Treatments and Therapies
Watch and wait
This period refers to a stage where scoliosis has been identified and diagnosed but is deemed by the physician to be not severe enough to intervene with any sort of treatment – bracing or otherwise. “The treatment for mild (<25°) adolescent idiopathic scoliosis (AIS) has traditionally been the ‘watch and wait’ approach1,2,3). “
A scoliosis brace is a device worn around the torso that can help prevent a scoliosis curve from getting worse. It can also make it less likely that you’ll need surgery in the future after bone growth has stopped. Braces are the most traditional conservative treatment for scoliosis and designed to slow or stop progression of a spinal curvature caused by scoliosis.
Rigid braces put pressure on your spine in several places to help prevent it from curving more than it already has. Dynamic braces slow curve progression by retraining your body into maintaining a corrective posture. Both types of braces may slow progression enough to remove the need for surgery, but they usually don’t straighten the spine.
A brace that goes from your thoracic spine (upper back) to your sacral spine (buttocks) is called a thoracic-lumbar-sacral orthosis (TLSO). It covers your body from your armpits to your hips and is the most common style of brace. A brace that goes from your cervical spine (neck) to your sacral spine is called a cervical-thoracic-lumbar-sacral orthosis (CTLSO). It braces your spine from your neck to your hips. Some braces are worn full-time; others are worn only while you’re sleeping (nighttime). According to the American Association of Neurological Surgeons (AANS), braces, in general are effective in around 80 percent of people treated with them.
There have been multiple studies done on different types of braces – hard plastic braces, flexible braces made of multiple straps, bending and nighttime-only braces to name a few. Some doctors favor one type over another and feel like their patients are more compliant and successful with that type. The basic concept that all braces share is the pressure they apply externally to the curved spine. Some similarities that have come out of various studies done over the years are listed below:
- A study done comparing the effectiveness of two different treatment protocols showed similar results to prior studies that longer hours of brace wear improved outcomes in high-risk adolescent idiopathic scoliosis patients.
- Brace wear for lumbar curves is more effective than for thoracic curves.
- Increased rotational deformity in the spine can decrease the success of brace wear.
- The distance from the greatest part of the curve (apex) to the center of the body, the location of the apex in the spine, and the tilt of the 4th lumbar vertebra have shown a correlation to curve progression and possibly to low back pain.
- The larger the curve is when your spine is done growing, the more likely it will show slow progression into adulthood.
When is bracing recommended?
After a curve has shown progression over time, or if, upon diagnosis, the curve is larger than 25 degrees, a physician may recommend the patient as a candidate for a scoliosis brace. According to Boston Children’s Hospital and many other pediatric organizations, orthopedic doctors typically recommend scoliosis bracing for children who are still growing and have a curvature of 25 degrees or more. The primary goal of a scoliosis brace is to keep the curve from progressing to the level that surgery is required. Some patients achieve curve reduction with bracing.
There are some recent advancements in bracing that may be able to offer correction of a curve, rather than just stopping progression, but the technology is new and still being studied. Depending on when a patient embarks upon their bracing journey, a brace or several different braces may be worn over a series of months and years. Brace treatment for scoliosis typically concludes for 2 reasons – 1. The patient has stopped growing (reached skeletal maturity) or 2. The patient’s curve has progressed beyond ~45 degrees.
Surgical intervention occurs when scoliosis is at an advanced state. According to The American Academy of Orthopedic Surgeons, most scoliosis surgeons agree that children who have very severe curves (45-50° and higher) will need surgery to lessen the curve and prevent it from getting worse… If your curve is greater than 45-50°, it will very likely get worse, even after you are fully grown. This may increase the cosmetic deformity in your back, as well as affect your lung function. This is the point where surgery would be presented as a good option.
The traditional procedure for scoliosis surgical correction is called spine fusion, however, there have been several new advancements in this area recently. Some of the newer surgical options are often referred to as Growth Rod Surgery (MAGEC, Api-Fix, etc.) and/or Vertebral Body Tethering (known as VBT for short). These new surgical technologies each have different pros and cons as well as different indications.
Physical Therapy – The Schroth Method
The Schroth Method is a specific form of physical therapy for treating scoliosis and other spinal conditions. Individualized instruction is given to help clients learn to self correct their unique curves. This is essential especially in treating scoliosis to avoid worsening the condition. The goal is to teach individuals to achieve their best posture from the inside out. Emphasis is placed on opening collapsed areas of the trunk and building postural muscle endurance in the corrected position. When instructed by a certified practitioner it is safe and is the BEST way to treat scoliosis with exercise. It is appropriate in all stages and for all ages. It is also applicable to other posture problems like kyphosis, flat back and age related changes.
The Schroth Method was conceived in Germany in the 1920’s by Katharina Schroth. Having scoliosis herself, she was inspired by filling a balloon and developed a technique to “fill in” her concavities. She and her daughter Christa Lehnert-Schroth founded their clinic in 1955 in Germany. Christa continued to run the clinic after Katharina’s passing and published the book “Three Dimensional Treatment for Scoliosis” in 1973.
Elena Salvá a physical therapist and a friend of the Schroths, brought the technique to Spain in 1968. Her daughter Gloria Quera-Salvá and son-in-law Manuel Rigo, both MDs, got approval to start teaching globally in 1989. The Barcelona Scoliosis Physiotherapy School (BSPTS) was founded in 2009 to develop Schroth curriculum for future therapists. The first BSPTS physical therapist in the US was certified in 2003. There are now several hundred physical therapists certified in the US. The Schroth Barcelona Institute is the USA organization for Schroth practitioners.
The Schroth Method is one of several types of physical therapy designed to treat scoliosis specifically. What they have in common is that all of these techniques correct the spine three dimensionally. As you read above, the Schroth Method is German and has a branch that is based out of Spain (BSPTS). The following are other established techniques:
- Lyon- France
- Scientific Exercise Approach to Scoliosis (SEAS)- Italy
- Dobomed Approach- Poland
- Functional Individual Therapy of Scoliosis (FITS)- Poland
- Side-Shift- UK
Pilates isn’t just for fitness fanatics. It’s actually an accessible way to build strength in your core muscles for better posture, balance and flexibility. Pilates is a method of exercise that consists of low-impact flexibility and muscular strength and endurance movements. Pilates emphasizes proper postural alignment, core strength and muscle balance. Pilates is named for its creator, Joseph Pilates, who developed the exercises in the 1920s.
A Pilates routine generally includes exercises that promote core strength and stability, muscle control, and endurance, including exercises that stress proper posture and movement patterns and balanced flexibility and strength. It can also be helpful in training for sports or in physical rehabilitation.
A common misperception is that Pilates requires specialized equipment. Maybe you’ve seen a Pilates apparatus — called a Reformer — that looks like a bed frame with a sliding carriage and adjustable springs, or perhaps you’ve seen a type of trapeze table. But don’t let those machines intimidate you. The reality is that many Pilates exercises can be done on the floor with just a mat.
By practicing Pilates regularly, you can achieve a number of health benefits, including:
- Improved core strength and stability
- Improved posture and balance
- Improved flexibility
- Prevention and treatment of back pain
One cannot expect to reverse a curve in the spine with pilates exercise but a targeted program can teach patients how to release tight areas of the spine, improve awareness of alignment and strengthen the internal muscles that support and control the spine.
The body with scoliosis has developed a highly sophisticated compensating ‘act’ and it can also learn a more refined symmetrical ‘act’ with proper instruction. By combining the yoga postures with breathing awareness, one can develop a structural alignment, creating a more normal symmetrical alignment. This is accomplished by stretching muscles that have tightened and strengthening muscles that have become weak from this asymmetrical imbalance. The body will create a more effortless posture using the bone structure, rather than over working the muscles to hold itself up. Through yoga, one can find that balance point that allows the scoliosis curve to coexist with gravity and activates the body’s natural plumb line. The result for most people with scoliosis is better posture and less pain. Additionally, psychologically, doing yoga can be very empowering and peaceful.