20 March 2019
Patients often ask our scoliosis physiotherapist questions about which lifestyle changes they can make to slow the progression of their curve and get the most from bracing treatment. Other patients want to know which activities, habits and exercises to avoid may exacerbate their curve.
Below are some of the most common questions asked by patients undergoing treatment, with LOC’s Schroth Certified BSc. CSP and HCPC registered physiotherapist Deborah Turnbull here to answer them.
Yes, definitely! Apart from being good for your general health, exercise and physiotherapy should be an integral part of any non-surgical scoliosis treatment package. Every exercise programme we prescribe at LOC is created uniquely for each individual’s postural compensations and flexibility. There’s no one-size-fits-all approach as each set of exercises is based on each patient’s curve-specific pattern and tolerance.
This entirely depends upon the patient’s age, the issue being addressed (i.e. appearance, pain, curve progression, avoidance of surgery) and tolerance and flexibility of exercise. Schroth method-based exercises can address all these issues. If they are teenagers and going through bracing treatment, Schroth Best Practice exercises are the most effective, but other Schroth-based exercises may help non-braced patients also.
Firstly, there’s no evidence that general physiotherapy is any benefit to scoliosis patients. The specialist physiotherapy techniques we prescribe work in tandem with the over-corrective Gensingen Brace, normalising the posture through static, dynamic and stabilising control. These techniques use gravity to the body’s advantage in gaining and maintaining spinal corrections through over-corrective positions.
These programmes are curve-pattern specific and are individual to the patients’ own postural compensations and flexibility. They are designed to address the patient’s main concerns and increase the length of the muscles, reduce rotational humps and prevent curve progression. For patients with small, immature curves, Schroth-based exercises have been shown to help reduce the deformity, even without bracing.
For patients with larger thoracic scoliosis, rotational breathing can help de-rotate the scoliotic curve and stretch the muscles between the ribs. Patients learn to use rotational breathing to add to three-dimensional corrections and to reduce rib cage deformity.
In the juvenile and adolescent age groups, hypermobility is much more common than stiffness. A specialist physiotherapist should always advise you on activities relating to your specific needs.
Multiple studies indicate that individuals who are hypermobile, i.e. their joints move beyond the normal range of motion, are more likely to suffer from scoliosis and exhibit a sway back or scoliotic posture. Sometimes increased flexibility can be brought on by over-exercise at a young age which can increase the likelihood of generalized joint hypermobility and scoliosis.
In my experience of over 12 years working as a specialist physiotherapist with scoliosis patients, this young patient group have too much mobility in their joints and generally lack stability. Therefore, it would be good to invest time in sports and exercises that encourage strength conditioning and help to strengthen the stabilizing muscles.
The types of sports I tend to recommend are those that improve spinal extension; netball, basketball, rock climbing for example, all increase extensor strength when done regularly (extensors being the muscles that keep us upright against the force of gravity).
Sports and activities that increase flexibility (which might not be prescribed for patients with hypermobile joints) include gymnastics, pilates and yoga. These are especially good for inflexible, stiff adult patients and those over the age of 15. There are benefits in increasing core strength with these activities, but they do not aim at increasing spinal extension and stability.
The brace should be removed during sports, especially contact sports to avoid the risk of damage.
For children, some activities can worsen or aggravate their spinal deformity. Sports to avoid include trampolining, which increases the forces of gravity on a curved spine and can compress it further. Other activities like cycling and rowing are sitting sports, therefore more likely to compress the spine and are not as beneficial as standing, running and extension-based sports.
Trampolining is one of the only sports we advise against for scoliosis sufferers, especially children.
Patients that continue to participate in sports often generally have less progression in their overall condition. At LOC, we feel that if a child loves an activity or sport, they shouldn’t be restricted from enjoying it (with the exception of trampolining). Encouragement and opportunity to participate in extension sports as a child can develop into a healthy active lifestyle choice. Bone health and weight bearing exercises become more important as a person with scoliosis ages.
My results are amazing and unexpected, and I am glad that I received the brace through LOC. I am still wearing the brace 18 months later and my back feels even straighter. Thanks to LOC I realised that I wanted to help people with similar if not the same condition as me, so I am now going to Salford University in September to study Orthotics and Prosthetics so I will hopefully be able to help others with Scoliosis as much as LOC has helped me.
If you say something is going to be easy it will be easy and if you say something will be hard it will be hard. So, I'm just going to say that wearing my brace is easy. And as it turns out, it really is.
Sally and Debs have helped remove the stress from our situation. They have given us hope based on their extensive knowledge and expertise.
I had my brace fitted and I was also given a personalised exercise programme to help with my 3D rotation. Not only was I wearing this new brace but I still had my pectus brace on and the amazing orthotists managed to combine the two so they worked together. I really struggled with this at first; however, I kept going and now I’m really glad I did. My scoliosis overcorrected by 10 degrees and I was able to reduce my scoliosis brace wear to 16 hours a day within 6 weeks.
Don’t wait. It’s about the children because they are more likely to be confident in their late teens if you act quickly and support them. We have been lucky because we understand the condition well. That’s one of the main things, to be honest. It was hard work, but it pays off in the end.
I finally found that I had arrived at the right place and something was actually being done.
My pain levels are hugely improved, my ribs were tender and now they are not. My brace was made individually for me. It’s not one size fits all and, if it is not completely perfect, LOC alters it on the spot. I was so surprised that I could wear the brace under my clothes, I did not need to go and buy anything, I just wear loose tops.
The brace is very light. Obviously, the first couple of days we were told it was going to be uncomfortable for her, I bought so many pillows! But although the first night was not very comfortable, the second night she got used to it and then she was wearing it all day long and I thought ‘that’s brilliant!’ She was only taking it off for two or three hours to go out with friends or do the exercises, but she didn’t have any problems really.
Debs and Sally are fantastic. I mean, they’ve become like family now. They are extraordinary people and do such good work with these kids, both of them, it’s fantastic. The whole experience has been very good. They make you feel welcome from the beginning, and you can ask as many questions as you want, and they answer everything. If you have a problem they give you their personal mobile so you can just call them if you have a problem and they’ll solve it straight away. I’m very pleased with the treatment, the people, with everything.
She’s wearing the brace all the time now and she’s doing very well. She’s very good at school too, the brace doesn’t get in the way of anything. It fits underneath her school uniform and you can’t see it. Sometimes I even have to ask her when she’s sitting down if she’s wearing it because I can’t see it! She says ‘of course mummy’ and I say ‘let me try!’ I have to knock through the clothes and only then can I hear she’s wearing the brace!
Obviously, the results speak for themselves. I would definitely credit LOC, but if I were to give any advice [to parents in a similar position] it would be to contact Debs and Sally. Ricarda likes it there, she loves the people like Debs and Sally and felt really comfortable, everything was really relaxed and nice. She worked really hard during training with Debs who kept saying that Ricarda was such a workhorse!
Swimming is great for rib cage flexibility (if rib cage deformity is an issue) and improves general strength though it involves little weight-bearing, so there’s not much benefit to the bones. The technique is important here and it’s best to work with a good swimming instructor initially to avoid poor neck posture. Butterfly stroke may contribute to poor back posture by arching the upper back.
We believe in the capacity of orthotics to intervene in the progression of scoliosis and prevent surgery in later life, that’s why we use the corrective Gensingen Brace by Dr Weiss® and Schroth-based physiotherapy to treat scoliosis patients. A full specialist physiotherapy assessment is carried out with each patient to establish the most appropriate treatment, according to their spinal flexibility, age and the patient's main concerns i.e. whether they want to avoid surgery, help with pain management or simply halt their curve progression and improve their appearance.
We also offer small group physiotherapy sessions for adolescent scoliosis patients every other Saturday at our Kingston clinic. You can make an appointment at any clinic by calling 020 8974 9989.
The operation used to treat severe scoliosis curves is typically spinal fusion surgery; a major procedure that involves moving muscles and realigning the skeleton into place. The curved, deformed vertebrae are fused together into a single bone, putting metal screws and rods into the spine to help straighten it. Surgery typically lasts between 4 and 8 hours depending on the severity of the curve. Bone graft is then taken from other parts of the body and used to cover the implants.
Following the operation, it is necessary to spend around a week in intensive care before returning home and the first few days are often uncomfortable. Most adolescents can expect to return to school from 2-4 weeks following surgery, but pain medication may be required up to 6 weeks following. A full recovery from the procedure can take up to a year, as it can take that long for the spine to heal fully.
Spinal fusion surgery causes the fused portion of the back to become permanently stiff, as a result, returning to sports that require large amounts of flexibility (ballet, yoga, gymnastics, dance) or contact (rugby, football, karate, hockey) may take longer.
Risks of spinal fusion surgery are like that of any other major procedure and include infection, blood clots and anaesthesia complications. The added risks include permanent nerve damage to the spine and paralysis.