
Topalis, C., Grauers, A., Diarbakerli, E., Danielsson, A., & Gerdhem, P. (2017). Neck and back problems in adults with idiopathic scoliosis diagnosed in youth: an observational study of prevalence, change over a mean four year time period and comparison with a control group. Scoliosis and Spinal Disorders, 12(1). https://doi.org/10.1186/s13013-017-0125-z
Weinstein, S. L., & Ponseti, I. V. (1983). Curve progression in idiopathic scoliosis. The Journal of Bone & Joint Surgery, 65(4), 447–455. https://doi.org/10.2106/00004623-198365040-00004
Weinstein, S. L., Dolan, L. A., Spratt, K. F., Peterson, K. K., Spoonamore, M. J., & Ponseti, I. V. (2003). Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA, 289(5), 559–567. https://doi.org/10.1001/jama.289.5.559

This blog was written by Samuel Bulten