The management of scoliosis is complex and is determined primarily by the type of scoliosis encountered: syndromic, congenital, neuromuscular, or idiopathic. Treatment options for idiopathic scoliosis are determined in part by the severity of the curvature and skeletal maturity, which together help predict the likelihood of progression. Non-surgical treatment (conservative treatment) should be pro-active with intervention performed early as "Best results were obtained in 10-25 degrees scoliosis which is a good indication to start therapy before more structural changes within the spine establish." Treatment options have historically been categorized under the following types:
Observation Bracing Specialized physical therapy Surgery
For adults, treatment usually focuses on relieving any pain, while physiotherapy and braces usually play only a minor role.
Painkilling medication Bracing Exercise Surgery
Treatment for idiopathic scoliosis also depends upon the severity of the curvature, the spine's potential for further growth, and the risk that the curvature will progress.
Mild scoliosis (less than 30 degrees deviation) has traditionally been treated through observation only. However, the progression of adolescent idiopathic scoliosis has been linked to rapid growth, suggesting that observation alone is inadequate as progression can rapidly occur during the pubertal growth spurt. Another study has further shown that the peak rate of growth during puberty can actually be higher in individuals with scoliosis than those without, further exacerbating the issue of rapid worsening of the scoliosis curves. Moderately severe scoliosis (30–45 degrees) in a child who is still growing requires bracing. A 2013 study by Weinstein et al. found that rigid bracing significantly reduces worsening of curves in the 20-45 degree range and found that 58% of children receiving "observation only" progressed to surgical range. Recent guidelines published by the Scientific Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) in 2016 state that "the use of a brace is recommended in patients with evolutive idiopathic scoliosis above 25º during growth" based on a review of current scientific literature. Severe curvatures that rapidly progress may be treated surgically with spinal rod placement. Thus, early detection and early intervention prior to the pubertal growth spurt provides the greatest correction and prevention of progression to surgical range. In all cases, early intervention offers the best results. A growing body of scientific research testifies to the efficacy of specialized treatment programs of physical therapy, which may include bracing.
Physical therapy Physical therapists and occupational therapists help those who have experienced an injury or illness regain or maintain the ability to participate in everyday activities. For those with scoliosis, a physical therapist and/or occupational therapist can provide assistance through assessment, intervention, and ongoing evaluation of the condition. This helps them manage physical symptoms and/or use compensatory techniques so that they can participate in daily activities like self-care, productivity, and leisure.
One intervention involves bracing. During the past several decades, a large variety of bracing devices have been developed for the treatment of scoliosis. Studies demonstrate that preventing force sideways across a joint by bracing prevents further curvature of the spine in idiopathic scoliosis, while other studies have also shown that braces can be used by individuals with scoliosis during physical activities. Scoliosis is not merely a lateral or sideways deformity, but occurs in three dimensions as a rotational component is often present.
Other interventions include postural strategies, such as posture training in sitting, standing, and sleeping positions, and in using positioning supports such as pillows, wedges, rolls, and corsets.
Adaptive and compensatory strategies are also employed to help facilitate individuals to returning daily activities.
Scoliosis Specific Exercises
Scoliosis specific exercises have been found to improve treatment outcomes when utilized in addition to bracing and other standards of care. Scoliosis specific exercises include methods such as Schroth which specifically aim to correct aesthetic differences and strengthened muscles and connective tissue that may have atrophied as a result of scoliosis and asymmetric posture. The Schroth method is a three-dimensional exercise approach aiming to improve spinal curvature and vertebral rotational angles. A physical therapist guides the patient through breathing techniques and exercises to strengthen weak muscles and relieve overactive ones. In addition to spinal realignment, the Schroth method improves self-image, quality of life, and lumbar extensor strength. Schroth exercises and other scoliosis specific exercises should be utilized in conjunction with bracing and other standards of care, and be performed under the guidance of a trained professional to ensure the exercises are effective and target the individual's curve pattern so that the correct muscles are strengthened. Strengthening spinal muscles is a crucial preventive measure. This is because the muscles in the back are essential when it comes to supporting the spinal column and maintaining the spine's proper shape. Exercises that will help improve the strength of the muscles in the back include rows and leg and arm extensions. Elastic resistance exercise may also be able to sustain the progression of spinal curvature. This type of exercise is able to sustain progression by equalizing the strength of the torso muscles found on each side of the body.
Self-care Disability caused by scoliosis, as well as physical limitations during recovery from treatment-related surgery, often affects an individual's ability to perform self-care activities. One of the first treatments of scoliosis is the attempt to prevent further curvature of the spine. Depending on the size of the curvature, this is typically done in one of three ways: bracing, surgery, or postural positioning through customized cushioning. Stopping the progression of the scoliosis can prevent the loss of function in many activities of daily living by maintaining range of motion, preventing deformity of the rib cage, and reducing pain during activities such as bending or lifting.
Occupational therapists are often involved in the process of selection and fabrication of customized cushions. These individualized postural supports are used to maintain the current spinal curvature, or they can be adjusted to assist in the correction of the curvature. This type of treatment can help to maintain mobility for a wheelchair user by preventing the deformity of the rib cage and maintaining an active range of motion in the arms.
For other self-care activities (such as dressing, bathing, grooming, personal hygiene, and feeding), several strategies can be used as a part of occupational therapy treatment. Environmental adaptations for bathing could include a bath bench, grab bars installed in the shower area, or a handheld shower nozzle. For activities such as dressing and grooming, various assistive devices and strategies can be used to promote independence. An occupational therapist may recommend a long-handled reacher that can be used to assist self-dressing by allowing a person to avoid painful movements such as bending over; a long-handled shoehorn can be used for putting on and removing shoes. Problems with activities such as cutting meat and eating can be addressed by using specialized cutlery, kitchen utensils, or dishes.
Productivity Productive activities include paid or unpaid work, household chores, school, and play. Recent studies in healthcare have led to the development of a variety of treatments to assist in the management of scoliosis thereby maximizing productivity for people of all ages. Assistive technology has undergone dramatic changes over the past 20 years; the availability and quality of the technology has improved greatly. As a result of using assistive technology, functional changes may range from improvements in abilities, performance in daily activities, participation levels, and quality of life.
A common assistive technology intervention is specialized seating and postural control. For children with poor postural control, a comfortable seating system that provides them with the support needed to maintain a sitting position can be essential for raising their overall level of well-being. A child's well-being in a productive sense involves the ability to participate in classroom and play activities. Specialized wheelchair seating has been identified as the most common prescription in the management of scoliosis in teenagers with muscular dystrophy.
With comfortable wheelchair seating, teenagers are able to participate in classroom activities for longer periods with less fatigue. By tilting the seating position 20° forward (toward the thighs), seating pressure is significantly redistributed, so sitting is more comfortable. If an office worker with scoliosis can sit for longer periods, increased work output is likely to occur and could improve quality of life. Tall, forward-sloping seats or front parts of seats, and when possible with tall desk with the opposite slope, can, in general, reduce pains and the need of bending significantly while working or studying, and that is particularly important with braced, fragile, or tender backs. An open hip angle can benefit the used lung volume and respiration.
For those not using a wheelchair, bracing may be used to treat scoliosis. Lifestyle changes are made to compensate for the proper use of spine braces.
Leisure Physical symptoms such as chest pains, back pains, shortness of breath, and limited spinal movement can hamper or preclude participation in leisure activities of a physical nature. The occupational therapist's role is to facilitate participation by helping the patient manage these symptoms.
Bracing is a common strategy recommended by an occupational therapist, in particular, for individuals engaging in sports and exercise. An OT is responsible for educating an individual on the advantages and disadvantages of different braces, proper ways to wear the brace, and the day-to-day care of the brace.
To help a person manage heart and lung symptoms, such as shortness of breath or chest pains, an occupational therapist can teach the individual energy conservation techniques. This includes scheduling routine breaks during the activity, as suitable for the individual. For example, an occupational therapist can recommend that a swimmer take breaks between laps to conserve energy. Adapting or modifying the exercise or sport is another way a person with scoliosis can do it. Adapting the activity may change the difficulty of the sport or exercise. For example, it might mean taking breaks throughout an exercise. If a person with scoliosis is unable to participate in a sport or exercise, an OT can help the individual explore other physical activities that are suitable to his/her interests and capabilities. An occupational therapist and the person with scoliosis can explore enjoyable and meaningful participation in the sport/exercise in another capacity, such as coaching or refereeing.
Bracing