Scoliosis
Scoliosis is defined as abnormal curvature of the spine in 3 planes3. This results in changes in the trunk and intervertebral discs which produce long term structural changes in the vertebrae3.
Scoliosis will consist of a Convex and concave aspect.
Scoliosis consists of a progressive disturbance of the intercalated series of spinal segments that produces a 3D deformity consisting of lateral curvature (sidebend) with associated rotation4.
Prognosis
- The younger the patient, the greater the risk of progression4
- Double curve patterns have a greater risk of progressiont han single curves4.
- Curves with greater magnitude have greater risk of progression4
- Females♀ have a 10x greater risk of progression than males&male: with comporable curvature4.
- Development of curves before menarche increases risk of progresion4.
Describing Scoliosis
Scoliosis is described based on the Location of the curve(s)4. In addition, the direction of the convexity and concavity towards the left or right should be detailed4.
If there is a double curve pattern then both curves should be described4.
Biomechanical changes
- Convex will have
- Concave
Non-Structural Scoliosis
“Nonstructural scoliosis is reversible and can be changed with forward or side bending and with positional changes, such as lying supine, realignment of the pelvis by correction of a leg-length discrepancy, or with muscle contractions. It is also called functional or postural scoliosis.”5.
Potential Impairments
- Hypomobility in joints, muscles, and fascia on the i{concave side}5
- Dysfunctional muscle performance due to excess stretch and weakness in the musculature on the convex side5
- If one hip is adducted, the ipsilateral adductors are strong and have decreased flexibility and the ipsilateral abductors will be lengthened and weak5
- If on hip is adducted, the contralateral side will have lengthened and weak adductors and short and tight abductors5.
- As scoliosis progresses, rib expansion decreases, resulting in cardiopulmonary impairments and difficulty with breathing5
Potential Sources of Symptoms
Common Causes
Causes of structural scoliosis:- Neuromuscular disorders (CP, SCI, progressive neurological diseases, progressive muscular diseases)
- Osteopathic disorders (e.g. hemivertebra, osteomalacia, Rickets, Fractures)5
- Idiopathic
Causes of Nonstructural Scoliosis:
Rehab Goals
- Facilitate correct postural alignment: Use asymmetrical postural habits to prevent further development
- Facilitate and maintain respiration: chest mobility4
- Improve spine mobility
- Reduce back pain: improve spine mobility and quality of movement4
- Functional training of pre-bracing skills
- Maintain muscle strength: Especially in the lengthened/weakened abdominals4
- Regain length/strength balance muscle relationships: in spine and extremities4
Length-Strength Relationship
Therex
Asymmetrical exercises should be used to alter the body’s alignment and return to symmetry4.
Example
- Example: R thoracic curve, L lumbar curve
- Thoracic spine has convexity towards the right
- Thoracic rotation towards convexity (right)
- Lumbar spine has convexity towards the left
- Lumbar rotation towards convexity (left)
- Expected findings:4
- Weak R Iliopsoas
- Weak R external oblique
- Asymmetrical exercises
- Functional exercises
- Superman with convex sidebend where the patient is prone with arms overhead while deviating thorax away from concave side4
- Supine + convex overhead abduction reach + concave arm extension/adduction to facilitate sidebend towards convexity
- Child’s pose + sidebend towards convex side4
- Sidebending off edge of treatment table4
- Sidebending over stability ball towards convexity4
- Thoracic spine has convexity towards the right
Schroth Method
Plan of Care
Phase 1: Position and gravity assisted
Phase 2: AROM
Asymmetrical thoracic rotation Asymmetrical scapulothoracic retraction/protraction
You will want to work on ipsilateral rotation and scapular retraction on the
- Horizontal cable pull through on concave side
Ipsilateral scapular protraction combined with contralateral trunk rotation on the
- Cable punch on convex side