Mild Scoliosis
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 – 25º.
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–you have the opportunity to take preventative action. Clinical experience has shown us that in most instances of scoliosis, it 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.
For very mild curves, 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. When a child is ten, eleven or twelve years old and has a curvature below 15º it may not be a cause for alarm but it certainly deserves your attention and vigilance, at minimum. For a child who has significant growth potential, waiting six months for the next x-ray may be too long – we’ve seen the danger of this documented on x-rays – especially when 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, and easy spinal exercises to address the sagittal plane. This is not a full program, but it is education, knowledge and simple skilss that a pre-teen can incorporate easily into 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 it’s time that parents consider scoliosis bracing. 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 an 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. Some critics may claim that this is over-treatment and provide the argument that not all scoliosis curves progress. As described above, when there is growth potential families should be proactive. What parents need to understand is that surgeons are the gatekeepers of scoliosis treatment and are untrained or unfamiliar with nuances of physical rehabilitation for scoliosis. Twenty plus years ago, at the time Dr. Moramarco was researching exercise-based scoliosis to help his daughter many prominent surgeons had spent the previous several decades denying that scoliosis exercise methods may be helpful to patients. Dr. Martha C. Hawes wrote a compelling account of this in her self-published text called Scoliosis and the Human Spine debunking many of the research work that came out of the 20th century. It was meeting her, and her book, that invigorated Dr. Marc on his journey. But, 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 but the number is growing. Few use the variety of load-altering methods used at Scoliosis 3DC® which are easier to learn and apply–the newest developments in scoliosis-specific exercise.
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 resulting in regret. There is a small window of opportunity to treat and manage scoliosis conservatively. Hesitating can potentially be a costly mistake.
It comes down to a matter of philosophy. Dr. Moramarco has two adult children with spinal curves, one in the severe range at its highest point. Once introduced to the Schroth method, she was able to use it to help reverse her thoracic curvature by about 10º and her lumbar curvature by 15º. Because of the insights he acquired on his journey to help his daughter treating scoliosis conservatively, and effectively, became his mission. Do you want to go there if you can help it?
The problem with adolescent idiopathic scoliosis is that no one has yet determined which curves will progress significantly and if or when a curve will stabilize. When there is a family history of scoliosis, then the likelihood of progression is most likely greater. Over the years we’ve treated many patients with multiple family members with scoliosis. Pay attention when there is a history of scoliosis in your family.
If your child is diagnosed with scoliosis in the mild stage, the Scoliosis 3DC® Schroth program can provide curve-management techniques that can help stabilize the spine when applied consistently. You have the opportunity to respond and make a difference for your child if they are willing to be a compliant patient.
Moderate Scoliosis
What is Moderate Scoliosis?
By definition, moderate scoliosis is a spinal curvature with a 25º – 44º degree Cobb angle measurement.
When scoliosis severity progresses into the moderate category, parents and patients are often confused about the most appropriate next step in scoliosis treatment. Curve progression can be scary, and treatment recommendations are sometimes confusing. Those on the smaller Cobb angle end of moderate (25º scoliosis) are usually advised to brace their child if the child still has a significant amount of growth potential. Those on the larger Cobb angle end of moderate scoliosis (40º scoliosis. plus) are often told it is too late to brace and that they might be a “candidate for surgery.”
At Scoliosis 3DC®, it is our goal to help patients avoid scoliosis surgery. We address moderate scoliosis via Schroth Rehabilitation and bracing.
My child has moderate scoliosis, do they need to wear a brace?
Bracing can be a very helpful tool in halting the progression of scoliosis or potentially reducing curvature. Refer to our research studies page if you are interested in reading about the benefits of bracing. When it comes to bracing, if the child is an adolescent with significant potential for growth, generally we say the earlier the better. Bracing which starts early is most effective. Unlike many other types of braces, Chêneau style scoliosis braces are designed to address moderate to severe curves (scoliosis of 40º, 50º and higher). This may differ from the information that surgeons provide since, for many, their focus once a scoliosis reaches 45º, 50º, or 55º (depending on their philosophy and the degree of spinal decompensation) is surgery, not bracing.
I have back pain and moderate scoliosis. Can the Schroth method help me?
Yes! One of the goals of our exercise rehabilitation program is to relieve pain associated with scoliosis.
What’s the best way to manage a moderate scoliosis?
A two-pronged approach to scoliosis management includes scoliosis bracing together with a scoliosis exercise immersion approach which addressed the patient’s specific curve pattern. With a well-designed brace, many compliant patients attain effective results, consistently. The earlier a family is proactive after a scoliosis diagnosis, the better!
Severe Scoliosis
What is Severe Scoliosis?
By definition, severe scoliosis (referred to as third degree scoliosis in some countries) is a spinal curvature (Cobb angle) at or above 45º.
I have severe scoliosis. Do I need spinal fusion surgery?
Every individual is different, but at Scoliosis3DC® we usually only endorse surgical intervention in extreme cases. On our scoliosis research page under the section entitled Long-term effects of Scoliosis, please read, Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study and its numerous conclusions. Of primary importance to note, individuals with scoliosis can live a relatively long and healthy life. Unfortunately, that view of scoliosis is not usually presented when spinal surgery is recommended. What you need to know is that spinal fusion surgery for scoliosis is a choice!
In fact, two prominent scoliosis surgeons have noted that evidence is lacking for scoliosis surgery (3). Finally, it’s important to understand the many risks and unknowns when it comes to surgery, both in the mid-and long-term (4).
At Scoliosis 3DC®, we’ve successfully treated patients with very severe scoliosis in terms of helping some achieve curve reduction, improve or reduce pain, improve postural appearance, and/or increase vital capacity. (Please see our Schroth Method Results page for a few results).
For severe scoliosis–Cobb angles of 50º, 60º, and higher we recommend introducing scoliosis education and curve-pattern-specific Schroth instruction as soon as possible to take advantage of any remaining growth potential. Our Schroth intensives in conjunction with effective scoliosis bracing will provide skills that the patient can use for life.
Other than surgery, what can be done for severe scoliosis?
Scoliosis surgery is usually done for cosmetic reasons and to prevent further progression, but Schroth exercises and/or bracing can help with both of those as well. Our patients improve postural appearance, stimulate spinal stabilization and improve muscle imbalances, without surgery. Patients are taught how to avoid curve-stimulating behaviors on their own. Practice can help improve vital capacity and reduce pain. It’s important to know that the above-referenced fifty year natural history study on scoliosis (2) states that the incidence of back pain for people with scoliosis is only somewhat greater than for the general population. Patients who gain the skills we teach learn how to help alleviate pain and progression, without surgery.
(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.
(3) Westrick ER, Ward WT. Adolescent idiopathic scoliosis: 5 year to 20-year evidence-based surgical results. J Pediatr Orthop. 2011;31(1 Suppl):S61–S68.
(4) 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;7(1):13. doi: 10.1186/1748-7161-7-13.
