Scoliosis
The spine has nomal curvatures in the sagittal plane that provide stability to the body, called lordosis (cervical and lumbar) and kyphosis (thoracic). However, the lateral curvatures are not physiological, which is why they are referred to as scoliosis, and can have clinical consequences with associated pain.
Scoliosis is a three-dimensional morphological deformity of the spine. It is characterised by a deviation of the spine in the frontal plane, resulting in an “S” (double curve) or “C” (single curve) shape, accompanied by an inadequate position of the vertebrae.
Classification varies according to the angle between the most proximal vertebra and the most distal vertebra of that curve, called the Cobb angle, ranging between mild (between 10º and 20º), moderate (between 20º and 40º), and severe (greater than 40º or 50º).
Scoliosis is most likely to develop at the onset of puberty, in healthy young people, and in females.
Scoliosis can be classified according to other criteria: aetiology (cause/origin), the location of the curves (dorsal or lumbar/single curve or double curve), whether it is structured (it is not possible to actively correct the deviation) or unstructured (the curves are slight and it is possible to correct and maintain posture).
Causes
According to their aetiology, most scolioses have no known cause, present without pain but with obvious postural changes, and are classified as idiopathic scoliosis. Non-idiopathic scoliosis is caused by a specific disease or clinical condition.
Within non-idiopathic scoliosis, adaptive scoliosis – occurs as a mechanism where the body adapts to a new situation (difference in the length of the lower limbs, rotation of the pelvis, etc.); congenital scoliosis – occurs during the development of the foetus; although the causes are irreversible, treatment reduces the worsening of the deformity and prevents pain and other complications; neurological or dystrophic scoliosis – develops in association with neurological and muscular pathologies (cerebral palsy, traumatic paralysis, poliomyelitis, muscular dystrophy, etc.); antalgic scoliosis – occurs as part of a painful process that may or may not be directly related to the spine; and finally, scoliotic posture – without discomfort or pain, but with symptoms that are “camouflaged” by the body’s defence mechanisms.
Diagnostic
It is often diagnosed during clinical examinations or routine tests requested by the family doctor, or following screening in schools or suspicion by a family member. In addition to the medical history and physical examination, the x-ray is the preferred test used to diagnose scoliosis. It can also be used to try to identify the possible causes, to calculate the Cobb angle and to determine the bone maturity, which will help to measure its possible progression.
Treatment
Treatment is based on the severity and remaining growth potential, depending on how the bones mature. Curvatures up to 20º can be treated with physiotherapy or observation alone. For curvatures between 25º and 40º, the use of trunk orthosis should be considered in young people with residual growth, in conjunction with physiotherapy. For curvatures greater than 45º, surgical treatment may be the most appropriate option.
Whatever the type and severity of scoliosis, there is pain, musculoskeletal imbalance and loss of body awareness. Physiotherapy aims to improve these changes and prevent the progression of scoliosis using a variety of methods.
The rehabilitation process must be specific and take into account the type of curve, aetiology, age and symptoms. Physiotherapy techniques include:
- as part of physiotherapy sessions, exercises to improve muscle strength, flexibility, motor coordination and posture;
- teaching of exercises using the GPR (Global Postural Re-education) method as part of a customised programme, which is an active method of global stretching through static postures. These postures last on average 20 minutes and are based on an eccentric effort by the muscle chains. It helps to prevent the progression of scoliosis by strengthening the muscles and reducing pain;
- specific Pilates exercises for scoliosis.
Scoliosis can be progressive, so the earlier it is detected and treated, the less likely it is to worsen.
If you need treatment for scoliosis, contact our physiotherapy clinics in Lisbon.
