Scoliosis is an abnormal lateral curvature of the spine. In order to determine the severity of the curvature, a standing AP x-ray is used to determine the Cobb angle. This angle is calculated by drawing two lines and measuring the angle at which they intersect as see in the picture. This calculation is used to monitor the progression of the curvature and helps dictate treatment. As the Cobb angle increases, certain symptoms can be expected until at a 90 degree Cobb angle cardiopulmonary compromise occurs. Treatment for this disease is to stop the progression!
Most people have some slight curvature to the spine. A 10 degree curvature is diagnostic of scoliosis but people rarely have significant symptoms until 20 degrees. This is one of the most widely screened for diseases in young people. You may remember having someone look at the alignment of the back while you bend your back and touch your toes. They may have even measured how much your back twisted when you bent over using what looks and functions exactly like a protractor, but medical personnel decided to call it a new name: the scoliometer. Any abnormal result on the screening requires x-ray for verification.
The reason that schools screen for scoliosis is the earlier you catch scoliosis, the better and more effective the treatment. While there is little that can be reliably done to reverse scoliosis short of major surgery, there is much that can be done to stop or slow its progression. Treatment includes:
1) Observation with physical therapy: With a cobb angle less than 25, observation with serial x-rays, and physical therapy are recommended. The physical therapy focuses on core strength especially the paraspinal musculature which can assist resisting the deformity.
2) Bracing with physical therapy: Bracing is recommended for skeletally immature patients with a cobb angle of 25-45 degrees. It is recommended they be used 16-23 hours each day in conjunction with physical therapy. This can be a huge emotional burden especially as the bracing is usually required during middle school and is not exactly inconspicuous.
3) If the scoliosis continues to progress above 45 degrees then surgical intervention can be considered, in which case a spine surgeon consultation would be necessary.
Once the scoliosis has matured, and is no longer progressing , treatment goals shift from halting the progression to avoiding disabling pain and maintaining full range of motion. This is where consistent, focused physical therapy dedicated to strengthening and stretching the core is a life long necessity. Recent evidence also suggests physical therapy combined with cognitive-behavioral therapy such as specialized counseling reduces disability in adults with scoliosis. 140 patients with scoliosis curvatures <35 degrees were randomly assigned to receive standard physical therapy regimens or the physical therapy with behavioral-cognitive therapy. They found a 12% improvement in overall functionality in patients recieving both the specialized counciling AND therapy when compared to the patients only recieving therapy.
There is hope for those struggling with back pain associated with scoliosis!
Scott Cochran, MS-IV
David Carfagno, D.O., C.A.Q.S.M.
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- Monticone, Ambrosini, Cazzaniga, et al. Adults with idiopathic scoliosis improve disability after motor and cognitive rehabilitation: results of a randomised controlled trial. European Spine Journal. 2016 Mar 25.
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