Physical therapy in the treatment of idiopathic scoliosis
Idiopathic Scoliosis can be defined as a complex three-dimensional deformity of the spine and trunk, which appears in apparently healthy children, and can progress in relation to multiple factors during any rapid period of growth.
Specific prevention of idiopathic scoliosis is not possible, because its ultimate cause is unknown; however, there is a high consensus about the necessity to prevent curve progression. For most scoliosis specialists, conservative management of idiopathic scoliosis is related to bracing, and its main objective is to prevent curve progression to a more or less arbitrary critical point, where surgical correction would be indicated. Scoliosis specific rehabilitation is more comprehensive than this, and has gained an increased interest during the past several years.
Goal of scoliosis rehabilitation is:
- to prevent curve progression,
- to correct the spinal and trunk deformity in the long term,
- to prevent the health related quality of life from deteriorating, while trying to improve it.
Scoliosis Rehabilitation follows a model including:
- Correct diagnosis and evaluation of the patient to make a treatment decision oriented to the patient.
- Treatment is based on: observation (with a rational use of X-rays), education, specific physical exercises, and bracing.
- Quality control and evaluation of the results.
Thus, scoliosis specific exercises are included in this model for many rehabilitation schools in several European countries. However, the role of scoliosis specific physical exercises has been underestimated, due to a lack of evidence published in the English literature. In addition, because of an understandable lack of interest from a vast part of the medical community, and little support for research in this area, the specific methods applied for these rehabilitation schools are nowadays unknown. Consequently, most of the specialists in the world consider physical methods to be 'alternative medicine'. No matter what name is given to any of those methods, and whether or not they have a more or less serious scientific, and/or empirical basis, they all tend to be considered in the same way. There is no distinction made between scoliosis specific exercises, general physical exercises, osteopathy, chiropractic, yoga, etc.
Specialists in scoliosis physiotherapy agree on several features that can be regarded, currently, as standard features in the rehabilitation of scoliosis patients. These features include auto-correction in 3D; training in activities of daily living; stabilizing the corrected posture, and patient education. Another important fact is a multidisciplinary approach. The majority of proposed conservative treatment methods recognize that no isolated professional can be successful on a regular basis. Therefore, most recognized rehabilitation schools use a basic multidisciplinary working team, formed by one medical doctor (MD) with specialized knowledge, one physiotherapist (PT), and one orthotist (CPO). A psychologist may also be included, or necessary at times, although an experienced basic team can properly manage most of the patients. In other words, in scoliosis rehabilitation, like in many other rehabilitation issues, methods are not efficient by themselves, and in any case, failures may always happen.
(The following text is taken from Scoliosis journal.)