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. It is important to note that 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.
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