Rehabilitation

Idiopathic scoliosis

Skolioza idiopatycznaIdiopathic scoliosis and posture correction require a therapy selected on a case-by-case basis. By specifying goals of the therapeutic procedure, it is necessary to take into account size of curvature and child’s bone age.

Idiopathic scoliosis – what is it?

Idiopathic scoliosis (IS) is a structural spine deformation in three planes. According to the criteria of Scoliosis Research Society (SRS), the scoliosis is a curvature whose spine lateral inclination angle according to Cobb in X-ray scan is at least 10°.

The frequency of emergence of minor scoliosis among girls and boys is equal, if the angle is larger, the tendency changes towards girls.

At present we can divide scoliosis by Cobb’s curvature angle into three groups/degrees:

  • 10°-24°
  • 25-40°
  • 50° and more

Idiopathic scoliosis – causes

We do not have a comprehensive knowledge about why the disease emerges. The scoliosis shows its symptoms when the spine grows fast.

Idiopathic scoliosis – diagnostics

The first most frequently noticed symptoms are waistline asymmetry, uneven height of arms or body inclination to the side in relation to pelvis (“prominent hip”). The specialist diagnostics is primarily concerned with clinical evaluation of patient’s posture, measuring body rotation angle when bending with the use of scoliometer, as well as assessing spine deformation in X-ray scan.

Idiopathic scoliosis – treatment

As for IS, there is one therapy adopted. Based on the curvature angle and anticipation regarding potential development of the deformation, the doctor makes a decision on a form of treatment.

At present an idiopathic scoliosis therapy is based on angle curvature (Table 1).

Stage Cobb’s angle Natural history Code of conduct
<10° Fails to satisfy IS diagnosis criteria Observation
I 10°-24° Course cannot be anticipated Observation, physiotherapy
II 25°-40° Progressive in the growth period brace, physiotherapy
III >50° Idiopathic progress in adulthood Surgery, physiotherapy

Table 1. Therapeutic procedure in idiopathic scoliosis

Idiopathic scoliosis – conservative treatment

The main purpose of the conservative treatment is to stop curvature growth in the adolescence period. It is essential that we prevent or treat respiratory system dysfunctions, prevent or treat spine pain, as well as improve the looks by correcting body posture.

The conservative treatment of idiopathic scoliosis is based on specific physiotherapies and brace treatment.

Idiopathic scoliosis – rehabilitation

Based on SOSORT’s (Society on Scoliosis Orthopedic and Rehabilitation Treatment) recommendation, the first stage of the therapy for patients (bone and biologically immature) with minor curvature (10° – 24°) and a supplementation of the brace treatment with regard to major-angle scoliosis (25°) is the so-called PSSE – Physiotherapy Scoliosis Specific Exercises.

The methods categorized as Specific Methods for idiopathic scoliosis should be as follows:

  1. be based on scientific evidence which confirms they are effective and have a positive impact on treating children with idiopathic scoliosis (Evidence Base Medicine, Evidence Base Physiotherapy)
  2. educate the patient and his/her family
  3. have a three-dimensional active auto-correction as a the main therapy purpose
  4. include stabilization exercises done during active body posture auto-correction
  5. include active auto-correction of body posture when performing everyday activities (ADL – activities of a daily living). At present 7 methods satisfy the aforesaid criteria: BSPTS – Spain, DoboMed – Poland, FITS – Poland, Lyon – France, Schroth – Germany, SEAS – Italy, Side Shift – Great Britain.
Idiopathic scoliosis: SEAS exercises

skolioza idiopatyczna - ćwiczenia SEAS

Idiopathic scoliosis: FITS exercises

Skolioza idiopatyczna - ćwiczenia FITS


Our physiotherapists follow the diagnostic and therapeutic criteria recommended by SOSORT and use 5 out of the above-stated methods of Specific Physiotherapy.

The primary purpose of specific physiotherapy is to learn active three-dimensional body posture auto-correction in functional positions, that is when sitting and standing which must be performed throughout the day (at the school desk, at home when doing homework, when having meals, or when standing).

Idiopathic scoliosis: Brace exercises

skolioza idiopatyczna - ćwiczenia w gorsecie


A very important element which allows or facilitates active auto-correction of body posture is soft tissue therapy based on FITS method. It is adapted to patients’ needs and performed by our therapists.

Idiopathic scoliosis: Soft tissue therapy

skolioza idiopatyczna - terapia tkanek miękkich


The therapy should include breathing exercises, in particular with regard to curvatures located in the thoracic spine section. Asymmetric breathing exercises stimulate proper breathing habits. What is more, they support reconstruction of natural spine curvature by stretching tissues on the concave side and strengthening muscles on the protruding side of the curvature.

Plus, specific breathing exercises which mobilize the sunken side of the curvature are done in the back brace.

Idiopathic scoliosis: Asymmetric inspiration exercises

skolioza idiopatyczna - ćwiczenia asymetrycznego wdechu


Idiopathic scoliosis – brace treatment

In the event of progressing scoliosis, over 25° of Cobb’s angle, lack of biological and bone maturity, it is advisable to commence the brace treatment.

The purpose of the brace treatment is to stop and slower the progression as well as have symmetric chest and torso.

The most frequently used stiff brace in Poland is Cheneau brace. It is made of a thermoplastic polyethylene (type of plastic). Cheneau brace allows a three-dimensional correction of the curvature thanks to the use of three-point force system. The use of corrective pelotas exerting pressure on specific body spots and relieving spaces which allow the torso to move in a specific direction make it possible to correct the curvature.

The brace takes a form of a hard shell which opens in the front and ranges from the hip to the armpit. It is manufactured and adapted to every patient on a case-by-case basis.

The attending physician specifies how long the patient must wear the brace (expressed in number of hours). As a rule it is 20 hours a day.

During the brace treatment the patient lives normally – he/she goes to school, may attend PE lessons and do sports. According to SOSORT’s recommendations, to supplement the brace treatment, a physiotherapist should select relevant idiopathic scoliosis specific exercises.

The brace must be used until the curvature has stabilized and bone maturity has been reached. Next, it is less and less frequently used – the wearing time is shortened. It takes nearly 6 months to remove the brace totally.

Plaster brace

In certain cases the treatment based on Cheneau stiff brace is preceded by a plaster brace which must be used two or three times. The advantage of using plaster braces is the fact that they have a permanent impact on the spine in order to improve initial correction of the curvature, and preparation for plastic brace treatment.

The plaster brace is made of natural „breathing” plaster. It is covered in wool from the inside, and synthetic gypsum from the outside to make sure the brace is solid. It ranges from the armpits to hips. We put it on the cotton decoration-free T-shirt which must be changed on a daily basis. To help you change your T-shirt, there is a small hole at the belly level at the front of the brace.

The plaster brace must be used for the period from 2 to 4 weeks. At this time the patient does not have to attend PE lessons but must do corrective exercises in accordance with physiotherapist’s recommendations.

Idiopathic scoliosis – surgical treatment

A decision to initiate surgical treatment is made on a case-by-case basis. The following symptoms should entail the surgical treatment: scoliosis progression, large curvature angles – above 45-50° by Cobb, lower curvature angles – 40° by Cobb, but with co-existing reduction or lack of backward curvature in the thoracic spine section, neurological disorders and pain among adults.

It is important that the patient is prepared for the surgery after the decision to operate is taken. The preparation process must include soft tissue therapy, breathing exercises and auto-traction exercises.

Idiopathic scoliosis and sport

The patients suffering from idiopathic scoliosis may attend physical education lessons normally. However, due to limited spine mobility, the grades they get must be better, in particular with special regard to exercises which require full spine mobility.

Speaking of children who suffer from idiopathic scoliosis, there are not any contraindications against recreational sport. Interestingly children should be encouraged to lead an active lifestyle.

If you do sport half-professionally or professionally, the workout must be supplemented with corrective exercises which aim to eliminate a potential negative impact of your sport discipline.

When the surgical treatment has ended, you can regain mobility after a couple of months. The decision to be back to sport is taken by the doctor responsible for the surgery.

Przydatne linki:

  1. https://www.sosort.mobi/index.php/en/
  2. https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-016-0076-9

Piśmiennictwo:

  1. Negrini S et al. 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 2012,7
  2. http://www.ortopedia.com.pl/api/files/view/153818.pdf
  3. https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-016-0076-9
  4. http://osw.olsztyn.pl/pliki/2014/09/Post%C4%99py-Rehabilitacji-Wytyczne-SOSORT.pdf

 

Authors:
mgr Katarzyna Politarczyk, mgr Mateusz Kozinoga, prof. dr hab. n. med. Tomasz Kotwicki

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