Baby boomers may recall days of being screened for scoliosis in elementary or middle school. While this practice was common in states across the US for a number of years, it has stopped in many communities.
Some may also remember when kids diagnosed with scoliosis wore heavy-looking metal braces. This full-torso brace extending from the pelvis to the base of the skull was designed by Milwaukee-area physicians. Commonly referred to as The Milwaukee Brace, it was the most popular scoliosis brace for several decades.
Today, screenings and treatment approaches are varied.
School screenings are not currently mandated in more than 25 states. Yet many organizations recognize the benefits of screening programs including the American Academy of Orthopedic Surgeons (AAOS), Scoliosis Research Society, and American Academy of Pediatrics.
Most physicians perform screenings during annual check-ups. Yet, a challenge exists because many adolescents do not have routine wellness doctor visits.
Screenings take as little as 30 seconds and are commonly performed on children between 10 and 15. A trained health care professional views the spine in both standing and bending positions. Children with suspicious findings should see a physician who often orders an x-ray. Parents may also want to have a child examined by a physical therapist (PT) to discuss exercise-based approaches to treatment.
Most children with scoliosis have mild curves and won't need aggressive treatment. When a curve is suspected or confirmed, follow-up screenings are critically important, especially during times of rapid adolescent growth. With follow-up screenings, clinicians can gain information about curve progression. This helps determine the best treatment approach.
Several medical organizations publish scoliosis treatment guidelines. The decision to treat scoliosis is based on many factors, including age, maturity, sex, family history, curve size and how much the child is likely to grow.
Traditionally in the US, treatment has involved a wait-and-see approach. Physicians most commonly monitor curve progression and initiate bracing treatment if the curve passes a certain threshold. When the curve continues to progress, surgery may be recommended. Surgery involves techniques to fuse or join the vertebrae at the levels of the scoliosis curve
Today, the most commonly used scoliosis brace is a thoraco-lumbo-sacral orthosis (TLSO), or underarm brace. It is more easily concealed under clothing than the Milwaukee Brace. Variations in TLSO braces have emerged in the US in the past several years. Most recently, a European brace, the Rigo-System Cheneau (RSC), has become popular for its unique three-dimensional correction principles.
Also in the US in recent years, scoliosis-specific physical therapy (PT) has become recognized as beneficial in influencing the progression of the curvature. In past decades, PT has played a minor role in scoliosis treatment in America. Patients and families are now seeking more proactive alternatives to addressing scoliosis early after diagnosis. With advancements in therapist specialization and education on scoliosis, physical therapy is now a more available option.
The primary PT-based approach seeing increased popularity in the US is the Schroth method, a conservative, non-surgical, exercise-based scoliosis treatment. Although practiced in Germany since the 1960s, this method became available in the US just 5 years ago. In Europe, more than 3,000 patients are treated with Schroth annually. Today, fewer than 20 therapists in the US are Schroth-certified.
The goal of Schroth is to reduce curve progression as well as provide additional benefits such as improved breathing and improved psychological outlook. Patients work intensively with a physical therapist, learning how to expertly perform exercises specific to their scoliosis curve pattern. Schroth may be combined with bracing, depending on cure severity and the age of the patient. The RSC brace is preferred for accompanying Schroth therapy. The US has fewer than 10 orthotists who are trained to fit RSC braces.
With Schroth therapy, patients report benefit in being empowered to take action in addressing scoliosis and also report a noticeable difference in postural deformity. Case reports are available showing success in preventing surgery through the combined use of RSC bracing and Schroth therapy. In select cases, patients have experienced reduction in the curve - exceeding the traditional goal of stabilization of the curve.
Decisions about scoliosis screening and treatment are always individual choices of families. Parents and children should be aware of the importance of screening and explore various treatment options if scoliosis is diagnosed.
Information about the Schroth Method and Rigo System Cheneau bracing at http://www.sdwpt.com.
What is Scoliosis? Scoliosis is the medical term for an abnormal curvature of the spine. It occurs in approximately 2-3% of people in the US, most commonly children. Idiopathic scoliosis means that the spinal curve develops for unknown reasons. Scoliosis curves are at highest risk for worsening during adolescent growth spurts. At onset, scoliosis rarely involves pain; thus, it is often not diagnosed early. Once progressed, scoliosis can seriously impact quality of life. Early detection is important to ensure optimal management of scoliosis.
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