24 Oct Scoliosis: Causes, Treatment, and Exercise Implications
It’s that time of year when back to school physical examinations are in high demand so students can participate in sports, have their weight and height monitored, and be evaluated for scoliosis. Wait….scoliosis? Yes, scoliosis. When primary care providers have an adolescent bend over to touch their toes, they are assessing the spine and looking for any abnormal curvature that could warrant further imaging to determine if scoliosis is present. So, is this why, at your yearly exam as a kid, you had to bend over and touch your toe? Yes, absolutely! Let’s chat a bit about what scoliosis is, who it affects, and what treatment options there are to keep a spine with scoliosis happy, including some awesome scoliosis exercises.
What is scoliosis?
Scoliosis is a three dimensional deformity of the spine, specifically the vertebrae, and the trunk (1). This three dimensional definition is given secondary to the fact that the vertebrae, the individual bones that make up the spine, shift in the frontal plane, but also rotate in the direction of the curve. For example, if an individual states that they have a “right thoracic curve”, this means that the vertebrae in their thoracic spine have shifted to the right and are rotating to the right. With the shifting and rotation, changes will be seen in the posture of the trunk and pelvis, the ribs, and the arms and legs. Both the rotation of the vertebrae and the shifting in the frontal plane are characteristic of a spine with scoliosis and both should be addressed with management and treatment!
If we do a deeper dive into scoliosis, it can be further categorized into functional scoliosis and idiopathic scoliosis. Functional scoliosis is a curvature that is a result of another cause. Examples of this may be a true leg length discrepancy or asymmetrical muscle tone in the muscles of the back due to a potential and additional primary diagnoses. However, when most people speak of scoliosis, they are referring to idiopathic scoliosis; a curvature with no known origin. Idiopathic scoliosis often occurs in healthy children and adolescents and tends to progress, for multiple reasons, under periods of rapid growth, aka those growth spurts! (1). This is often referred to as adolescent idiopathic scoliosis secondary to the age in which it is identified, diagnosed and treated.
How Is Scoliosis Diagnosed?
So how is scoliosis diagnosed? Often, the Adam’s forward bend test, which is the “bend over and touch your toes” mentioned above, is used to first identify a potential curve. This test assesses for asymmetry in the spine as the patient bends forward from the waist. A clinician with training in how to properly administer the Adam’s forward bend test should be the one performing the test. A clinician is often looking for elevation of the ribs on one side of the rib cage compared to the other, or asymmetrical muscle definition on one side of the spine, amongst other signs. If notable asymmetries are recognized, further imaging is often the next step. Once an x-ray has been performed, a confirmed Cobb angle is needed for a diagnosis of scoliosis (2). A Cobb angle is the sum of the tilt of both the upper end vertebrae and lower end vertebrae that, together, determine the significance of the curve (3). The Scoliosis Research Society has determined that a Cobb angle of more than 10 degrees with notable rotation confirms an idiopathic scoliosis diagnosis (4). Remember it is important to be evaluated by a skilled clinician who has expertise in the care of scoliosis and can determine the most individualized and appropriate plan of care!
Cobb Angle – Scoliosis
Who Does Scoliosis Tend To Affect?
Both males and females can be diagnosed with scoliosis, however, females are likely to progress at a greater rate. Progression is most likely to occur during periods of rapid growth, such as puberty, and should be monitored appropriately and closely by a healthcare team (1). Many factors should be taken into consideration such as rate of progression, skeletal maturity, and any underlying conditions that could be contributing to curvature progression in order to best manage a scoliosis diagnosis. It is very unique to the individual and should be addressed as such!
With all of this being said, there is no need to hit the panic button. Many individuals with scoliosis respond great to conservative care, which is often multifactorial. Conservative treatment of scoliosis may include scoliosis specific exercises, brace wear, modification of certain activities and movements, and more often than not, all of the above!
So what can be done?
In 2011, the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORTS) determined that Physiotherapy Scoliosis Specific Exercise (PSSE), observation, and bracing were all beneficial therapeutic interventions for the management of idiopathic scoliosis, and highly approved over the typical “wait and see” approach (5). Physiotherapy Scoliosis Specific Exercise is a treatment model approach that features three dimensional self correction, scoliosis specific education, and modifications to activities of daily living that are unique to the individual patient. Physiotherapy Scoliosis Specific Exercise is not an alternative to bracing and/or surgery, but is an adjunct to a scoliosis specific patient care model and is a clinical expertise that is continually growing and being supported by high level evidence. Patients with scoliosis are finding success in perceived self image (6), improved overall quality of life (7), and even Cobb angle reduction in appropriate adolescent cases (8). Physical therapists with specialty training in PSSE often work intimately with an orthotist, orthopaedic doctor, and a mental health care provider to provide the best care for an individual with scoliosis.
Find Your Team And Communicate Goals
Once you have found your team, it is important to clearly communicate with your physical therapist what your goals are for treatment as scoliosis can be a complex and multifactorial diagnosis. At this point, the real work can then begin! Your physical therapist and team should then be able to guide you in appropriate activity modifications, scoliosis specific exercises specific to your curve, and even answer questions such as appropriate sleeping and sitting habits. Activity modifications may be made to activities that require excessive extension, flexion, rotation or sidebending of the spine. Because scoliosis causes three dimensional changes in the thoracic, lumbar and sometimes cervical vertebrae, lots of movement in any of these directions can inappropriately load the spine with risk of progressing the curve. Clinicians with training in PSSE want to reduce excessive motion of the spine and bring the body to a resting “neutral”. If you’re a gymnast, dancer, or swimmer with scoliosis, it does not mean you can’t participate in your elected sport! Simply lean on your healthcare team and physical therapist to make the appropriate modifications necessary to protect the health of your spine. Your curve will thank you!
LISTEN: LEARN HOW MOVEMENT IS MEDICINE
Exercises For Scoliosis
While Physiotherapy Scoliosis Specific Exercise is unique to an individual’s curve and requires guidance from a clinician with specialty training, there are several strengthening and mobility exercises that can assist in working towards a neutral pelvis and spine. These exercises are not designed to correct scoliosis, and are not PSSE, but can assist in maintaining a healthy spine and normalizing movement patterns. Clinicians with training in PSSE may elect to modify the below exercises and should do so if appropriate.
Core stability is important for overall spine health, however it should be noted that this program will not address scoliosis, and you should consult with a physical therapist to determine if this program is right for you.
Core Exercises For Scoliosis
Are you in search of more scoliosis exercises? If so, our program is full of progressions ranging from standard planks, dead bugs, hip stability, and more! Learn more about the full program HERE!
I recommend doing it at a wall and attempting to maintain contact with the back of the head, both shoulders, both glutes, and both ankles to maintain appropriate neutral alignment
Supine Hamstring Stretch – Strap
This is a great exercise to progress with a dynamic hamstring stretch on your back to better stabilize your pelvis while performing this exercise.
A clinical diagnosis of scoliosis can oftentimes be overwhelming, daunting, and happen very suddenly. It is important to know that if given a diagnosis of scoliosis, a physical therapist with specialty training in PSSE can assist in creating a comprehensive plan of care alongside a group of other well trained healthcare providers to best manage the curve! Activity modification, brace wear (if appropriate), and scoliosis specific exercise should always be unique to the individual and their scoliosis curve and should never be a “one size fits all” treatment approach! Let’s make sure to prioritize our students getting yearly physical examinations to keep them healthy, happy, and supported if scoliosis is identified. Whatever is on the other side of “bend over and touch your toes”, find yourself a healthcare team that responds with, “WE GOT THIS”.
Looking For A Morning Routine To Combat Low Back Tightness?
- Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3. Published 2018 Jan 10. doi:10.1186/s13013-017-0145-8
- Horne JP, Flannery R, Usman S. Adolescent idiopathic scoliosis: diagnosis and management. Am Fam Physician. 2014;89(3):193-198.
- Wang J, Zhang J, Xu R, Chen TG, Zhou KS, Zhang HH. Measurement of scoliosis Cobb angle by end vertebra tilt angle method. J Orthop Surg Res. 2018;13(1):223. Published 2018 Sep 4. doi:10.1186/s13018-018-0928-5
- Korbel K, Kozinoga M, Stoliński Ł, Kotwicki T. Scoliosis Research Society (SRS) Criteria and Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2008 Guidelines in Non-Operative Treatment of Idiopathic Scoliosis. Pol Orthop Traumatol. 2014;79:118-122. Published 2014 Jul 28.
- Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al. Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools. Scoliosis Spinal Disord. 2016;11:20. Published 2016 Aug 4. doi:10.1186/s13013-016-0076-9
- Schreiber S, Parent EC, Moez EK, et al. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”. Scoliosis. 2015;10:24. Published 2015 Sep 18. doi:10.1186/s13013-015-0048-5
- Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J. 2014;23(6):1204-1214. doi:10.1007/s00586-014-3241-y
- Schreiber S, Parent EC, Khodayari Moez E, et al. Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis – an Assessor and Statistician Blinded Randomized Controlled Trial. PLoS One. 2016;11(12):e0168746. Published 2016 Dec 29. doi:10.1371/journal.pone.0168746
About The Author
Written by Lyndsay Provencio, PT, DPT
BSPTS C2 Certified
Dr. Lyndsay Provencio graduated from Colorado State University with a BS in Health and Exercise Science and a concentration in Sports Medicine. After multiple personal sports related injuries and discovering a passion for healing through movement, Lyndsay attended Creighton University to receive her Doctorate of Physical Therapy.
An avid runner herself, she has a particular interest in working with high school, recreational and elite endurance athletes and has undergone specialty training in pelvic floor rehabilitation to better serve her clientele. Additionally, Lyndsay is BSPTS C2 certified in scoliosis specific exercise and has found a niche working with adolescents with scoliosis to improve overall spinal health.
No, you’re not seeing double! Lyndsay is an identical twin to Lauren Lynass, one of our [P]rehab rockstars. A native to Colorado, Lyndsay is an adventure seeker who loves to hike, camp, and race her twin sister on the mountain trails. When the Portland rain hits, you can find her curled up with a good book and a cup of tea.