Scoliosis

Authors
Affiliations

Nate Yomogida, PT, DPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, PT, DPT

Doctor of Physical Therapy

B.A. in Neuroscience

Reading list
  • To do
    • Ch23 scoliosis
  • In progress
    • Dutton
      • Finished p1461 interventions
  • Finished
    • Grieves

Scoliosis is defined as abnormal curvature of the spine in 3 planes. This results in changes in the trunk and intervertebral discs which produce long term structural changes in the vertebrae.

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 rotation.

Prognosis

  • The younger the patient, the greater the risk of progression
  • Double curve patterns have a greater risk of progressiont han single curves.
  • Curves with greater magnitude have greater risk of progression
  • Females♀ have a 10x greater risk of progression than males&male: with comporable curvature.
  • Development of curves before menarche increases risk of progresion.

Describing Scoliosis

Scoliosis is described based on the Location of the curve(s). In addition, the direction of the convexity and concavity towards the left or right should be detailed.

Note

If there is a double curve pattern then both curves should be described.

Biomechanical changes

  • Convex will have
    • Elongated back extensors
    • Weak back extensors
    • Rotation of vertebral body towards convexity
      • Spinous processes move away from convexity
      • As vertebra rotate towards the convexity, this brings the ribs posteriorly on the convex side resulting in a “rib hump”.
    • Ribs are widely spaced
  • Concave
    • Shortened back extensors
    • Tight back extensors
    • rotation of vertebral body away concavity
      • Spinous processes move towards concavity
      • As vertebra rotate away from the concavity, this brings the ribs anteriorly on the concave side
    • Ribs are close together

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.”.

Potential Impairments

  • Hypomobility in joints, muscles, and fascia on the i{concave side}
  • Dysfunctional muscle performance due to excess stretch and weakness in the musculature on the convex side
  • If one hip is adducted, the ipsilateral adductors are strong and have decreased flexibility and the ipsilateral abductors will be lengthened and weak
  • If on hip is adducted, the contralateral side will have lengthened and weak adductors and short and tight abductors.
  • As scoliosis progresses, rib expansion decreases, resulting in cardiopulmonary impairments and difficulty with breathing

Potential Sources of Symptoms

  • Muscle fatigue on convex side
  • Ligamentous strain on convex side
  • Nerve root irritation on concave side due to closing of intervertebral foramen
  • Joint irritation on concave side due to joint closing

Common Causes

Causes of structural scoliosis:
  • Neuromuscular disorders (CP, SCI, progressive neurological diseases, progressive muscular diseases)
  • Osteopathic disorders (e.g. hemivertebra, osteomalacia, Rickets, Fractures)
  • Idiopathic

Causes of Nonstructural Scoliosis:

  • Structural or Fucntional Leg Length Discrepancy
  • Muscle guarding or spasm from back or neck pain
  • Habitual or Asymmetrical postures

Rehab Goals

  • Facilitate correct postural alignment: Use asymmetrical postural habits to prevent further development
  • Facilitate and maintain respiration: chest mobility
  • Improve spine mobility
  • Reduce back pain: improve spine mobility and quality of movement
  • Functional training of pre-bracing skills
  • Maintain muscle strength: Especially in the lengthened/weakened abdominals
  • Regain length/strength balance muscle relationships: in spine and extremities

Length-Strength Relationship

As a general rule, it is best to strengthen convex muscles and to stretch concave muscles.

Therex

Asymmetrical exercises should be used to alter the body’s alignment and return to symmetry.

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:
      • Weak R Iliopsoas
      • Weak R external oblique
    • Asymmetrical exercises
      • Weak R external oblique treated with left ue diagonal reach resulting in R thoracic sidebend
      • Resisted Seated R hip flexion to strengthen R iliopsoas
    • Functional exercises
      • Superman with convex sidebend where the patient is prone with arms overhead while deviating thorax away from concave side
      • Supine + convex overhead abduction reach + concave arm extension/adduction to facilitate sidebend towards convexity
      • Child’s pose + sidebend towards convex side
      • Sidebending off edge of treatment table
      • Sidebending over stability ball towards convexity

Schroth Method

Plan of Care

Phase 1: Position and gravity assisted

  • Sidelying on the convex side over a pillow to facilitate sidebending towards the convex side
  • While in the sidelying position, perform lateral costal breathing to improve diaphragmatic breathing and rib expansion on the concave side

    • Phase 2: AROM

    Asymmetrical thoracic rotation Asymmetrical scapulothoracic retraction/protraction

    You will want to work on ipsilateral rotation and scapular retraction on the concave side

    • Horizontal cable pull through on concave side

    Ipsilateral scapular protraction combined with contralateral trunk rotation on the convex side to return to realignment

    • Cable punch on convex side

    Phase 3:

    1.
    Goodman C, Fuller K. Goodman and Fuller’s Pathology. 5th ed. Elsevier, Inc; 2020.
    2.
    Falla D, Moore AP, Jull G, et al., eds. Grieve’s Modern Musculoskeletal Physiotherapy. 4th ed. Elsevier; 2015.
    3.
    Schreiber S, Whibley D, Somers EC. Schroth Physiotherapeutic Scoliosis-Specific Exercise (PSSE) Trials-Systematic Review of Methods and Recommendations for Future Research. Children (Basel, Switzerland). 2023;10(6):954. doi:10.3390/children10060954
    4.
    Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill Education; 2020.
    5.
    Kisner C, Colby LA, Borstad J. Therapeutic Exercise: Foundations and Techniques. Seventh edition. F.A. Davis Company; 2018.

    Citation

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