A Physiotherapist’s Guide to Scoliosis

Authored by Katie Harrison, a physiotherapist with personal experience in dealing with scoliosis, this guide delves into the various aspects of the condition, including its types, diagnosis methods, progression with age, and the role of physiotherapy in its management. Are you ready to understand the different scoliosis types and their respective treatments? Keep reading!

What is Scoliosis?

Scoliosis is an abnormal lateral (sideways) curvature of the spine, that can also include rotation or twisting of the vertebrae. While a degree of curvature is normal, scoliosis is classified as anything over 10 degrees of sideways bend.

Scoliosis can be Postural / Nonstructural, meaning there is a temporary spinal curve which disappears when the person bends their back. This can be caused by anything from muscular discomfort to leg length differences and should resolve with time and muscle strengthening.

However, sometimes it can be Structural, meaning that the curve is permanent. With this type of scoliosis, the spine remains curved even when the person is bending into different positions.

Within the realm of true structural scoliosis, there are multiple types:

• Congenital (childhood) – this is very rare (1/10,000) and develops in the womb.
• Idiopathic -  this accounts for 80% of structural scoliosis cases and usually begins during puberty then continues to progress until skeletal maturity is reached.
• Degenerative – this sometimes occurs as a byproduct of spinal degeneration and only develops as the person ages.

How is Scoliosis diagnosed?

A true structural scoliosis can easily be differentiated from a postural curve via the Adam’s forward bend test, where the person bends forwards while standing and your doctor or physiotherapist assesses any asymmetry, such as a one sided ‘rib hump’. If scoliosis is suspected, you may be referred onwards for an X-Ray which can confirm a diagnosis and stage of progression.

Does Scoliosis get worse with age?

True scoliosis is progressive, meaning it does typically worsen with age, although a postural spinal curve can be reversed. It is impossible to predict how much a scoliosis will progress, but typically the larger the curve in childhood or adolescence, the larger the risk for progression. Bracing and surgery are the only evidenced ways to prevent curvature worsening, although these are not needed in most cases.

What happens next?

This very much depends on your symptoms, your age, your lifestyle, and how progressed your curve is. Most people cope well with conservative management or no treatment at all. Spinal curves are roughly divided into three stages based on Cobb angles:

• Mild – under 25 degrees – the person is usually offered physiotherapy to keep the supporting muscles strong and limber, and if they are still growing are given follow up appointments every 6 months to check for progression
• Moderate – 25 to 40 degrees – if still growing, the person is offered a brace which can slow or stop curve progression, alongside physiotherapy
• Severe - >40 degrees – many people with severe curves opt for surgical spinal fusion, which can improve quality of life in those with neural symptoms, breathing or cardiac difficulties caused by large spinal curves. However, not all people with severe scoliosis require surgery, and there are nowadays a lot more options such as partial fusions.

How can my Physiotherapist help me with my Scoliosis?

Although physiotherapy cannot reverse or stabilise a structural curve, it can provide many benefits and is often the first line of treatment for those recently diagnosed.

Treatments are normally a combination of muscle stretches and strengtheners, to ensure the muscles move in the correct way as the spine changes shape. You may also be offered some hands-on therapy like massage or acupuncture if your curve gives you any pain or discomfort. (It is worth noting that not everyone with scoliosis has back pain!)

Treatment for scoliosis has changed massively in the past decade, with surgeons in the past drastically limiting activities for those diagnosed. However, we now know that keeping as active as possible is key to reducing pain and improving function in those with even severe curvatures, so your physiotherapist should also be able to make suggestions on how to continue doing what you love or even start a new activity that might help your symptoms.

Scoliosis treatment in Sheffield, how can you get started?

With many expert Physiotherapists, we are well placed to provide Scoliosis Physiotherapy treatment in Sheffield and beyond into Nottinghamshire, South Yorkshire and North East Derbyshire. The author of this article, Katie Harrison, even grew up dealing with Scoliosis so can empathise with your journey. Hit the button below or get in touch to book your first appointment.