Scoliosis is a medical condition in which a person’s spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an “S” or a “C”, rather than a straight line. Scoliosis is typically classified as either congenital (caused by vertebral anomalies present at birth), idiopathic (cause unknown, subclassified as infantile, juvenile, adolescent, or adult, according to when onset occurred), or neuromuscular (having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma). A lesser known underlying cause of scoliosis could be attributed to a condition called Chiari malformation.
Recent longitudinal studies reveal that the most common form of the condition, late-onset idiopathic scoliosis, is physiologically harmless and self-limiting even without treatment. The rarer forms of scoliosis pose risks of complications.
What is Scoliosis?
The Scoliosis Research Society defines scoliosis as a curvature of the spine to the side that also includes rotation. As previously mentioned, scoliosis causes postural and trunk alignment changes that cannot be corrected by “standing up straight. On an x-ray, the spine may appear to have an “s” or “c” shape. The severity of scoliosis is determined by measuring the angle of the curvature, also called a Cobb angle. A minimum of “10° of Cobb” needs to be present for a diagnosis of scoliosis.
Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, is diagnosed in children aged 10-18 years. Idiopathic means no identifiable cause is known, but 30% of children with AIS have some family history of the condition.
Other types of scoliosis include congenital, neuromuscular, and early onset (infantile and juvenile).
- Congenital scoliosis is caused by a deformity in the bones of the spine that occurs during a baby’s early development in the womb.
- Neuromuscular scoliosis is caused by a medical condition of the nervous system, such as cerebral palsy or muscular dystrophy, which triggers weakening of the muscles that support the spine.
- The cause of early onset scoliosis is not known. Early onset scoliosis includes infantile scoliosis diagnosed from birth to 3 years of age, and juvenile scoliosis diagnosed before the age of 10.
How Does it Feel?
Scoliosis is usually a pain-free condition, but pain may occur as the spine curves abnormally and affects the surrounding muscles and joints. These changes may alter a person’s alignment, posture, and movement patterns, causing irritation and pain. Muscles that usually support the spine may become imbalanced in scoliosis, leading to a loss of strength and flexibility. A person with scoliosis may note:
- Uneven shoulder height.
- Uneven hip height.
- An uneven waistline.
- A general sense that the 2 sides of the body don’t line up.
- Pain in the areas surrounding the spine, including the shoulder, pelvis, and hip.
- Pain with specific movement or activity.
A primary goal of physical therapy is to identify conditions, such as scoliosis, help the individual restore and maintain mobility so they can function at their personal best, and improve their quality of life.
How Can a Physical Therapist Help?
The variety of treatment options for scoliosis includes physical therapy, bracing, and surgery. Determining the best course of treatment is based on the type and severity of the scoliosis, the patient’s age, and the guidelines established by the Scoliosis Research Society.
Physical therapists can provide care during any of the phases of scoliosis treatment, including bracing or postsurgery. They will evaluate and assess the posture and movement patterns of the whole body, noting any limitations caused by changes in the spine, and address other symptoms, such as pain and muscle imbalances.
Your physical therapist will work with you and your child to develop an individualized plan tailored to the type and severity of the scoliosis as well as patient goals. Your physician will continue to closely monitor progress throughout the course of rehabilitation.
Physical therapy treatments may include:
Range-of-Motion Exercises. Your physical therapist will design a gentle range of motion treatment program to prevent limitations or to increase the body’s range of motion, if movement limitations are present.
Strength Training. Your physical therapist will design a treatment program to strengthen any muscles surrounding the spine or in other parts of the body that have been weakened by the change in the spine’s position, such as the hips, shoulders, or even the head and feet.
Manual Therapy. Physical therapists are trained to gently restore motion to joints and muscle tissue that may have become restricted due to scoliosis. They may use their hands to help guide and retrain movement patterns.
Modalities. Several additional treatments, such as ice, heat, electrical stimulation or ultrasound may aid in achieving physical therapy goals. Your physical therapist will choose the most appropriate modalities for your particular case.
Functional Training. Physical therapists are trained to be experts in assessing movement patterns, providing education on proper movement patterns, and retraining the body for optimal movement.
Education. Your physical therapist will provide information about scoliosis and the effects on the body and movement.
What is Osteoarthritis of the Spine?
As we age, the discs in our spine can wear, begin to bulge, and become narrowed. These changes can put strain on the cartilage, ligaments, and joints at the involved level of the spine and may cause pain. The narrowing of the disc also results in narrowing of the space between the spinal joints, called the “facet” joints. Weight-bearing forces on the joints increase because of these disc changes. As a result, the cartilage covering the joint surface can begin to fray and wear away over time. If your cartilage wears down so that your bones begin to rub together, it can result in enlarged joints, inflammation, stiffness, and pain.
As OA of the spine progresses, your body will try to repair it by growing new bone. This bony growth is called a “bone spur.” Spur development can result in a condition known as spinal stenosis. Most often this disorder affects men and women over 50 years of age. If the spurs enlarge, they can create a narrowing of the spaces in the spine. The narrowing can involve small or large areas and can result in pressure on nerves near the involved joints, resulting in symptoms that may include pain, tingling, numbness, or burning.
How Does it Feel?
Symptoms of OA of the spine vary from person to person and can range from mild to disabling. You may not have symptoms even though the condition is present. Its onset and progression can be quite slow.
With early or mild disease, symptoms will be intermittent, or come and go. You might feel stiffness or aching after sitting a long time, on waking in the morning, or after vigorous activity. You or your family may notice changes in your posture. Some people will bend forward or shift to the side. With more advanced OA of the spine, symptoms will become more constant and tend to interfere more with your daily activity, especially with walking and standing.
Common symptoms of OA of the spine include:
- Pain in the back or neck
- Pain that is worse after prolonged inactivity, on getting up in the morning, or after physical activity
- Pain that worsens with standing and walking, and gets better with sitting or lying down
- Stiffness after prolonged inactivity, on getting up in the morning, or with movement of the involved area of the spine
- With a more advanced condition, symptoms that do not improve with rest and that interfere with sleep
- Pain, burning, or tingling sensations that spread to the shoulder or arm, or to the buttocks or leg
- Difficulty performing normal daily activities, such as dressing and bathing, as well as walking and standing as the condition progresses
- Pain caused by the weakening of muscles surrounding the joint, due to inactivity
How Can a Physical Therapist Help?
Your physical therapist will help you set goals to reduce your symptoms and slow the progression of the disease. You’ll learn how to safely exercise and continue to participate in your normal daily activities.
Your physical therapist can help with a variety of treatment options, including:
Exercise: Exercise is the most important treatment to lessen your pain and improve your mobility. Your physical therapist will prescribe specific low-impact activities that will strengthen your spine, abdomen, and hip muscles—to improve your ability to stand, walk, and balance, and lower your risk of falling.
Caution: Please consult your physical therapist or doctor before starting any exercise program.
Stretching: Your physical therapist will prescribe specific stretching exercises for your spine, arms, or legs based on the results of your initial evaluation. Obese individuals are in special need of stretching and exercises. Combined with strengthening, stretching may help slow the progression of the disease.
Symptom management: Symptom management means learning to feel better and remain active. Sometimes people are fearful that increased activity will worsen their symptoms or increase their pain. Your physical therapist will help you learn how to be more active without worsening your symptoms. He or she will help you find your appropriate activity levels, and develop a unique program to keep you moving.
Daily activity training: Your physical therapist can teach you how to get in and out of bed, in and out of the bathtub, or out of a chair, and how to bend and walk with more ease.
Use of modalities: Treatment “modalities” such as heat or ice may be used to help manage your symptoms.
Manual therapy: Your physical therapist may use gentle hands-on techniques (manual therapy) to help improve your spinal flexibility and ease stiffness.
Balance and walking training: Exercises and instruction may be used to improve your balance safely,and reduce your risk of falls.
Specialized braces or taping:Your physical therapist may use taping or specialized braces to help support your joints. Back bracing is used most in more advanced conditions.
Weight control: If you are obese, you are likely to have more spinal impairment in your upper back. Your physical therapist can help you improve your activity levels, and refer you to nutritional experts.
Remember, all cases of OA of the spine are different. Your physical therapist will choose the best treatment options for you based on his or her evaluation of your specific problem.