Scoliosis – an exaggerated curve of the spine
By Brian Fuller Accredited Exercise Physiologist
Scoliosis describes an abnormal curvature of the spine away from the midline. There are two types of scoliosis – structural and functional. As the name suggests, a structural scoliosis describes excessive rotation of a section of spine (usually between the shoulder blades) which is clearly evident when the patient bends forward to touch their toes. A functional scoliosis is a transient deviation away from the midline created by unnatural protective muscle spasm at times of acute spinal pain. It corrects itself as soon as the spinal pain had settled but a structural scoliosis is a fixed deformity, not necessarily related to pain.
There is no one reason as to why scoliosis forms in some individuals and not others. Scoliosis that is noticed before the age of 3 is termed Infantile scoliosis. An abnormal curvature of the spine noticed between the ages of 3 and 9 years is termed Juvenile scoliosis or Early Onset Scoliosis.
Adolescent Idiopathic Scoliosis is by far the most common form of scoliosis noticed effecting roughly 4 out of 100 children between 10 to 18 years of age. Some suggested reasons for the formation of adolescent idiopathic scoliosis include, a family history of scoliosis, and hormonal imbalances to asymmetric growth. Most of these patients generally live life pain free and when viewed from the side present with normal posture.
Individuals with scoliosis may present with any of the following or a combination of all
- Uneven shoulder heights
- One shoulder blade protruding out from the back further then the other
- Uneven waist crease lines
- A larger hump down one side of the spine
- Uneven hip heights
- Visual curvature of the spine
- Back pain
- A postural lean to one side
A traditional approach to scoliosis has been a wait and see approach, especially in young children where a curvature has not been considered to be at a stage where bracing or surgery has been recommended, and generally a doctor will just monitor the curvature over a period of time. Observation when surgery and bracing is the only option makes sense, as it should be the last option, however with the availability of specific scoliosis exercise rehabilitation now available such as the Schroth or SEAS methods, the opportunities for early intervention are greater than ever.
The ability to predict the progression of a curvature is difficult and involves several factors such as, family history, maturation, age, curve location and curve magnitude. In 1984, a study was undertaken by Lonstein and Carlson, where 727 children with idiopathic scoliosis were studied. The study looked at the relationship between the age of onset and the degree of severity of scoliosis. The study confirmed the clinical belief that the younger the onset of scoliosis, the more likely it was to develop to a severe degree.
So why should we NOT just wait and monitor the curve?
Two German surgeons Carl Hueter and Richard von Volkmann are responsible for research into the effects of compression on the spine in an abnormal position. They co-founded what is now known as the Hueter-Volkmann principle. This principle proposes that skeletal growth is retarded due to increased mechanical compression and accelerated due to a reduction in loading in comparison with normal values. Where compression occurs on a growth plate, there will be an inhibition of growth to that specific section of bone, whilst at the same time a distraction (or unloading) of bone elsewhere can cause the bone growth to accelerate.
Now keeping it to a level we all can understand it basically highlights that if significant changes to the spine go untouched it can progress over time, and the spine will continue to change with more force then when the spine was considered less asymmetrical.
The views of many surgeons around the world that exercise programs don’t offer any benefit to patients with scoliosis may be true for a generalised exercise approach to scoliosis, such as core strengthening to prevent the curve worsening.
The development of exercise programs such as the Schoth method as an example offer a very specific range of exercises used for scoliosis. These exercises are not your general abdominal exercises such as planks and knee lifts etc. rather a set of movements aimed to straighten and de-rotate the spine back to its natural alignment. These exercises alone may be enough when done daily for scoliotic curves up to 20 degrees.