Scoliosis

It is a complex deformity of spine characterized by abnormal sideways curvature of spine or increased lateral curvature and rotation of vertebrae involving deformity of rib cage.

EPIDEMIOLOGY AND CAUSES

CAUSES

Congenital Scoliosis – bone malformation present at birth.

Neuromuscular Scoliosis – results from abnormal muscles or nerves seen in people with spina bifida and cerebral palsy.

Degenerative Scoliosis – results from traumatic bone collapse.

Idiopathic Scoliosis – results from no specified identifiable cause.

CLINICAL FEATURES AND PATHOPHYSIOLOGY

Deformities like skew back, rib hump

Asymmetrical breast and shoulder level

One shoulder blade is more prominent than other

On bending rotation of spine becomes more prominent

Asymmetrical hip

Associated with skin pigmentation

Associated back pain

PATHOPHYSIOLOGY

Idiopathic Scoliosis is associated with CHD7 and MATN1 gene.

Congenital scoliosis has been associated with malformation of the spine during 3-6 weeks in utero due to a failure of formation, a failure of segmentation, or a combination of stimuli.

PHYSICAL EXAMINATION AND DIAGNOSIS

Various diagnosis and physical examination is applied to evaluate Scoliosis spine curvature

COBB METHOD
In this a horizontal line is drawn on the upper part of the first vertebrae involved in the curve and a horizontal line is drawn from the lower part of the last vertebrae involved in the curve now a perpendicular line is drawn from both horizontal lines, the angle formed at the intersection is the “Cobb Angle”.

RISSER FERGUSON METHOD

In this method a line is drawn from the centre of the first vertebrae involved and a line us drawn from the centre of the last vertebrae involved in the curve, the point of intersection of these lines gives the Angle of Scoliosis according to Risser Ferguson Method.

ADAM’S FORWARD BEND TEST

Bend forward flexion reveals abnormal uneven framework of spine suggestive of Scoliosis.

COMPLICATIONS

Lung and Heart Disease

Chronic Back Pain

Long term Postural Abnormalities

Physiotherapy Management

Physiotherapist have three important considerations firstly is to inform, advice and instruct. For the treatment of scoliosis, it’s not only important to do the correct exercises but the physical therapist also needs to inform the patient &/or parents about his/her situation. An educational program makes sure that the therapy accuracy from the patient improves. Some physiotherapists recommend a brace to prevent the worsening of the scoliosis. An often used brace is the Milwaukee Brace. We can conclude that bracing is recommended as a treatment for female patients with a Cobb angle of 25-35°. In this it is evident that bracing and exercises have positive effects on patients with idiopathic Scoliosis

Schroth Method for Scoliosis Management

Goals -:

Stabilization of the curves

Mobilization of stiff body parts

Improve postural alignment

Teach activities of daily living

Promotes corrections

Enhance neuromuscular control

Increase muscle strength and endurance

Pain reduction

Improve Cardio-pulmonary function

Exercises given are

Pilates for Scoliosis

The SEAS exercises are, according to the Italian Scientific Spine Institute, based on a specific form of Active Self-correction, that is advised and taught individually to every patient. This is to achieve the maximum possible structural correction

Manipulation and Electrical Stimulation
are also used for Scoliosis management