Scoliosis is a lateral curvature of spine. it is mostly in c shape and also in s shape.
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| Scoliosis |
Sign/SYMPTOMS in Scoliosis
Uneven shoulders
One shoulder blade that appears more prominent than the other
Uneven waist
One hip higher than the other
If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side.
Which Are the CAUSES of Scoliosis
There are three other main types of scoliosis:
→ Functional: In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.
→ Neuromuscular: In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of congenital scoliosis develops in people with other disorders, including birth defects, muscular dystrophy, cerebral palsy, or Marfan syndrome (an inherited connective tissue disease). People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.
→ Degenerative: Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures, and disc degeneration.
There are other potential causes of scoliosis, including spine tumors such as osteoid osteoma. This is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce the amount of pressure applied to the tumor. This can lead to a spinal deformity. In addition, researchers suggest that genetics (hereditary), muscle disorders, and/or abnormal fibrillin metabolism may play a role in causing or contributing to scoliosis development.
Risk factors :-
Age. Signs and symptoms typically begin during the growth spurt that occurs just prior to puberty.
Risk factors for developing the most common type of scoliosis include:
Sex. Although both boys and girls develop mild scoliosis at about the same rate, girls have a much higher risk of the curve worsening and requiring treatment.
Family history. Scoliosis can run in families, but most children with scoliosis don’t have a family history of the disease.
How to DIAGNOSIS ?
→If someone thinks he or she has scoliosis, see a doctor for an examination. The doctor will ask questions, including if there is any family history of scoliosis, or if there has been any pain, weakness, or other medical problems.
→The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves, physical deformities, or uneven waist.
→The person will then bend over trying to touch their toes. This position can make the curve more obvious. The doctor will also look at the symmetry of the body to see if the hips and shoulders are at the same height, leaning to one side, or if there is sideways curvature. Any skin changes will also be identified that can suggest scoliosis due to a birth defect. A doctor may check your range of motion, muscle strength, and reflexes.
COBB ANGLE MEASUREMENT :
→A Cobb angle of 10 degree is regarded as a minimum angulation to define Scoliosis.
→A scoliosis curve of 10 to 15 degrees normally do not require any treatment generally recover with regular exercise and braces.
→If the scoliosis curve is 20 to 40 degrees, doctor will generally prescribe a back brace to keep the spine from developing more of a curve.
→The more growth that a person has remaining increases the chances of scoliosis getting worse. As a result, the doctor may measure the person’s height and weight for comparison with future visits. Other clues to the amount of growth remaining are signs of puberty such as the presence of breasts or pubic hair and whether menstrual periods have begun in girls.
→If the doctor believes a patient has scoliosis, the patient could either be asked to return for an additional examination in several months to see if there is any change or the doctor may obtain X-rays of the back. If X-rays are obtained, the doctor can make measurements from them to determine how large of a curve is present. This can help decide what treatment, if any, is necessary. Measurements from future visits can be compared to see if the curve is getting worse.
→It is important that the doctor knows how much further growth the patient has left. Additional X-rays of the hand, wrist, or pelvis can help determine how much more the patient will grow. If a doctor finds any changes in the function of the nerves, he or she may order other imaging tests of your spine, including an MRI or CT scan to look more closely at the bones and nerves of the spine.
→If the curve <20 degree need observation and exercise , >20 required treatment, between 20-40 required milwaukee brace and physiotherapy exercise , >40 surgical correction needed.
Treatment :
Scoliosis Treatment are Variable mostly accordingly mild , Moderate or Severe.
Mild Scoliosis :
- Do Not Require Any Medicine.
- Symptom’s Are Not seen Easily.
- No Braces Require.
- Simple Corrective Physiotherapy Exercise is Enough to normalize curve.
- Follow up require for regular interval.
Moderate Scoliosis :
- Pain, Muscle Spasm And Other Symptom’s are visible and Require medical treatment.
- Medical treatment are mostly accordingly symptomatic.
- Braces Are require to reduce the curve.
- Physiotherapy Exercise 2 times a day.
- Spine mobilization exercise.
- Muscle Strengthening And Stretching Exercise.
Severe Scoliosis :
- symptom’s are clearly visible and require medical and even sometimes surgical treatment.
- If symptom’s are not progressive then medical, physiotherapy exercise and Braces are enough but if progressive scoliosis surgery is preferable.
- Surgery depends upon a severity and progressiveness of scoliosis.
- Braces And Physiotherapy treatment also require simultaneously.
- Post-operative Physiotherapy session also require.
Physiotherapy Treatment :
Physiotherapy Treatment is Varies According to symptom’s And Curvature of the spine and severity. Few Common Exercise are as per Below.
- Dog crawl
- Low dog crawl
- Arm stretch
- Deep breathing exercise
- Spine Mobilization
- Active ROM exercise spine
- Strengthening exercise to abdominal and spinal muscle
- Passive stretching of the muscles on the concave side of the curves is highly effective
- Hanging Exercise.
Physiotherapy Treatment After Surgery :
First 4 Days : Vigorous chest PT, patient turn to side every 2 hour, active ROM exercise with in pain limit for shoulder and ankle,at the end full rang active and passive movement of hip and knee joint are carried out.
After 4 Days : With assisted guidance patient taught to sit,roll and stand and walking training. And Follow Up Strengthening Exercise of Weak Spinal Muscle Around Upper Back And Middle Back And Lower Back Area.
BRACES :
Milwaukee brace
TLSO Brace
If the patient has moderate scoliosis and the bones are still growing, the doctor may recommend a brace. This will prevent further curvature, but will not cure or reverse it.
Braces are usually worn NOT all the time, even at night. The more hours per day the patient wears the brace, the more effective it tends to be.
There are two types of braces:
Thoracolumbosacral orthosis (TLSO) – the TLSO is made of plastic and designed to fit neatly around the body’s curves. It is not usually visible under clothing.
Milwaukee brace – this is a full-torso brace and has a neck ring with rests for the chin and the back of the head. This type of brace is only used when the TLSO is not possible or not effective.
Surgery :
Severe scoliosis typically progresses with time, suggest scoliosis surgery to reduce the severity of the spinal curve and to prevent it from getting worse.
In spinal fusion : surgeons connect two or more of the bones in the spine (vertebrae) 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. Spinal Fusion is restrict movement that’s why least preferences option in scoliosis.
