The Scoliosis SOS Clinic was founded by Erika Maude on 29 May 2006 - which means we're 13 today!

We've achieved a lot in the last 13 years. Here are just a few highlights:

• We've made Schroth method-based scoliosis therapy readily available to people in the UK
• We've relocated from Suffolk to London in order to make our treatment courses more accessible
• We've treated scoliosis patients from all over the world
• We've presented scientific research at a number of international scoliosis conferences
• We've won a Queen's Award for Enterprise
• We've received a lot of news coverage and even appeared on national TV!

Most importantly, though, we've helped thousands of people with scoliosis to take control of their condition, keep doing the things they love, and - in many cases - completely avoid undergoing spinal fusion surgery.

We'd like to say a huge THANK YOU to all the patients (and their families) who have visited the Scoliosis SOS Clinic over the past 13 years. It's been a huge honour to meet and help so many of you - long may it continue!

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The history of scoliosis therapy can be traced all the way back to ancient Greece.

More specifically, scoliosis treatment has its roots in the 5th century BC and one man in particular: Greek physician Hippocrates (c. 460 – 370 BC).

Who was Hippocrates?

The mid-to-late 5th century BC was a turbulent time for the Hellenic people.

From 431 to 404 BC, the country was entrenched in a titanic war between the Delian League of Athens and the Peloponnesian League of Sparta. Meanwhile, Athens was also suffering from a devastating plague, which wreaked havoc in the city periodically between 430 and 426 BC.

In short, it was a dark time for Greece. But this was also the period that gave us Hippocrates, often referred to as the 'father of medicine'.

Born on the island of Kos around 460 BC, Hippocrates was the son of a physician and is believed to have learned the trade from his father. Among his long list of medical achievements, Hippocrates is heralded as the first person to theorise that diseases and ailments were caused by environmental factors and not the result of superstition or an act of the gods.

He's also the namesake of the 'Hippocratic Oath': the pledge taken by doctors declaring their moral and ethical obligations to their patients as medical practitioners.

Hippocrates and Scoliosis

Separating medicine from religion would probably have been enough on its own to secure Hippocrates's place in history, but his achievements go far beyond that. Notably, he was also a key figure in the history of spinal treatment, and he is believed to have been the first physician to focus on the anatomy and pathology of the human spine.

Through his revolutionary study of the spinal structure and vertebrae, Hippocrates's work led to the pioneering identification of many spine-related diseases – including scoliosis.

Hippocrates is commonly credited as the person who coined the term 'scoliosis' and the first to try treating this condition.

Hippocratic Scoliosis Treatment

From his unprecedented study of orthopaedics, Hippocrates created three pieces of equipment to treat spinal ailments: namely the Hippocratic ladder, the Hippocratic board, and the Hippocratic bench.

Hippocratic Ladder

Intended to reduce spinal curvatures, the Hippocratic ladder treatment required the patient to be elevated and tied to the ladder upright or head down (depending on the where the curvature lay). The patient would then be shaken on the ladder, with the gravitational pull theoretically straightening the spine.

Hippocratic Board

Similar to the ladder, treatment via the Hippocratic board involved the patient being tied to the board; however, this time, the patient was required to be prone, lying face down and flat. The physician would then apply pressure to the affected area of the spine using a hand, foot, or even the entire weight of the body.

Hippocratic Bench

Also known as the Hippocratic scamnum, the bench technique saw the patient lie face down on a bench similar to the board technique above. A smaller wooden board was then inserted into a pre-made hole in the wall, leaving the plank protruding out above the patient's back. An assistant would then apply pressure on the end of the plank while the physician manoeuvred the board along the body.

Like many ancient treatments, these techniques naturally seem archaic, even barbaric by today's standards. Nevertheless, these apparatuses – based on the principles of axial traction and three-point correction – were hugely innovative at the time, and they had a profound influence on the direction of spinal treatment to follow.

Luckily, medical science has come a long way since the days of Hippocrates, and there are now a variety of comfortable and safe non-surgical scoliosis treatments available. At Scoliosis SOS, our team of friendly, skilled therapists offer patients specialised scoliosis treatment that's specifically designed to enhance your quality of life.

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Menopause usually occurs between the ages of 45 and 55, although it can come earlier or later. Symptoms of the menopause can be quite unpleasant at times; many women experience hot flushes, night sweats and depression (to name a few).

The arrival of the menopause also tends to trigger a loss of bone density. This is known as osteoporosis, and unfortunately, it can increase your risk of developing a curvature of the spine - especially if you already had bad postural habits.

Retaining your bone strength

There are a few ways to slow down the rate at which your bones weaken once you've reached menopause. The NHS recommend:

• Exercising regularly
• Eating a healthy, nutrient-rich diet
• Increasing your vitamin D levels (i.e. spending more time in the sun)
• Stopping smoking
• Reducing your alcohol intake
• Taking calcium / vitamin D supplements

Treating your scoliosis

Even if you do all the things listed above, you may still find that your spine is developing a curve. The good news is that there are plenty of different treatment options that can help you to improve the look and feel of your back.

Read our Scoliosis Treatment in Adults blog to see some of the different treatment options that are available at this stage of life. Most often, you will be offered one or a combination of the following treatments:

• Physiotherapy
• Hydrotherapy
• Pain Management
• Spinal Surgery

What do we have to offer?

Here at the Scoliosis SOS clinic, we have treated lots of women who were suffering from adult degenerative scoliosis. Our exercise-based ScolioGold therapy programme is tailored to each patient's scoliosis curvature so that we can help them to achieve their specific treatment goals.

Our physical therapy courses may be able to:

• Relieve pain in your back
• Boost your mobility / flexibility
• Reduce the visibility of your curvature

If you have any questions about scoliosis treatment, please feel free to get in touch with our specialist team, who will be able to advise you on the best course of action.

Enquire About ScolioGold Treatment Today >

As we've discussed on this blog previously, scoliosis is generally not considered a life-threatening condition. A curved spine can cause a great deal of pain and discomfort (among other complications), but cases where the patient's very life is at risk are vanishingly few and far between.

Leaving out the risk of suicide - see Scoliosis and Depression - the only exceptions occur when scoliosis is allowed to progress to the point where the body is so distorted that vital organs can no longer function properly.

Can scoliosis affect your heart?

In the vast majority of cases, no. If your condition is closely monitored and treated in a timely manner, you should never come anywhere near the point where your scoliosis begins to cause heart problems.

Theoretically, however, scoliosis can affect the heart if the curvature goes untreated and progresses unabated over an extended period of time. A severely curved spine can distort the rib cage, and a severely distorted rib cage can leave the heart and lungs with too little room to beat / inflate.

Thus, heart failure is a possible outcome of severe progressive scoliosis - but again, it's important to bear in mind that is an extremely rare occurrence.

Treat your scoliosis early!

The symptoms and complications associated with scoliosis vary enormously from one patient to the next - pain isn't always proportional to the angle of one's curve - but nevertheless, it's always better to catch the condition early and seek treatment right away than to let it progress.

Here at the Scoliosis SOS Clinic, we provide non-surgical scoliosis therapy for patients of all ages and curves of all sizes. Here's an example of a patient who came to us for early (almost pre-emptive) treatment after her older brother ended up requiring spinal fusion surgery:

Call Scoliosis SOS on 0207 488 4428 or use the links below to find out more about our ScolioGold treatment courses.

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Erika Maude, our Clinic Principal, delivered a scientific presentation to the 2019 SOSORT conference in San Francisco last week.

Watch the video below to see her presentation in full.

Video Transcript

Erika Maude: Hello everybody, and thank you for having me along today. This is a continuation of the research that my colleague Jason Black first presented in Lyon two years ago looking at the cost-effectiveness of exercise therapy for adults with scoliosis.

Introduction - Health Economics

Adult patients with idiopathic scoliosis have been shown to present with impaired health-related quality of life. Therefore, in health systems globally, a key objective of treatment is to improve quality of life whilst maintaining cost-effectiveness. The cost-effectiveness of PSSEs [physiotherapeutic scoliosis-specific exercises] has not been researched, and thus conclusions about whether or not they are a viable economic alternative to surgery or bracing for healthcare systems cannot be made.

In the UK, the National Health Service offers spinal fusion surgery as the only treatment for adults with idiopathic scoliosis. They treat about 360 cases per year, each costing £24,853. Under cost-utility analysis, cost-effective analysis estimates the cost of treatment. It is used to inform funding decisions based on the benefit of treatment versus how much it costs. It requires extrapolation of data because it estimates the lifetime benefits of treatment.

Introduction - QALYs

The primary outcome of cost-utility analysis is the cost per quality-adjusted life year, or 'QALY' for short - otherwise known as the incremental cost-effectiveness ratio, which I'll come onto a bit more in a moment. QALYs analyse both the quality and the quantity of life years, where (rather morbidly) 0 equals death and 1 equals perfect health. QALY are accumulative, and thus a 0.2 QALY improvement lasting for 5 years equals 1 QALY for the patient.

The ICER [incremental cost-effectiveness ratio] is calculated as the difference in the expected cost of Intervention A compared to Intervention B divided by the difference in the expected QALYs produced by Intervention A and Intervention B. Generally, it is considered that the interventions costing the UK's National Health Service less than £30,000 per QALY gained are deemed to be cost-effective.

Introduction - EQ-5D

The EQ-5D is the measure preferred by the UK's National Institute of Clinical Excellence [NICE] for comparing cost-effectiveness. It's a descriptive system, and it defines health-related quality of life in terms of five dimensions:

• Mobility
• Self-care
• Usual activities
• Pain and discomfort
• Anxiety and depression

Responses to each of these dimensions are divided into three levels (1st, no problems; 2nd, some to moderate problems; and 3rd, severe to extreme problems), thus generating a total of 243 possible health states. On the left is an example EQ-5D form, which can only be used with licensed permission.

Objectives

The aim of this study was to explore the cost-effectiveness of physiotherapeutic scoliosis-specific exercises for adult patients with idiopathic scoliosis using an intensive, group-based therapy approach.

Method

183 consecutively-recruited UK-based adult patients (with an average age of 38.5 years at the start of treatment) attending the Scoliosis SOS Clinic in London for intensive ScolioGold treatment filled out the EQ5D5L questionnaire at 5 different time points:

1. Before treatment
2. After treatment
3. 6 months check-up
4. 12 months check-up
5. 18 months check-up

The EQ-5D results were then converted into QALYs using assumptions about the duration of treatment effect. A linear regression model was then used to statistically analyse the results.

Results - Response Rate

Due to the method of data collection, consecutive nature of patient recruitment, and time limitations imposed by the 3-year EQ5D5L licence, 100% of the participants completed the questionnaire pre-treatment, 91% immediately post-treatment, 68% at their 6-month check-up, with 51% at both 12- and 18-month check-ups.

Results - EQ5D5L Scores

Before treatment, the average EQ-5D score was 0.773, and immediately after treatment, this increased to an average of 0.881. At 6 months, the average was 0.862, and at both 12 and 18 months check-up, the average was maintained at 0.863. All of these changes were statistically significant.

Results - Calculation of QALYs

Although patient scores were statistically much improved at 12 and 18 months post-treatment, due to the fewer number of patients who reached the later time points, reliable data was only available up to 6 months following treatment, and therefore an assumption on the persistence of the treatment effect is required for later time points. To look at both extremes: assuming that the treatment benefit ended after just six months, additional QALYs were 0.045, which means that the ICER would be £90,000 per QALY. However, assuming that the treatment effect continued for 43.8 years (the average life expectancy of the patients in this study), then additional QALYs were 3.899, meaning the ICER would fall to just £1,000 per QALY.

Therefore, to meet NICE's requirements for health economics, the effects of treatment would need to persist for 1.5 years.

Conclusion

In conclusion, EQ-5D results improved with PSSE in adult patients with idiopathic scoliosis. If the treatment effect of the PSSEs persists for only 1.5 years, it is expected to be cost-effective in UK-based adults. Further long-term research is required to start planning for PSSE to become available within national healthcare services; with publication of these results, we hope to highlight that the input of physiotherapy in this patient group should warrant funding.

Limitations

We are aware that there are several limitations to this study, namely lack of a control group, limited long-term follow-up, and no data on cost savings from exercise therapy.

Thank you for listening.

More Scoliosis Research >   About Erika and the Team >