Comprehensive Guide to Scoliosis Treatment: Understanding and Options

Scoliosis is a common spinal condition characterised by an abnormal curvature of the spine. It can affect individuals of all ages, and if left untreated, it may lead to pain, discomfort, and potential complications. In this comprehensive guide, we will delve into the world of scoliosis treatment, exploring various options available for patients. Whether you’re seeking information for yourself or a loved one, this guide aims to provide valuable insights into scoliosis treatment.

Understanding What Is a Scoliosis?

So, exactly what is a scoliosis? Scoliosis is a medical condition characterised by an abnormal sideways curvature of the spine. In a person with scoliosis, the spine may develop an “S” or “C” shape when viewed from the front or back, respectively. This deviation from the normal straight alignment of the spine can cause various physical and functional issues. However, for most people it does not cause any problems.

At What Age Does Scoliosis Develop?

Scoliosis can develop at any age, but it most commonly appears during adolescence, between the ages of 10 and 18. This is known as adolescent idiopathic scoliosis, and it is the most prevalent form of scoliosis (59%). However, scoliosis can also occur in infants (known as congenital scoliosis – 17%) or develop later in life (known as adult degenerative scoliosis – 11%). While the other 13% are caused by unknown unclassified causes. (1)

What Causes Scoliosis?

The exact cause of scoliosis is often unknown, which is why it is referred to as idiopathic in most cases. However, there are several other types of scoliosis that can have identifiable causes, such as:

• neuromuscular scoliosis (related to neurological or muscular conditions) – For example this can be due to contractures associated with high muscle tonicity in conditions like Cerebral Palsy or Due to spinal cord tumours.
• degenerative scoliosis (caused by age-related changes to the spine) – For example this could be due to stress fractures as a result of osteoporosis.
• congenital – This is usually down to a failure of formation of the vertebrae and although the malformations will be present from birth the curve may not be apparent until later in childhood.
• Miscellaneous: These can be due to a variety of conditions. This can range from conditions such as neurofibromatosis or connective tissue disorders such as Marfan’s syndrome or Ehlers-Danlos. Or metabolic diseases such as Rickets or even tumours.

What Is an Idiopathic Scoliosis?

Idiopathic scoliosis is the most common cause of scoliosis, and accounts for around 80% of scoliosis in children. The term idiopathic is used when there is no obvious specific cause for the scoliosis.

It is sub-divided into infantile (onset 0-3 years – less than 1% of idiopathic scoliosis), juvenile (3-10 years – between 12 and 21% of IS) and adolescent (>10 years – most common between 78 and 87% of IS)

How is a scoliosis diagnosed?

Diagnosing scoliosis typically involves a physical examination, including a visual inspection of the spine and a measurement of the curvature using the Cobb angle. Further imaging tests, such as X-rays or MRI scans, may be used to evaluate the spine’s structure and rule out any underlying causes.

How Do I Know if My Scoliosis Needs Treatment?

Scoliosis can vary in severity, with some individuals experiencing only mild curvature that may not require treatment, or cause any symptoms. While others may have a more pronounced curvature that can impact their daily life and require intervention.

Scoliosis typically manifests in uneven shoulder or hip heights, an asymmetrical waistline, a visible tilt or rotation of the spine, and sometimes is accompanied by occasional back pain or discomfort. If the degree of curve is low (i.e. below 15° Cobb Angle) then it can usually be treated well with exercise. When the curve exceeds certain levels (often over 30°) then it may need additional treatments such as bracing. If however it progresses to over 50°, usually the progression does not end with growth, even if it becomes very slow 0.5–1 degrees per year. At this stage if quality of life is being impeded by the degree of scoliosis a surgical opinion may be appropriate.

Does a Scoliosis Cause Back Pain?

The good news is having a scoliosis means that you are no more likely to get back pain than someone without a scoliosis (2, 3). The bad news is if you do have pain from a scoliosis it will often get worse with age, without the right advice and treatment.

There is also evidence that scoliosis severity can often increase with age. However, the great news is that there is evidence that treating it early can halt the decline and even reduce the severity of scoliosis. (4)

In our experience, prevention is better than cure when it comes to scoliosis. Even if you have no pain, but you notice some of the early signs described above. Early assessment and following an expert’s advice on managing your specific type of scoliosis can significantly improve your outcomes in the long term.

What Is Scoliosis Treatment?

Treating scoliosis requires a systematic approach, starting with the right course of action at the right time.

The goal of conservative treatment, which usually involves exercises or bracing, is to achieve a functional spine that promotes a healthy body and mind throughout life.

It’s important to understand that scoliosis cannot be fully cured. Complete restoration to a zero-degree curvature is extremely rare. What truly matters is achieving a manageable curve that allows for good functionality, even if the spine isn’t perfectly straight.

The treatment choices are influenced by several factors. These include:

• curve severity, location and cause
• level of maturity and remaining growth
• cosmetic appearance
• the individuals thoughts and feelings around their scoliosis

Following a thorough assessment by a specialist physio, we can guide you in what treatments are appropriate for your particular type of scoliosis. Our goal is to give you a bespoke plan suited to your individual circumstances and needs.

How Can I Treat My Scoliosis?

Types of Scoliosis Treatment:

1. Non-Surgical Treatment Options:
   • Physiotherapy and Exercises: Key exercises to strengthen core muscles and improve posture.
   • Pain Management Techniques: Strategies for alleviating discomfort and improving quality of life.
   • Bracing for Adult Scoliosis: Types of braces and their role in managing scoliosis in adults.
2. Surgical Treatment Options:
   • Spinal Fusion: An overview of the surgical procedure and its potential benefits.

Treating scoliosis without surgery

Physiotherapy:

Role of Physiotherapy in Scoliosis Treatment:

A physiotherapist can play a crucial role in the conservative management of scoliosis. They can provide personalised treatment and guidance to address the specific needs of individuals with scoliosis. Here is a list of treatment options and what they would entail from a physiotherapist:

1. Assessment and Education:
   • A physiotherapist can undertake a thorough assessment of your scoliotic curvature, posture, movement patterns, and overall musculoskeletal function.
   • They can help educate you about scoliosis, its effects on the body, and the importance of maintaining optimal posture and movement mechanics.
2. Exercise Prescription:
   • Physiotherapists can design a customised exercise program tailored to your specific needs and scoliotic curve characteristics.
   • The exercises may focus on improving core stability, muscle balance, flexibility, and postural control.
   • The program may include a combination of stretching, strengthening, and stabilisation exercises targeting specific muscle groups.
   • Your physiotherapist will guide tyou in the correct technique, frequency, and progression of exercises.
3. Manual Therapy:
   • Physiotherapists may also employ manual therapy techniques to address muscle imbalances, joint restrictions, and soft tissue tightness associated with scoliosis.
   • This may include hands-on techniques such as massage, joint mobilisations, myofascial release, or trigger point therapy.
   • Manual therapy can help reduce pain, improve joint mobility, and enhance overall musculoskeletal function.
4. Postural Training and Ergonomics:
   • They can also provide you with guidance on postural variation and ergonomics during daily activities, such as sitting, standing, lifting, and carrying.
   • They may suggest modifications to workstations, chairs, or sleeping positions to support optimal spinal alignment and reduce postural strain.
5. Breathing Exercises:
   • Breathing exercises can help improve respiratory function and enhance thoracic mobility, which may be impacted by scoliosis.
   • A specialist physiotherapist can teach specific breathing techniques, such as diaphragmatic breathing or rib cage mobilisation exercises, to promote efficient breathing patterns and maintain flexibility in the thoracic region.
6. Functional Movement Training:
   • Physiotherapist’s will usually incorporate functional movement training into your treatment plan, focusing on activities relevant to your daily life and specific functional goals.
   • This may involve exercises that mimic real-life movements, such as lifting, reaching, or bending, while emphasising proper posture and spinal alignment.
7. Progress Monitoring and Adjustment:
   • Through regularly assess the individual’s progress, a physio will also monitor the effects of treatment, and make necessary adjustments to your exercise program as needed.
   • This may involve modifying the exercises, progressing the intensity or complexity of the program, or introducing new techniques based on your individual response and changing needs.
8. Education and Self-Management:
   • Your physiotherapist will also aim to educate you about effective self-management strategies, including home exercises, postural awareness, and activity modification.
   • With the goal of empowering you with knowledge and tools to take an active role in managing your scoliosis, promoting long-term self-care and minimising the impact of the condition.

Exercises:

What Is the Schroth Method of Scoliosis-Specific Exercise?

The Schroth method is a specialised exercise-based approach for the conservative management of scoliosis. It was developed in the 1920s by Katharina Schroth, a German physiotherapist who herself had scoliosis. The Schroth method focuses on improving posture, body awareness, and muscle imbalances to help reduce the progression of scoliotic curves and alleviate associated symptoms. Here are key points to understand about the Schroth method:

1. Three-Dimensional Approach:
   • The Schroth method employs a three-dimensional approach to address the asymmetrical nature of scoliosis.
   • It emphasises elongation, rotation, and correction of the spinal curvature in all three planes (sagittal, frontal, and transverse).
2. Individualised Assessment:
   • The Schroth method begins with a comprehensive assessment to understand the unique characteristics of your scoliosis, such as the curve pattern, flexibility, and postural imbalances.
   • The therapist will evaluate your posture, spinal alignment, breathing patterns, and muscle imbalances specific to your scoliosis.
3. Postural Correction:
   • Specific exercises and techniques are employed to correct your posture and promote alignment.
   • This involves learning to elongate the spine, creating a sense of traction, and actively working against the scoliotic curve.
4. Breathing Techniques:
   • Breathing exercises are an integral part of the Schroth method.
   • Diaphragmatic breathing and specific breathing patterns are taught to optimise lung function and improve thoracic mobility in relation to the scoliotic curvature.
5. Active Self-Correction:
   • The Schroth method aims to empower you to actively participate in your scoliosis management.
   • You will learn self-correction techniques to maintain optimal posture and alignment throughout daily activities.
6. Muscle Activation and Strengthening:
   • Specific exercises are designed to activate and strengthen the muscles on the concave (inner) side of the scoliotic curve.
   • These exercises aim to rebalance muscle imbalances and promote better stability and support for the spine.
7. Equipment and Props:
   • Various equipment and props, such as physioballs, foam rolls, and wall bars, may be used to support and enhance the effectiveness of the exercises.
8. Progression and Integration:
   • The Schroth method follows a progressive approach, starting with basic exercises and gradually advancing to more challenging movements as your strength, control, and postural awareness improve.
   • The ultimate goal is to integrate the principles of the Schroth method into your everyday life and functional activities.
9. Guidance and Supervision:
   • Learning the Schroth method typically involves you working closely with a trained Schroth therapist.
   • The therapist provides personalised guidance, corrections, and feedback to ensure proper technique and maximize the benefits of the exercises.

What is the Scientific Exercise Approach to Scoliosis?

The Scientific Exercise Approach to Scoliosis (SEAS), is a specialised method developed for the conservative management of scoliosis. It was created by the Italian physical therapist Dr. Michele Romano and his colleagues.

SEAS focuses on a comprehensive approach to scoliosis treatment, incorporating specific exercises and corrective movements that aim to improve posture, increase spinal mobility, and reduce the progression of the curvature. It is primarily used as a non-surgical intervention for individuals with idiopathic scoliosis, especially during the adolescent growth phase when the spine is more prone to progression.

Key Principles of SEAS:

1. Individualised Assessment: Each patient’s scoliosis is assessed comprehensively, considering factors such as curve pattern, severity, flexibility, and postural alignment. This assessment helps in tailoring the exercise program to address specific needs.
2. Specific Exercises: SEAS utilises exercises that are specific to each patient’s unique scoliotic curvature and functional limitations. The exercises target imbalances and asymmetries in the spine, promoting muscle activation, improved alignment, and postural control.
3. Corrective Movements: SEAS employs specific corrective movements that aim to reverse abnormal postural patterns associated with scoliosis. These movements help in elongating and de-rotating the spine, reducing the curvature, and promoting a more aligned posture.
4. Active Participation: SEAS places a strong emphasis on active patient participation. Patients are actively engaged in the exercise process, learning to self-correct their posture and movement patterns. This active involvement enhances body awareness and promotes long-term self-management.
5. Gradual Progression: SEAS adopts a gradual progression approach, gradually increasing the intensity, complexity, and duration of exercises over time. This progressive approach allows the body to adapt and strengthen gradually, minimising the risk of strain or injury.
6. Regular Monitoring: Regular monitoring and re-assessment are essential in SEAS. The patient’s progress is closely monitored to evaluate the effectiveness of the exercise program and make necessary adjustments as needed.

SEAS exercises often involve three-dimensional movements, including specific rotational and elongation techniques. The exercises can be performed with or without specialised equipment, and they are typically performed under the guidance of a trained SEAS practitioner or physiotherapist.

Interestingly, a systematic review in 2019 looking at the efficacy of scoliosis-specific exercise programme such as SEAS and Schroth showed these programmes were no more effective than normal exercise in maintaining or reducing idiopathic scoliosis. (6) A more recent systematic review in 2020 drew the same conclusion (7)

Example of a Home Exercise Programme for Scoliosis Management:

Before starting any exercise program, it is essential to consult with a qualified healthcare professional, such as a physiotherapist, who can assess your specific condition and provide personalised recommendations.

Exercise Program for Scoliosis Treatment at Home:

1. Stretching Exercises:
   • a. Side Stretch:
     • Stand with your feet shoulder-width apart.
   • • Extend your left arm overhead and reach towards the right side.
   • • Hold the stretch for 20-30 seconds.
   • • Repeat on the other side.
   • • Sets: 2
   • • Reps: Hold each side for 20-30 seconds
   • • Frequency: Perform this stretch daily to improve flexibility and alleviate muscle tightness.
     b. Spine Rotation:
     • Sit on a chair with your feet flat on the ground.
     • Slowly rotate your upper body to the right, keeping your hips facing forward.
     • Hold the stretch for 20-30 seconds.
     • Repeat on the other side.
     • Sets: 2
     • Reps: Hold each side for 20-30 seconds
     • Frequency: Perform this stretch daily to increase spinal mobility and reduce stiffness.
2. Strengthening Exercises:
   • a. Plank:
     • Start in a push-up position, resting on your forearms and toes.
   • • Keep your body in a straight line, engaging your core muscles.
   • • Hold the position for 20-30 seconds.
   • • Rest for 10 seconds, then repeat.
   • • Sets: 2
   • • Reps: Hold for 20-30 seconds
   • • Frequency: Perform this exercise 2-3 times per week to strengthen the core muscles, which helps support the spine.
     b. Bridging:
     • Lie on your back with your knees bent and feet flat on the ground.
     • Slowly lift your hips off the ground, squeezing your glutes and engaging your core.
     • Hold the position for 5-10 seconds.
     • Lower your hips back down and repeat.
     • Sets: 2
     • Reps: 10-12 repetitions
     • Frequency: Perform this exercise 2-3 times per week to strengthen the muscles in the lower back and buttocks, providing stability to the spine.
3. Postural Exercises:
   • a. Wall Angel:
     • Stand with your back against a wall, feet hip-width apart, and knees slightly bent.
   • • Raise your arms to shoulder level, and press them against the wall.
   • • Slide your arms up and down, maintaining contact with the wall at all times.
   • • Perform the movement slowly and controlled.
   • • Sets: 2
   • • Reps: 10-12 repetitions
   • • Frequency: Perform this exercise daily to improve posture, strengthen the upper back muscles, and promote proper alignment.
     b. Scapular Squeeze:
     • Sit or stand with your arms relaxed by your sides.
     • Squeeze your shoulder blades together without shrugging your shoulders.
     • Hold the squeeze for 5-10 seconds, then release.
     • Sets: 2
     • Reps: 10-12 repetitions
     • Frequency: Perform this exercise daily to promote scapular stability and enhance postural alignment.

Remember, the recommended sets, reps, and frequency mentioned above are general guidelines and should be adjusted based on your individual condition and fitness level. It is crucial to listen to your body and progress gradually. If any exercise causes pain or discomfort, stop immediately and consult with your healthcare professional.

Consistency is key in achieving the best results. By performing these exercises regularly and as part of a comprehensive treatment plan, you can strengthen your muscles, improve posture, and manage the effects of scoliosis effectively.

Bracing for Scoliosis:

Bracing is a non-surgical treatment option commonly used in the management of scoliosis, particularly during periods of growth in adolescents. The primary goal of bracing is to prevent or slow down the progression of the spinal curvature, ultimately aiming to maintain a more aligned posture and prevent the need for surgical intervention.

Here are some key points to understand about bracing for scoliosis:

1. Purpose of Bracing:
   • Bracing is typically recommended for individuals with moderate spinal curves (typically between 25 to 40 degrees) who are still growing.
   • The main purpose of bracing is to apply external forces to the spine, exerting pressure in specific directions to influence the growth of the spine and limit further curvature progression.
2. Types of Braces:
   • Boston Brace: The Boston brace is one of the most commonly prescribed braces for scoliosis. It is a custom-made, rigid brace made of plastic and designed to apply corrective forces to the spine.
   • Charleston Bending Brace: The Charleston bending brace is a nighttime brace designed to apply corrective forces in a specific direction while the patient sleeps. It is typically prescribed for patients with curves that are more flexible when side-bending.
   • Milwaukee Brace: The Milwaukee brace is a full-torso brace that extends from the pelvis to the neck. It incorporates a neck ring and is often prescribed for curves involving the thoracic and/or cervical regions of the spine.
   • TLSO (Thoracolumbosacral Orthosis): The TLSO brace is a custom-made brace that covers the thoracic and lumbar regions of the spine. It is typically made of rigid plastic and designed to provide support and corrective forces.
3. Wearing the Brace:
   • Braces are typically worn for a specified number of hours per day, usually between 16 and 23 hours, depending on the specific treatment plan prescribed by the healthcare professional.
   • The brace is worn snugly against the body and is customized to fit the individual’s unique spinal curvature.
   • It’s important to follow the healthcare professional’s instructions regarding the proper wearing and maintenance of the brace.
4. Effectiveness of Bracing:
   • Bracing can effectively slow down or halt the progression of spinal curvature in many cases, especially during the period of skeletal growth. (5)
   • The success of bracing depends on various factors, including the severity of the curve and the individual’s growth potential. However, the most important factor for success is the compliance of the individual to waer the brace as prescribed.
   • Regular monitoring and periodic X-rays are typically conducted to assess the effectiveness of bracing and make any necessary adjustments.
5. Emotional and Psychological Support:
   • Wearing a brace for an extended period can have emotional and psychological impacts, particularly for adolescents.
   • It is important to provide support and encouragement to individuals undergoing bracing treatment, emphasising the long-term benefits and the importance of compliance.

Bracing is most effective when combined with other elements of scoliosis management, such as physical therapy, exercises, and regular monitoring by healthcare professionals. A comprehensive treatment plan that addresses the individual’s specific needs is essential to achieve optimal outcomes in scoliosis management.

Treating Scoliosis With Surgery:

Surgical intervention, specifically spinal fusion, is an option for scoliosis treatment in cases where the curvature is severe, rapidly progressing, or causing significant symptoms. Spinal fusion aims to correct the spinal curvature and provide stability to the spine. Here are some key points to understand about surgical options for spinal fusion in scoliosis treatment:

1. Preoperative Evaluation:
   • Before considering surgery, a thorough evaluation is conducted by a spine surgeon. This evaluation includes a review of medical history, physical examination, and imaging studies (such as X-rays, MRI, or CT scans) to assess the severity and characteristics of the scoliotic curve.
   • The surgeon will consider factors such as age, skeletal maturity, curve magnitude, curve pattern, flexibility, and overall health in determining the surgical approach.
2. Surgical Procedure:
   • The most common surgical procedure for scoliosis is spinal fusion. It involves joining (fusing) the affected vertebrae together to create a solid bone mass, correcting the curvature, and preventing further progression.
   • During the procedure, the surgeon makes incisions, accesses the spine, and places bone graft material along with implants (such as rods, screws, or hooks) to stabilize and align the spine.
   • The bone graft serves as a scaffold for new bone growth, facilitating the fusion process.
3. Instrumentation Techniques:
   • Various instrumentation techniques may be employed during spinal fusion surgery, including:
     • Pedicle screws: These screws are placed into the vertebrae and act as anchors for the rods, providing stability and support.
     • Rods: Metal rods are attached to the screws and used to straighten and align the spine.
     • Hooks or wires: These devices may be used in conjunction with screws to provide additional stability.
   • The specific choice of instrumentation depends on factors such as the curvature pattern, surgeon preference, and patient-specific factors.
4. Bone Grafts:
   • Bone graft material is typically used to promote fusion between the vertebrae. The graft material may be sourced from the patient’s own bone (autograft) or from a donor or synthetic source (allograft or synthetic graft).
   • Autografts, such as bone taken from the patient’s hip, are considered the gold standard due to their high fusion rates and bone-forming potential.
5. Recovery and Rehabilitation:
   • Following spinal fusion surgery, a period of hospitalization is typically required for monitoring and pain management.
   • Physical therapy and rehabilitation play a crucial role in the recovery process. A structured program is designed to gradually increase mobility, strengthen muscles, and improve overall function.
   • The timeline for recovery varies depending on the individual and the extent of surgery. It may take several months to a year to achieve optimal recovery and return to normal activities.
6. Potential Risks and Complications:
   • As with any surgical procedure, spinal fusion for scoliosis carries potential risks and complications, including infection, bleeding, nerve injury, blood clots, or complications related to anesthesia.
   • Surgeons take precautions to minimize these risks, and thorough preoperative evaluations and discussions with the surgical team are essential to address any concerns.

It is important to have detailed discussions with the surgeon to understand the potential benefits, risks, and expected outcomes of spinal fusion surgery. The decision to proceed with surgery should be carefully considered, taking into account factors such as the severity of the scoliotic curve, the impact on daily life, and the individual’s overall health. Close postoperative care and adherence to the recommended rehabilitation program are critical for successful recovery.

Conclusion

Like most things we come across the treatment for your scoliosis would be very dependant on your individual circumstances. While we aim to have given you a comperehensive view of all the treatment options out there for you nothing beats having an assessment with a specialist physio. If you’d like to have an assessment with one of our specialist physio’s then get in touch via the contact methods at the bottom of this page.

References:

1. Karimi & Rabczuk, 2018. Scoliosis conservative treatment: A review of literature. J Craniovertebr Junction Spine. 9(1):p 3-8.
2. Kostiuk & Bentivoglio, 1981. Spine. 6(3):p 268-273.
3. Jackson, et al. 1983. Spine. 8(7):p 749-756.
4. Ionite, et al. 2022. Scoliosis incidence and treatment methods. Baleno and PRM Research Journal. 13(2):504
5. Weinstein SL, Dolan LA, Wright JG, et al. Effects of bracing in adolescents withidiopathic scoliosis. N Engl J Med 2013;369(16):1512–21. http://dx.doi.org/10.1056/NEJMoa1307337.
6. Day, J.M., Fletcher, J., Coghlan, M. et al. Review of scoliosis-specific exercise methods used to correct adolescent idiopathic scoliosis. Arch Physiother 9, 8 (2019). https://doi.org/10.1186/s40945-019-0060-9
7. Fan, Y., Ren, Q., To, M.K.T. et al. Effectiveness of scoliosis-specific exercises for alleviating adolescent idiopathic scoliosis: a systematic review. BMC Musculoskelet Disord 21, 495 (2020). https://doi.org/10.1186/s12891-020-03517-6