Scoliosis
Scoliosis is a three-dimensional spinal deformity involving lateral curvature and rotation. Our pediatric physiotherapists provide comprehensive assessment and evidence-based treatment to manage progression and optimize function.
Understanding Scoliosis
Types
- Idiopathic: Most common (80%), unknown cause
- Congenital: Present at birth
- Neuromuscular: Secondary to conditions
- Functional: Compensatory, reversible
Age Classifications
- Infantile: 0-3 years
- Juvenile: 4-10 years
- Adolescent: 11-18 years (most common)
- Adult: Degenerative or progression
Signs and Symptoms
Visual Signs
- Uneven shoulders or shoulder blades
- Prominent rib hump when bending
- Uneven waist or hips
- Body lean to one side
- Uneven leg lengths (apparent)
Functional Impact
- Back pain (variable)
- Postural fatigue
- Reduced flexibility
- Breathing difficulties (severe cases)
- Self-image concerns
Assessment
Screening Tests
- Adam’s Forward Bend Test: Detecting rotation
- Scoliometer: Measuring trunk rotation
- Postural Assessment: Standing alignment
- Flexibility Testing: Spine and hips
- Growth Assessment: Remaining growth potential
Curve Measurement
- Cobb Angle: Gold standard measurement
- Mild: 10-25 degrees
- Moderate: 25-40 degrees
- Severe: >40 degrees
- Surgical Consideration: >45-50 degrees
Risk of Progression
High Risk Factors
- Large curve at young age
- Significant growth remaining
- Female gender
- Family history
- Thoracic curves
- Double curves
Monitoring Schedule
- Mild curves: Every 6-12 months
- Moderate curves: Every 4-6 months
- During growth spurts: Every 3-4 months
- Post-growth: Annual monitoring
Physiotherapy Treatment
Scoliosis-Specific Exercises (PSSE)
Schroth Method
- 3D Correction: Addressing all planes
- Rotational Breathing: Directed expansion
- Postural Training: Daily positions
- Muscle Activation: Specific patterns
- Home Program: Daily exercises
SEAS Approach
- Active self-correction
- Task-oriented exercises
- Neuromotor rehabilitation
- ADL integration
- Family involvement
Treatment Goals
- Halt or slow progression
- Improve postural alignment
- Reduce pain if present
- Improve respiratory function
- Enhance quality of life
- Avoid or delay surgery
Exercise Components
Core Strengthening
- Asymmetric strengthening
- Deep stabilizer training
- Anti-rotation exercises
- Plank variations
- Specific to curve pattern
Flexibility
- Concave side stretching
- Thoracic mobility
- Hip flexor stretching
- Hamstring flexibility
- Fascial release
Postural Training
- Mirror feedback
- Wall exercises
- Sitting posture
- Standing alignment
- Activity-specific training
Breathing Exercises
- Rotational breathing
- Rib cage expansion
- Diaphragmatic training
- Chest mobility
- Relaxation techniques
Bracing
Indications
- Curves 25-40 degrees
- Significant growth remaining
- High progression risk
- Compliant patient/family
Physiotherapy Role
- Exercise within brace
- Skin care education
- Maintaining flexibility
- Psychological support
- Brace weaning exercises
Sports and Activities
Recommended Activities
- Swimming (not competitive butterfly)
- Yoga and Pilates
- Walking and hiking
- Cycling
- Dance (with modifications)
Considerations
- Avoid high-impact initially
- Monitor during growth spurts
- Technique focus important
- Balance both sides
- Regular reassessment
Family Education
Home Management
- Daily exercise compliance
- Posture awareness
- Proper backpack use
- Ergonomic setup
- Activity modifications
Psychological Support
- Body image concerns
- Peer relationships
- Treatment compliance
- Coping strategies
- Support groups
Adult Scoliosis
Degenerative Scoliosis
- Later onset
- Associated with arthritis
- Pain management focus
- Function maintenance
- Different treatment approach
Progression in Adulthood
- Slower progression
- Pain more common
- Postural management
- Strengthening crucial
- Activity modification
When Surgery is Considered
Indications
- Curves >45-50 degrees
- Documented progression
- Significant cosmetic concern
- Pulmonary compromise
- Failed conservative treatment
Pre/Post-Surgical Physio
- Pre-operative conditioning
- Post-operative rehabilitation
- Scar management
- Return to activities
- Long-term monitoring
Long-Term Management
Ongoing Care
- Regular monitoring
- Exercise program updates
- Growth spurt management
- Transition to adult care
- Lifetime exercise habits
Prognosis Factors
- Early detection improves outcomes
- Consistent treatment important
- Family support crucial
- Individual variation significant
- Quality of life focus
Expected Outcomes
With appropriate treatment:
- 30% chance of improvement
- 60% chance of stabilization
- 10% may still progress
- Improved function regardless
- Better long-term outcomes
