Physical Therapy Scoliosis Management [Infographic]

Scoliosis is a condition that affects the normal shape of the spine, altering a person’s back alignment and posture and causing a lateral curvature of the spine. The abnormal curvature of the spine can place stress on the surrounding muscles and joints, causing loss of strength and flexibility in the spinal and back muscles over time. Physical therapy is an effective, non-invasive treatment method to manage scoliosis, stabilize the scoliosis curve, improve postural alignment, enhance neuromuscular control and muscular strength, and improve overall function in individuals with scoliosis.

FAQ on Scoliosis

Scoliosis is a condition that affects the normal shape of the spine, altering a person’s back alignment and posture and causing a lateral curvature of the spine. Those with scoliosis may have an “S” curve, meaning their lower lumbar spine curves one way and their middle thoracic spine curves the opposite direction; others may have a “C” curve, where the lumbar and thoracic spine curve in one direction together. As the spine curves laterally, the vertebrae of the spine rotate slightly.

There are three types of scoliosis. The most common type is adolescent idiopathic scoliosis (AIS) that accounts for 80% of cases. The cause is unknown and typically develops during adolescence (ages 10-18). Congenital scoliosis presents at birth and occurs due to abnormal spinal development in utero, usually associated with spinal malformations or fused vertebrae. Neuromuscular scoliosis develops from muscle imbalances, weakness, or abnormal control caused by an underlying neurological condition, such as cerebral palsy or muscular dystrophy.

Symptoms of scoliosis can include:

• Uneven shoulder height

• Uneven hip height

• Uneven waistline

• Bony bump on one side of the back

• Appearance of a difference in leg length

• Pain around the spine and areas like the shoulder, pelvis, or hip

• Mild or low back pain

• Sense that the two sides of the body are not symmetrical

• Difficulty maintaining upright posture

• Difficulty breathing or shortness of breath

A doctor typically diagnoses scoliosis using an x-ray to assess the spinal curvature and the Cobb angle. The Cobb angle is a measurement of the spine’s curvature that determines if scoliosis is present and its severity. The level of severity of the scoliosis varies according to the degrees of curvature: 25 degrees is considered mild scoliosis; 25 to 45 degrees is moderate scoliosis; and 45+ degrees is severe scoliosis.

Physical Therapy Management of Scoliosis

Physical therapy is an effective, non-invasive method to manage scoliosis, stabilize the scoliosis curve, improve postural alignment, enhance neuromuscular control and muscular strength, and improve overall function in those with scoliosis. Research has shown that physical therapy can reduce curvature progression and improve functional outcomes for scoliosis patients.

The physical therapist initially conducts a thorough evaluation, assessing posture, spinal and extremity range of motion, strength, and balance, pulmonary function, and functional mobility, before designing a customized exercise therapy program for the scoliosis patient. The aim of physical therapy management of scoliosis is to decrease side-to-side curvature, slow curve progression of the spine, improve breathing function and muscular balance, decrease pain and stress on the back, and enhance posture.

Physical therapy treatment for scoliosis can include:

• Pain management using modalities like ice, heat, electrical stimulation, or deep heat ultrasound to relieve back pain

• Manual therapy using joint and soft tissue mobilizations to help restore mobility to joints and muscles that have been restricted by scoliosis and retrain movement patterns

• Patient education involving movement strategies to manage the condition, particularly during activities of daily living

• Postural and body mechanic training to improve asymmetry of the trunk musculature and teach the patient proper movement patterns and body mechanics for optimal movement

• Range of motion exercises of the spine to expand spinal muscle mobility

• Core stabilization exercises to stabilize the lumbar spine and pelvis to decrease pain and  provide support to the spine

• Targeted strengthening exercises of the spine to address muscular imbalances in the back. Strengthening exercises can also include areas of the body that may have been weakened by scoliosis like the hips and shoulders

One of the most well-known physical therapy exercise programs for scoliosis is the Schroth Method, which involves specific exercises in all three planes of movement to treat the scoliosis patient’s specific curvature. Research has shown that the Schroth Method can reduce trunk rotation angle and pain and improve the patient’s overall respiratory function and quality of life. The Schroth method focuses on restoring muscular symmetry through targeted stretching and strengthening exercise, rotational angular breathing to rotate the spine, and postural awareness for correct body mechanics.

A recent research study found that targeted spinal exercises were effective in decreasing the Cobb angle of the spine in the experimental group. A randomized controlled trial assessed 110 male and female patients under the age of 10, 55 of whom were assigned to an experimental group who underwent active self-correction, task-oriented spinal exercises, and patient education and 55 of whom were assigned to the control group, who followed conventional spinal exercise rehabilitation. The experimental group showed a decrease in the Cobb angle of the spine by more than 5 degrees, while the control group remained unchanged. Benefits persisted at least a year following the intervention in the experimental group.

Scoliosis is a condition requiring lifelong management. Work with a physical therapist to help you manage the condition and maintain function and mobility safely!