What is scoliosis?
Scoliosis is a lateral curvature of the spine. When the spine is viewed from the side it should have curves but when viewed front on, the spine should be straight. In scoliosis, the curvatures are usually described as being an “S” or “C” shape . The cause of most cases is idiopathic, meaning the cause of the curvature is not known. Adolescent idiopathic scoliosis is a relatively common disease with a prevalence of 2-3% in the Australian population, with about 1 in 15 girls developing some scoliosis during their growing period, from 9 to 14 years .
There are three main types of idiopathic scoliosis which are classified based on the age of onset:
- Infantile: a curvature of the spine that develops before a child is two years of age.
- Juvenile: a curvature that develops between the ages of two to ten years.
- Adolescent: a curvature that appears in early adolescence (the most common type as it is driven by growth).
Signs and Symptoms
Signs and symptoms of adolescent idiopathic scoliosis (AIS) are usually related to changes in posture. There are some typical posture presentations of scoliosis, and parents are encouraged to look out for these. If you have any concerns regarding the development of your child’s spine, seek a medical professional’s opinion and your child’s spine can be assessed and x-rays performed if necessary. It is worthy to note that pain is not often a sign or symptom of the condition in AIS.
Common signs for parents to be mindful of include, but are not limited to, the below:
- Shoulder height asymmetry: Look out for an imbalance in shoulder height, when one shoulder appears higher than the other.
- Rib prominence: Look out for a hump on the back near the ribs or waist, this is easier to see if you get your child to bend forward, with their shirt lifted or bathers on.
- Torso lean: A shift of the body to the left or right. Look out for one hip appearing higher than the other.
Treatment of AIS will depend on the degree of the curvature, risk of curve progression, and location of the curve. However, there are 3 main categories of treatment:
- Observation: Generally, for patients whose curves are mild (less than 25 degrees) and are still growing. It is the first step of an active approach to idiopathic scoliosis. Observation involves regular clinical evaluations with a specific follow up period. .
- Bracing: Aimed to control a curve and keep it at an acceptable angle through the growth phase. Bracing will not cure scoliosis but is aimed to prevent the curve from worsening . Seek advice from a spinal surgeon if bracing is something you think your child could benefit from.
- Surgery: In more advanced cases some children may require surgical correction. Metal implants are attached to the spine and then connected to a single rod or two rods. .
What about conservative treatment?
Exercise for children with scoliosis can help maintain flexibility and movement in the spine, maximise function, and reduce pain. Helping your child manage their symptoms will allow them to continue to enjoy activities at school and home.
Conservative treatment can include:
- Scoliosis specific exercise programs: SEAS (Scientific Exercise Approach to Scoliosis) and the Schroth method have been shown to improve posture, aesthetic appearance, breathing and flexibility of the spine in children with AIS [6,7]. These scoliosis specific exercises are commonly used in conjunction with bracing to prevent curve progression. It is recommended that scoliosis specific exercise programmes are led by therapists specifically trained in the approach they use.
- Postural correction exercises: Correcting posture and advice on positioning helps reduce pain and increase comfort. In addition to this, visual correction of scoliosis related deformities can improve quality of life as it helps aesthetic self-perception. .
- Muscle stretching: This helps restore the normal function of tight muscles and relieve pain.
- Muscle strengthening: This helps to strengthen the supporting muscles of the spine and helps correct muscle imbalances.
- Day JM, Fletcher J, Coghlan M, Ravine T. Review of scoliosis-specific exercise methods used to correct adolescent idiopathic scoliosis. Archives of physiotherapy. 2019;9(1):8–8.
- Government of Western Australia Child and Adolescent Health Services. Scoliosis; [updated 2021; cited 2022 January 30]. Available from: CAHS | Child and Adolescent Health Service – Scoliosis
- Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, et al. 2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and spinal disorders. 2018;13(1):3–3.
- Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of Bracing in Adolescents with Idiopathic Scoliosis. The New England journal of medicine. 2013;369(16):1512–21.
- Lonner BS, Ren Y, Yaszay B, Cahill PJ, Shah SA, Betz RR, et al. Evolution of Surgery for Adolescent Idiopathic Scoliosis over 20 Years: Have Outcomes Improved? Spine (Philadelphia, Pa 1976). 2017;43(6):402–10.
- Romano M, Negrini A, Parzini S, Tavernaro M, Zaina F, Donzelli S, et al. SEAS (Scientific Exercises Approach to Scoliosis): A modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis. 2015;10(1):3–3.
- Vrećić Aleksandra, Glišić Marija, Živković Vesna. Significance of Schroth method in the rehabilitation of children with structural idiopathic scoliosis. Medicinski podmladak. 2020;71(1):33–8.
- Zaina F, Negrini S, Atanasio S. TRACE (Trunk Aesthetic Clinical Evaluation), a routine clinical tool to evaluate aesthetics in scoliosis patients: Development from the Aesthetic Index (AI) and repeatability. Scoliosis. 2009;4(1):3–3.