Idiopathic Scoliosis Management and Treatment
The word scoliosis is a Greek word meaning crooked. About 3/100 of individuals have some form of scoliosis. For a small percentage of people curve gets worse as they grove. Scoliosis is
classified into different groups which idiopathic scoliosis (IS) is the most common one. Genetic predisposition, mesenchymal disorders, metabolic causes, functional (muscle imbalances) are some of the potential causes for scoliosis to happen. X-ray is the modality of choice for evaluation of congenital anomalies such as hemivertebra, wedged bodies, possible osteoarthrosis. The curve can be measured by Cobb’s method.
There are different ways to treat and manage people who have scoliosis such as exercise therapy, bracing, and finally surgery. However, exercise therapy has been shown to be only effective to treat chronic LBP. Having said that, in this clinical practice, they found a unilateral instability with right thoracic scoliosis patients while doing asymmetric spinal stabilization exercise (ASSE). There were 25 participants in total where 15 were without IS and 10 patients with IS. For example, patients with right thoracic scoliosis, were unable to maintain a bird-dog by holding the left hand and right leg up. Patients with scoliosis at the L/S that convex to the left side, also showed instability with maintaining bird-dog with right leg up. Also, upper extremity weakness was noted at the thoracic concave side. This study showed a decrease in the number of slow twitch muscle fibers as well as the EMG activity on the concave side of the spinal curvature. So, the hypothesis is to strengthen the muscles on the concave sides of the curvatures to reduce and improve scoliosis. Also, asymmetric components of ASSE which activates the concave side muscles were effective for correction of scoliotic curvature. Both cobb angle and rotational grade showed a statistically significant difference when comparing the concave side hand up or leg up exercise. (Cobb angle: 16.36± 8.51°, rotation grade: 0.55 ± 0.82°) with the convex side hand-up or leg-up exercise (Cobb angle: 20.49 ± 9.35°, rotation grade: 1.55 ± 1.04°).
However, this can cause strengthening of the musculature on the concave side, it could exacerbate the tension on the muscles of the concave side as well which this is known as the bowstring effect. The most significant findings from the EMG data were the increased activities of ipsilateral 7th thoracic during hand-up motion, ipsilateral 3rd lumbar ES during leg-up motion, and 12th thoracic and 3rd lumbar ES during side-bridging.
Limitations of this study was having a small sample size, and lack of outcome. Hence, a future randomized prospective study is needed for a better evaluation.
References
1: Ko J, Suh J, Kim H, Ryu J. Proposal of a new exercise protocol for idiopathic scoliosis. Medicine. 2018;97(49):e13336.
2: Scoliosis (for Parents) – KidsHealth [Internet]. Kidshealth.org. 2019 [cited 25 February 2019]. Available from: https://kidshealth.org/en/parents/scoliosis.html
