Almost 20% of Brazilians live with back pain due to chronic problems, according to the National Health Survey. If we consider the global data, according to the World Health Organization (WHO), 80% of people will have back pain throughout their lives.
The spine is responsible for the support and locomotion of the body. The structure is rigid, composed of a segment of bones (vertebrae), but flexible. Only then is it able to provide support and allow movement at the same time.
Several problems can interfere with the health of the spine, causing pain, difficulty in walking or directly impacting the patient’s life and routine. Among these possible problems is scoliosis.
According to the WHO, between 2% and 3% of the world population suffers some degree of vertebral deviation, representing more than 7 million diagnoses. Data from the National Scoliosis Foundation point out that, in the United States, about 30,000 children begin to wear vests for treatment each year.
Scoliosis is defined as a three-dimensional deviation of the spine with rotation of the vertebra on its axis, which can have several causes, causing it to deviate to the left or right when viewed in the frontal plane.
To understand this process well, it is necessary to know that the spine has normal curvatures, which guarantee stability to the body, and are called lordosis and kyphosis . These curvatures are the result of the adaptation of the vertebral segment to the different postures that the man maintained.
When needing to stand, it was necessary for the vertebral structure to adjust itself so that the body remained balanced. Our body, therefore, is the result of a complex process of evolution and adaptation.
But there are some types of curvatures that are considered incorrect deviations and can cause pain. Among them, scoliosis.
To differentiate between natural and undue curves is simple: seen from the side (as if you were looking at a person from the side, in profile), the correct vertebral segment has a shape slightly similar to the “S”.
It is possible to observe two natural inclinations: backwards, in the chest and coccyx area (kyphosis), and forwards in the lumbar and cervical area (lordosis). But, seen from the front, it is like a straight line.
Scoliosis occurs when, seen from the front, the spine is not linear and, therefore, presents inclinations or curvatures to the sides, due to the rotation of the vertebrae.
But why is it a three-dimensional deviation? This is because there is a deviation to one side (lateroflexion), a deviation that accentuates lordosis (posteroflexion) and a flattening or approximation between the vertebrae (craniocaudal).
In addition, there is a rotation of the vertebra on its own axis. Imagine the vertebrae as interlocking triangular pieces that, when stacked, form a path (like a pipe). All vertebrae must have the tips of the triangle aligned, that is, pointing in the same direction.
But, when there is a rotation on the axis itself, it is as if one of the pieces is misaligned, with the tips in different directions from the others.
The treatments, prognosis and interference in the patient’s life are very different due to the variation in the progressiveness and severity of their curves.
In general, the disease causes unevenness of the hips (pelvic bones) and shoulders, which can impair locomotion and the accommodation of the organs, with or without pain.
Most conditions do not have defined or known causes (idiopathic scoliosis), but there are other diseases that can trigger undue curvature, such as neurological factors.
In ICD-10, scoliosis is found in code M41, and can be subclassified as:
- ICD 10 – M41.0 : Childhood idiopathic scoliosis;
- ICD 10 – M41.1 : Juvenile idiopathic scoliosis;
- ICD 10 – M41.2 : Other idiopathic scoliosis;
- ICD 10 – M41.3 : Thoracogenic scoliosis;
- ICD 10 – M41.4 : Neuromuscular scoliosis;
- ICD 10 – M41.5 : Other secondary scoliosis;
- ICD 10 – M41.8 : Other forms of scoliosis;
- ICD 10 – M41.9 : Scoliosis, unspecified.
In adults, it is usually between 72cm and 75cm. Composed of 33 or 34 overlapping vertebrae, the spine extends from the skull to the pelvis.
The lumbar, thoracic and cervical vertebrae are mobile, while the rest merge into the sacrum and coccyx bones. This flexible bone lengthening is quite complex, composed of curvatures, relative mobility, intervertebral discs and muscles.
The segment is divided into:
- Cervicals : 7 vertebrae, ranging from C1 to C7;
- Thoracic : 12 vertebrae, ranging from T1 to T12;
- Lumbar : 5 vertebrae, ranging from L1 to L5;
- Sacrum : 5 vertebrae, ranging from S1 to S5;
- Coccyx : 4 or 5 fused vertebrae.
Laterally, the regions have normal curvatures that help balance and support the body. Think that it would be much more difficult to maintain balance if our spine were a straight line.
The curves occur in order to compensate for the structure, that is, they are opposed to each other. While the cervical and lumbar regions are convex, if you look at a person from the front, the thoracic and sacral regions are concave.
Stayed in doubt? Hold a spoon as if you are going to bring food to your mouth and watch the curvatures. The part that has the sunken surface (top) is called the concave, while the bottom part is called the convex.
Most of the vertebrae are connected to the next by semi-movable joints, ligaments and muscles that also help with stability, but, above all, provide movement and relative flexibility.
To maintain proper balance and body movement, the spine tends to adapt to the conditions imposed. That is, if there is any malformation or problem that causes the spine to deviate, the segment may cause a new curvature in order to stabilize the body.
Imagine that there is a large deformity in the lumbar region, causing the body to be tilted to the right. The spine will force a vertical corrective adjustment.
However, as it is probably not possible to correct the vertebrae affected by scoliosis, the organism causes a new curvature in the upper part. In this case, there is a secondary curvature, resulting in “S” scoliosis.
The way to classify scoliosis is quite diverse, and may be according to the vertebral region affected, the degree of curvature or, still, as to the origin.
Regarding the shape, the curve can have a “C” shape, being called a simple curve, as there is only an accentuation of the deviation.
In the double curve, the spine has an “S” shaped scoliosis. In this case, there is a primary and a secondary curve that occurs through postural compensation mechanisms.
These deviations can be:
- Cervicothoracic : affects the upper (cervical) parts, going from vertebrae C-1 to C-7, and the middle (thoracic), going from T-1 to T-12;
- Thoracic : affects the middle part of the spine (thoracic), between vertebrae T-1 and T-12;
- Thoracolumbar : affects the regions of the thoracic spine (middle), between T-1 and T-12, and the lumbar spine (lower part), between L-1 and L-5;
- Lumbar : affects the lumbar region, between L-1 and L-5;
- Lumbosacral : affects the regions between the lower back, L-1 and L-5, and the sacrum (final part), S-1 to S-5.
The degree of curvature can be classified into 5 levels:
- 0 to 10 degrees : there is no need for physical therapy;
- 10 to 20 degrees : there is a need for physical therapy treatment;
- 20 to 30 degrees : physiotherapy treatment and use of orthopedic vest;
- 30 to 40 degrees : wearing an orthopedic vest or Milwakee;
- 40 to 50 degrees : only surgical treatment.
In addition to the above classifications, scoliosis needs to be classified according to its origin or triggering agent, because regardless of the location or degree of deviation, the condition can be divided into structural and functional.
In non-structural or functional scoliosis, the spine has a correct structure and does not present excessive curvatures, but there are factors that cause the misalignment of the vertebral segment.
In general, there is a disturbance or dysfunction in other regions of the body and, in order to adjust or compensate for this alteration, the spine ends up being deflected.
It is important to differentiate and characterize functional scoliosis, as it is a manifestation secondary to a dysfunction in another part of the organism, the curvature tends to be softened or resolved by treating the causative problem.
Some bodily dysfunctions that can cause scoliosis are:
- Difference in the growth of the leg bone;
- Muscle spasms;
- Difference in the tone of the paravertebral muscles;
- Nerve root compression;
- Spine injuries;
- Malpositioning of the trunk.
About 80% of cases of structural scoliosis are idiopathic, that is, the diagnosis fails to identify what caused the spinal deviation.
Structural scoliosis is generally a serious and progressive condition, which tends to increasingly compromise the patient’s quality of life if left untreated.
While the functional type usually manifests only a lateral curvature of the column, the structural type presents, in addition to the deviation to the sides, a rotation (torsion) of the column on its own axis.
The most current definitions of the condition point out that it is not enough to define structural scoliosis as a vertebral gap, as this does not account for the complexity of the diagnosis.
It is, therefore, necessary to consider it as a deformity in the 3 planes of the body – frontal, sagittal and transversal -, generally progressive and with severe impairment of posture.
In addition, structural scoliosis has protrusions or prominences, due to vertebral rotation, which are called gibosities or gibas.
Within the structural type, it is possible to subclass the deviations in:
The idiopathic nomination indicates that it is not possible to determine the origin or the cause of the spinal deviation, and some researchers and specialists attribute multiple causes associated with the condition.
It is estimated that up to 80% of patients have idiopathic structural scoliosis, and the condition can appear in healthy children and adolescents, who are developing well and have no history of pathologies or malformations.
The idiopathic columnar deviation can be divided according to the age group that the patient presents the signs:
- Infant – from birth to 2 years of age: it is a rare condition and the most estimated factors are the birth position and the position that the baby, after delivery, maintains when sleeping. In this phase, mild scoliosis affects more boys and tends to resolve itself with simple measures, such as stretching;
- Juvenile – from 3 to 9 years old;
- Adolescent – from 10 to 18 years of age: minor curvatures (mild scoliosis) occur in similar proportions between girls and boys, but the most pronounced deviations affect 4 female patients for every 1 male;
- Adult – after 18 years of age: occurs after the complete formation of bones. Some studies classify the type as Adult Idiopathic Scoliosis (EIA).
However, currently some researchers and specialists use another subclassification for idiopathic scoliosis, dividing it into:
- Early – up to 5 years of age: the condition has a greater impact on the formation of the heart and lungs, which can cause problems in adulthood;
- Late – after 5 years: despite compromising quality of life, the condition that occurs after 5 years tends not to have a severe impact on the patient’s cardiac and respiratory health, as the organs are already almost or completely formed.
There are patients who are more susceptible to spine bending, especially during puberty, due to body growth (called a stretch).
During this period of adolescence, the body tends to show rapid growth, which can accentuate the undue curvature of the vertebral structure, but, even so, there are not always symptoms (such as pain or noticeable deviation).
Several diseases or disorders that affect the central nervous system, nerves and muscles can be the cause of scoliosis, in this case called neuromuscular scoliosis.
Generally, neuromuscular scoliosis has a long “C” shaped curve.
Congenital scoliosis is caused by malformation of the vertebral structure during pregnancy or in newborns. Changes in the constitution of the cartilage of the vertebrae or in the fusion of the ribs may occur. On average, it represents up to 10% of diagnoses.
Some professionals also consider that congenital neuromuscular disorders (that is, when the child is born with the disorder) can be classified in this scoliosis subtype.
They occur due to injuries, fractures, accidents or surgeries improperly performed or recovered.
A study published in the medical journal Revista Portuguesa de Ortopedia e Traumatologia, in 2013, points out that adult scoliosis affects up to 64% of the elderly and causes moderate or severe restrictions on the lives of patients.
Scoliosis diagnosed in adulthood is characterized by marked deviations in the vertebral segment after the total formation (maturation) of the bones. It can also be subdivided into Adult Idiopathic Scoliosis (EIA) and Degenerative Adult Scoliosis (EAD).
While the idiopathic type occurs due to an undiagnosed or untreated scoliosis progression during childhood, without any identifiable causes, the degenerative type is caused by some disease or condition that compromises bone integrity.
In this second type, some factors such as osteoporosis , fractures in spinal compression or degeneration of spinal structures (such as intervertebral discs) may be the cause of scoliosis.
However, the study points out that it is only possible to distinguish the two types of adult scoliosis if there are medical examinations or opinions carried out during childhood or adolescence that attest to the presence or absence of the curvature. That is, it is difficult to make this distinction and the conditions are classified only as degenerative scoliosis.
When the patient suffers an injury or has diseases that cause para or quadriplegia (total loss of movement), due to changes in the spinal cord, a curvature in the vertebral segment may develop, called paralytic scoliosis.
The scoliosis triggered by the impairment of the axial musculature (which supports the body) may be due to infantile paralysis or polio, for example.
Age, traumas or diseases that compromise the body’s structures, whether bones or discs, can favor the degeneration of the spine and cause marked and irregular wear in the lower back.
Most scoliosis is idiopathic and the triggering agent of the deviation cannot be determined. It is believed that, in these cases, there are a number of factors that, together, cause undue spinal curvature.
Some studies suggest that inheritance and genetic predisposition may have a large percentage in the development of the condition.
When vertebral deformation is characterized in the other types – that is, it is possible to determine the cause – they can be:
Scoliosis may also have its origins in the formation and development of the baby. During pregnancy, the vertebrae are forming and, due to some alteration, there is a bone deficiency, causing separation, union or improper accommodation of the vertebrae.
It is a genetic disease of the connective tissue, in which the patient is tall, with elongated limbs and chest deformity. Scoliosis is quite common in these patients.
The syndrome is characterized by a set of hereditary disorders that mainly affect the joints, the skin and the blood vessels. In general, these tissues are extremely flexible, facilitating displacement or rupture. Patients with Ehlers-Danlos Syndrome suffer, among other things, from scoliosis.
Also called dwarfism, osteochondrodystrophy is an inherited autosomal recessive disease. Patients have shortened limbs, short stature, joint contractures and have early joint degeneration.
In addition to scoliosis, other spinal deformities are often noticed, such as cervical kyphosis, lumbar hyperlordosis.
Asymmetry of the lower limbs
Undue growth or malformation of the bones and muscles of the lower limbs can cause scoliosis due to secondary causes. That is, as the person has a body unevenness, the spine tends to mold and adjust to maintain balance when standing or moving.
However, this adaptation can generate deviations in the vertebral segment or increase in curvature, when there are other factors contributing to the deviation.
Tumor or infectious
Tumors in the vertebral region, such as an osteoid tumor, can affect the structure of the region and cause a sharp deviation of the segment. In addition, infections in the vertebral region can be the cause of the deviation of the spine.
Conditions that can favor scoliosis due to tumors or infections can be:
The condition is characterized by the growth of benign tumors in the nerves and can, in some cases, cause bone or soft tissue deformities.
Mal de Pott
Also called vertebral tuberculosis , the infection affects the thoracic region of the spine in approximately 50% of cases, followed by the lumbosacral spine in 40%.
Osteoid osteoma is a very common benign bone tumor, which predominates in young men. The condition can cause pain that usually shows a slight and temporary reduction with the use of anti-inflammatories.
Falls, fractures and accidents can generate spinal injuries, impairing the patient’s quality of life due to pain and movement limitations.
Scoliosis can occur due to injury or due to incorrect treatment and recovery, as they can generate undue scarring, pain or subsequent injuries that can cause undue curvature.
Bone wear is one of the causes most associated with degenerative scoliosis. When the patient has osteoporosis (which is bone degeneration due to loss of calcium), the spine is weakened and is unable to sustain the body axis efficiently, forcing postural curvature.
One of the consequences of neurological disorders is scoliosis. In this case, there are a number of factors that can trigger it, but generally the origin is associated with:
Muscular dystrophies cause weakening of the muscle, loss or alteration of tissue and weakening of the body.
After the muscle is contracted, mechanically or electrically stimulated, the return to the relaxed state is quite slow. The condition can be of hereditary origin or acquired (for example, through the use of medications).
These are conditions in which there are factors causing a significant reduction in muscle strength and tone, often caused by infantile paralysis.
Cerebral palsy is a brain disease that occurs after injuries to the brain, usually during childbirth or early in life. As a consequence, it can cause permanent motor impairment and scoliosis.
As cerebral palsy causes a series of motor worsening – muscle weakness, difficulty in muscle control and spasticity (muscle alteration) – multifactorial causes are attributed to scoliosis due to paralysis.
Some factors and characteristics are observed in patients with scoliosis and may involve:
Scoliosis, in general, is predominant in childhood . In some cases, it is suspected that the vertebral alteration may have developed while the patient was still a child, but it has not been identified, showing signs only when favored by other factors, such as bone degeneration due to age.
Although in newborns scoliosis predominates in boys, throughout life, there are more risks for women . It is estimated that at least 4 diagnoses occur in females for every 1 in males.
The genetic load is attributed as a weight factor for the occurrence of scoliosis. Therefore, people who have affairs in the family should be aware.
Contrary to what some think, bodily conditions and life habits do not cause scoliosis, but they can favor the appearance in those who are predisposed.
Factors such as sedentary lifestyle, obesity and poor posture can be associated with the onset of vertebral deviation.
There are several signs and symptoms that, when they occur, can indicate scoliosis. In a significant part of the cases – especially in children – there are no complaints or reports of pain, which can hinder and delay the diagnosis.
In cases of degenerative scoliosis, pain is reported more frequently, being called low back pain , due to weakening and bone and muscle involvement.
Porém, os sinais físicos são, geralmente, mais evidentes e podem incluir:
- Desnivelamento dos ombros: um ombro fica mais baixo que o outro;
- Cintura irregular: o quadril aparenta estar torto;
- Tórax pendendo para um dos lados: o tronco é assimétrico, como se um lado estivesse estufado;
- Pernas irregulares: um membro maior que o outro;
- Clavícula proeminente: o osso da clavícula tende a ficar mais saltado e evidente.
To make the diagnosis, the general practitioner, orthopedist or physiotherapist will investigate the patient’s history, identifying whether there are hereditary factors that predispose to scoliosis.
The doctor will evaluate the patient with physical, neurological and imaging exams, allowing an overview of the spine structure to be drawn.
The Scoliosis Research Society establishes the essential criteria for the standard diagnosis of the deviation, which should include simple flexion (Adams’ test) and X-ray.
Examining the patient from the front and back, the doctor will observe if there is an asymmetry in the shoulders, the scapula and the iliac region. Laterally, normal (physiological) curvature is observed and there are changes in them as well.
Through physical observation, the specialist will already be able to identify whether the vertebral segment indicates any marked degree of curvature. If so, confirmation and specific analysis must be done with imaging exams.
Observing the surface of the skin, the doctor or physiotherapist can see the presence of tissue changes, such as spots or irregularities. These findings may be signs of other diseases or disorders that cause scoliosis.
Test and Adams
One way to show undue curvature of the spine is to perform the Adams test, which consists of reflecting (or bending) the trunk forward, as if you were going to join something from the floor or stretch.
Neurological exams are used to measure and assess muscle strength and whether there are changes in reflexes or sensitivity. The evaluation is especially relevant to identify tumors or conditions that affect the nervous system and are capable of irritating the nerve root (causing scoliosis).
Imaging exams help healthcare professionals to more accurately identify the location and degree of scoliosis. They can be requested:
The examination shows the curvatures of the spine, indicating whether there is slipping (overlapping) of vertebrae, arthrosis , fractures or degeneration, lesions by infection or tumors. The exam is part of the scoliosis diagnostic protocol.
Tomography assists health professionals in assessing bone anatomy and checking for the presence of herniated discs or changes in the vertebrae.
Magnetic resonance imaging is especially indicated to check the soft parts of the body (such as blood and lymph vessels, muscles, fatty tissue and tendons), but the test is also able to assess bone structures.
Cobb’s angle is considered the gold standard in the diagnosis of scoliosis. First described in 1948, the technique checks and evaluates deformities, and is widely used worldwide to measure the scoliosis angulation from radiography.
Its importance occurs, above all, in the therapeutic referral, as soon as the treatment also depends on the degree of angulation.
Through the image exam, the professional will identify the first and the last vertebrae affected by the incorrect curvature, and will make the measurement, determining the degree of scoliosis.
No, but there is treatment. The deviation in the spine that is not very sharp can dispense with the surgery, but still cause pain in the patient’s adult life. In such cases, palliative therapy does not resolve the deviation, but alleviates symptoms.
When scoliosis is secondary, caused by neuromotor diseases, for example, treatment is done in order to mitigate the consequences of the disease and improve the patient’s quality of life.
The treatment of scoliosis will depend on several factors, such as age, flexibility, severity of curvature and the degree of angulation.
In 2015, a meeting of researchers in the treatment of scoliosis was held, in order to establish parameters to guide the patient. The result was the SOSORT Consensus – International Conference on Scoliosis 2015, which defines therapeutic referrals. The guidelines are mainly based on the size of the curvature of scoliosis.
In general, the curvatures considered severe enough to be treated are from 25 degrees, but experts point out that it is not only the scoliosis angulation that should determine the treatment, but also the patient’s reports.
The presence of pain, physical or emotional limitations is decisive for the realization and choice of therapeutic guidance.
For patients with a curvature between 0 and 10 degrees, in general, there is no recommendation for physiotherapy or surgical treatment.
In such cases, it is necessary to carry out observation and follow-up, checking whether the deviation is progressing.
Observation is the first intervention in all cases. Although it may seem like an absence of treatment, it is, in fact, an effective follow-up of the condition and allows the doctor to make more precise interventions if necessary.
In this regard, exams are requested with regulated frequency and consultations should be periodic.
Specific physiotherapy treatment
For scoliosis between 10 and 20 degrees, specific physiotherapy treatment is recommended.
It is worth remembering that physiotherapy exercises for scoliosis are often incorrectly treated simply as physiotherapy. However, the planning of the sessions is all focused on the disorder of the vertebral segment.
The Brazilian Institute of Scoliosis adopts, for non-surgical treatment, the SEAS approach (Scientific Exercises Approach to Scoliosis). The method consists of approaching scientific exercises for scoliosis.
In this case, the patient is subjected to a rigorous evaluation (using physical, neurological and imaging exams) and then a specific exercise plan is drawn up for him.
That is, the treatment is based on standards of care, but aims to pay attention to the special characteristics and needs of each case, promoting the individualization of care.
The patient is taught to perform specific exercises, keeping an eye on how to perform, the duration and frequency of each session. Thus, it is possible that the plan is continued at home, according to the professional’s guidance.
This facilitates patients who do not live close to the call centers or are unable to attend the sessions frequently, due to locomotion conditions or economic issues, for example.
On average, the reevaluation of the condition is done every 2 or 3 months, checking the need to change or adapt the exercise program.
Orthosis and orthopedic vests
For curvatures up to 40 degrees, specific physiotherapy treatment must be done together with the use of orthopedic vests, preventing the progression of the curvature while the child or adolescent is in the growth phase.
The orthopedic vest, in general, should be worn from 16 to 23 hours a day and the models vary depending on each case.
Until reaching the recommendation of the vests and orthoses, there is a long path that must be guided by the specialist doctor. But the study on the effects of orthosis in adolescents points out that in 75% of the cases it had positive results with the adoption of the treatment.
For the vest to be an option, the patient must have scoliosis between 20 and 40 degrees, according to the SOSORT determinations, emphasizing that the treatment is always done together with the conservator.
In the study carried out on the effectiveness of the vests, patients who were at risk of being referred for surgery were significantly less submitted to surgery when compared to patients who did not use vests.
Among those who did not correct with a vest, there was a worsening of scoliosis above 50 degrees in at least half of them.
However, studies that demonstrate the inefficiency and some losses of the adoption of this treatment in some patients are also extensive. In these studies, many of the cases evaluated continued to show curvature progression, and it is generally necessary to refer to surgery.
Although it is of fundamental importance to follow therapeutic recommendations, the use of vests needs to consider psychological monitoring due to the possible impacts on their emotional, mental and social health.
It is also important to note that the model is indicated according to the type of scoliosis and the mold is made individually. Recommendations for use should always be followed strictly to avoid worsening the curvature.
Other research indicates that, on average, among patients who need to wear vests, 70% are successful in treatment and do not need to be referred to surgery.
Below are the models listed by the European Journal of Physical and Rehabilitation medicine as suitable for the treatment of scoliosis:
Developed in the city of Milwaukee, USA, by Walter Blount and Albert Schmidt in 1945, the model was used, in the beginning, to immobilize post-operative patients in the spine.
Developed in Boston, in 1972, after a patient with lumbar deviation presented resistance to the use of the Milwaukee vest.
Colete from Lyon
The model is an adaptation to the Milwaukee vest, it was developed in 1947 and later adapted in 1958.
Thoracolumbar Lordotic Intervention (TLI) packages
The Thoracolumbar Lordotic Intervention model is an adaptation of the existing ones, emphasizing the alignment of the thoraco-lumbar region.
Vest Rigo Chêneau
Developed in 1960, in France and Germany, it is widely used and accepted today.
Colete de Sforzesco
The model was developed in Milan, Italy, in 2004, by ISICO – Istituto Scientífico Italiano Colonna Vertebral . The model is based on restructuring of the Lyon, Chêneau and Lilwaukee vests.
The model was developed in 1979, especially to serve a patient resistant to the use of other vests for long hours.
In 1992 the model was developed at the Rhode Island Children’s Hospital.
Colete Dynamic Derotating (DDB)
Developed in 1980 in Greece, the model is a thoraco-lumbo-sacral (LSO) type.
A study of more than 70 researchers resulted in the SpineCor model, which was funded and developed with assistance from the Canadian government, in 1993. The model is flexible and not rigid, allowing for greater patient movement.
Colete de Progressive Action Short Brace (PASB)
Developed in 1976, the model is aimed at lumbar correction and lumbar thoracotomy.
Developed in 1969, the model is rigid and symmetrical, one-piece that generally involves the entire trunk.
Scoliosis exercises must comply with the SEAS method criteria, which are defined by a qualified professional according to the needs of each patient. Thus, there is no better or more efficient type of exercise.
Aiming at postural rehabilitation, the activity plan applied to the patient seeks to gradually hinder movement, stimulating physical capacities by maintaining active self-correction.
In other words, the treatment aims to educate the patient so that he has body and postural self-perception, prioritizing conscious posture adjustments.
In addition, socio-family integration is considered part of the exercises for scoliosis, in which the whole family must be present and active in the treatment.
The exercises follow the determinations of SOSORT, the International Society for Orthopedic Treatment and Scoliosis Rehabilitation, which generates guidelines for the treatment and approach of scoliosis.
Altogether, there are 7 centers linked to SOSORT and include:
- Lyon, France approach;
- Approach Katharina Schroth Asklepios, from Germany;
- Scoliosis Scientific Exercise Approach (SEAS), from Italy;
- Barcelona Scoliosis Physical Therapy School (BSPTS) approach, from Spain;
- Poland’s Dobomed approach;
- UK’s Side Shift approach;
- Poland’s Scoliosis Functional Individual Therapy (FITS) approach.
Apart from the above lists, no publication or indication of treatment has proven scientific results.
Muscular endurance and strengthening of posture guide the exercises in order to work the static and dynamic balance (that is, of the patient standing and moving).
It is worth mentioning that SEAS encourages the participation of patients in sports activities, maintaining an active and integrated routine with social activities. Since self-perception of the body has a great impact on the development of activities outside the specific exercise sessions for scoliosis.
Patients with curvature equal to or greater than 45 degrees are indicated for surgery, whether adolescents or adults.
Like any highly invasive procedure, surgery acts as a last resort or form of treatment. It is also possible that the patient will be referred to the use of vests and, if between 4 and 6 months the doctor evaluates the need, surgery may be suggested.
The procedure aims to correct the curvature and prevent its progression by placing implants in the vertebral segment. Metal implants connected to 1 or 2 rods and that make a ligament in the spine, maintaining the correct linearity.
The implant forces the spine to adjust until the operated vertebrae merge, that is, they form a single block.
In general, hospitalization lasts between 5 and 7 days and the time to return to normal light activities (such as going to school) takes, on average, 4 weeks.
However, when the patient is still in the growth phase, it is necessary to consider that the surgeries may impact or hinder the growth of the spine, due to arthrodesis – a process in which the vertebrae fuse.
There are no medications for scoliosis, so patients may experience pain that is difficult to resolve.
Although conservative or palliative therapies are not recognized for the treatment of scoliosis, they are generally good options for adding tactics to reduce pain and discomfort.
However, after studies and consensus from the Italian Health Community, guidelines for conservative treatment of scoliosis have been published which indicate that GPR and other palliative measures may not be safe and suitable for patients.
Adopted by the international SOSORT guidelines, the indication is that alternative therapies are not used to treat scoliosis without being scientifically proven before.
Properly monitored by the specialist, chiropractic , pilates and RPG techniques can be used as a way to strengthen the muscles, increase resistance and stretch the body, and can assist in treatment, as long as they are not the primary or primary method.
Global Postural Reeducation works with postural readjustment, helping in the rehabilitation of the patient to his activities.
With the application of specific maneuvers, movements and manipulations of the spine, arms and legs, the qualified professional also uses breathing, balance and body awareness techniques to improve vertebral alignment.
There are researches, such as one published in the journal Fisioterapia e Pesquisa, in 2010, that point to the use of RPG as highly promising in the treatment of scoliosis, bringing significant changes to the patient’s physical, mental and social health.
Pilates is a set of exercises with low impact on the joints and that promotes an intense work of the muscles through balance, posture, breathing and stretching.
With attention to the centralization of strength, the pilates exercises aimed at scoliosis aim to strengthen especially the transverse muscles of the abdomen. With this, the stability of the spine is improved and the entire body balance is favored.
The respiratory work developed in pilates sessions can also help in the stability of the rib cage and in emotional control.
Chiropractic is a method of alternative medicine that aims to treat conditions of the musculoskeletal system. It can be effective in the treatment of acute pain caused by scoliosis.
Massage can help some patients who complain of back pain, as well as helping with muscle and mental relaxation.
When the degree of curvature is low, living with scoliosis may not have a severe impact on the patient’s quality of life. If there is a medical recommendation, it is necessary to practice specific physiotherapy sessions and strictly follow the exercise plan.
In general, these are sessions that can be done at home and should be taught and monitored frequently by the professional. Regular consultations and examinations are important for observing the state of the spine and whether scoliosis is being accentuated.
The conditions that, in general, most compromise the patient’s life are those that cause pain or require the use of vests, in addition to cases of neuromuscular scoliosis (as there may be severe impairment of other body functions).
For the Scoliosis Research Society, scoliosis should not interfere with life activities. All physical exercises are allowed – they should even be encouraged. Patients who wear vests also have no restrictions on sports or other physical activities, as long as they are done during free time (without a vest).
Pain and discomfort
Spinal pain can be quite debilitating and affect the patient’s life. Simple activities are often compromised due to the difficulty in dealing with spinal discomfort, muscle overload or severe pain.
According to the Scoliosis Research Society, patients with less than 30 degrees of scoliosis have approximately the same chance of suffering from pain as patients without any deviation, with the majority of children and adolescents having no discomfort.
Medical recommendations should always be followed, seeking to alleviate the condition. In addition, alternative treatments can be associated and promote a significant reduction in daily limitations.
Physical exercises, stretching, RPG, pilates, in addition to meditation or natural therapies can promote relaxation and ease the perception of pain.
Take care of the emotional
More than bringing benefits to the physical body, relaxing activities improve mental health as well. Then seek to combine programs or tasks that promote satisfaction, calm the mind and provide well-being.
It does not matter exactly what the purpose of the activity is – entertaining, distracting, relaxing or having fun – as any action that brings satisfaction is beneficial to the body.
In addition, psychological counseling is generally recommended, especially for those who wear vests or have noticeable deviations from the spine, as they can bring social limitations to patients.
One study found that up to 43% of all scoliosis patients (whether mild or severe) feel isolated or avoid social environments.
Especially children and adolescents tend to have a greater refusal of treatment and difficulty in accepting or dealing with vertebral deformity, causing the emotional and psychological conditions to be highly affected.
Medical products assist in body correction in necessary cases. Patients who have, for example, scoliosis due to the asymmetry of the legs, can have their locomotion facilitated with the adoption of orthopedic shoes that run the unevenness of the limbs.
The patient’s prognosis will depend on a number of factors, such as the degree of deviation, the time of diagnosis and the effectiveness of treatment.
Data suggest that patients with scoliosis below 30 degrees remain stable in most cases, provided the recommended treatments are followed. For pictures with a curvature of 50 degrees or more, scoliosis usually worsens in adulthood, and may evolve by 1 degree per year.
Between these two ranges, above 30 degrees and below 50, the prognosis is varied and depends on a number of factors, making it difficult to determine a general prognosis.
The use of vests has varied referrals. If, in the first 6 months of use, the curvature is stabilized, there is a tendency to not need surgery.
But studies indicate that many patients with a high degree of scoliosis did not obtain good results only with the use of the vest, requiring surgical intervention.
Cases of severe childhood scoliosis can damage the lungs and heart, bringing risks to the patient’s health, requiring complications to be treated. The success and maintenance of the quality of life of these patients also have uncertain data, as they depend on several individual factors.
Currently, there are a number of tools and products that assist in the quality of life of those who deal with scoliosis, improving the prognosis and living with irregularities in the spine. Thus, physical, mental and social conditions tend to show good results when properly adapted to the person.
Complications related to scoliosis are, in general, caused by more pronounced curvatures that compromise other areas and systems of the body.
When scoliosis occurs in the chest region, the lungs can be affected, with a discrepancy or high asymmetry in the accommodation of the organs.
As the spine tends to adjust to maintain balance (favoring the appearance of secondary curvature or unevenness of the pelvis, for example), other regions are affected, such as the heart and hips.
In addition to muscle pain, some patients may experience impaired movement or muscle limitations.
A study published in 2013 in the Revista Portuguesa de Ortopedia e Traumatologia, points out that patients undergoing surgery may have specific complications resulting from the intervention, such as:
- Junctional ciphose;
- Neurological injury.
- Myocardial infarction;
- Paralytic ileus;
- Urinary tract infection;
- Deep vein thrombosis;
- Upper mesenteric artery syndrome.
There is no effective way to prevent scoliosis, as it is usually idiopathic (attributing multiple triggering factors) or congenital.
Conservative measures can prevent scoliosis from developing in adult patients with a predisposition, such as preventing osteoporosis or bone-muscle weakness.
When scoliosis is secondary, prevention occurs by treating the primary disease or condition. For this, medical monitoring and effective adoption of treatments is essential to avoid all other complications arising.
Does a lack of calcium cause scoliosis?
No . The lack of calcium can favor bone degeneration and, with age, promote scoliosis in predisposed patients, but it is not able to cause it.
Does carrying a heavy backpack cause scoliosis?
No . Like bad posture, backpacks do not cause scoliosis. They can cause pain in the spine or strain the lower back.
Does the vest correct scoliosis?
No . The vest is used in patients who have a gradual increase or increase in curvature and have the possibility of avoiding surgery. That is, they only serve to prevent the curvature from worsening.
Does scoliosis cause pain?
Not directly. This means that, according to experts, the deviation in the spine is not responsible for the pain, but rather the body’s mechanism to warn that something is wrong.
Patients with deviation and spinal compensation can force the region or some muscle group to try to maintain balance, causing the pain to arise.
In general, children and adolescents do not experience pain, but in adult and elderly patients it is usually reported, probably caused by a secondary effort due to the curvature of scoliosis.
Can patients with scoliosis exercise?
-Yeah . In general, there are no restrictions on the practice of sports and physical activities. It is recommended that the patient exercise regularly and maintain a normal life routine.
The conditions that affect the spine are varied and can have a high impact on daily, social, physical and emotional routines.
Some conditions can be prevented by varying measures, but others – such as scoliosis – can only be treated when identified. Still, keeping up with health, regularly consulting a health professional and adopting healthy habits helps throughout the body.
Follow the Healthy Minute for more tips and information!