Common Mistakes When Managing Adolescent Scoliosis
We’ve been involved in the non-surgical treatment for scoliosis for the past eighteen years, both personally and professionally. After interacting with scoliosis families on a regular basis, rarely a week goes by that we do not hear a scoliosis story gone awry. We’ve decided to share some of these common mistakes when managing adolescent scoliosis (AIS) so you can hopefully avoid them with your child.
Every family/individual has to determine their own path. Hopefully sharing some of these insights will serve as guidance and help you determine the right path for your child’s scoliosis journey.
Mistake #1 – Not Paying Attention to Your Parental Instincts
We recently spoke to a mom whose premenarcheal daughter had just been diagnosed with scoliosis at 13 years old. The mom was upset as she explained that on every annual visit to the pediatrician she asked him to check for scoliosis. She did this because four years prior, she had noticed that her daughter’s hips were “off.” The doctor obliged for the first three years, but on the last visit he informed the mom there was no need to check any longer. Fast forward to a couple of weeks ago: her daughter’s scoliosis was “suddenly discovered” at 41º. Mom had known for a long time that something wasn’t right. If you suspect a problem with your child’s posture and you aren’t taken seriously, consult another practitioner for a second opinion.
Mistake #2 – Watch & Wait
While scoliosis research states that not everyone’s scoliosis will get worse, there is probability inherent to that statement. In many instances, waiting to see what happens is not in your child’s best interest. Waiting to act until scoliosis progresses may be too late to avoid bracing, the recommendation for surgery, or both.
Watch and wait is particularly questionable advice especially for those who still have a substantial amount of growth potential. This is akin to playing the odds when a child is at high risk of progression. Scoliosis usually progresses during a growth phase. For girls, whose scoliosis progresses at about 8:1 to boys, this usually happens just before the first period. Read more about scoliosis progression here.
The “do nothing” advice for managing adolescent scoliosis is not always the best course of action. The basis for our statements is research. Martha C. Hawes, the author of Scoliosis and the Human Spine, states that sometimes scoliosis begins as a functional curve. When a curve is functional, it may be reversible [1]. This means that early conservative treatment may have a positive influence on a functional curve. However, when a curve persists it can become a structural spinal deformity. When this happens, the spine becomes decompensated and in this “unbalanced” state the spine is more likely to progress [2].
Another issue related to watch and wait is not bracing when it’s timely. While this is situation dependent, we have heard many stories of growing patients with 25º plus curves that were told to continue monitoring the curve – creating the impression that bracing is not of immediate importance. Unfortunately, some of those parents come to regret that advice when they discover their child’s scoliosis has progressed on their next visit.
Mistake #3 – Using the Wrong Scoliosis Brace
The Boston Brace, the Wilmington Brace, and the Providence Brace and Charleston Brace (the latter two being nighttime braces) for years have been the go-to braces most doctors prescribe. That time has passed. Rigid braces are a far better choice than the well-marketed soft, stretchy braces like SpineCor. However, what parents ultimately want when managing adolescent scoliosis is the best back brace possible for their child.
Anyone who is familiar with our site knows how passionate we are about the Cheneau-Gensingen Brace. The Gensingen brace can be used as a full-time brace or a nighttime brace for scoliosis. It’s the most advanced scoliosis brace available today and created via CAD/CAM technology. Each brace is Schroth method compatible and custom-made according to individual curve pattern.
Mistake #4 – Rushing to Scoliosis Surgery or Having Surgery
Often, parents are told their child with scoliosis should have surgery at Cobb angles around 45º – 50º. We’ve heard some recommendations for surgery at 35º – 40º for growing kids–which is quite aggressive! While the decision to operate is personal and can be dependent on other factors, in many cases surgery can be avoided with the right tools.
Contrary to what many people are led to believe, there are families/kids who choose to forego surgery and take proactive steps. Before considering surgery, we recommend you read Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study, by Weinstein et al [3]. Our research page has additional links for your reading pleasure. Also, consider the recent comments by an orthopedic surgeon, Dr. Timothy Ward:
“My patients without surgery are doing every bit as well as my patients with surgery. Plus, they haven’t been subjected to these surgical risks…. and some of the complications are large.”
Mistake #5 – Not Considering Scoliosis Rehabilitation
Schroth exercise in its original form first began in Germany in 1921 and is scoliosis exercise according to an individual’s specific curve pattern. In the most recent decade, the Schroth program has been simplified to be more user-friendly. It’s now known as Schroth Best Practice® but few U.S. Schroth practitioners have been trained in the updates. Dr. Moramarco is and knows what to use and when. He and colleagues, Amy Heller and Kim Kruzel, will guide you through the scoliosis maze and show you that there is almost always hope and options. Patients are educated about their scoliosis and instructed in our comprehensive five-part program which is designed to engage and empower patients.
At Scoliosis 3DC®, we will open your eyes about scoliosis treatment in new ways. We want to help you avoid some of the mistakes we made and have committed ourselves to help others learn what we learned about managing adolescent scoliosis. To learn more, check out some of our Schroth method results or check out our Facebook Page.
Mistake #6 – Expecting or Looking for Guarantees
Our advice is to avoid any practitioner/practice who makes guarantees about outcomes. In truth, there are NO GUARANTEES when it comes scoliosis treatment. This applies to scoliosis exercise and bracing, and especially to surgery. With that said, many of our patients are experiencing successful results with managing adolescent scoliosis conservatively (curve reduction, improved posture, reduced pain etc.), but we don’t make guarantees and frankly, we don’t think it’s ethical when others do.
Mistake #7 – Believing Everything You Read on the Internet
If we’ve learned anything in the the last seventeen years it’s that each case of scoliosis is different. Techniques for managing adolescent scoliosis have changed with the increased popularity and availability of newer treatment methods. That said, be cognizant of where you are getting your information from. Consider that advice on the internet comes from people whose philosophies vary. Our philosophy differs significantly from others with different approaches. While the internet is a powerful source of information, be wary. Also, please keep in mind that forum moderators have the ability to block/exclude comments from contributors whose opinions and philosophies differ from theirs.
Mistake #8 – Taking the Wrong Course of Action
Since time is of the essence when it comes to managing adolescent scoliosis, taking the wrong course of action may be costly. In many instances, we’ve spoken to parents on the phone months before they actually decide to come and see us. Sometimes it’s because they decided to attend another program or see a practitioner based on proximity. We get it, we’re in Boston and not everyone can make the trip for our intensive program although our patients come from more than forty states and counting. Many of those patients who eventually came to us in the end. Keep this in mind as well, when kids are dragged from place to place for scoliosis treatment it can result in burnout and/or confusion. Choosing the right program/practitioner from the get-go will prevent lost time and is more likely to improve outcome.
Mistake #9 – Not Taking the Right Steps Simply to Avoid X-ray Exposure
Unfortunately, x-rays are necessary for managing adolescent scoliosis. Naturally, parents want to take steps to reduce a child’s x-ray exposure. Start by making sure shields are used to protect sensitive areas. Sadly, we’ve received x-ray files from parents coming from other doctors with ten images or more when a child’s curves are severe. This is often because doctors planning surgery tend to order an extensive number of x-ray views for planning purposes. If your child’s curve is in the range where the doctor mentions surgery, be aware of the number of views being ordered and their purpose. They may not be necessary.
Initially, when scoliosis is diagnosed getting two views is the norm: the PA view and the sagittal view. Subsequent to this, a PA view is usually sufficient for monitoring.
In our office, when a brace is needed, we use one PA x-ray view prior instruction to allow us to identify Schroth curve classification and to ensure the most accurate assessment and design. After fitting the brace, an in-brace x-ray confirms the correction effect and assists in adjustments for optimal in-brace correction.
A relatively new option is EOS x-ray. It’s now available in most major cities and reportedly has about 1/6 the radiation of standard x-ray.
Mistake #10 – Not Keeping a Health Record
Each time a child has an x-ray, get a copy of the disc to have as your own. If scoliosis is suspected and the scoliometer reading is 5º and visual imbalances are noticeable it’s not a bad idea to have a baseline x-ray. This makes it easier to keep track of the progress or deterioration of scoliosis. Keeping a copy of records, Cobb angle measurements and scoliometer readings is important. For girls, monitoring and noting the date of the first period and changes in height can also help. Family history often plays a role as well so keep a record of family relations with scoliosis.
1] Hawes MC, O’Brien JP. The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment. Scoliosis. 2006;1:3.
2] Stokes IAF. Hueter-Volkmann effect. In: Burwell RG, Dangerfield PH, Lowe TG, Margulies JY, editor. Etiology of Adolescent Idiopathic Scoliosis. Vol. 14. State of the Art Reviews: Spine; 2000. pp. 349–357. Philadelphia, Hanley & Belfus Inc.
3] Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and Function of Patients With Untreated Idiopathic Scoliosis: A 50-Year Natural History Study. JAMA. 2003;289(5):559-567.
