Scoliosis

May 14, 2014

For many, parenthood is a joy. There’s nothing like the ability to experience the world through the eyes of a child. The first trip to the zoo, the first time playing catch, the first time you share a favorite song or movie. In many ways, it’s a window into your first memories of the same experiences.

At the other end of the parenting spectrum, there’s the fear of something going wrong. It can mean sleeping with one eye open because of SIDS. Perhaps it’s an unnecessary trip to the emergency room because it’s better to be safe than sorry when your child has a high temperature or a big knock on the head. It never ends too, because the anxiety remains when your child jumps in a car and begins driving.

These fears, most often irrational, come from our hope and desire to provide for our children in every possible way.

It’s not a bad thing to be thinking in these ways. It’s always a good idea to be prepared, not only for life threatening issues, but also for items that could harm quality of life.

One item along these lines is scoliosis.

What Is Scoliosis?

It appears to be a sideways curvature of the spine that typically happens during a growth spurt just before puberty. In reality, it is a three dimensional deformity of the spine. Idiopathic scoliosis (IS) is a three-dimensional deformity, which concerns not only the vertebral column, but also the whole trunk, including the pelvis. Most scoliosis cases are mild, but some children develop spine deformities that worsen as they grow. In its worst cases, scoliosis can be disabling and could even result in lung dysfunction as the space around the chest is impacted. In many cases it creates a concern because of the change in posture and movement that it can create. For a young girl or boy, scoliosis affects health, appearance, self-esteem, and quality of life

Children with scoliosis are usually monitored with x-rays to see if the curvature is getting worse. Most mild forms of scoliosis do not require any intervention. If there is concern, some children are placed in a brace with the hopes of stopping the spinal curvature from getting worse. If it’s bad enough, sometimes surgery is an option.

What Are the Symptoms?

The principle sign for scoliosis comes from unevenness in the body. Are shoulders uneven? Is one shoulder blade more prominent than the other? Is the waist uneven? Is one hip higher than the other?  When the child bends forward there is a noticeable hump on one side of the rib cage, typically on the right?

If you see any signs of scoliosis, it is important to take your child to the doctor.

What Are the Causes?

There is still no apparent accepted scientific theory for the causes of idiopathic scoliosis.  The origin of the deformation has been recently postulated to be explained by a concept called NOTOM (neuro-osseus timing of maturation). The hypothesis describes two separate but related processes. These two processes or (escalators) provide the necessary balance between spinal growth and the muscular control of spine as it grows.  The first escalator creates bone growth and development of the spine, while the second promotes the development of sound muscular control and optimal position sense. When the timing and balance between these two systems is interrupted, abnormal growth occurs resulting in scoliosis.

The Nottingham concept further builds on this process. This approach describes scoliosis as a failure to control the cyclical rotations of the spine created by the pelvis. The scoliosis starts from a developmental abnormality in the central nervous system, which creates the rib-vertebrae angle assymetry. The pelvis, like a merry go round, rotates from side to side inducing the lumbar and thoracic spine to resist the motion. The failure to control this rotational stress to the spine results in rib and spinal deformity.

Treatment

As mentioned, most cases of scoliosis are mild and require consistent checkups to monitor the spine. Braces are the first treatment step, used mostly with children who are still growing. It doesn’t cure scoliosis, but research shows that braces can prevent further progression of spinal curvature. Most braces are worn continuously as its effectiveness is relative to the amount of time it’s worn. Braces don’t restrict its wearers from most activities and they can be taken off for sporting activities.

At Pro-Motion, we believe the physical therapy can be a key part of preventing the scoliotic curve from progressing. If indeed the curve is escalated by poor muscular control and strength, then the proper strengthening and proprioceptive exercises are key. A brace is helpful, but a brace is nothing more than an extrinsic constraint. It does not know what the child wants to do. It cannot measure the child’s strength, and it certainly cannot provide the proper training a child needs to improve how she walks.

If it’s bad enough, surgery might be recommended. Surgery doesn’t occur until after the bones have finished growing. Most often, doctors recommend a spinal fusion. This is essentially a “welding” process. The basic idea is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone.

Physical Therapy as a Treatment Tool

Studies suggest physical therapy and a set exercise program help decrease or keep spine curvature static in 95% of the people studied. Thus, specific physical activity is an important preventative aspect of scoliosis. Evaluation is performed to determine the shape of the curve and to assess mobility of the curve. Tests are performed to determine neuro muscular strength and control. The hip joint and pelvis are evaluated to determine assymetries in motion and control. A custom exercise program is prescribed for each child.

If you have a child with scoliosis, we would love to have the opportunity to help connect your child’s purpose with their potential.

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