Scoliosis is a sideways curvature of the spine that occurs mostly during the growth spurt just before puberty. It can also be caused by conditions such as muscular dystrophy and cerebral palsy. 

It’s estimated that around 3% of the population have scoliosis. The good news is that most cases are mild and in many cases treatment is unnecessary.

Where there is no known cause for this condition, it’s labelled idiopathic scoliosis. There are three types of childhood idiopathic scoliosis: –

• Birth to 3 years – infantile idiopathic scoliosis

• 4 years to 9 years old – juvenile idiopathic scoliosis

• 10 years to 18 years old – adolescent idiopathic scoliosis. Eighty per cent of all idiopathic scoliosis cases fall in this category

The most common types of scoliosis curves are: –

• Right thoracic curve – the curve bends to the right side of the upper back

• Right thoracolumbar curve – the curve bends to the right side, going from the upper to lower back

• Right lumbar curve – the curve bends to the right side, beginning and ending in the lower back

• Double major curve – often this is a right thoracic curve at the top of the spine and a left curve in the lower back

What is the number one sign of scoliosis to look out for in a therapists’ clinic?

Mr Darren Liu is a trauma and orthopaedic surgeon who is fellowship trained in complex spinal surgery. He is one of the leading experts on scoliosis.

Mr Lui points out that “very few parents or children look in the mirror and think they or their children have scoliosis. It’s extremely rare, and, whilst they say about 3% of the population have scoliosis of less than 30 degrees, there’s probably only 0.3% that have a curve of more than 30 degrees.”

It’s extremely common for sports coaches, teammates and teachers to first notice something unusual or asymmetric in a child, as parents see their children every day and it’s a condition which generally progresses gradually and is normally painless.

According to Mr Lui, there are two main reasons why a child visits a therapist.

• Back pain – which is surprisingly common in children, with 85% complaining of back pain at some point. Although the majority of these patients who visit a therapist won’t have scoliosis, therapists will still investigate the possibility

• Known deformity – they may have a truncal shift where their waistline is asymmetric, a hump on their back (often called a rib hump which can be quite high up) or a loin hump (which is lower down)

The main symptoms and signs of scoliosis to look out for are: –

• Uneven shoulders

• One shoulder blade that protrudes more than the other

• Uneven waist

• One hip higher than the other

• Leaning to one side

• The spine is visibly curved

• Clothes hanging unevenly

In severe cases, the spine will not only curve side to side but will also rotate or twist. This will cause the ribs on one side of the body to stick out further.

Causes of scoliosis

There is no known cause for the most common type of scoliosis. However, it does appear to run in families, so hereditary factors can play a minor role.

Research has shown that while both boys and girls experience scoliosis at the same rate, however, girls are more likely to experience severe scoliosis and require treatment.

It’s known that the less common types of scoliosis can be caused by: –

• Neuromuscular conditions

• Birth defects which affect the development of the spinal column

• Infections or injuries to the spine

How do consultants work with therapists?

The first step is to visit your GP. Your GP will then examine your child and refer you to a hospital for X-rays and further diagnosis. Should your child be diagnosed, he/she will be referred to a specialist to discuss the way forward.

Consultants work with therapists at various different levels and points in children’s and adults’ treatment. As Mr Lui states, “scoliosis itself is a non-life threatening disease and a non-neurological threatening disease – you will never be paralysed from it and you will never die from it. So, I always emphasise to patients that surgery is never mandatory, we try our very best to help them avoid it. If they do not meet surgical criteria, we do everything in our power to help to keep it a bay by using therapists with various roles and expertise.”

Apart from the work done with therapists it’s important that children are encouraged to stay fit and flexible. Standard physiotherapy can be helpful in maintaining flexibility. Mr Lui points out that it’s difficult to say whether physiotherapy alone can reverse scoliosis, considering that sometimes it reverses itself spontaneously.

SSPE (scoliosis specialist physiotherapy exercises), also known as the Schroth Method, plays an important role in the treatment of scoliosis and is often used in conjunction with brace treatment. These exercises are tailored to each patient’s spine curvature and can be beneficial to patients of all ages, regardless of the severity of scoliosis.

The exercises focus on alignment of posture and muscular symmetry, plus breathing into the concave side of the body, while also teaching patients to be aware of their posture. This approach to scoliosis treatment was developed in the early 20th century by Katharina Schroth, who suffered from moderate scoliosis and wanted to find an alternative treatment to a steel brace.

Standard physiotherapy is also useful before and after surgery and many children opt to take advantage of the extra assistance to optimise their treatment before getting back to playing sport.

Consultants try and avoid large procedures on more elderly patients therefore physiotherapy is used extensively in older adults who develop scoliosis later in life. Consultants monitor patients to ensure that therapists’ treatment programmes are beneficial and helping to alleviate the problems associated with scoliosis.

Mr Lui’s CPD course: ‘Current Concepts in Scoliosis – Bespoke Treatment for the Patient’ is being held online on Thursday 24^th June. Book on here!

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