Scoliosis

Scoliosis And Its Treatment By Physical Therapy

Scoliosis is a three dimensional, tri-planer skeletal deformity in which there is lateral deviation and rotation of the spine in an upright position. It can be caused by either neurologically, congenital, or can be caused by carcinoma, e.g. spinal tumors. The lateral curvature of the spinal cord is normally 10 degrees or less, but during scoliosis, it can increase from 10 and can go up to 40 degrees. The most common type of scoliosis (about 80-90%) is idiopathic (proper caused by the disease is unknown) and can occur in all ages but commonly seen in adolescent age. It can be properly seen in frontal plane by taking x-ray from the posterior side, but it can also be done anteriorly. In the sagittal plane, the kyphosis (extensive outward curve of cervical and thoracic region) and lordosis) inward curvature of the spine at lumbar or cervical level) can also be checked out, which are usually caused alongside scoliosis. In the transverse plane, the rotational curvature of the spine can be seen.

Scoliosis depends on its type, either it is structural or functional. Structural scoliosis is based on the structural changes that occur in the vertebral body, facet orientation, wedging of vertebrae, bone defects, osteoporosis, inter vertebral disc collapse, bone rigidity, and bed-bound patients. Functional scoliosis is not related to the body structuralization of the spine, but the muscles, tendons, and ligaments are checked as it is caused by faulty posture, muscular weakness, muscle atrophy, and partial flexibility. During forward bending, functional scoliosis would show no deviation of the spine, but in structural scoliosis, there would be a proper deviation, which can be seen which x-ray, limited flexibility, and scapular prominence.

During child growth, there can be certain factors that can lead to the onset of adolescent idiopathic scoliosis, i.e. heavy bag pack, poor posture, trauma, prolonged sitting in abnormal back posture, etc. can be some of the leading causes of this disease.

Diagnosis

The steps which are used to diagnose scoliosis are

  • Curve: the direction, shape (either C or S-shaped) and side location of the vertebral column
  • Etiology: the cause which caused this to occur. It can be moving vehicle collision, trauma, infection, cerebral palsy, muscular dystrophy, etc. this can be checked by taking the history of the patient.
  • Decompensation: failure of visceral organs (lungs, heart, liver) due to compression exertion.
  • Flexibility: the spine can move either partially or with no flexibility; it depends on the type of scoliosis.
  • Neurology: spinal problems occurred by this (can be a direct hit on the spine or nerve compression)

Signs And Symptoms

Due to the curvature of the spine, one of the few first signs that occur is muscular weakness around the spine, which can restrict movement. There is already limited movement in the region of thorax as there is no space for movement of the vertebrae due to the placement of ribs, but after muscular weakness, thorax along with limited lumbar and cervical movement is possible. Scapula of the affected side is prominent along with uneven shoulder and lateral pelvic tilt.

 Due to the angulation of the spine, the affected vertebrae also affects its corresponding ribs, which will cause rotation of the ribcage that will immediately affect the cardiopulmonary system as there would be less space for the lungs to inflate properly which will cause less saturation oxygen and fatigue. Myocardial space will also be compressed and can restrict the pumping of blood and can cause heart failure in the long term.

 Abdominal visceras, such as the liver can also be affected. Due to the vertebral column rotation, the spinal cord inside can be directed compressed, which can cause loss of movement of the lower limbs or can either cause nerve compression, which is the sensory or motor loss of a specified area along with a tingling sensation accompanied by pain.

 Pain is not a common symptom of scoliosis as the body has already compensated for the changed, but it can occur when the Cobbs angle increases to more than 40 which can be cured surgically by using titanium rods and a plate or removing the affected vertebrae and replacing them with artificial custom made vertebral bodies.  Rib hump or paraspinal muscular prominence indicates spinal rotation. Signs which indicate scoliosis are raised chest, abnormal gait, shoulder downwards, prominent and raised scapula along with pelvic tilt. The relationship of pedicle of vertebral body to midline determines the degree of rotation of the vertebral column.

Mild scoliosis is caused when the Cobbs angle is between 10 degrees to 19 degrees, but there is no prominent structural change and can only be seen in X-ray. Further increase in cobs angle from 20 degrees to 40 degrees is moderate scoliosis is seen by the naked eye. Severe scoliosis is when the angle increases further from 40 degrees. After this point, no amount of physical therapy can change the deformity and can only be cured using surgical methods.

Risk Factors

There are a few risk factors for developing the most common type of scoliosis:

  • Age: The signs and symptoms of scoliosis usually begin at some stage in the growth spurt that occurs just before puberty.
  • Gender: Although both girls and boys develop mild scoliosis at the same age, yet there is a greater risk of increasing curvature of the vertebral column and requiring proper treatment.
  • Family history: Scoliosis may be hereditary, but the majority of the cases do not have a family history of this disease.

Scoliosis Treatment

Mild scoliosis can be easily treated with scoliosis specific physical therapy, bracing, and medical observation. Moderate scoliosis is treated by specific physical therapy, braces which are customized according to the patient size and severity of the curvature and mobilization. Different exercises are used to strengthen the muscles surrounding the vertebral column and pelvis, such as a step down and one arm reaches, upward and downward dog, split stance with arm's reach.  By being proactive and performing proper exercises, the curvature can be reversed, but the process will be slow but will decrease the pain. Pilates and yoga routines are also added to the regime to improve spinal flexibility and muscular atrophy.

Scoliosis

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