Non-surgical Scoliosis Treatment

TREATMENT FOR SCOLIOSIS

In our clinical practice we receive children with various spinal deformities including defects of posture, mild scoliosis (Cobb angle 10-24 degrees), moderate curves (Cobb angles 25-50 degrees) and severe scoliosis (Cobb angle greater than 50 degrees). We also work with adults who suffer from spinal deformities and back pain.

Our conservative treatment is based on Physiotherapeutic Scoliosis Specific Exercises. These exercises are specific to the curve pattern and are connected with de-rotation and de-flexion of the spine and ribcage. We follow principles described by Katharina Schroth and her daughter Christa Lehnert-Schroth in the Schroth method.

Physiotherapeutic Scoliosis Specific Exercises are always individualized according to patient needs, curve pattern and treatment phase, even if performed in small groups. They must be performed regularly throughout treatment in order to achieve the best result. All patients are regularly assessed during the treatment. The difficulty of exercises is always increased according to patient ability.

Physiotherapeutic Scoliosis- Specific Exercises (PSSE) include:

Patients education about their condition, auto-correction in 3D and stabilization the corrected posture. 

Patients exercise in a small group or receive individual training sessions.

Patients should be able to follow the instructions.

Benefits of PSSE over Surgery

Surgery is clearly more invasive, carries further risks and possibly further pain and does not always provide favourable outcomes. Exercises provide a non-invasive means of control. 

Main principles of our treatment:

• to make the patient aware of existing deformation of the spine and the trunk
• to teach the correct shift of the spine in frontal plane in order to correct the primary curve while stabilizing the secondary curve
• to facilitate of corrective breathing with concavities
• to improve neuro-muscular coordination
• to strengthen muscles

Treatment options for scoliosis:

1/ Physiotherapy -  Specific physiotherapeutic techniques aim to address the spinal curvature itself, attempting to achieve self-correction with active trunk movements.

2/ Brace -  Moderate but progressive idiopathic scoliosis in skeletally immature adolescents can be successfully halted using a brace. The corrective brace is able to prevent more severe deformity and avoid the need for surgical treatment. However, the brace has to be worn full time for several months or until skeletal maturity.

3/ Surgery -  It is the treatment of choice for severe idiopathic scoliosis which is rapidly progressive, with early onset or late diagnosis.

Surgery is advised if the Cobb angle exceeds a threshold of 50 degree at completion of growth and when a risk of progression remains. The main goals of operative treatment for progressive idiopathic scoliosis in the adolescent age group are to halt progression of deformity. However, surgery does not restore the normal spine. The final decision regarding operative treatment should be an intentional choice made by the patient and parents supplied with adequate information about the surgery itself. The two surgical approaches are used in the surgical treatment.

The most widely used technique is posterior spinal instrumentation, which provides good curve correction in three dimensions and reduces rib hump. Curve correction is achieved using screw, hooks, or wires implanted in posterior elements of the vertebrae and connected with rods. An alternative to the posterior approach is anterior instrumentation. It is recommended mainly for single thoracolumbar and lumbar curves. Surgery reduces deformity and prevents further curve progression. However, in the long term, surgically treated patients have more degenerative disc changes than patients without surgery. Also, they have more frequent lumbar or bodily pain. Moreover, surgically treated patients have reduced physical functioning and general health as well as more sick-leaves due to back pain [4].

CONSERVATIVE MANAGEMENT OF SPINAL DEFORMITIES

Chiropractic specific treatments of spinal manipulation and rehabilitation should not be recommended over treatments that have demostrated evidence, such as bracing and scoliosis specific rehabilitation programs. If chiropractors wish to play a role in the management of scoliosis, then they should offer evidenced based approaches to scoliosis management [1,2]

There is no evidence to support osteopathy in the treatment of mild adolescent idiopathic scoliosis [3]

   Reference:

[1] J McAviney: Chiropractic treatment of scoliosis; a systematic review of the scientific literature. From 9th International Conference on Conservative Management of Spinal Deformities - SOSORT 2012 Annual Meeting

[2] Lantz CA, Chen J: Effect of chiropractic intervention on small scoliotic curves in younger subjects: a time-series cohort design. J Manipulative Physiol Ther 2001, 24(6): 385-393

[3]Hasler C, Schmid C: No effect of osteopathic treatment on trunk morphology and spine flexibility in young women with adolescent idiopathic scoliosis. J Child Orthop. 2010; 4(3): 219-226     

[4] Danielsson AJ¹, Nachemson AL. Back pain and function 23 years after fusion for adolescent idiopathic scoliosis: a case-control study-part II. Spine (Phila Pa 1976). 2003 Sep 15;28(18):E373-83.

Consultations are by appointment only.

Joanna Slup scoliosis expert

2A Prebend Street,

Islington, N1 8PT

Phone: +44 77 1999 7920

Email:

appointment@schrothmethod.co.uk