Lumiere Children’s Therapy: Scoliosis

The spine is a series of bones (vertebrae) that run in a straight line down from the skull to the lower back. The spine assists in our ability to hold our weight, maintain posture and participate in a variety of activities such as walking, running, jumping, lifting, etc. Scoliosis is the curvature of the spine appearing like a “S” or “C” when viewed from behind. Scoliosis commonly presents during the growth spurt before puberty. Continue reading for more information on scoliosis, including symptoms and treatment.

What is Scoliosis?

When viewed from behind, the spine should appear straight with no curvature. In a person with scoliosis, the spine curves to one side causing the spine to appear in a “S” or “C” shape. It may give the appearance that the person is leaning towards one side. Scoliosis, or curvature of the spine, typically occurs in the upper or middle back but can occasionally occur in the lower back. The Scoliosis Research Society classifies scoliosis as a curvature of 10 degrees or greater. There are three types of scoliosis with idiopathic scoliosis.

What are the three types of Scoliosis?

  • Congenital: Congenital Scoliosis occurs at birth, usually during fetal development. It usually forms during the development of vertebrae in utero. The vertebrae may fail to form normally or not form completely.

  • Neuromuscular: Neuromuscular Scoliosis is associated with many neurological disorders, which may cause difficulty walking.  These conditions include, but are not limited to, cerebral palsy, spina bifida, muscular dystrophy, paralytic conditions and spinal cord tumors.

  • Idiopathic: Idiopathic Scoliosis is the most common, especially in women. It typically occurs during growth spurts and the cause is unknown. Idiopathic scoliosis is broken into three types:

    • infantile (birth-three years), which may resolve and is commonly found in boys

    • juvenile (3-10 years)

    • adolescent (10-18 years) commonly seen in girls

Since Idiopathic scoliosis is the most common, the following information will focus on that type.

What are the causes of Idiopathic Scoliosis?

Idiopathic scoliosis has no known cause, but genetics often plays a role in the development. Approximately 30% of idiopathic cases have a family history of scoliosis. It is important to note that sports injuries, poor posture, or heavy backpacks do not cause idiopathic scoliosis.

What are the symptoms of Idiopathic Scoliosis?

Symptoms may vary depending on degree, progression and site of curvature. There is little pain associated with scoliosis, so if your child is complaining of severe back, neck or knee pain, seek medical attention. Idiopathic scoliosis often goes unnoticed due to lack of pain, and is usually detected at school screenings or regular checkups. Common symptoms may include:

  • Shoulder height differences

  • Head uncentered on body

  • Sides of back appearing different in height when bending forward

  • When standing, the arms hang at different heights beside the body

  • Differences in hip height

  • Differences in shoulder blade height

How is it diagnosed?

  • Physical examination: As mentioned before, scoliosis is usually first diagnosed at a school screening or regular checkup. During a regular checkup, the pediatrician may use the Adam’s Forward Bend Test to evaluate any dissymmetry in the back

    • Adam’s Forward Bend Test is the screening used to first assess idiopathic scoliosis. The child is instructed to bend at the waist at 90 degrees with arms stretched toward the floor and knees straight. The healthcare professional will assess the symmetry of the spine by examining for differences in shoulders, hips, waist, or legs.

  • X-rays: If scoliosis is suspected after the Adam’s Forward Bend test, a pediatrician will request an x-ray for a formal measurement of the degree of curvature. X-rays can help confirm suspected scoliosis using the Cobb angle. The Cobb angle gives the degree of the curve. The curve must be 10 degrees or higher to be considered true scoliosis. This information will aide in the treatment of scoliosis. X-rays also help determine how mature the child’s skeleton is and predict if scoliosis will continue to progress. If the child’s spine is still maturing, regular x-rays are recommended every 3-12 months to check if the curve continues to progress.

What is the treatment?

The goal of treatment is to stop the progression of the curve, as well as prevent deformity. The four main types of treatment include observation, bracing, surgery and physical therapy depending on the individual.

  • Observation. The majority of idiopathic scoliosis cases are mild in nature, only requiring observation every 4-6 months to assess for an increase in curve. Monthly checkups will continue until the skeleton has fully matured.

  • Bracing. If the curve measures more than 25-30 degrees after assessing an x-ray, the physician will suggest bracing to support the spine as the skeletal growth continues.

  • Surgery: Surgery is recommended when the curve measures 45-50 degrees or greater and bracing was not successful. The surgery is a spinal fusion which straightens the curve by fusing the vertebrae together in order to heal into a single solid bone. Spinal fusion stops the growth of the spine to prevent the curve from increasing. Spinal fusion uses a bone material (bone graft) to fuse the bones together. Then, metal rods are used to hold the spine in place until the fusion fully happens. After surgery, most children are able to return to school within four weeks after surgery. Between 6-9 months after surgery, children can return to most sporting activities.

  • Physical therapy. Physical therapists can provide care during any of the phases of scoliosis treatment. Physical therapists will create an individual treatment plan for your children to increase the body’s range of motion, strengthen, retrain the body for optimal movements, and educate you on your child’s diagnosis. Physical therapist are an important member of the treatment team, especially if bracing or surgery is recommended.

If you notice dissymmetry in your child’s back, contact your pediatrician for a formal assessment. For physical therapy inquiries about scoliosis, contact Lumiere Children’s Therapy for an evaluation and treatment plan.




Resources:

“Scoliosis: Frequently Asked Questions - OrthoInfo - AAOS.” Muscle Strains in the Thigh - OrthoInfo - AAOS, orthoinfo.org/en/diseases--conditions/scoliosis-frequently-asked-questions/.

“Scoliosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Dec. 2017, www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716.

“Scoliosis.” Mobile Header, 17 Aug. 2016, www.stlouischildrens.org/diseases-conditions/scoliosis.

“Scoliosis Treatment | Gillette Children's Specialty Healthcare.” What Is Rhizotomy or SDR Surgery? | Gillette Children's Specialty Healthcare, www.gillettechildrens.org/conditions-care/scoliosis-idiopathic-neuromuscular-and-congenital/scoliosis-treatment.

“X-Ray Exam: Scoliosis.” Edited by Yamini Durani, KidsHealth, The Nemours Foundation, May 2014, kidshealth.org/en/parents/xray-scoliosis.html.