What’s the best treatment for paediatric scoliosis?

Scoliosis is a spine condition that causes an unnatural curve in the spine by 10 degrees or more . A child with scoliosis can have a spine with an S or C shape curve, with both the thoracic and lumbar spine affected. In Singapore, scoliosis affects children of all races but is more prevalent in girls than boys — girls are 7 times more likely to get scoliosis than boys. It’s also been shown that the older the child, the higher the prevalence of scoliosis. For example, idiopathic scoliosis in schoolgirls stand at 1.4 percent for girls 11 to 12 years of age and 2.2 percent for girls at 13 to 14 years of age.

Thus, it’s important to notice the signs of scoliosis in your child as soon as possible and get the necessary treatment needed to stop your child’s scoliosis from progressing. Early detection is key, better if the scoliosis can be diagnosed before your child hits a growth spurt in puberty.

How do I know if my child has scoliosis?

Most signs of scoliosis in children can be detected in early childhood. They include:

In Singapore, scoliosis in children is commonly detected during annual school health screenings. The Adam’s forward-bending test is carried out (where the child bends forward) to detect any curvature of the spine. While scoliosis is an unnatural curve of the spine, most children with scoliosis are otherwise as active and athletic as their peers with no scoliosis.

Are there different types of scoliosis?

There are four main types of scoliosis, and they are:

Is scoliosis caused by carrying heavy school bags?

Most cases of idiopathic scoliosis in children occur from age 10. Many parents think that scoliosis is caused by heavy school bags, poor posture, sports or physical activities or a lack of calcium in the diet. But the truth is, there is no known cause for idiopathic scoliosis. However, research shows that genetics do play a part in scoliosis; about 30% of patients including children with scoliosis have a family history of the condition.

What are some paediatric scoliosis treatment options?

Before suggesting the best treatment option, factors like the severity of the child’s curve, location of the curve, child’s age and the number of remaining growing years left will be taken into consideration.

For children with curves less than 25 degrees, observation is usually first protocol. The doctor will monitor your child’s curve every 6 to 12 months to ensure the curve does not get worse.

Bracing is recommended for children with curves between 25 degrees and 45 degrees. While bracing will not straighten the existing curve, it prevents the curve from progressing further. Braces for scoliosis have evolved over the years, with the type of material commonly changed to ensure the child remains as comfortable as possible. Regardless of material used, the concept for bracing treatment remains the same: the brace applies forces through the ribs or soft tissues of the trunk to enact a reduction of the curvature so as the child grows, progression of the curve is prevented or minimised. A recent research study shows that bracing significantly decreased the incidence of curves progressing to the point of needing surgery. In Singapore, the thoraco-lumbar-sacral-orthosis (TLSO) brace is one of the more commonly used scoliosis braces.

In growing children with curves over 40 degrees, surgery may be required. If left untreated, large scoliosis curves will continue to progress in adulthood despite skeletal maturity. Scoliosis treatment involves using special stainless steel or titanium rods, hooks, screws and bone graft to carefully straighten the curved portion of the spine. Scoliosis surgery can be achieved by making small incisions on the side of the chest for some patients. Children who undergo scoliosis surgery go on to lead normal and independent lives and can participate in most, if not all forms of sports.

Is there treatment for adults with scoliosis?

Usually adults with scoliosis lead normal and independent lives. The SOSORT guidelines suggest monitoring for scoliosis with a cobb angle of less than 50 deg if they do not have any pain. For adults with any cobb angle experiencing musculoskeletal pain, PSSE is recommended for optimal spine care and upright posture. Lastly, for adults with a cobb angle> 50 deg, for whom a correct conservative treatment has failed, surgery would be suggested.

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Living With Scoliosis – What You Need To Know

What Is Scoliosis?

Living With Scoliosis In Singapore

Scoliosis means a side-to-side (lateral) curvature of the spine usually combined with a rotation of the vertebras.

Frequently Asked Questions

1) How do I know if I have scoliosis?

Look at your posture from the back from top down:

• Head not centered to the body
• Uneven shoulders (either one is in front of the other or one’s higher than the other)
• Uneven shoulder blades: one is more prominent or higher
• Uneven waist angle: the gap between arm to trunk is wider on one side
• One hip is more prominent than the other or the hips are not leveled
• The spine line is not straight

Now perform the Forward bend test:

• Standing with the feet together, then bend forward as far as you can with your palms together, fingers pointing at between your toes.
• Look at the back, one side of the back (either upper or lower back region) will be higher than the other side

2) Is scoliosis caused by bad posture, or by not taking enough calcium?

• In most cases, scoliosis is caused by genetic factors which lead to uneven growth of the spine;
• It can also be caused by problems of other parts of the body, such as one leg being shorter than the other, or back muscle spasm;
• Birth defects and some diseases such as cerebral palsy, Marfan syndrome can also cause curvature of the spine;
• Degeneration of spine may sometimes cause scoliosis too;
• So, bad posture may lead to scoliosis due to muscle imbalance, which is not the same with scoliosis caused by bone deformities. In this case, the curve shall disappear if taking an X-ray in lying.
• Lack of calcium weakens the bones, but it does not cause scoliosis.

3) Does scoliosis cause back pain?

• The curvature of the spine itself does not cause pain, as the body adapts to the way the spine grows;
• However, because the muscles and soft tissues (ligaments, joint capsule etc.) grow unevenly on the sides of the spine, the imbalance of them may cause pain;
• Secondly, over time, in order to achieve certain movements in everyday activities, the body develops compensatory faulty posture and muscle imbalance that leads to pain.

4) Can I exercise if I have scoliosis?

• Yes, one can usually participate in any type of exercises; but due to the posture changes in scoliosis, some movements will be harder to achieve, and some will be restricted due to the lack of flexibility or muscle control;
• Exercises endurance sometimes can be affected by reduced lung capacities but this is rare in idiopathic scoliosis;
• Exercises do not have any adverse effects on the curve;
• If exercises that did not hurt before are now giving you pain, please tune down on the intensity of exercises for a few days. If the pain does not go away, you may need to consult a Dr. or a physiotherapist.

5) Can swimming help reduce the curve of scoliosis?

• Swimming is frequently recommended for patients with back problems because the spine is less loaded in the pool with the help of buoyancy;
• Swimming is good for general strengthening of back muscles; it is also good for breathing function. As scoliosis involves uneven development of the spine and muscles, swimming would not be able to specifically help reduce back pain caused by scoliosis, it does not help reduce the curvature too.

6) Do I have to have surgery if I have scoliosis?

• No. Surgery is usually only indicated when the curve is bigger than 50 degrees, or is severely affecting one’s quality of life;
• Majority of scoliosis cases do not require surgery;
• Surgery needs to be considered if the curve is still worsening in spite of bracing and exercises, and is reaching or beyond 50 degrees;
• One must be aware that there are complications after the surgery such as stiffness, muscle weakness and possible broken rods;
• Surgery should be delayed as much as possible in growing children in order not to stunt the growth of the spine;

7) What else can help control scoliosis besides surgery?

• Besides surgery, the most commonly used treatment are bracing and physiotherapy;
• The purpose of using a brace is to control the progression of the curve, not to eliminate it;
• Physiotherapy works to strengthen the weak muscles, to improve the flexibility of the shortened & tight tissues, which helps slow down the development of muscle imbalance and joint stiffness;
• The stiffer the curve is, the more strongly physiotherapy is recommended addition to the bracing.

8) How many types of brace are available for scoliosis?

• In general, there are 2 main types of braces: hard brace and soft brace;
• Hard braces are made of thermoplastic. Like what its name suggests, it is hard and wearing hard brace limits spinal movements, therefore the individual’s sports participation would be greatly affected; it also creates much stiffness of the spine, weakness and tightness of the spine muscles;
• Common types of hard braces are Boston’s, Charleston’s, and Milwaukie’s etc.
• Soft brace on the other hand, allows movement of the spine when worn. Therefore, the spine is much more mobile during and after the treatment, there is also much less muscle imbalance and joint stiffness of the spine;
• Both hard and soft braces are effective before the bones of the spine reach maturity, which is between 13-15 years old for girls and 15-17 years old for boys; and both braces need to be worn regularly throughout the day (16 hours per day);
• Hard braces are usually much heavier and hotter to wear and results in a poorer compliance compared to soft braces;
• Soft braces are lighter and more comfortable to wear, it is more cosmetically acceptable as it can be well hidden under the clothes; it also allows better posture & muscle development;
• For people who participate in sports like dancing, gymnast, running or badminton, soft braces are of a much practical choice.

9) Can I move or exercise like before if I wear a brace?

• If you are wearing a hard brace, due to the weight and movement restriction, you will have to change the way you do sports or exercises; for example, if you used to run, you probably will have to run for a shorter distance or run at a slower speed;
• Exercises that require many trunk movement will likely to be difficult;
• You may tired out sooner too because of the pressure on the rib cage which affects chest expansion during breathing;
• You may need to exercise at a cooler time of the day as it will be hotter to exercise with the brace;
• You need to be careful with the skin condition at which the pressure is applied to control the curve; this too may affect how much and the kind of exercise you can participate in;
• So…most likely, if you need to exercise like before, you need to keep the brace off.
• If you are wearing soft brace, there will be minimum movement restriction, it is less hot and, less skin problems;
• All land exercises are encouraged as exercising with the brace on speeds up the curve correction;
• Soft brace allows much better muscle retaining and joint mobilization, which has a great impact on curve correction retention after the brace treatment is over.

10) What exercises are good for scoliosis?

• Exercises that are designed to work specifically on muscle imbalance, posture faults are more beneficial than general exercises like swimming, jogging, generic yoga & back stretching exercise; the reason is that general exercises usually fail to stress the “imbalance” in scoliosis, either for strength or flexibility;
• Swimming is good to unload the spine and improve the breathing function; it may also help to reduce back pain that results from excessive loading or tension;
• Correct breathing techniques are important as rib cage deformity is common in scoliosis;
• In order to specifically work on the muscles affected, the curve of the scoliosis needs to be assessed, the posture changes need to be analyzed in details;
• After the study of the curve type and the posture changes, specific movement can be taught and implemented to work on the faulty muscle and posture development;
• The exercises can then be progressed with resistance or more repetitions.

If you’re suffering from scoliosis, please click to find out more about the available physiotherapy treatments. Alternatively, get in touch with your local PhysioActive clinic to arrange an appointment.

Thanks for reading!

This post has been written by PhysioActive’s resident sports therapist, Tian Li Feng MMS, B.H. - Sports Therapist, Manual Therapist and Scoliosis Specialist.

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Image creditBlausen.com staff, via wikimedia.org