Mild Scoliosis: Part II
For moms and dads new to the topic, and in consideration of Scoliosis Awareness month, we are starting with a review of what happens to the spine and torso when scoliosis happens:
Spinal changes occur in three dimensions. On-x-ray (AP or PA view) the spine appears to curve from side-to-side. From the side view, the spine may appear flatter than the ‘ideal’ physiologic curves. Thirdly, the vertebrae may begin to twist or rotate (measured on x-ray or by Scoliometer™). As a result of these spinal malalignments, the spine moves the attached rib cage out of the normal physiologic position. This causes shifts, prominences and asymmetries of the spine and trunk.
As with any health condition, when a child is diagnosed with mild scoliosis a parent must become their child’s best advocate and make a plan. Doing nothing isn’t much of a plan and is counterintuitive to most people’s instincts when the potential for progression is looming.
One of the reasons we are so write so much about this topic is because most parents don’t pay serious attention to mild scoliosis because of their doctor’s recommendation to ‘watch and wait’. In our opinion, mild scoliosis is a warning to do something!
Although our daughter’s scoliosis wasn’t mild at diagnosis, Marc asked her doctors, repeatedly, what physical rehabilitation we should begin to help her manage her scoliosis. The answer was, repeatedly, “There is nothing.” We’ve never forgotten that feeling of frustration because we wanted to do something, something worthwhile.
So, here’s what we recommend:
First, arm yourself with information. Learn about risk of progression and the factors that play a role. Learn about Risser sign and potential for growth. At the very least, you will be better equipped to make informed decisions.
Each case of scoliosis is unique and there are multiple factors to consider. Doctors can’t say conclusively who will progress and who will not. They make recommendations based on clinical experience, a child’s Cobb angle, stage of growth and other factors. There is no conclusive diagnostic test doctors agree upon which can be used with confidence to determine whether progression will or will not occur. A doctor’s estimation is not a concrete prediction.
After information gathering, you’ll need to decide whether you are comfortable with a ‘watch and wait’ approach or would rather take proactive steps to avoid progression and stabilize the spine. That’s what the parents of the child in the x-ray above did. Here’s another example of a girl who was able to successfully reduce her mild scoliosis and maintain that reduction. If you decide on trying to stop scoliosis progression rather than waiting to see what happens, you should know you are going against the grain of traditional medical advice since most doctors do not advocate physical rehabilitation for scoliosis.
Thinking ahead may help your decision-making process. Imagine scenarios that may potentially arise in the event of progression. If you subscribe to the philosophy, as we do, that it is usually better to try and to stay ahead of a problem rather than be reactionary, here are some scenarios to consider:
How will your child react, adapt and respond if their Cobb angles reach 25º or 30º? These are the degrees at which bracing is often recommended (depending on age and growth potential). Some kids are incredibly compliant when it comes to brace wear (the right brace helps, it’s the Gensingen Brace by Dr. Weiss® – a Chêneau style brace) while other fight bracing tooth and nail. Still, some kids just can’t tolerate compression braces. How will your child respond to bracing? What about you? Scoliosis becomes a family condition. Remember, this is adolescents we are talking about and unfortunately, sometimes there needs to be an enforcer.
Think about your family’s philosophy on health. Are you proactive or willing to let nature run its course without action?
If your child’s scoliosis reaches a Cobb angle of 35º or 40º, this can be a very stressful time since doctors begin warning that any further progression may warrant surgery, in their opinion. Fear and anxiety can really begin to set in at this point.
Knowing if you should adhere to ‘watch and wait’ is complicated by the fact that scoliosis progression is not always a long, slow drawn-out process. Sometimes rapid growth occurs and a mild curve may progress to surgery territory without warning. We’ve guided many, many cases of kids whose parents have subscribed to ‘watch and wait’ only to have their child have a rapid growth spurt with significant progression. These aren’t scare tactics but reality.
The mom of a boy here a couple of weeks ago for bracing and a program told us her son was upset with her and asked how she could let this happen to him, without noticing. You can imagine how that made her feel! I told them, emphatically, it’s not that she failed to be a vigilant parent but that growth is unpredictable and rapid progression sometimes happens without warning.
A proactive game plan, early on, may save you and your child immense stress. We recommend including your child in decision making when possible. They deserve a voice in the process since they are the one who must exist in their body for the several subsequent decades. I’m willing to be your child will surprise you. Most kids who come for our programs are willing and eager to become empowered.
Is your child athletic, musical, a dancer, or performer? What are his/her aspirations and goals? Scoliosis need not crush those dreams, especially when proactive management begins early.
Kids, beginning at nine, ten or eleven-years-old, learn our protocols and are introduced to the big picture as early as possible. One benefit of that is that younger children are more inclined to be pleasers compared to older adolescents–some of whom can get a little rebellious or angry (no news there)! Despite this, it is always important to encourage your child to comply with treatment and avoid future complications.
Surgery for idiopathic scoliosis is a significant procedure and revision surgery and complications (1,2) are not as rare as some doctors lead you believe. Are you willing to be responsible for such an impactful decision for your minor child? Do some research: scoliosis surgery is basically an elective surgery without any proof that it is superior to natural history (3). Remember, we are talking idiopathic, not congenital or neuromuscular scoliosis.
As we prepared to this post, we were discussing the topic. One of our insightful team members raised the point that many parents aren’t proactive because they are unwilling to go against the recommendations of their mainstream doctor and lack trust in others. We don’t blame people for being skeptical. In fact, there is a lot to be skeptical of when it comes to conservative scoliosis opinions and claims on the internet.
We introduced the Schroth Method, and its recent more user-friendly updates, so other parents wouldn’t have to travel our same path. It’s been our mission to educate other scoliosis families like ours and inspire parents of kids with mild scoliosis to react sooner rather than later when scoliosis is diagnosed to try and avoid progression or even better, to take steps to potentially reduce the curvature.
If you want to learn more about our philosophy and evidence-based management protocols, call and speak with one of us. We are here for you.
1 -Hawes M. Impact of spine surgery on signs and symptoms of spinal deformity. Pediatr Rehabil 2006, 9(4):318-39.
2 – Mueller FJ, Gluch H. Cotrel–Dubousset instrumentation for the correction of adolescent idiopathic scoliosis. Long-term results with an unexpected high revision rate. Scoliosis 2012 Jun;7(1):13.
3- Westrick ER, Ward WT: Adolescent idiopathic scoliosis: 5-year to 20-year evidence-based surgical results. J Pediatr Orthop. 2011 Jan-Feb;31(1 Suppl):S61-8.