Physical Therapy and Scoliosis

Physical Therapy and Scoliosis

July 6, 2021

When we begin working with new patients it’s actually quite common for us to hear people say they have been told at some point in their lives that they have scoliosis. But what is scoliosis, how common is it, and how does it affect our bodies?

What is scoliosis and how is it diagnosed?

Scoliosis is an abnormal curvature of the spine. Our spine has three “natural” curves which go forward and backwards: these go in at the neck, out at the upper back, and in again at the low back. These normal curves are named lordosis and kyphosis curvatures. When our bodies grow, notably during puberty, some people develop curves to the right and left. These sideways curves are what defines scoliosis. Because of the intricate nature of how our vertebrae fit together, with each of these right or left curves often comes a rotation, too. The related rotation can cause what is known as a “rib hump”.

If you were ever asked by a nurse or gym teacher in middle school, or a doctor or physical therapist, to bend forward while they looked at your back, they were probably looking for the telltale “rib hump” which indicates a rotation of the spine that typically results from scoliosis. It is standard for pre-teens and teenagers to be scanned for scoliosis multiple times in their middle school years. Another common sign of scoliosis is the elevation of one shoulder higher than the other. Once identified, scoliosis should be monitored, as progression of the curve can occur (especially during growth spurts) which is cause for consideration of treatment options.

Curves typically do not arrive alone, but are most often in pairs – a right curve in the low back is often paired with a left curve in the middle back – making an S shape in the spine. This pairing of curves helps our body keep the head centered – which is really important for balance and function. The larger curve is the primary curve and the smaller curve the secondary.

Scoliotic curves are measured by both visualization of an unclothed back and by x-ray imaging. The specific measurement is known as a “Cobb Angle” which is calculated based off the angles found at the top and bottom of the primary curve in an x-ray; the larger the cobb angle, the more severe the scoliosis curvature.

What does scoliosis feel like?

Most people with scoliosis do not “feel” like they have any curves in their back. In fact, when a person with scoliosis is moved into a more symmetrical position it often feels off-center to them. This is due to the fact that our brains sense where are bodies are in space (this is called proprioception) and become accustomed to the position our bodies are in most often.

Some people with scoliosis feel back pain of different types. For some tightness, tension, or a feeling of needing to “pop” or “crack” a certain area of the back is common. Occasionally a sharp pain may associate with the rotation or the rib cage where a rib is at risk of displacing. Sometimes an aching sensation accompanies a muscle that has been shortened for an extended period of time as may occur with the concave side of a curve. Nerve compression due to a smaller space on one side of the back can cause tingling or radiating electrical type pain.

Some people with scoliosis can have symptoms of weakness on one side of their body more than another. One arm may be weaker, or feel “unengaged” or disconnected from the brain in some way. Similarly, one leg can also have weakness in the muscles when the other leg is normally strong. Additional symptoms can include fatigue, difficulty breathing or shortness of breath, tingling sensations through the back, legs, or arms, digestive troubles, a difference in leg length, or postural abnormalities. Shirts or pants not sitting evenly on the right and left sides, and backpack straps being uneven can be more outward signs of scoliosis.

The good news with a long list of potential symptoms from scoliosis is that with conservative physical therapy treatment, most of the symptoms can be decreased or fully resolved.

I was just told I have scoliosis: now what?

First, know that millions of people around the world live with scoliosis, (some estimates say that over 60% of people over the age of 60 years old have some form of scoliosis) and most of them do not suffer from this condition. I like to remind people that we are *not* symmetrical – we have dominant hands, eyes, and more freckles on one side than the other. This asymmetry in the spine can be asymptomatic. But if you are feeling pain, stiffness, having difficulty turning one way, or have weakness on one side of your body more than the other, this is a reason to reach out and look into physical therapy for scoliosis.

My back hurts: could it be scoliosis?

Back pain is very common and there are many causes of back pain. Scoliosis does not always cause pain; however, if you have back pain you should definitely seek treatment! We are experts in both diagnosing and treating the underlying causes of back pain, including scoliosis, and can help you determine if scoliosis or another issue such as degenerative disc disease, spondylosis, nerve impingement, muscle spasm, or weakness might be contributing to your pain – and what to do about it.

What does Physical Therapy for Scoliosis look like and when are other treatments needed?

Mild scoliosis (clinically defined as scoliosis with a cobb angle less than 20 degrees) is often determined not to need “intervention” by diagnosing doctors; however, both the short and long term effects of even a mild case of scoliosis on a body can benefit from conservative preventative and maintenance treatments as well as education about management and signs to look out for to prevent issues from developing down the line.

More severe scoliosis, especially when diagnosed in a child or teenager, can be cause for recommendations for bracing or even surgery. Physical therapy is excellent at addressing symptoms from both mild and moderate scoliosis, and can sometimes prevent the need for surgery in those with severe scoliosis, too.

Surgery for scoliosis is a serious consideration and we suggest researching and exploring non-invasive techniques to address symptoms before going down this irreversible road. If you are considering surgery, or have had surgery for scoliosis, physical therapy can help to keep the joints and muscles above and below the location of the surgery healthy, safe, and strong.

Treatment for scoliosis should never be painful. We use manual techniques to help keep the joints moving, and assure that nerves have the room and movement they need to function best. We also use strengthening of muscles that are weak due to being constantly overstretched (the outside edge of the curves) and stretching of muscles that are tight due to being compressed (the inside edge of the curves). The goal for physical therapy treatment is typically to decrease symptoms, but often is not to decrease the actual curvature of the bony alignment. There are some instances where cobb angles can be decreased with consistent strengthening and stretching to improve the balance from the right to left sides of the body; however, depending upon the length of time each body has had scoliosis, and if the curves have progressed over time or not, as well as the fitness and health status of the client, the actual changing of the curve may or may not be possible, but the treatment of symptoms is always possible, as even a small change in strength or flexibility can often be enough to return to pain free and active living.

It’s extremely important to have *your* scoliosis assessed before undertaking an exercise program intended to work on scoliosis symptoms. If you were to strengthen the right upper back when instead you should be stretching the right upper back, for example, you risk increasing the symptoms you are trying to manage.

There are a number of schools of training for scoliosis treatment. One of the most well known and regarded is the Schroth Method. Katharina Schroth developed a treatment method for scoliosis which is extremely individualized, nuanced, and progressive. Patients are examined by a trained therapist to determine the direction of the curves and rotations in their back at each level. An individualized treatment plan is developed and modified over time to work toward balancing the curves and rotations.

Lots of work is performed sitting, kneeling, or standing and the patients are encouraged to learn the position of each segment of their spine and how to move in each plane at each segment. Using the lungs to move the back is a unique and important component of the Schroth method. Strengthening the right side bending muscles in the low back and the left side bending muscles in the upper back along with the left rotating muscles of the entire back takes practice, guidance, and repetition. The use of therapy balls, light weights, resistance bands, and hands on guidance will help each patient to re-learn a “centered” position for their bodies. This retraining of the position is called proprioception and is paired with strengthening exercises and endurance exercises for muscles that support the spine. This type of therapy can be fun and is extremely personalized. Manual therapy, or hands on techniques to loosen tight structures using massage, trigger point release, joint mobilization, and myofascial release techniques will help to allow more movement in restricted segments of the spine. You will be given selected exercises to continue doing at home or at work to progress and maintain any gains you’ve made in physical therapy treatments.

As a physical therapist who has scoliosis, I personally love working with people who have struggled with scoliosis symptoms. The stretching I do every day helps to keep me active and strong despite having a moderate curvature in my upper back. I’m happy to share with my clients the personal experiences I have had as well as my extensive knowledge of conservative physical therapy treatment techniques for this condition.

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