Scoliosis 3DC℠, Not Wait and See …
It is our mantra for good reason. Every case of mild scoliosis as a result of adolescent idiopathic scoliosis we have treated has halted or reduced. Here’s an example: Schroth method results.
Unfortunately, we don’t see as many mild curves as we would like – if we did, our job would be much easier. In fact, we are confident that the incidence of scoliosis progression, brace wearing and surgery could and would decline if only more parents adopted our early intervention methodology for their children.
What is mild scoliosis?
By definition, mild scoliosis is a spinal curvature with a Cobb angle measurement of 10º – 24º.
Why are about 90+% of the cases we see moderate and severe scoliosis curves and not mild?
Well, for starters, not all kids are diagnosed when scoliosis is in the mild phase. If your child has been then you have an opportunity to respond. Although your physician or pediatrician will probably tell you there is nothing to be done at this point, other than take an x-ray in a few months, we disagree with that philosophy.
“Early structural scoliosis is more amenable to conservative treatment owing to residual growth potential of the spine.(1)”
The argument for early intervention for mild scoliosis:
As a parent, Dr. Moramarco didn’t have an opportunity to address scoliosis at the mild phase, nor do many others who have brought their children to Scoliosis 3DC℠ for scoliosis-specific exercise instruction and/or Chêneau bracing. Many kids we treat have curves that were not discovered until the moderate or moderate/severe stage. However, others coming to us have larger Cobb angles which began in the mild stages and although under a doctor’s watch, their scoliosis progressed with each semi-annual or quarterly x-ray.
If you have a child whose scoliosis has been detected early and is currently in the mild range, consider yourself fortunate if you are willing to take the appropriate steps. Clinical experience has shown us that scoliosis can be controlled non-surgically. Depending on where a curvature falls on the spectrum of mild to moderate, and the stage of growth, there are decisions to be made and interventions that can positively affect scoliosis Cobb angle outcomes at skeletal maturity – with management and compliance.
We consider ‘watch and wait’ or ‘do nothing’ inadvisable in most instances. We know this advice is probably in direct contrast to your orthopedic surgeon’s advice. Certainly, if a child is ten, eleven or twelve years old and has a curvature below 15º then it is not cause for alarm. However, if a child has significant growth potential, waiting six months for the next x-ray may be too long – we’ve seen this documented on x-ray – especially if a major growth spurt occurs during this time span.
When a child has a 15 – 20º Cobb angle and has significant growth potential, then there are simple interventions we teach older children, pre-teens and teens that can and do help the compliant patient. It is not our full program, but a short program to introduce postural education, instruction in scoliosis ADLs, physiologic® exercise (Schroth Best Practice®) and perhaps a 3D Made Easy® exercise (also Schroth Best Practice®) or two. This is not a full program, but it is education, knowledge and tools a pre-teen can incorporate easily in everyday life to counteract the curve and empower themselves.
When a curve is over 20º and the child has significant growth potential, exercises in addition to those listed above will be introduced and perhaps our Cheneau-Gensingen® brace (Schroth compatible). Treatment using exercise for scoliosis, or bracing, depends on age, skeletal maturity (Risser sign) and growth potential. In-brace corrections are more easily achievable when a child’s spine is still flexible. This is demonstrated on the x-ray indicating a correction, in-brace, of 20º to 5º on a girl, just about to turn ten years old.
From our vantage point, the ‘wait and see’ way of thinking puts children that do not need to be at risk. Parents should know there is opportunity to slow, stop or reverse progression and manage scoliosis to a more successful outcome rather than following the ‘watch and wait’ scenario. If a curve is above 20º and risk of progression is not high (for example, a patient in their mid-teens with a higher Risser sign) then pattern-specific exercise alone can very possibly prevent the need for bracing altogether and prevent progression.
Parents should react when scoliosis threatens. Critics say this is over treatment and provide the argument that not all scoliosis curves progress. You should understand that surgeons are the gatekeepers of scoliosis treatment and they are not trained in physical rehabilitation methods. In fact, they have spent the previous several decades denying that exercise methods can be helpful – to learn more about this Scoliosis and the Human Spine, by Dr. Martha C. Hawes. Beyond that, general physical therapy is not enough; scoliosis rehabilitation must be curve-pattern specific to be effective. Moreover, there are few qualified physicians or therapists in the U.S. who are trained specifically in Schroth methodology and very few who are certified in Schroth Best Practice®. Best Practice makes the load-altering methods of Katharina and Christa Lehnert-Schroth easier to learn and apply and they are the newest developments of this scoliosis-specific technique.
Depending on how much growth potential a child has and his/her risk of progression, we equate our proactive approach for mild scoliosis to an insurance policy as opposed to gambling with a child’s health. Untreated, maybe your child’s scoliosis will progress – maybe it won’t, but is it worth taking a chance with your child’s health?
Finally, according to Weinstein’s natural history, curves held to 30º or lower are less likely to progress into adulthood. A few months of watching and waiting may end up being a big mistake. There is a small window of opportunity to treat and manage scoliosis conservatively. It is our firm belief that hesitation can potentially be a costly mistake.
It comes down to a matter of philosophy. Dr. Moramarco has two adult children with spinal curves, one who was in the severe range at its highest point before he discovered the existence of the Schroth method and used it to help her reverse her thoracic curvature by about 10º and her lumbar by 15º. Treating scoliosis conservatively and effectively became his mission because of the insights he acquired on his journey to help his daughter. You don’t want to go there if you can help it.
The problem with adolescent idiopathic scoliosis is that no one has yet to determine whose curve will progress and whose will not. If you have a family history of scoliosis, then obviously the likelihood is greater.
If your child is diagnosed with scoliosis in the mild stage Schroth Best Practice® methodology provides management techniques that can help stabilize the spine. You have the opportunity to respond and make a difference for your child if they are willing to be a compliant patient.
(1)Aulisa L, Lupparelli S, Pola E, Aulisa AG, Mastantuoni B, Pitta L. Biomechanics of the conservative treatment of idiopathic scoliotic curves in surgical “grey area”. Stud Health Technol Inform. 2002;91:412-8.