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Friday, September 25, 2020

Scoliosis – deformation of the spine

Scoliosis is every spinal deformation seen from the front or the back in the frontal plane. Scoliosis can be right or left accentuated, and can be seen on both sides at the same time, presenting two curvatures. 

Spinal curvature does not necessarily mean that there is a structural deformation present – it is often only a sign of bad posture. Long-term bad posture can lead to structural problems including deformation. Today we have two basic types of scoliosis – non-structural and structural. 

NON-STRUCTURAL SCOLIOSIS CAN BE A CONSEQUENCE OF:

  • One leg being shorter than the other
  • Acute and long lasting sciatica
  • Long-term carrying of a bag on just one shoulder
  • Genetic reasons
  • Quick growth
  • Ophthalmologic issues…

Resolving those issues often solves scoliosis problems. 

Today’s way of life with long periods of sitting and not enough physical activity leads to problems which can develop into health issues. One of these problems is bad posture, leading to structural scoliosis. Scoliotic posture occurs due to weak paravertebral muscles (by the spine) and their imbalance, as well as the difference in strength between back and abdominal muscles. 

Curvature (structural curve) often occurs in one part of the spine and it is called primary curve. In order for the body to balance it out, it adapts, leading to secondary curve on the opposite side. This is when the spine begins to look like letter S. 

SCOLIOSIS IS DIVIDED BY THE TIME OF ITS OCCURRENCE:

  • Infantile scoliosis – first three years of life
  • Juvenile scoliosis – between three years of life and beginning of puberty
  • Adolescence scoliosis –   occurs in the beginning of puberty and lasts until bone maturity
  • Adult scoliosis– occurs in adults after bone maturity

Structural scoliosis is not just about spine deformity in frontal plane. It often comes with deformations in sagital plane so we can speak about kyphoscoliosis (when there is more kyphosis present) or lordoscoliosis (presence of lordosis). 

Structural scoliosis is followed by trunk asymmetry due to spine rotation and vertebrae torsion, exhibiting via hunch on the back on the side of convex curve – and since the thorax is a unity, hunch occurs on the front as well, on the side of concave curve.

When diagnosing, RTG is also done, along clinical examination, so we can see and measure spine curves, and foresee rehabilitation prognosis. 

CLINICAL IMAGE AND ESTIMATION

Clinical estimation for scoliosis is done by front bend test. The patient is initially observed standing upright. Even if scoliosis is present, we see only trunk asymmetry. On the convex curve side the shoulder is bent down and scapula is distanced from the trunk, cranially placed, with the same side hip lowered.
If asymmetry disappears during the test, this is the case of non-structural (postural) scoliosis – otherwise this is a structural change

COBB’S ANGLE

One of objective methods for spine curvature is determining Cobb’s angle. It is measured by spine RTG – we pick most caudal vertebrae where lower plane leans to concavity of the curve, and draw a vertical line in accordance to the plane. Then we locate the most cranial vertebrae where upper plane leans to concave curve, and draw the vertical line there as well. The point where these two lines connect is Cobb’s angle – degree of scoliosis. The image shows simplified description

Up to 30 degrees permits loose treatment – intense exercise, swimming, electrostimulation etc. 

30-50 degrees asks for more exercise and also wearing Milwaukee compression in order to physically correct the spine. 

Scoliosis with more than 50 degrees usually asks for surgery. 

TREATING SCOLIOSIS

The best and most qualitative way to solve scoliosis is medicinal gymnastics. It involves daily exercises for trunk and spine, with swimming and other sports. Basic goal is strengthening spine and core muscles, especially on the curvature side, to pull the spine towards the central plane. This process is long and effort consuming, but success is guaranteed. 

Consult your physical therapist about exercises which are best for you, and some of the exercises can be seen here as well.

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