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Understanding Non-Surgical Treatments
Spinal fusion surgery may be recommended by a spinal consultant or scoliosis specialist, as a treatment option for people with Adolescent Idiopathic Scoliosis (AIS). This decision will be based upon curve severity and stage of growth, which are used to calculate the risk of progression.
How is curve severity determined?
Curve severity is determined by measuring the sideways curvature of the spine using a standing posterior-anterior radiograph (X-ray). This measurement is known as the Cobb angle.
What is the recommended surgery threshold?
The threshold commonly used for recommending surgical intervention in those with risk of progression, is 50 degrees. However, in the United Kingdom the threshold is lower at 40 degrees. Once skeletally mature, the risk of rapid progression typically decreases, therefore monitoring, rather than surgery, is usually recommended, regardless of curve magnitude.
What can be done to avoid surgery?
Since surgery is recommended in adolescents whose Cobbs angles exceed 40-50 degrees, any intervention that is able to reduce/ stabilise or minimise the rate at which the Cobb angle progresses, will lower the change of surgery being recommended by a scoliosis specialist.
Non-invasive treatment options: can these help to avoid surgery?
Physiotherapy Scoliosis Specific Exercises (PSSE), such as the ones used at the Scoliosis SOS Clinic, are one conservative treatment option which can be used alone or alongside, other non-invasive treatments to help avoid surgery. Other conservative treatment options might include bracing, core stabilisation exercises, manual therapy and non-specific scoliosis exercises.
What are Physiotherapy Scoliosis Specific Exercises?
PSSE are a combination of individually tailored specific postural, sensorimotor and breathing exercises, that target the 3-dimensional deformities that scoliosis causes. Addressing scoliosis as a 3-dimensional condition, not only targets the sideways curvature, but also the trunk rotation and changes in the sagittal (side on) spinal balance, which occur in scoliosis too.
PSSE are prescribed by scoliosis specialists, trained in one (or more) of the following scoliosis specific treatment techniques, based in different scoliosis clinics around Europe:
- Schroth Method (Germany)
- Scientific Exercise Approach for Scoliosis (SEAS) (Italy)
- Functional Individualised Treatment of Scoliosis (FITS) (Poland)
- Lyon School of Physiotherapy (France)
- Barcelona Scoliosis Physical Therapy School (BSPTS) (Spain)
- Dobomed Method (Poland)
- Side shift Method (UK)
Although these treatment techniques differ in their approach, they all share the common goal of addressing scoliosis as a 3-dimensional condition; aiming to improve the alignment the spine, ribcage, shoulder blades and pelvis. In doing so, this reduces the muscle imbalances and asymmetrical spinal loading caused by scoliosis and can reduce the Cobb angle, or prevent/ slow progression. At our scoliosis clinic, we use a combination of the above treatment approaches, alongside other conservative treatment options, as part of our ScolioGold programme.
Which Physiotherapy Scoliosis Specific Exercises are best?
A recent extended literature review of current research investigating the effectiveness of the different PSSE treatment methods concluded that the Schroth method is the most widely studied, and hence has the best evidence behind curve regression/ stabilisation. However, both the SEAS and BSPTS techniques have proven effectiveness in stabilising or even reducing the Cobb angle. There is a call for continuation of high-quality research in this field to expand upon these findings (Seleviciene et al 2022). The Scoliosis SOS clinic employ a combination of the above techniques to enhance the beneficial effects PSSE can have on Cobb angle progression.
What about other conservative treatment options?
Other treatment options used for management of scoliosis include bracing and more general core stabilisation exercises.
Bracing
Bracing is recommended for those with a Cobb angle of between 25-40 degrees, if they are still growing. Bracing is used to exert an external force upon the spine, aiming to improve spinal alignment in all 3-dimensions and attain vertebral remodelling whilst the spine is still growing. Most commonly, bracing is prescribed to be worn upwards of 20 hours per day.
Core stabilisation Exercises
Physiotherapeutic exercises, such as core stabilisation exercises, are sometimes used to treat scoliosis. These exercises are focused on developing spinal stabilisation and core strength. This is done by controlling the deep trunk muscle in static and functional postures and functional movements.
What is the latest evidence for these conservative treatment techniques?
Schroth versus Core stabilisation Exercises
A recent review giving an update of conservative treatment options for AIS concluded that Schroth exercises were superior to core stabilisation exercises for reducing Cobb angle and angle of trunk rotation, and improving spinal mobility, cosmetic appearance and quality of life. Core stabilisation exercises were found to more effective for increasing peripheral muscle strength and reducing pain and vertebral rotation (Blachnio et al 2024). At Scoliosis SOS clinic, we recognise the individual benefits that both Schroth and core stabilisation exercises have, which is why both of these techniques are included in our ScolioGold approach.
Bracing and surgery avoidance
A large, recent systematic review reported that in those who are compliant with their bracing prescription, bracing has a positive affect on curve regression. The degree of compliance has a big impact on the outcome of this regression, where non-compliant patients are much ore likely to exceed surgery threshold (Tang et al 2024).
Bracing versus combined PSSE and bracing.
Several studies have reported bracing combined with PSSE has a higher Cobb angle reduction rate, when compared with bracing alone or bracing alongside non-scoliosis specific exercise (De Silveira et al 2022; Gao et al 2019; Catanzariti et al 2024). Additionally, a systematic review by Tang et al (2024) concluded that bracing combined with PSSE for those with 40-60 Cobb angles, can halt or even improve their angles. This indicates that the addition of PSSE to a bracing programme, may be superior to bracing alone, in reducing the chance of progression to surgery threshold, and preventing progression in those with curves over surgical threshold. At Scoliosis SOS Clinic, we work with many patients who are undergoing brace treatment, prescribing scoliosis specific exercises to complement their bracing prescription.
Find out more about non-surgical scoliosis treatment with an initial consultation at Scoliosis SOS.
📞 02074884428
🌐 www.scoliosissos.com
📷 @scoliosissosclinic
📧 enquiries@scoliosissos.com
📍 63 Mansell Street, London, E1 8AN (headquarters)
References:
da Silveira GE, Andrade RM, Guilhermino GG, Schmidt AV, Neves LM, Ribeiro AP. The Effects of Short- and Long-Term Spinal Brace Use with and without Exercise on Spine, Balance, and Gait in Adolescents with Idiopathic Scoliosis. Medicina (Kaunas). 2022;58(8). doi:10.3390/MEDICINA5808102
Gao C, Zheng Y, Fan C, Yang Y, He C, Wong M. Could the Clinical Effectiveness Be Improved Under the Integration of Orthotic Intervention and Scoliosis-Specific Exercise in Managing Adolescent Idiopathic Scoliosis?: A Randomized Controlled Trial Study. Am J Phys Med Rehabil. 2019;98(8):642-648. doi:10.1097/PHM.0000000000001160
Blanchnio K, Kopcial S, Piecuch D, Hanczyk E. Conservative treatment of adolescent idiopathic scoliosis (AIS): A narrative review of current evidence and implications for clinical practice. Quality in Sport. 2024. 22:54352. eISSN 2450-3118. doi: 10.12775/QS.2024.22.54352
Souder C, Newton PO, Shah SA, Lonner BS, Bastrom TP, Yaszay B. Factors in Surgical Decision Making for Thoracolumbar/Lumbar AIS: It’s About More Than Just the Curve Magnitude. J Pediatr Orthop. 2017 Dec;37(8):e530-e535. doi: 10.1097/BPO.0000000000000746. PMID: 26945244.
Seleviciene V, Cesnaviciute A, Strukcinskiene B, Marcinowicz L, Strazdiene N, Genowska A. Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice. Int J Environ Res Public Health. 2022 Jul 28;19(15):9240. doi: 10.3390/ijerph19159240. PMID: 35954620; PMCID: PMC9368145.
Tang S, Cheung JPY, Cheung PWH. Effectiveness of bracing to achieve curve regression in adolescent idiopathic scoliosis. Bone and Joint Journal. 106-B (3), 286-292. doi: 10.1302/0301-620X.106B3.BJJ-2023-1105.R1
