Physiotherapy Treatment for Scoliosis

What Is Scoliosis?

Scoliosis is a condition with a lateral curvature of the spine. In severe cases, it is visible easily. Torticollis is referred to as scoliosis of the cervical spine. There are two types of scoliosis. They are:

1. Structural Scoliosis: It involves bony deformity, which may be congenital or acquired because of excessive muscle weakness, as seen in patients with quadriplegia. Quadriplegia refers to multiple disabilities, such as paralysis from the neck to the arms and legs involving the trunk. It may be idiopathic, neuromuscular, myopathic, or caused due to an upper and lower motor neuron lesion or due to arthrogryposis resulting from persistent joint fracture. Arthrogryposis refers to a lack of muscular development and is characterized by multiple muscle stiffness or contractures.

2. Nonstructural or Functional Scoliosis: It may be caused due to nerve root irritation, postural problems, hysteria, inflammation, and compensation caused by leg length discrepancy.

What Are the Effects of Scoliosis?

• Scoliosis affects the postural relationship of the scapula (shoulder blade) to the spine.

• The scapula is elevated on the convex side and depressed on the concave side of scoliosis.

• Spine curves to left or right.

• Ribs may bulge out on one side and bulge in on the other side.

• The patient may have a short leg, and pelvis tilted laterally and with the concave side high.

• The shoulder or scapula may drop on the concave side of the curve.

• Muscles on the convex side are elongated and weak, along with the hip abductor muscles concave side and foot pronator muscles on the long side.

• Muscles on the concave side are short and strong, along with hip adductor muscles on the convex side and foot supinator on the long side.

• The joints most commonly affected are the lumbar spine, thoracic spine, cervical spine, glenohumeral and scapulothoracic joints, pelvic joints, hip joints, and foot joints.

What Are the Treatment Options?

In adults, non-surgical treatments consist of physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and activity modification. The goal is to decrease symptoms and improve function. Surgery in cases of large curves or curves that may create significant imbalance.

How Can Scoliosis Be Treated Through Physiotherapy?

1. Manipulation: Spinal manipulation is done to relax, strengthen or stretch the musculotendinous structures.

2. Electrical Stimulation: Electrical stimulation through TENS(transcutaneous electric nerve stimulation) may help decrease symptoms like pain. Transcutaneous electric nerve stimulation involves the application of heat to the affected area that helps relieve pain.

3. Bracing: In the growing patient, bracing has been shown to be an effective method. Bracing is done to prevent the progression or worsening of the curve until the patient reaches maturity. Night bracing is an alternate approach to scoliosis.

4. Heat and Cold: Heat and cold therapy are given to the spine to decrease pain and inflammation. It also eases the tight muscles and improves blood circulation at the application site.

5. Ultrasound: Ultrasound produces heat that provides a numbing effect on the area of application. It brings about improved blood circulation in that area.

6. Kinesiology Taping: It is a tape that helps gently relax the muscles when applied. It also helps treat spasms.

7. Scoliosis Orthoses: Children and adolescents are fit with a TLSO (thoracic-lumbar-sacral orthosis) that applies distraction, derotation, and bending forces to realign the spine.

8. Schroth Method: The Schroth method returns the spine to its normal position, and the exercises are customized for each individual. This method aims to restore posture alignments and muscular symmetry and teach the patient to be aware of the posture. It includes three main components:

• Muscular Symmetry: Muscular asymmetry is addressed, and the muscles that are overworked are relieved through this method.

• Rotational Angular Breathing: Breathing is important in all exercises. Reshaping of the ribcage is brought about by rotating the spine with breathing.

• Awareness of Posture: Correcting the posture comes only after being aware of the malaligned posture. So this technique involves the use of a mirror to adjust any malalignment.

9. Klapp Exercises: They consist of stretching and strengthening exercises of the back muscles to improve posture.

10. Scientific Exercises Approach to Scoliosis (SEAS) Exercises: These exercises help slow down the progression of scoliosis. Maximum possible correction is achieved in this exercise. They are associated with activities that focus on stabilization.

11. Breathing Exercises: The breathing exercises are done along with active thoracic mobilization. Relaxation techniques are done to help the patient in respiration.

Exercises:

1. Pelvic Tilts: Try to lie flat on the floor with the head facing the ceiling and knees bent as close as possible to the hip. Try to draw in or tighten the belly muscles while lifting the hip alone off the floor. Hold for five seconds, and then release. Do this exercise for two sets ten times.

2. Cat-Cow Pose: Sit with hands and knees on the floor while holding the back straight. Try to inhale deeply by arching the back and caving the abdominal muscles. Following this, try to exhale, relaxing the abdominal muscles by letting the belly fall and the head towards the ceiling. Do this exercise for two sets ten times.

3. Arm and Leg Raise: Try to lie flat on the floor with the head facing the floor. Now slowly try to extend both legs and hands while the body is contacting the floor. Hold this raise for a few seconds and then return to the resting position. Repeat this exercise 15 times.

4. Bird-Dog Pose: Sit with hands and knees on the floor while holding back straight. Now slowly extend the right arm outside while extending or kicking the left leg. Breathe through this exercise and hold the stretch for five seconds. After this, relax for a few seconds and repeat the same in the opposite direction 15 times on each side.

5. Abdominal Press: Lie flat on the floor with the back in a tension-free position. Slowly raise both feet off the floor parallel to the floor and perpendicular to the thighs. Now slowly, use both hands to push the knees and simultaneously pull the knees towards the hands, engaging the abdominal muscles. During this exercise, arms and legs should not move. Hold this position for a few seconds and relax. Do this exercise for two sets ten times.

Conclusion

Scoliosis is a disabling condition, and certain milder forms can be treated completely through physiotherapy. Disease progression can be slowed down by bracing and orthoses applications. Along with physiotherapy, practicing a good posture while standing and sitting can help reduce the worsening of scoliosis. Massaging and heat therapy can be done at home, along with a few other exercises that can be easily done without any supervision. However, in case of pain and discomfort, seeking the advice of a specialist is mandatory. In severe cases of scoliosis, surgery is recommended.