Physical Therapist's Guide to Scoliosis
Scoliosis is a condition that affects the normal shape of the spine, altering a person's overall trunk alignment and posture. Scoliosis causes the spine to move to the side and turn. This condition can occur at any time during the lifespan, but is more commonly detected during adolescence. Scoliosis affects 2% to 3% of the general population, and is more common in females than males. Scoliosis ranges from mild to severe cases, requiring a variety of treatments. The more severe cases may require surgery. Scoliosis is best managed with a team approach that includes the family, orthopedic physician or surgeon, orthotist, and physical therapist.
What is Scoliosis?
The Scoliosis Research Society defines scoliosis as a curvature of the spine to the side that also includes rotation. As previously mentioned, scoliosis causes postural and trunk alignment changes that cannot be corrected by “standing up straight. On an x-ray, the spine may appear to have an "s" or "c" shape. The severity of scoliosis is determined by measuring the angle of the curvature, also called a Cobb angle. A minimum of "10° of Cobb" needs to be present for a diagnosis of scoliosis.
Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, is diagnosed in children aged 10-18 years. Idiopathic means no identifiable cause is known, but 30% of children with AIS have some family history of the condition.
Other types of scoliosis include congenital, neuromuscular, and early onset (infantile and juvenile).
- Congenital scoliosis is caused by a deformity in the bones of the spine that occurs during a baby's early development in the womb.
- Neuromuscular scoliosis is caused by a medical condition of the nervous system, such as cerebral palsy or muscular dystrophy, which triggers weakening of the muscles that support the spine.
- The cause of early onset scoliosis is not known. Early onset scoliosis includes infantile scoliosis diagnosed from birth to 3 years of age, and juvenile scoliosis diagnosed before the age of 10.
How Does it Feel?
Scoliosis is usually a pain-free condition, but pain may occur as the spine curves abnormally and affects the surrounding muscles and joints. These changes may alter a person's alignment, posture, and movement patterns, causing irritation and pain. Muscles that usually support the spine may become imbalanced in scoliosis, leading to a loss of strength and flexibility. A person with scoliosis may note:
- Uneven shoulder height.
- Uneven hip height.
- An uneven waistline.
- A general sense that the 2 sides of the body don't line up.
- Pain in the areas surrounding the spine, including the shoulder, pelvis, and hip.
- Pain with specific movement or activity.
A primary goal of physical therapy is to identify conditions, such as scoliosis, help the individual restore and maintain mobility so they can function at their personal best, and improve their quality of life.
How Is It Diagnosed?
Scoliosis is usually detected during a physical examination or school screening performed by a pediatrician, school nurse, or physical therapist, with the goal of early detection and treatment.
An initial visit with a physical therapist includes a thorough medical history, and specific questions about the family health history and current activities. Your physical therapist will closely examine the spine in several positions and check factors, such as strength and flexibility, and any feelings of tenderness or swelling. You or your child may be asked to briefly demonstrate the activities or positions that cause difficulty or pain.
The physical therapist also will identify symptoms the individual is experiencing that are caused by the curve to the spine. If the patient goes to the physical therapist before seeing a physician, the individual will be referred to an orthopedic physician, since a radiograph is needed to confirm a diagnosis of scoliosis.
How Can a Physical Therapist Help?
The variety of treatment options for scoliosis includes physical therapy, bracing, and surgery. Determining the best course of treatment is based on the type and severity of the scoliosis, the patient’s age, and the guidelines established by the Scoliosis Research Society.
Physical therapists can provide care during any of the phases of scoliosis treatment, including bracing or postsurgery. They will evaluate and assess the posture and movement patterns of the whole body, noting any limitations caused by changes in the spine, and address other symptoms, such as pain and muscle imbalances.
Your physical therapist will work with you and your child to develop an individualized plan tailored to the type and severity of the scoliosis as well as patient goals. Your physician will continue to closely monitor progress throughout the course of rehabilitation.
Physical therapy treatments may include:
Range-of-Motion Exercises. Your physical therapist will design a gentle range of motion treatment program to prevent limitations or to increase the body's range of motion, if movement limitations are present.
Strength Training. Your physical therapist will design a treatment program to strengthen any muscles surrounding the spine or in other parts of the body that have been weakened by the change in the spine’s position, such as the hips, shoulders, or even the head and feet.
Manual Therapy. Physical therapists are trained to gently restore motion to joints and muscle tissue that may have become restricted due to scoliosis. They may use their hands to help guide and retrain movement patterns.
Modalities. Several additional treatments, such as ice, heat, electrical stimulation or ultrasound may aid in achieving physical therapy goals. Your physical therapist will choose the most appropriate modalities for your particular case.
Functional Training. Physical therapists are trained to be experts in assessing movement patterns, providing education on proper movement patterns, and retraining the body for optimal movement.
Education. Your physical therapist will provide information about scoliosis and the effects on the body and movement.
Can this Injury or Condition be Prevented?
Scoliosis cannot be prevented. Research is ongoing regarding treatments to stop the progression of scoliosis, such as bracing. A recent study has demonstrated that bracing is effective at limiting the progression of spinal curves. The primary goals of physical therapy are to manage symptoms and maximize each individual's functional capacity. A team approach to treating scoliosis works best.
Real Life Experiences
Anna is a 13-year-old girl who recently joined her middle-school soccer team. In preparation for the upcoming season, her team has been training, including a significant amount of running.
Recently, Anna began experiencing hip pain during her 2-mile run. The pain would go away after a while, but it would come back each time she ran. She told her mom about the pain in her hip. Her mom realized that recurring pain during physical activity is not typical, and called their physical therapist.
Anna's physical therapist took a full family health history and performed a thorough examination. He asked Anna about her pain and her soccer training. He asked her mom about any recent growth spurt. Anna’s mom also said that lately she had noticed Anna's legs appeared to be different lengths, and her shoulders seemed to be at different heights.
Anna's physical therapist assessed her movements, such as walking, squatting, bending forward and backward, and running. He noted Anna's posture from the front, back, and each side, and assessed her leg strength and range of motion.
He explained to Anna and her mom that her spinal alignment was not centered, and that the change may be contributing to Anna’s hip pain. Suspecting scoliosis, he referred Anna to an orthopedic physician and notified her pediatrician.
Anna's pediatrician took radiographs of her back, which confirmed the diagnosis of mild idiopathic scoliosis. With this diagnosis, Anna is expected to regain full function by consistently performing physical therapy exercises.'
Together, Anna, her mom, and her physical therapist developed a treatment plan to help Anna return to pain-free sport participation. The plan began with a 2-week period of rest from sports, while Anna worked regularly with her physical therapist on gentle stretching and strengthening exercises. While at soccer practice, Anna continued to just work on ball handling skills, which did not aggravate her hip pain.
After 2 weeks, Anna's hip was pain free. Her physical therapist and coaches helped her develop a gradual reintegration plan for her to return to soccer. They helped Anna understand the importance of being honest about her hip pain, and asked her to tell her coach if the hip started to hurt again. Anna continued to attend physical therapy once a week to perform exercises that strengthened her back, and helped improve her soccer movements.
One month later, Anna joined her team back on the field. She changed her routine to allow for an appropriate warm-up time before practice, which included exercises prescribed by her physical therapist. At the end of the season, Anna’s team won the county championship—and she felt at the top of her game!
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic or musculoskeletal injuries, or who is experienced in pediatrics.
- A physical therapist who is a board-certified specialist, or who has completed a residency in orthopedic or pediatric physical therapy will have advanced knowledge, experience, and skills that apply to an adolescent, particularly in the athletic population.
- A physical therapist who has received advanced training in scoliosis-specific exercises.
Physical therapists who have these and other credentials can be identified by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping young athletes with scoliosis.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, report activities that make your symptoms worse, and set your goals for completing physical therapy.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for their visit with their health care provider.
The following research articles provide some of the most current and highest level of scientific evidence related to physical therapy and treatment of scoliosis. The articles report research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a Pub Med abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Additional websites are listed as resources for the scientific organizations mentioned here.
Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512–1521. Free Article.
Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: orthopedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012;7(1):3. Free Article.
Romano M, Minozzi S, Bettany-Saltikov J, et al. Exercise for adolescent idiopathic scoliosis. Cochrane Database of Syst Rev. 2012;8:CD007837. Article Summary on PubMed.
The Scoliosis Research Society provides information helpful to families, including the various treatments recommended for the ranges of spinal curves.
The Society on Scoliosis Orthopaedic and Rehabilitation Treatment provides information about conferences on scoliosis.
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