Posture Correction for Scoliosis - An Outline

Introduction:

Scoliosis refers to an abnormal S-shaped curvature of the spine or abnormal rotation of the curvature of the spine. The cause of this condition is unknown and is diagnosed during the childhood or adolescence stage. The angulation of the curvature tends to be a minimum of ten degrees. This condition results in aberrant posture changes in the patient, which can disrupt the quality of life and causes various other complications. However, numerous treatment options have been used for patients with scoliosis for posture corrections.

What Is Scoliosis?

The human spine is the body's primary supporting system, with 33 individual bones interlocked with each other. The vertebral column is divided into seven cervical (neck region) vertebrae, twelve thoracic (trunk region) vertebrae, five lumbar (between the ribcage and pelvis region) vertebrae, sacral vertebrae, and coccyx vertebrae. The spine has normal curvature along the cervical, thoracic, and lumbar regions, which acts as a shock absorber and distributes the mechanical stress during the body’s movement.

When there is a three-dimensional abnormality in the curvature of the spine causing rotation and side-to-side curvature with an angle of more than ten degrees, it is referred to as scoliosis. The coronal plane refers to the vertical plane from head to toe parallel to the shoulders. Normally, the curvature of the spine is measured in the coronal plane. But in this case, scoliosis is a complex condition with abnormality in the coronal, sagittal (plane that divides the body into right and left sections), and axial (a plane that divides the body into superior and inferior sections) planes.

How Common Is Scoliosis?

Scoliosis occurs in about two to three percent of the world’s population and occurs equally among males and females. This condition develops during childhood. Progression of this condition occurs eight times more likely in females than males.

What Are the Causes of Scoliosis?

Based on the causes of this condition, they are classified as :

• Idiopathic scoliosis.

• Congenital scoliosis or neuromuscular.

Idiopathic scoliosis is when all other causes of scoliosis are excluded in these conditions. Adolescent idiopathic scoliosis is the most common type of scoliosis. Congenital scoliosis occurs when there is any malformation of one or more vertebrae in any spine location during birth. Neuromuscular scoliosis occurs secondary to any muscular or neurological diseases. The progression of this condition is more rapid than any other type of scoliosis and often requires surgical intervention.

What Are the Clinical Manifestations of This Condition?

The symptoms of scoliosis include

• Pain over the shoulders or back.

• One or both shoulders may be elevated, leading to uneven shoulders.

• Improper fitting of the clothes.

• One or both hips raised unusually.

• The head is not in line with the pelvic bone.

• The body leans towards a single side.

• The presence of skin changes over the spine region, such as color abnormalities and hairy patches.

• One side of the rib cage might be bulging out.

• Presence of breathing difficulties.

• Change in shape of the thoracic part of the spine.

How Is Scoliosis Diagnosed?

The doctor will perform an initial assessment of the spine and a detailed physical examination. The doctor will take a detailed history of the patient regarding the family history, symptoms of pain, and the progression of the spine curvature. Radiographic investigation of the patients includes X-ray, CT (computed tomography) scan, or Magnetic Resonance Imaging (MRI). The curvature of the spine is measured through the Cobb method. The coronal curvature of the spine exceeding more than ten degrees suggests scoliosis. In severe cases, the angle of the curvature exceeds more than 45 to 50 degrees. The most standard method in diagnosing scoliosis is the forward bent test.

How to Correct Postural Deformities in Scoliosis?

The management of impaired posture in scoliosis needs a multidisciplinary treatment approach. It includes

• Patient education.

• Physical therapy exercises.

• Observation and surveillance.

• Psychological support.

• Bracing.

• Surgery.

How Does Physiotherapy Help in Managing Impaired Posture?

The various modalities of physical therapy in managing a patient's impaired posture include

• Bracing.

• Exercises.

• Manipulation.

Bracing: The doctor might suggest bracing when there is mild to moderate scoliosis and if the child's bones are still growing. The most commonly recommended braces are the Milwaukee braces which are advised to be worn day and night.

Exercise: The non-surgical treatment option for scoliosis is the Schroth method. This method includes individualized exercises tailored by the physical therapist to manage impaired postures and return them to a natural state. This is achieved by focusing on the following:

• Re-establishing muscular symmetry and posture alignment.

• Focusing on breathing into the concave side of the body.

• Posture awareness to the patient.

Scoliosis is a complex condition requiring a three-dimensional approach to treat abnormal curvatures. This method helps in the derotation, deflexion, and correction of the spine’s curvature while elongating the spine. The commonly used exercises in this method are:

• 50 X Pezziball Exercises: In this exercise, the patient sits on a Swiss ball in front of the mirror. The patient works on auto self-elongation and activation of the muscle that forces the convexities in the trunk.

• Prone Exercise: In this exercise, the lumbar curve is corrected by activating the iliopsoas muscles and thoracic curve through shoulder traction and counter-traction.

• Sail Exercise: It is a stretching exercise where the patient stands on a half foam roll with two poles. It is effective in helping in the elongation of the thoracic concavity.

• Muscle Cylinder Exercises: It is also known as side-lying exercise. This exercise focuses on the correction of the lumbar spine. It engages the Quadratus Lumborum muscle in correcting the lumbar curve against gravity.

This method emphasizes the daily habitual posture corrections to maintain the default posture, improve body alignment and prevent the progression. Working consistently to correct the spine is necessary for the therapy to succeed. Physical therapy management also includes breathing exercises in combination with active thoracic mobilizations.

Conclusion:

Scoliosis is a condition characterized by the lateral deviation of the spine’s curvature, mostly involving the lumbar and thoracic spine. Normally, right-handed individuals have a mild right thoracic and left lumbar S-shaped curvature. Symptoms of scoliosis are mostly uneven shoulder blades and bulged ribcage on one side and the body leaning towards a side. Proper diagnosis of this condition on the type and causes is necessary. Management of this condition depends on the patient's severity of the condition. The ultimate aim of the treatment is re-align the spine, shoulders, ribcage, and pelvic bone to their natural position.