Adolescent Idiopathic Scoliosis

You can see the curve quite clearly here due to the colours of the rainbow

“I’ve got a curve, scoliosis in my spine, but it’s nothing that has bothered me”. Most people, if you actually look properly at their spine, have a few curves, and most of the time they aren’t an issue. So what’s the big deal?. It’s a big deal if it’s missed early on and not managed properly, leading to possible chronic pain and disability in adult life.

We’re jumping ahead though, so lets start with the basics.

Spinal growth

The spine will exponentially grow over two many phases, between birth and 3 yrs of age, and again at various growth spurts during adolescence. Yes you do see slow growth in-betweem these phases, but we notice bigger changes at these times which is generally when a scoliosis is diagnosed.

The spine itself is a framework for all of our movements and posture. Made up of 7 cervical, 12 thoracic and 5 lumbar vertebrae, and the sacrum, it also has multiple curves that are natural and well designed for shock absorption. The spine keeps us upright, supports our arms and legs to move within multiple planes, supports our head and spinal cord and allows for respiration/the ability to breathe.

Definition: what is a scoliosis?
A scoliosis is a lateral curvature of the spine, with an element of torsion/rotation where there shouldn’t be at the spine and chest.

There are two types of scoliosis

1) Strutural: a fixed curve of the spine that no manual correction can change be it massage, exercise or manipulation. The vertebrae rotate towards the convexity of the curve. Most commonly you’ll see a prominent thoracic spine or rib, pelvis or lumbar paraspinal muscle prominence, uneven shoulders, a lower hip, uneven or prominent shoulder blades and the flank is asymmetrical.

2) non-strutural/postural: this type of curve is fully correctable, and often associated with muscle spasm or weakness. It lacks any vertebrae rotation and is not progressive. However, in some cases it can develop into a structural curve.

How is it diagnosed?

Sometimes we will diagnose a scolisos in the clinic because a patient has presented with another problem that is related to it, for example, neck pain, or while we’re assessing any child we will routinely check the spine for curvatures. Initially it is a clinical diagnosis using the Forward Bend Test and clinical history, which is then usually followed by an x-ray of the spine and pelvis. The Cobb angle is a measure of the degree of curvature in the spine, seen on x-ray, any curve greater than 10 degrees is scoliosis, anything over 40 degrees is considered a severe curvature. The Risser Sign is an x-ray of the pelvis and gives the practitioner an idea of growth plates and their fusion. This greatly affects the management of a scoliosis. A self assessment test has been provided by Scoliosis Australia as a means of early diagnosis within the community.

Signs and symptoms

• uneven waist

• one hip sits higher

• uneven shoulders

• shoulder blade sits higher than the other

• hips may twist to the side

• low back pain

• neck pain

• difficulty with walking and running (in severe cases)

• shorter stature than expected

• aches, limping, pain in hip, knee or pelvis, and pain worsening at the end of the day and over time.

How do we manage scoliosis?

In the long term, if managed well, children who have a scoliosis less than 40 degrees on the Cobb Angle statistically do well. Untreated curves can lead to severe complications of the cardiopulmonary system and decreased quality of life.

The main aim of physiotherapy is to stop the progression of a curve in the spine, which can lead to possible pulmonary compromise and pain. We use a variety of treatments to manage scoliosis ranging from exercise based therapy, manual therapy to manage pain and orthoses. Bracing can be beneficial for the right patient and is considered in severe cases. However, these cases are usually reviewed by a spinal specialist and may or may not require surgery as well.

Physiotherapists will continue to see young patients with scoliosis on and off for review, particularly at 4-6mnthly intervals to reassess and monitor any progressions in the spinal curve Cobb Angle. Finding the right therapist to help manage your child’s condition is an absolute must.

If you have any questions about this weeks blog feel free to reach out to us via our social media platforms. All information gathered comes from the Australian Bureau of Statistics, The Australian Institute of Health and Welfare, and Scoliosis Australia.