A COMPREHENSIVE APPROACH TO NON-OPERATIVE SCOLIOSIS AND KYPHOSIS CARE
The most important element of non-operative scoliosis and/or kyphosis care isn’t a brace; it is the patient. Conservative treatment relies heavily on a patient’s compliance, honesty and vigilance, and we are here to educate and empower you. We encourage active participation in your treatment plan as a member of a multidisciplinary team that includes YOU, your physician, orthotist, physical therapist, and counselor if necessary.
Upon visiting our practice to have your spine evaluated, we will collect information regarding your medical history, perform a physical exam, and obtain diagnostic images. With this information, a decision can be made on how to proceed with caring for your spine and body.
*Currently, standard imaging of the spine is done by x-ray. However, we have been leaders in the use of non-xray light-based surface topography screening (Scoliscan). Ask our team about Scoliscan and whether you or your child is a candidate for this imaging tool. Please note, though it is not covered by insurance, we have priced it reasonably to give our patients access to this special and safe technology.
Small scoliosis curves less than 20 degrees, or curvatures up to 40 degrees in skeletally mature patients, do not require bracing or surgery. Nor do mild cases of kyphosis (roundback). Therefore, observation is the standard of care if your curve measurement is low, and your curve isn’t progressing or causing pain. If observation is right for you, we will set up a program for you to visit us periodically. We will monitor your curve by means of physical exam and imaging. If changes are noted at subsequent visits, we may collaboratively re-evaluate your treatment plan. This may include the need for bracing or potentially surgery.
There has been a movement in recent years toward the use of specific exercise and physical therapy programs directed toward the treatment of scoliosis. Although the highest level of clinical evidence is still lacking for these techniques, we do believe that exercise and physical activity in many forms are useful in helping patients with postural realignment, decreasing muscle fatigue and discomfort, and improving breathing mechanics. To date, little evidence exists that curve progression can actually be stopped with exercise and/or physical therapy methods alone, but clinical trials are ongoing that hope to answer this question.
The Schroth Method
The Schroth Method is a physical therapy technique developed in the 1920s specifically for scoliosis. Its thesis states, “scoliosis involves asymmetrical muscle groups in the back and elsewhere, which in normal bodies are more evenly symmetrical.” The method, therefore, consists of exercises meant to strengthen certain muscles around the spine and within the torso while stretching and lengthening others. Its goals are to reverse abnormal curvatures and associated pain.
Schroth Method exercises are coordinated in three dimensions, sagittal (side), frontal (side to side), and transverse (cross sectional). They include breathing techniques, pelvic corrections, isometric contractions, and posture practices. Therapy is tailored to the individual. The aim is to teach the patient about his or her own body, and demonstrate practices that can be implemented in daily life rather than just during exercise sessions. We have certified Schroth therapists available at our Manhattan location who can be contacted for an appointment.
Independent Physical Activity
While physical activity and formal exercise are important in everyone’s daily life, exercise is especially important for patients who have scoliosis and/or kyphosis. Exercise strengthens the muscles of the back and abdomen (the so-called core), thereby decreasing episodes of back pain throughout your life and improving your ability to carry out your daily activities including sports and exercise.
Yoga and Pilates are great ways to stretch and strengthen your back. They improve core strength, which supports the spine and assists in posture. Practice either activity to your comfort level. In many cases, informing the instructor that you have a spinal condition will prompt him or her to offer variations of the postures. Additionally, we have resources in our office for scoliosis-specific yoga instruction.
Swimming is an exceptional form of exercise that allows you to obtain physical activity with reduced effects of gravity.
We may instruct additional exercises or individualized therapy to compliment your condition.
If your scoliosis curve measures between 20-40 degrees or your kyphosis (roundback) curve measures greater than 50 degrees, and you are still growing, our team may prescribe a brace. Bracing your spine may achieve one or both of the following:
Halting progression (worsening) of a curve
Reducing the degree of a curve (more commonly for kyphosis)
*In some cases, bracing may also address body alignment issues, such as a shift of the upper body to one side, or uneven shoulder levels. It may also improve a rib prominence (bump) through molding of the chest wall.
How long is a brace worn?The brace is worn until growth is completed. We monitor growth by using skeletal x-rays to evaluate four growth centers: the femur, iliac crest, humerus and ribs. Once skeletal maturity is reached, these growth centers close. On average, girls complete their growth at age 15-17, or 2- 3 years post menarche (the first menstrual period). Boys complete their growth by age 17-19 years, on average.
How many hours per day is the brace to be worn? You are to wear the brace 16-23 hours per day depending on the severity of the curve. A more precise number, tailored to your needs, will be discussed with our team.
Time in brace:The brace can be worn to school, to bed, and for almost all daily activities. It may be worn for gym and non-contact sports, or you can take the brace off for these activities and count that among your “out of brace” time. The brace should not be worn for contact sports.
Time out of brace:Patients are encouraged to do core strengthening exercises (sit-ups, yoga, Pilates), if not participating in active sports or gym, while they are out of the brace. It may be removed for after-school sports. Additional latitude is given during the summer to allow for camp activities, particularly swimming, which is the exception to “out of brace” time. If the brace is removed for swimming activities, up to 4 hours are allowed.
Brace wearing in adult patients may be useful, but for different reasons than pediatric or adolescent patients. In adults, a spinal deformity will not be halted or corrected by use of a brace, because the bones have completed growth. Bracing in this population is intended for support and pain reduction purposes only, and is part of a comprehensive non-operative program that should include exercise and close observation. It is important to combine bracing with exercise so that your core is not deconditioned due to the unloading of muscles during physical activity. Dynamic bracing using a strap system (SpineCor) may be helpful for some adults. This can be discussed with our team.
A brace can only serve its purpose if it fits well and is worn for the number of hours prescribed, and we strive to make those objectives as attainable as possible. Because there is little scientific evidence as to which type of brace is “best,” we work alongside a variety of orthotists in the area who produce numerous brace styles. Recent, innovative technology has even allowed for specialized bracing capabilities for even those in need of a highly customized brace that is done through scanning of your body shape and then computer generation of a brace that precisely fits your body. We will facilitate choosing a brace type to suit your individual needs and preferences. Bracing