Category Archives: Scoliosis

Effective Scoliosis Treatment Depends on Individualized Diagnosis

The most appropriate treatment options for scoliosis is when the care is determined in a case-by-case manner. Individualized diagnosis is paramount to effectively treating and managing scoliosis, no exceptions.

Over the past several years that I have treated scoliosis, I found that one of the most frustrating and confusing aspects for a patient or a parent of a child with scoliosis, is understanding how to navigate the many different treatment options available and ultimately feel confident enough to choose the right solution.  Many patients are given conflicting opinions on treatment from various health care professions including:  watch & wait, physical therapy, bracing and scoliosis specific rehab programs. This often leaves patients and parents of patients feeling unsure of who to trust and how to proceed with care.

I suggest a different approach. First, every scoliosis case is unique and specific recommendations need to be given on a case-by-case basis. Second, there is no need for guess work as the International Society on Scoliosis Orthopedic Rehabilitation & Treatment (SOSORT) has established treatment guidelines for scoliosis based on age, severity of curve and risk of progressions.  These guidelines should be used to assess each scoliosis case and determine the most appropriate treatments options.  Also, there are a variety of causes of scoliosis, we are primarily talking about treatment for idiopathic scoliosis here. These guidelines may also apply to other forms of scoliosis.

A Couple Of Key Points To Understand About Scoliosis:

  • Scoliosis is defined as a lateral bending of the spine of 10° or greater with rotation.
  • Curve angles are measured by using Cobb angle, which is the measure of the most superior and inferior vertebra with the greatest lateral bending.
  • Risser sign is a measurement of skeletal maturity and if the growth plates have begun to close.  It’s a predictor of how much growth an individual has left.  Risser zero means the growth plates have not begun to close and there is more growth expected.  At Risser 5 the growth plates have closed and skeletal maturity is reached. Scoliosis curves have the greatest risk of progress during growth spurts and the Risser sign helps to distinguish the likelihood of curve progression.

Progressive Treatment Options for Scoliosis:

  1. Physical therapy:  Physical therapy for scoliosis is not just general exercises but rather scoliosis specific rehab and application of such rehab must be administered by a health care professional with training in scoliosis specific rehab wether it be a chiropractor or physical therapist.  Physical therapy for scoliosis is generally performed in the clinic along with home rehab for 3-7 sessions per week for 3 months. After 3 months exercises every 2 weeks may be sufficient.
  2. Scoliosis Intensive Rehabilitation (SIR):  SIR has been shown to be effective in treating scoliosis where available and may also be a great option for patients traveling longer distances.  SIR involves a 3-5 week program with 4-6 hours of treatment per day.
  3. Brace treatment is a 3rd option and has been found to be the most effective treatment for preventing curve progression and thus preventing surgery and frequently improving scoliosis curves.  Brace treatment is usually used in conjunction with a scoliosis specific rehab program.

Progressive Scoliosis Treatment Guidelines:

1.  Children (no signs of maturity)

a.  <15° Cobb:  Observe every 6-12 months.

b.  Cobb angle 15-20°:  Scoliosis specific exercise program with home rehab programs.  Part-time scoliosis brace if curves do not improve.

c.  Cobb angle 20-25°: Scoliosis specific exercise program, scoliosis intensive rehabilitation program where available.

d.  Cobb angle >25°: Scoliosis specific exercise program, scoliosis intensive rehabilitation program and part-time brace wear.

Risk Of Progression

Scoliosis Progression Factor (SOSORT)
Scoliosis Progression Factor (SOSORT)

 Progression Risk Factor = [ Cobb Angle – (3 x Risser sign)] / Chronological age.

II.   Children and adolescents, Risser 0-3:  These recommendations are based on progression risk rather than curve angle alone. (see above chart)

a.  Progression risk less than 40%:  Observation every 3 months.

b.  Progression risk 40%:  Scoliosis specific exercise.

c.  Progression risk 50%:  Scoliosis specific exercise and scoliosis intensive rehabilitation program.

d.  Progression risk 60%:  Scoliosis specific exercises, scoliosis intensive rehabilitation program + part-time brace.

e.  Progression risk 80%:  Scoliosis specific exercises, scoliosis intensive rehabilitation program and full-time brace.

III.  Children and adolescents with Risser 4

a.  <20° Cobb:  Observation every 6 months.

b.  <20-25° Cobb:  Scoliosis specific exercise.

c.  >25° Cobb:  Scoliosis specific exercise, scoliosis intensive rehabilitation program.

d. >35° Cobb:  Scoliosis specific exercise, scoliosis intensive rehabilitation program + brace.

IV. First presentation with Risser 4-5

a.  >25° Cobb:  Scoliosis specific exercise

b.  >30°  Cobb:  Scoliosis specific exercise, scoliosis intensive rehabilitation program.

Adults with Cobb angels >30°

Scoliosis specific exercise and scoliosis intensive rehabilitation program.

VI.  Adolescents and adults with scoliosis (of any degree) and chronic pain.

Scoliosis specific exercises, scoliosis intensive rehabilitation program and brace treatment.

At Square ONE all of our scoliosis treatments follow guidelines set by SOSORT.  Our treatments include a combination of Chiropractic BioPhysics, Scientific Exercises Approach to Scoliosis (SEAS), Scoliosis Intensive Rehabilitation and Scolibrace.

Click here to learn more about scoliosis treatments.

Click here to learn more about Square ONE.

For a FREE consultation call 970-207-4463 or click below.

Screen Shot 2015-04-14 at 10.23.13 AM

Why Do More Adults Have Scoliosis Than Kids? | Square ONE

Why Do More Adults Have Scoliosis Than Kids?

Scoliosis gets the most attention in youth, particularly during growth spurts.  The reason for this is because this is when scoliosis curves can progress the fastest and small curves can rapidly become larger curves and potentially lead to surgery.

However only 3% of adolescents under 18yo have scoliosis.  In comparison; 9% of adults over 40yo have scoliosis, as do 30% of adults over 60yo and 50% of adults over 90yo.

There are two reasons for this:

  1. Some of the adults with scoliosis are adults who had scoliosis when they were younger.
  2. Many of them have different form of scoliosis all together, known as de novo scoliosis or adult degenerative scoliosis.  De novo comes Latin origin and means over again or anew.

Before skeletal maturity the progression of scoliosis is caused by

Hueter-Volkmann Priciple
Hueter-Volkmann Priciple

uneven pressure on growth plates or epiphysis.  This known as the Hueter-Volkmann Law which states, “Growth is retarded by increased mechanical compression, and accelerated by reduced loading in comparison with normal values.”  Growth plates are stunted under pressure and

Hueter-Volkmann Principle
Hueter-Volkmann Principle

as scoliosis begins the unbalanced pressure on the vertebral bones can cause the bones to grown unevenly.

Scoliosis progresses in adults for completely different reasons, degenerative reasons.  Uneven pressure on bones will causes bones to breakdown and degenerate after skeletal maturity.  This follows Wolf’s Law which proposes the skeletal hard and soft tissues will remold under stress.  Increases pressure on unbalanced bones will cause the vertebra to breakdown and degenerate.  This can be Adolescent Idiopathic Scoliosis in adults that became degenerative or a new scoliosis that begins in adulthood.

Scoliosis Progresses in Adults

Larger curves have been shown to progress 1-3° per year.  As curves in the lumbar spine progress they can become unstable.  This degenerative process combined with increased scoliosis curves and increased spinal instability is frequently accompanied by increases in pain and discomfort.

Scoliosis Treatment for Adults

Scoliosis treatment for adult is a case-by-case basis.  Smaller scoliosis in adults are typically treated with scoliosis specific rehab and exercises.  As curves progress intensive scoliosis rehabilitation several times a week, or several times a day if patients are traveling from long distances to a clinic are appropriate. Larger degenerative scoliosis curves are frequently treated with bracing to stabilize the curve and often times gets the best results with intensive scoliosis rehabilitation programs.

Research Show Bracing Is Effective In Slowing Scoliosis Progression in Adults

A retrospective study was done to determine the effectiveness of bracing in slowing the progression of scoliosis in adults.  Both the progressions of idiopathic scoliosis in adults and degenerative scoliosis were observed.  In both types of scoliosis the rate of curve progression decreased from 1.28° to .21° after bracing.  This study shows the bracing can be effective in slowing the progression of scoliosis in adults.

For more information on scoliosis treatments at Square ONE click here.

To schedule a FREE consultation call 970-207-4463 or click on the box bellow.

Screen Shot 2015-04-14 at 10.23.13 AM

Can Sports Cause Scoliosis? Fort Collins Scoliosis Doctor | Square ONE

Do SportsCauseScoliosis-

Can sports cause scoliosis?

One sided sports such as tennis and golf are often blamed for contributing to the development of scoliosis, however there is no evidence to support such claims.

However there is a statistical prevalence with scoliosis and some sports, specifically dancing, rhymthmic gymnastics and competitive swimming have been found to correlate with increased incidence of scoliosis.

Competitive Swimming

Research has show that competitive swimmers have an increased prevalence of spinal deformities.  A study published in The Journal of Pediatrics:  Swimming and Spinal Deformities:  A Cross-Sectional Study  found competitive swimmers (particularly females) have more spinal asymmetries, positive scoliosis screenings and increased kyphosis compared to normal populations of the same age.  Female competitive swimmers are 2.5x more likely to have scoliosis than non-swimmers of the same age.  Additionally, swimmers were found to be a increased risk of low back pain.  This study suggest that adolescents that swim regularly (2 hours per day at least 4 times per week) are more likely to have scoliosis.

Clinical Journal of Sports Medicine: “The high-repetition nature of competitive swimming causes imbalances in musculature in the adolescent athlete.  Scoliosis as a musculoskeletal condition of the adolescent can be detected in high incidence among swimmers owning to the training phenomenon. 

Dance

A paper in Archives of Physical Medicine and Rehabilitation:  Prevalence and Predictors of Adolescent Idiopathic Scoliosis in Adolescent Ballet Dancers  found 30% of dancers tested positive for scoliosis compared to 3% of non-dancers.  This study suggest that dancers are 12.4 times more likely to have scoliosis than non-dancers of the same age.  Conclusion: Adolescent dancers are at significant higher risk of developing scoliosis than non-dancers of the same age.  Vigilant screening and improved education of dance teachers and parents of dance students may be beneficial in earlier detection and, consequently, reducing the risk of requiring surgical intervention.

Should kids with scoliosis stop participating in sports?

With the exception of competitive swimming, high level ballet and Rhythmic gymnastics, children should be encouraged to participate in sports.

SOSORT (Scientific Society on Scoliosis Orthopedic Treatment and Rehabilitation) recommends sport as a compliment of brace treatments.  Specific scoliosis exercises can be incorporated into sport specific training programs. Sports can also help strengthen the muscles that stabilize the spine.

Scoliosis Screenings

Research shows that early detection leads to early intervention and better outcomes (less surgeries).  Scoliosis progresses the fastest during growth spurts and The Scoliosis Research Society recommends girls should be screened at ages 10 & 12 and boys at 13-14yo.  Learn more about scoliosis screenings.

What is the best treatment for scoliosis?

Treatment for scoliosis is specific for each case and is dependent on ages  and many things need to be considered when determining the best treatment for each case including:  Severity of curve, Risk of progression, Distance to a scoliosis treatment facility, Willingness to wear a brace, etc.

Scoliosis Treatment in Adolescents

  • Curves <10° watch and wait
  • Curves 10°-25° night time bracing with scoliosis specific rehabilitation program
  • Curves 25°-30° part time bracing with scoliosis specific rehabilitation program
  • Thoracic curves 30°-60° full time bracing with scoliosis specific rehabilitation program
  • Lumbar curves 30°-50° full time bracing with scoliosis specific rehabilitation program
  • Thoracic curves >60° surgical management
  • Lumbar curves >50° surgical management

What are the best braces?

Traditional scoliosis braces such as the Boston Brace are a symmetrical brace which is designed to hold the scoliosis in its position and just tries to stop the progression.

Modern Advanced Scolibrace

Scolibrace is different than traditional braces in that it’s an asymmetrical brace and it actually puts the scoliosis in its 3D over

Scolibrace
Scolibrace

corrected position.  In other words it takes a right thoracic scoliosis and puts it in its exact opposition position (as seen in the picture on the right) and actually works to correct or improve the scoliosis instead of just trying to prevent progression.  Learn more about Scolibrace.

By Dr Chris Gubbels D.C.

If you think your child may be at risk of scoliosis and you would like to schedule a FREE scoliosis screening or for a FREE scoliosis consultation call 970-207-4463. 

To learn more about Square ONE click here.

Screen Shot 2015-04-14 at 10.23.13 AM