Many people suffer from Scoliosis, spinal asymmetry, aberrant spinal curve development, physical pain and neural pain interpretations. Our specialist trained Physical Rehabilitation clinician works in our specialist rehabilitation clinic for Cambridge based patients suferring scoliosis and spinal asymmetry with spinal pain management treatment and dynamic exercise rehabilitation therapy, for spinal pain and spinal control, and other scoliotic pain conditions, including hyper-kyphosis (mainly Scheuermann’s Kyphosis), and hyper-lordosis conditions.
Scoliosis is a tri-planar deformity which requires the most up to date training and skills in asymmetry and scoliosis assessment, stabilization, reduction and rehabilitation methods.
Our rehabilitation specialist team, work with a vast range of physical capabilities, allowing us to have very positive impact on scoliosis and asymmetry symptom sufferers. We provide some of the most effective Cambridge based Scoliosis Specific Exercise Therapy Treatments (SSET).
Our realised goal is to have a positive effect on people’s ability to work and their quality of life. Additionally, preventative interventions are important and a suggested focus.
Some of the most common issues associated with or leading to diagnosis of scoliosis, scoliosis types, other spinal, trunk, and structural asymmetries, and associated singular episodes (acute), or multiple episodes (chronic), of spinal pain including neck pain, mid back pain and low back pain are:-
Asymmetry, Scoliosis, aberrant global movement patterns, nervous systems controls of the spine / pelvis / trunk, global motor controls, scoliosis and asymmetry, including that of adolescent idiopathic scoliosis (AIS), congenital scoliosis, infantile scoliosis, juvenile scoliosis, acquired scoliosis, neuromuscular scoliosis, adult idiopathic scoliosis, adult scoliosis, adult degenerative scoliosis, primary scoliosis, and all forms of structural scoliosis and all forms of functional scoliosis, reduced stability, muscle stiffness, spinal stiffness, muscle strength alterations, central co-ordination dysfunction, central co-ordination disturbance, Syndromic Scoliosis, Scheuermann’s Kyphosis, Degenerative Scoliosis (De Novo Scoliosis), asymmetric growth, neurologic abnormalities uneven shoulders, rib hump, leaning torso, adult onset scoliosis, late onset scoliosis, degeneration of the joints and discs in the spine, spinal curvature, progressive curvature, myelodysplasia, cerebral palsy, Duchenne muscular dystrophy, Freidrich ataxia, spinal muscular atrophy, secondary scoliosis, poor posture, muscle fatigue, Rett’s syndrome, Beale’s syndrome, muscular dystrophy, osteochondro-dystrophy, connective tissue disorders, early onset scoliosis, adolescent scoliosis, uneven hips, tilted head, asymmetric contour of the waist, ‘Turn Head-Adducted Hip Truncal Curvature’ (TAC) syndrome, vestibular dysfunction, structural, Non-structural, transient structural, Central co-ordination disturbance, leg length discrepancy, congenital scoliosis, malformation of the vertebrae, birth defects, spinal injuries….. The list goes on!
The quality of some of these diagnosis concepts, and the actual correlation to your asymmetry and scoliosis, and then the correlation between the asymmetry and other symptoms, are even more fascinating!
How This May Affect People
When this doesn’t go well, it often leads to a very dissatisfying outcome. This can manifest itself as: deconditioning, disability development, curve progression, affects to general health, depression, loss of confidence in yourself and your body, which ultimately often leads to a dependency on pain altering medications, with the possible need of surgical intervention, and in some cases poorer physical health.
So what are we to do? Are we to:- be immobile?, be mobile?, be active?, or minimally active?, train into pain (‘no pain no gain’)?, or train avoiding pain?, use medication management?, use spinal braces and whole trunk braces? use massage?, use spinal manipulation?, Osteopathy or chiropractic or physiotherapy?, use prescriptive exercise?, regular treatments or minimal treatments?, use surgical intervention? or avoid surgery?, have imaging or not to have imaging?, should we focus on structure or function?, or is it just age?!!!
Michael has been the only person able to fix me! I have had over 13 years of widespread joint pain including my whole spine. I had undergone numerous diagnostic investigations and was constantly told that there was nothing wrong. I steadily increased my pain medication to try to ‘deal’ with the pain. Eventually I was taking over 40 pills a day and wearing pain relief patches on my skin. I couldn’t sleep, read, think properly, and I was just about maintaining my role as a teacher. I had no life outside of work as I was too shattered and down to do anything.
Our knowledge and understanding of the body, spinal development and spinal curve development, neural pain interpretations (spinal pain syndromes) and mechanical anatomy of the back and trunk, its associated structures and the muscles used for core control, spinal stability, movement and curve progression prevention, are still being updated and evolving. Allowing for constantly changing assessments, treatment and rehabilitation techniques.
Sometimes additional investigations are needed. ‘Scoliosis is defined as a lateral spinal curvature with a Cobb angle of 10° or more’. However, structural scoliosis can be seen with Cobb angles under 10 degrees, with a potential for progression. The Cobb angle is the angulation measurement of the spinal curvatures. ‘This abnormal curvature may be the result of an underlying congenital or developmental osseous or neurologic abnormality, but in most cases the cause is unknown. Imaging modalities such as radiography, computed tomography (CT), and magnetic resonance (MR) imaging play pivotal roles in the diagnosis, monitoring, and management of scoliosis, with radiography having the primary role and with MR imaging or CT indicated when the presence of an underlying osseous or neurologic cause is suspected.’
‘The treatment of idiopathic scoliosis is governed by the severity of the initial curvature and the probability of progression. When planning treatment or follow-up imaging, the biomechanics of curve progression must be considered: In idiopathic scoliosis, progression is most likely during periods of rapid growth, and the optimal follow-up interval in skeletally immature patients may be as short as 4 months. After skeletal maturity is attained, only curves of more than 30° must be monitored for progression.’
The severity of the scoliosis curves are ‘usually assessed by measuring the Cobb angle on the spinal X-ray film. The measurement of the Cobb angle is an important basis for selecting therapeutic methods and evaluating therapeutic effects’.
Additionally, in adolescent scoliosis the ‘Risser Sign’ which is another radiographic evaluation, can assist with indicating the patients growth status.
Magnetic resonance imaging (MRI), does not currently seem to aid deformity evaluation in scoliosis and asymmetry. However, it can help rule out ‘non-idiopathic scoliosis‘.
Surface Topography, seems to ‘provide an objective, systematic evaluation of anterior trunk asymmetry that can be used in the assessment of patients with scoliosis.’ However, research to validate this is still limiting.
Digital photogrammetry (digital photography) for body posture assessment, is simple, quick, harmless, and cost-effective. There is a reliability, allowing for posture documentation and corrective therapy effects’ monitoring. While it provides reliable and valid measurements of posture. This may improve clinical practice by facilitating posture analysis.
Physical assessment by a clinician is vital in all cases of scoliosis, spinal curves, body asymmetry and any spine pain.
There are many ways to assess a patient for asymmetry and scoliosis. The methods used at each clinic maybe variable, and with different clinical interpretations and outcomes. Measurements on different planes, seem to not correlate to each other as well as clinicians would like.
Some of the physical examinations can show comparable differences in neuro-motor strength. A study stated that scoliosis sufferers ‘were found to be significantly weaker when contracting toward their main curve concavity in the neutral and concave pre-rotated positions compared to contractions toward the convexity.
Using a method of clinical assessment for three dimensional disturbances, the consulting rehabilitation clinician looks at all three planes of postures and motion, including the functional presentation of Global Movement Patterns (global postural re-education / GPR).
Does This Apply To You?
The “wait and see” methods are now seen as not suitable for those with any level of asymmetry or curves. Assessment and conservative interventions should be applied as early as possible.
Asymmetries including scoliosis and other three dimensial spinal changes, thoracic changes, and trunk shape changes are supprisingly common.
We clinically see these more than people would expect. You are not alone, people can help and support you.
What Can Help
Bracing is generally suggested to be used when the cobb angle, is 21-50 degrees. All bracing treatments, must be accompanied by scoliosis specific exercise therapy.
Surgical interventions are generally suggested to be used when the cobb angle is over 50 degrees, and more clearly advised when there is a curve that is over 60 degrees in angle. Post operatively, it is very important to establish a healthy physical rehabilitation programme.
Pre-Surgery and Post-Surgery Rehabilitation
Specialist scoliosis exercises as a treatment for the asymmetry, and sometimes as an alternative to surgery and invasive spinal procedures. As some studies show an improvement in curvatures in all treated patients with back control exercises.
This doesn’t always remove the need of surgical care, and at those times, Specific Physical Exercises can help prepare the body for the intervention, and then assist after the intervention, to re-activate motor control of the area.
Conservative methods such as manual therapy, seem to assist in pain management of spinal pain, rib pain, and thorax pain.
Releasing undesirable tensions in soft tissues, may facilitate in correction with exercises.
Soft tissue mobilization, rib mobilization, diaphraghm release, and flexibility improvement from hands on treatment, from an osteopathy, chiropractor or physiotherapist, seem to assist.
Conservative management, of physical rehabilitation, and brace use in combination, are effective at reducing the prevalence of surgery in patients (children and adolescents) with adolescent idiopathic scoliosis (AIS).
When it is time to reduce the use of the brace, specific exercises performed in this period of ‘brace weaning’, can avoid loss of corrections achieved from the brace, where as those who discontinued the exercises or those who just stopped using the brace, who shoes a significant increase in cobb angle. Even when they look at the results many years on.
In progressive thoracic scoliosis, ‘stabilization of progressive thoracic scoliosis was achieved’ with a brace and scoliosis specific exercise therapy.
This stabilization can be achieved, even during periods of rapid adolescent growth, in up to 89 percent of people.
Scoliosis-Specific Exercise Therapy
Scoliosis specific exercises (SSE), are suggested from the start of any assessment and intervention.
Any scoliosis with a cobb angle of 10 – 20 degrees, are generally advised that they should undergo Physical Scoliosis Specific exercises (PSSE) to help manage the case.
Scoliosis exercises can be a sole treatment for mild scoliosis in adolescents and for adult scoliosis, while the combination with bracing is perhaps advisable during growth spurts, seems to provide better results.
There are many methods of physical scoliosis exercise therapy.
The spinal stabilization exercises, look to acquire and then strengthen neuro-motor control.
For the early application of scoliosis specific exercise therapy, for curvatures below 10 degrees cobb angle (not classified as scoliosis, but as asymmetry), and the smaller cobb angle curves of scoliosis (10 degrees or over, up to 20 degrees cobb angle), the recommendation is not to watch and wait, but to provide specialist exercises, taught one to one with the patient, and specifically target the patients needs.
This non-invasive method of treatment, is attempting to not allow the progression of the curves, to prevent the curves ever being seen as a curve which requires additional therapeutic interventions to coincide with the scoliosis specific exercise therapy (SSET).
This active Early Stage Scoliosis Intervention (ESSI) is performed with the intent of achieving stabilization of the spinal curvatures, which may lead to the clinically assessable reduction in the curvatures, and with the hope to reduce the risk of future scoliotic curve progression.
The studies show that in the short term exercise therapy, can improve back asymmetry, spinal imbalance.
Helping positively influence the cobb angle of the scoliosis, vital capacity of breathing, even helping strength and postural defects.
There are also some very key points found in some studes, which include, that a program of well-planned individualised exercises under clinical supervision is an ‘effective method for improving regression or stopping progression of idiopathic scoliosis in adolescents’.
A home exercise program alone, ‘without supervision is not an effective treatment method for adolescent idiopathic scoliosis’.
Curvature progression is inevitable for most children with idiopathic scoliosis if they are not treated by exercise, bracing or surgery.
Exercises have been shown to be effective in reducing the need for brace prescription.
In patients with scoliosis who are at high risk of progression. Specific and personalized treatments are more effective than ‘non-adapted exercises’.
Whole Body Integration
Then we can start to look at more global motor patterns, and treatment plan.
Vestibular dysfunction, may have a relationship with scoliosis. The ‘perception of visual vertical is altered in idiopathic scoliosis’, ‘which may play role in development of idiopathic scoliosis’.
Different forms of hypermobility, can present in different ways, however, they seem to be present more in the Scoliotic population. Therefore recognition of those who are hypermobile is important.
Movement Screens and Balance Tests, seem to correlate with the ‘Beighton Score (BS) in dancers with implications for performance and injury.’
Scoliosis sufferers have been shown to have a slower speed walking gait, shorter stride length and longer stride time, with additional variations in timing of muscle activation throughout the body.
Postural preferences are seen in ‘so-called Adolescent Idiopathic Scoliosis (AIS)’, and are seen as causative influences.
Hip movement issues, related to ‘real or functional abduction contracture’, have been found. Contracture of the hip is connected with a “syndrome of contractures” of new-borns and babies. This was seen in small children, with rotation deformity and in older children, it was proven ‘that the “new prophylactics” through “new clinical test” and “new rehabilitation treatment” at school children (5-6-7-8 years old) gives positives results.’
The technique includes a specialised research informed Scoliosis Specific Exercises (SSE) approach, specifically designed to work with its influence on the nervous systems control of the spine, pelvis, trunk and whole global motor controls.
The advanced techniques and scoliosis exercises, are designed to retrain a patient’s brain, with cognitive awareness training, sensory-motor training, kinesthetic training, and dynamic stabilization training. To help them learn how to optimally stabilize their spine, straighten and elongate their spine while, performing physical activity. This dynamic neuromuscular re-education can often lead to long term positive outcomes.
This may show why whole body assessment and treatment, is reported anecdotally to be so effective in clinic.
These positive effects from manual therapy and exercise, may be due to the increasing body of evidence, that pain is a brain interpretation of data, and the local structure itself, cannot be consistently linked with pain or general function.
Additionally, manual therapy by an osteopath including the use mobilization and manipulation, and prescription exercise therapy including scoliosis specific exercise therapy, are all safer than long, or even short term medication treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs). Additionally, these are statistically safer than surgical intervention.
The point here is that there are many opinions and many solutions, to treating scoliosis (scoliosis and / or asymmetry). Perhaps some, in our opinion, are more rational than others and some statistically safer than others, and some more empowering than others.With all treatments, it’s important to get the diagnosis, advice, and treatment programme from people who are trained, skilled and prepared to aid your neuro-musculo-skeletal needs, such as at our Cambridge Physical Rehabilitation Clinic.
The guidelines for ‘scoliosis and asymmetries’, includes the guidance to when suitable remain as active as possible, continue activities of daily living (ADL), continue sports when possible, seek support and advice at a specialist clinic, for, assessment, diagnosis, education, management advice, prevention of symptoms re-occurrences advice, stabilisation and manual therapy including mobilisation treatment, hydrotherapy application, increases in strength and muscle control (motor control training) and specialist exercise therapy (SET) for physical rehabilitation.
This specialist physical training should be in the form of conservative Scoliosis Specific Exercise Therapy (SSET).
At Elementary Health our Cambridge Physical Rehabilitation Clinic, we provide a seamlessly layered combination approach, of assessment, diagnosis, education and therapeutic application.
This includes education of anatomy, scoliotic patterns and pain theories, assymetry and scoliosis therapy theories, manual therapy, osteopathy for spinal pain and rib pain, posture advice and training, lifestyle advice, hydrotherapy guidance, dietary overviews, and dynamic exercise therapy with motor control training rehabilitation, as Scoliosis Specific Exercises (SSE).. Working to form, a preventative methods, stopping or slowing of scoliotic progression, correction of current curves and rotations, reduction of pain, improved quality of life, improve exercise mechanics, improve breathing, encouraging mobilisation and flexibility and stabilization of correct postures, maintenance of the achieved corrections, education including attempts for correction of normal activity postures and training of activities of daily living (ADL’s).
All of these work together to provide a uniquely structured approach, towards the aim of restoring your brain’s interpretation, or ‘mapping’ of your healthy functioning body, giving you back the control!
If there are any other questions, or, you wish to book a consultation with Michael Parr the consulting osteopath in Cambridge, based at Elementary Health. Please don’t hesitate to call or email.