Scoliosis

Dr. Reetika Singh

Asst Professor
 Introduction

• Scoliosis is an abnormal lateral

curvature of the spine. It is most often
diagnosed in childhood or early
adolescence.
• The spine's normal curves occur at the
cervical, thoracic and lumbar regions in
the so-called “sagittal” plane. 
•  Scoliosis is often defined as spinal curvature in the “coronal” (frontal)
plane. While the degree of curvature is measured on the coronal plane,
scoliosis is actually a more complex, three-dimensional problem which
involves the following planes:
1. Coronal plane
2. Sagittal plane
3. Axial plane
 Cont..
• The coronal plane is a vertical plane from head to foot and parallel to
the shoulders, dividing the body into anterior (front) and posterior
(back) sections. The sagittal plane divides the body into right and left
halves. The axial plane is parallel to the plane of the ground and at right
angles to the coronal and sagittal planes.
• Scoliosis is defined by the Cobb's angle of spine curvature in the
coronal plane and is often accompanied by vertebral rotation in the
transverse plane and hypokyphosis in the sagittal plane.
 Clinical Presentation

• Sideways curvature of the spine

• Sideways body posture
• One shoulder raised higher than the other
• Clothes not hanging properly
• Local muscular aches
• Local ligament pain
• Decreasing pulmonary function
 Cont..

• These abnormalities in the spine, costal-vertebral joints, and the rib

cage produce a ‘convex’ and ‘concave’ hemithorax.
• The rotation component starts when the scoliosis becomes more
pronounced. This is called a torsion-scoliosis, causing a gibbus
 Diagnosis

• Scoliosis is usually confirmed through a physical examination, an x-ray,

spinal radiograph, CT scan or MRI.
• The curve is measured by the Cobb Method and is diagnosed in terms
of severity by the number of degrees.
• .A standard exam that is sometimes used by pediatricians and in grade
school screenings is called the Adam's Forward Bend Test. 
 Examination

1. Examination of the active movements(flexion, extension and side

flexion) of the spine in the cervical, thoracic and lumbar segment.
• 2. The Adam forward bend test can be used to make a distinction
between structural scoliosis or non-structural scoliosis of the cervical to
lumbar spine. The test can be performed in the standing and sitting
position.
 Cont..
• 3. The Cobb angle is a standard
measurement to determine and track
the progression of scoliosis
 Cont..
• 4. The scoliometer is an inclinometer designed to measure trunk
asymmetry, or axial trunk rotation. It’s used at three areas:
• Upper thoracic (T3-T4)
• Middle thoracic (T5-T12)
• Thoraco-lumbar area (T12-L1 or L2-L3)
• If the measurement is equal to 0°, there is a symmetry at the
particular level of the trunk. An asymmetry at the particular level of
the trunk is found, if the scoliometer measurement is equal to any
other value
 Cont..
•  Pulmonary function testing is useful in the preoperative evaluation of
patients.
Spirometer
• FVC gives an assessment of lung volume
• FEV1 provides an assessment of flow function.
 Medical Management

• Patients with early-onset scoliosis, defined as a lateral curvature of the

spine under the age of 10 years, are offered surgical treatment when
the major curvature remains progressive despite conservative
treatment (Cobb angle 50 degrees or more). Spinal fusion is not
recommended in this age group, as it prevents spinal growth and
pulmonary development.
 Conservative Treatment

• Most people with scoliosis have mild curves and probably won't need
treatment with a brace or surgery. Children who have mild scoliosis
may need regular checkups to see if there have been changes in the
curvature of their spines as they grow.
 Braces
• When children's bones are still growing and he or she has moderate
scoliosis, the doctor may recommend a brace. Wearing a brace won't
cure scoliosis or reverse the curve, but it usually prevents further
progression of the curve.
• The most common type of brace is made of plastic and is contoured to
conform to the body. This brace is almost invisible under the clothes, as
it fits under the arms and around the rib cage, lower back and hips. eg 
Milwaukee brace
 Cont..

• Most braces are worn day and night. A

brace's effectiveness increases with the
number of hours a day it's worn. Children
who wear braces can usually participate
in most activities and have few
restrictions. If necessary, kids can take off
the brace to participate in sports or other
physical activities.
 Cont..
• Braces are discontinued after the bones stop growing. This typically
occurs:
• About two years after girls begin to menstruate
• When boys need to shave daily
• When there are no further changes in height
• In general, most congenital scoliotic curves are not flexible and
therefore are resistant to repair with bracing. For this reason, the use of
braces mainly aims to prevent the progression of secondary curves that
develop above and below the congenital curve, causing imbalance. In
these cases, they may be applied until skeletal maturity
 Surgical Treatment

• Severe scoliosis typically progresses with time

• A specialist may suggest scoliosis surgery to reduce the severity of the
spinal curve and to prevent it from getting worse.
• The most common type of scoliosis surgery is spinal fusion.
• In spinal fusion two or more of the vertebrae are fused together, so
they can't move independently. Pieces of bone or a bone-like material
are placed between the vertebrae. Metal rods, hooks, screws or wires
typically hold that part of the spine straight and still while the old and
new bone material fuses together.
 Cont..
• If the scoliosis is progressing rapidly at a young age, surgeons can
install a rod that can adjust in length as the child grows.
• This growing rod is attached to the top and bottom sections of
the spinal curvature, and is usually lengthened every six months.
• Complications of spinal surgery may include bleeding, infection,
pain or nerve damage. Rarely, the bone fails to heal and another
surgery may be needed.
 Physical Therapy Management

•The aims of physical therapy are:

•Autocorrection 3D
•Coordination
•Equilibrium
•Ergonomical corrections
•Muscular endurance/ strength
•Neuromotor control of the spine
•Increase of ROM
•Respiratory capacity/ education
•Side-shift
•Stabilization
 Cont..

1.Spine forward stretching: The patient sits on the floor with a straight back and the legs
stretched. The patient has to bring the trunk forwards. Goal: Stretching the posterior
muscle chain and mobilizing the vertebral spine
2.Upper rolling: The patient lies supine with the arms besides the body. The patient has to
raise both legs till the toes touches the floor. Then, unroll spine slowly (vertebra by
vertebra) Goal: stretching the posterior chain, mobilizing the spine and strengthen the
abdomen.
3.Child position: The patient sits in a four support position and has to stretch the spine,
arms and push the hands against the floor. Then lower the spine. Goal: Stretching the
thoracic paravertebral, lumbar and gluteal regions and mobilizing the vertebral spine
4.Forward leg pull: The patient sits in a four support position. Then raises the right arm and
leg while the spine stays aligned. Than the same exercise but change arm and leg. Goal:
Stretching the concavity of the vertebral spine.
 Cont..
•#1 Bridging exercise for spine with scoliosis
•#2 Chest raise exercises for treating mild scoliosis
•#3 Cat dog exercise treatment for scoliosis adults
•#4 Hand raise in quadruped scoliosis exercise at home
•#5 Leg raise in quadruped scoliosis correction exercise
•#6 Hand and leg raise in quadruped
•Scoliosis-specific exercise
•#7 Hip & chest raise in side-lying for treatment of scoliosis in adults
•#8 Spine straightening scoliosis adults exercise
•#9 Sleep position for scoliosis
•#10 Stretching with scoliosis