February 24, 2020
Juvenile Idiopathic Scoliosis – What is it?
Scoliosis management has often involved a ‘wait and see’ approach. This is ‘wait and see’ if the scoliosis gets worse. And then what? Well, if the scoliosis curve gets large enough, surgery can be offered as a treatment approach. Surgery may be a viable option for scoliosis patients in many situations. However isn’t it time that more people were aware that conservative options for scoliosis do exist?
Why is Scoliosis Conservative Therapy Often Ignored?
Scoliosis conservative treatment options do exist, but they are often ignored. Why? In my opinion it is often deep rooted in confusion and lack of understanding. This is a lack of understanding of what constitutes evidence based therapy specific for scoliosis, compared to ‘usual’ therapies that a patient may seek, such as physiotherapy, chiropractic or osteopathic care.
Not all therapies are the best treatment for scoliosis. While usual physiotherapy, chiropractic or osteopathic treatments may provide some support for scoliosis patients, alone they are not in fact considered best practice for therapy options for scoliosis.
I think this confusion has led to much frustration amongst health professionals and patients. Well meaning health professionals are trying to help these patients, but they are doing so while not being aware that scoliosis specific guidelines exist. These guidelines are provided by The International Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) (1). The latest guidelines or adolescent idiopathic scoliosis treatment were published in 2018.
Each child is different, but what is clear from the SOSORT guidelines (1) is that the ‘wait and see’ approach needs to be forgotten. While we cannot cover all the details of what is right for each child, parents and health professionals should be aware that options in the way of Physiotherapeutic Scoliosis Specific Exercises (PSSE), and sometimes PSSE combined with bracing, should be used in many cases of AIS.
In situations where curves reach 20-25 degrees, with signs of progression and growth remaining, bracing is often recommended. Bracing should occur in conjunction with PSSE. PSSE is not the same as usual physical activity such as gymnastics, Pilates, Yoga or other fitness or gym activities.
In cases where curves reach 45-50 degrees or more, surgery is often then recommended. Remember that this article is not to be used in place of getting specific attention for your child. However your child should have a team of people around them that specialise in scoliosis including a doctor, a physiotherapist, an orthotist (if needed) and in some cases, a psychologist (1).
Conservative therapy for scoliosis in the way of PSSE and/or bracing, is gaining more and more supportive traction in the scientific literature. I see parents every day that are relieved that they have some options to at least explore, in order to try to prevent surgery. I also see adults who have had surgery, wishing they had known about conservative options earlier.
A trial on bracing (2) has provided us with the best evidence so far that bracing for AIS is effective. More and more PSSE evidence is emerging too. SOSORT recommends that PSSE is also used when a child is being weaned from a brace (1).
Just like any therapy for any condition there are situations where not all people can be helped. I see conservative management success being heightened when you have a compliant child and a supportive family, friend and school network. Lots of things have to work together for success to occur. However, for many families I see they report that it is worth the effort.
Allied health professionals and General Practitioners who are interested to find out more about scoliosis can contact our clinic for details on our next face-to-face seminars, or we are happy to travel to deliver the seminar in your location. We also have online learning seminar options that can be found at here .
Seminars for parents are also available online or face to face. Parent seminars can be found here to empower parents to have a good starting point of information. More detailed face-to-face seminars will be posted here.