- What is the Scoliosis?
- It is a lateral rotatory deviation of the spine.
- In scoliosism not just the spine but also the ribs and pelvis are laterally bent, rotated and distorted. The pelvis may be torqued.
- Adolescent idiopathic scoliosis is the most common type of scoliosis and is usually diagnosed during puberty.
- Most common scoliosis in S-shape ; usually between T5 and T11(convex to the right side), and T12 to L4(convex to the left side). The apex is T8
- Female > Male
- Age of oneset : 10-15 years old
- Cause
- Idiopathic
- Neuromuscular : Cerebral palsy, muscular dystrophy
- Congenital : Spinal cord abnormalities
- Birth defects affecting the development of the bones of the spine
- Injuries to or infections of the spine : spinal cord trauma
- Types
- Functional curves = Postural
- It may be voluntarily altered or reversed by positional changes or muscular action.
- It can be corrected with passive soft tissue stretching, joint monilization and active strengthening or fix the short leg
- Structural
- They are fixed due to bony changes and cannot be corrected by positional changes or voluntary effort.
- Usually childhood onset
- correction requires bracing or sugery
- Difference between functional or structural scoliosis
- The hump on the ribs(on the convex side) will go away in functional scoliosis if the client bend over and rotate towards to the convex side.
- But, in structural scoliosis, the hump does not change.
- Functional curves = Postural
- Terminology
- Span : the distance on the spine that the curve coves(Ex, thoracolumbar curve spanning T8 to L3)
- Apex vertebra : The one that is farthest from the midline(Ex, Apex L2)
- The major curve in an S-curve : the largest curve with the greates angulation
- The minor curve : It is a smaller, compensatory curve
- Transitional vertebra : the one that makes the end of one curve and the beginning of the next
- Severity
- mild : up to 20 degrees, May be corrected with stretching and strengthening
- moderate : 20 to 50 degrees, usually treated with bracing
- severe : greater than 50 degrees, associated with decreased life expectancy in children, due to reduced pulmonary function, and osteoarthritis in adults. it is treated by surgery
- SOAP
- Symptoms
- Local muscular and ligament pain
- Decreasing pulmonary function, major concern in progressive severe scoliosis.
- Objective information
- Observation of shape of the spine
- Vertebral bodies rotate towards the convexity of a curve.
- The spinous processes rotate to the concave side.
- From a posterior view, the transverse processes and the attached ribs on the convex side are more posterior and prominent on the convex side. On the convex side the ribs are also farther apart.
- On the concave side, the transverse processes and ribs are more anterior and the ribs appear flattened in the posterior view. Ribs are closer together.
- From an anterior view, the ribs are prominent on the concave side and flattened on the convex side.
- C-curve scoliosis( ex, Right thoracolumbar functional curve)
- Rt AC joint is higher
- Rt scapular is higher
- Rt rib humping
- Lt iliac crest levels are higher
- S-curve scoliosis(ex, Right thoracic, left lumbar functional curve)
- Rt AC joint is higher
- Rt, scapular is higher
- Rt rib humping
- Rt iliac crest levels are higher
- Observation of shape of the spine
- Treatment Plan
- Due to the complexity of scoliosis, it is recommended that, after thoroughly assessing the client, the therapist know which areas are tight and stretched.
- Generally
- Convex side : muscles are overstretched
- Concave side : muscles are contracted
- https://youtu.be/wT7oeUUHLOU
- Pelvic could be only lateral tilted or only anterior/posterior rotated or together.
- Depends on client’s condition, muscles status are different.
- For tight muscles : apply heat, swedish, fascial techniques, trigger point, stretching
- For stretched muscle : apply ice or cool, stimulating techniques such as tapping, Strengthening exercise. Do not use longitudinal work or stretching techniques.
- Symptoms
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