SCOLIOSIS

SCOLIOSIS
REHABILITATION

SCOLIOSIS
A general term used to describe a
lateral curvature of the spine
p
Most often develops on childhood
Can occur on cervical thoracic or
lumbar vertebra

Types:
1.
2.
3
3.
4.
5
5.
6.

Structuralvs.NonStructural
Accordingtothedirectionofcurves
Major vs minor curve
Majorvs.minorcurve
Accordingtotheshapeofthecurve
According to the severity of the curve
Accordingtotheseverityofthecurve
Accordingtoetiology

STRUCTURAL
vertebral bodies
rotates towards convex
spinous process rotates
towards concave
Irreversible lateral
curvature with fixed
rotation of vertebrae.
(+) rotation of
p
vertebrae; apex:
greatest

NON STRUCTURAL
(functional scoliosis)
g of
No change
structure
Positional or dynamic
y
in
nature
Reversible

(-) rotation

( ) rib hump
(+)
p (p
(posterior ((-)) rib hump
p
rib hump)
(+) bony deformity
(+) progressive
(-) corrected by
positioning or voluntary
efforts

((-)) bony deformity

(-) progression
(+) correction
forward bending/ lateral
bending
positional changes
side bending
muscle contraction

NOTE: Forward bending of trunk produces

posterior rib hump on convex side (thoracic
region) due to rotation of vertebra & rib cage
(prominence of scapula)
scapula).

CONCAVE
Shortened
Muscle & ligaments are
contracted
Th
Thoracic:
i
Spinous process
Compression of ribs
Prominence of rib cage
anteriorly

CONVEX
Lengthened
Muscle & ligaments are
stretched
Vertebral body
Separation of ribs
Prominence of rib hump
and scapula posteriorly
Disc space widens
Pedicle in
anteroposterior
direction

CONCAVE
Disc space narrow
lateral displacement of
nucleus pulposus.
Wedging of vertebral body
on concave part of curve
2 pressure on epiphyseal
2
plate. Most especially
seen on >25
>25 curve.
curve
Pedicle more transverse

CONVEX

CONCAVE

CONVEX

Lumbar:
L
b
Prominence of ES
muscle
l

Neck & Shoulder:

Neck angle decrease
Rib flatten
Shoulder decrease

Neck angle increases

Bulging of ribs
Shoulder increased

NOTE:
Direction of the curve is always
identified by the convexity
thoracic scoliosis convexity is on right
(L) thoracic scoliosis convexity is on left

MAJOR
primary curve; most
primary
significant
most
most significantly
occurs in thoracic
region

MINOR
Less severe may
Less
develop on the opposite
direction of the major
curve on either above or
below the major curve.
curve
Compensatory curve
structural or non
structural

(+) structural

(+) structural / non

structural

(+) structural

(+) structural / non structural

Primary
Pi
curve
Idiopathic
scoliosis:
li i right
i ht
thoracic T4 T12

Found
F
db
below
l
or above
b
th
the
major curve
Compensated
C
t d shoulders
h ld
&
hips are leveled
Decompensated/
D
t d/
uncompensated when sum
off degrees
d
off the
th
compensatory curve does not
equall the
th degrees
d
off d
deformity
f
it
of major curve.
(+)
( ) lilisting
ti
shoulders not leveled

C-CURVE
high
hi h shoulder
h ld on
convex; high pelvis on
concave.

S-CURVE
most commonly
l seen
in idiopathic scoliosis

From thoracic to
lumbar

Usually right thoracic

curve & left lumbar
curve

Uncompensated/Decom Compensated
pensated

 Double Major curve has 2 major curve of

q
severity
y & significance;
g
; Both structural
equal
Transitional vertebra makes transition
from one curve to another
Neutral vertebra least rotated vertebra
Apical vertebra most rotated vertebra

 Severityy of scoliosis is determined byy the

angle of curvature
The greater the rotation of vertebra; the
more severe the lateral curvature
The more severe the curve; the greater
the affectation on cardiopulmonary
affectation
Decrease vital capacity & total lung
capacity
Hypertrophy of the ventricle & atrium
f
from
pulmonary
l
h
hypertension
t
i

Measurement Techniques
X ray measurement
Cobb method
most commonly used; more reliable
a line is drawn perpendicular to the upper
margin of the vertebra that inclines most
toward the concavity. A line is also drawn on
the inferior border of the lower vertebra with
greatest angulation toward the concavity. The
angle of these transecting lines is noted &
recorded

 Risser Ferguson method

look for 3 vertebra: uppermost, apical, and
lowermost

 Nash Moe method

Normally pedicles are symmetrical
positioned on either side of each spinous
process
Grading:
0 no vertebral rotation
+ & ++ - mild or minimal rotation
+++ - moderate rotation
++++ - severe rotation

SEVERITY

CURVE

MANAGEMENT

Mild

< 20

Observe; exercise

Moderate

20- 40

Severe

40 - 50
40
50
40 >
60 - 70
60
70

Structural
changes
Brace; exercise
Brace & surgery
Pain & DJD
Cardiopulmonary
affectation
Decrease life
expectancy

NOTE: Curves < 10 - WNL no tx.

Etiology of Structural Scoliosis:

1. Idiopathic unknown/ most common
classification idiopathic
p
adolescent scoliosis
Age of onset
yp Young
g
Adolescent most common type.
girls age 10-15
g 4 & 9.
Juvenile occurs between ages
seen often in girls
Infantile from birth to age
g 3. seen often in
boys

 Causes:
Causes
1. Bone malformation during development
y
muscle weakness
2. Asymmetric
3. Abnormal distribution of muscle spindle in
paraspinal
p
p
muscles
2. Neuromuscular 15
2
15-20%
20%
Neuropathic causes problem in CNS. CP,
Polio
Myopathic causes problem is on muscles
Muscular dystrophy

3. Osteopathic problem in bones

3
Hemivertebra, osteomalacia, rickets, fracture,
dislocation of spine
Etiology of Non Structural Scoliosis:
1. LLD
2. Spasm in back muscles
3. Habitual asymmetric postures

1.
2.
3.
4.
5.
6.

Factors affecting Decision making to

initiate Treatment
Etiology
yp
Type
Location
y
Severity
Age
p g
Rate of progression

Evaluation
Postural assessment plumb line C7C7
gluteal cleft (S2)
The following deviation are often noted:
Asymmetric shoulder level
Prominence of the scapula on the side
of the convexity
Protrusion of the hip in one side
Pelvic obliquity
Increased lumbar lordosis

 Lateral bend test done to determine

whether the curve corrects or reverses as the
pt. side bends towards the convex side of the
curve.
curve
Asymmetric side bending is an early sign
that the structural changes may have begun to
develop in the spine
Forward bending test done to determine
whether the curve straightens out as the pt.
bends forward and to identify a visible,
rotational deformity of the rib cage.
MMT

Non-Operative treatment of Scoliosis

1. Exercises
2. Cast
3. Traction
4. Spinal bracing
5. ES
Sites of curves:
Cervical: C1-C6
Thoracic: T2-T12
T2 T12
Cervico Thoracic: C7-T1
Lumbar: L1 & L4
Lumbo Sacral: L5 or below

Exercise in scoliosis:
1. exercise alone will not prevent progression of a
scoliotic spine nor will correct an existing
scoliosis
2. exercise has been traditionally been used to
stretch
t t h tight
ti ht trunk
t k and
d hip
hi muscles/
l / strengthen
t
th
muscle of the trunk
3 exercise may be beneficial as tx for pt
3.
pt. with mild
idiopathic scoliosis
4 exercise will not alone halt the progression of or
4.
correct an existing moderate or severe scoliosis
5. exercise is used in conjunction with other
methods such as braces, cast, etc.

Exercise with Milwaukee brace:

Goals: to strengthen the muscle that provides
stabilization to the trunk
Decrease or correct spinal curves
NOTE:
j
is to move away
y from the p
pads
The objective
that are inside the brace.
Treatment is geared towards stretching of the
CONCAVE side and strengthening
g
g of the
CONVEX side

For C curve scoliosis:

Cross walk
Done with the pt. in quadruped position.
Done by initially crossing the UE along the
concave side towards the convex side, followed
by the advancement of the contralateral LE.
Cycle repeats until the pt. completes one
whole round within the mat
mat.

EXAMPLE:
Pt. has C-curve dextroscoliosis
Pt.
assumes
quadruped
position.
Crosses the (L) UE towards UE then
hold that position for 15-30 sec. Followed
by crossing of the LE being crossed over
the (L) LE hold for 15-30 sec. This followed
by crossing over the UE over the (L)
UEholdthen lastlycross over the (L)
LE over the
th LE.
LE Cycle
C l repeats
t

for S-curve scoliosis:

Ambling
A bli walk
lk
pt. in quadruped position. Advance the UE
g the concave side followed by
y
along
advancing by the ipsilateral LE. hold is
maintained after each extremityy has been
advanced

Klapps exercise
Done
D
iin reference
f
tto the
th apex off the
th curve.
Emphasis is placed on exercise designed
f maximum
for
i
straightening
t i ht i off the
th pathologic
th l i
curves whatever their site, direction, &
magnitude
it d

T3 - sala position (lowered)

T6 on elbows (semi-lowered)
(
)

T8 on hands Horizontal quadruped)

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T11 fingertips (semi straightened)

L4 reversed position (reversed erect)

L2 erectt k
kneeling
li posn
(erect)
(
t)

Dry Swimming exercise

Beginner
Beginners
s exercise
Decrease static works of spinal muscles

1.
2.
3
3.
4.
5
5.
6.

In prone position
prone (B) UE on the sides of the body
prone; (B) UE abducted to 45
45
prone; (B) UE in reverse T posn
prone; (B) UE flying V
prone; (B) UE crossed against the nape
area

General instruction: As pt. assumes the

posn:
pt.
t lifts
lift trunk
t k off
ff the
th matt & rotate
t t the
th
trunk towards the convex side. 15-30 SH.

CAT & CAMEL

Designed to increase and improve
fl ibili off the
flexibility
h spine
i
CAT exercise performed by increasing
thoracic kyphosis
CAMEL exercise performed by
increasing lumbar lordosis

CAMEL EXERCISE

CAT EXERCISE