Table of Contents
Introduction
Hello everyone, my name is Claire and I’m a physical therapist who specializes in helping adolescents manage their scoliosis. I’ve been in this field for over 15 years now and have seen many young patients learn to live well with their condition through exercise and proper management techniques.
Adolescent scoliosis is a common spinal deformity that can begin to develop during the growth spurt of puberty between ages 10-15. During this time, the spine is still growing and developing which makes it vulnerable to curving sideways (laterally) in the thoracic and lumbar regions. While the cause of scoliosis is usually unknown, genetics do play a role. Female adolescents are also 2-3 times more likely to develop scoliosis compared to males.
In this post, I want to share more about what adolescent scoliosis is, how it is diagnosed, various treatment options with a focus on exercise-based scoliosis management therapy and techniques you can try at home. My goal is to empower families living with this condition by providing helpful information to proactively manage scoliosis and live an active lifestyle.
Let’s get started!
What is Adolescent Scoliosis?
Adolescent scoliosis refers to a sideways curvature of the spine that develops during the growth spurt of puberty. The spine normally has a slight inward curvature at the thoracic region (upper back) and a reverse curvature at the lumbar region (lower back). Scoliosis causes an abnormal lateral (sideways) curvature or ‘S’ shape of the spine.
There are three main types of adolescent scoliosis:
- Idiopathic scoliosis – This is the most common type accounting for 80-85% of cases. The cause is unknown but there is usually a genetic component or family history.
- Neuromuscular scoliosis – Develops secondary to neurological conditions like cerebral palsy or muscular dystrophy which affect muscle tone.
- Congenital scoliosis – Present at birth and caused by abnormalities in the formation of the spine during fetal development.
In adolescent idiopathic scoliosis, the degree of curvature is classified using the Cobb angle method where x-rays are used to measure the most angulated vertebrae. A curvature less than 10 degrees is considered minor, 10-25 degrees is mild, 25-40 degrees is moderate, and over 40 degrees is severe. The goal of treatment is to prevent moderate to severe curves from progressing.
Early Signs and Diagnosis
Some early signs that may point to adolescent idiopathic scoliosis include:
- Uneven shoulders or hips while standing
- Prominence of one hip bone or shoulder blade compared to the other side
- Leaning to one side
- Rib bump on one side of the back
- Looking lopsided from behind
A physical therapist or orthopedist will do a clinical examination including:
- Inspection for signs on standing and bending forward
- Evaluating the rib hump and spine alignment
- Measuring any existing curve using a scoliometer to detect angles greater than 5-7 degrees
- Ordering x-rays to accurately measure the Cobb angle if curve is suspected
Screenings are routinely done in schools at ages 10, 12 and 14 to catch the condition early before curves have a chance to progress significantly. Early detection and treatment gives the best results.
Treatment Options
The main goals of treatment are to stop curve progression, prevent deterioration of posture and spinal balance, and minimize future medical intervention needs as the child grows. Treatment depends on the Cobb angle measurement and may involve:
- Observation only for minor curves less than 25 degrees
- Bracing for curves between 25-40 degrees
Braces like the Boston brace or Milwaukee brace aim to correct posture and prevent progression during growth. Compliance with at least 23 hours per day of bracing is important.
Spinal fusion surgery for severe curves over 40-45 degrees
This involves fusing the spinal bones to stop growth in the curved section. It is only considered if bracing fails and curve worsens beyond safe limits.
Exercise therapy
Specific active self-correction and spinal stabilization exercises aim to train posture muscles. When done correctly, exercises alone can successfully manage mild to moderate curves in many cases without need for bracing.
I will discuss exercise-based scoliosis management in more detail later in this post. But first, it’s important to understand how scoliosis can affect daily activities and quality of life if left unmanaged.
The Impact of Adolescent Scoliosis
Beyond the potential cosmetic aspects, an untreated or progressive scoliosis curve during growth spurts can negatively impact overall health and wellbeing in these key ways:
- Back pain – As curves worsen, they put increased pressure and strain on muscles, ligaments and joints leading to discomfort and pain in the back and shoulders.
- Pulmonary function – Large thoracic curves over 60 degrees may compress the lungs and rib cage limiting full expansion. This can potentially cause shortness of breath, especially during exercise.
- Fatigue – Back muscle imbalances from scoliosis require more energy to support the spine leading to easy tiredness.
- Daily activities – Activities like sports, carrying backpacks, maintaining good posture for long periods like during school can be difficult. This affects activity levels.
- Self-esteem – Visible spine deformity can impact self-perception and confidence especially during the teenage years.
- Future health issues – Severe untreated curves have a higher likelihood of developing arthritis, traction spurs, and spinal stenosis in adulthood.
So in summary, proactive management early on aims to minimize scoliosis impact on physical, pulmonary and emotional wellbeing during growth and long term. The potential challenges also underscore the importance of following treatment for best outcomes.
Exercise Therapy for Scoliosis Management
As a physical therapist who has successfully treated many adolescents through exercise-based techniques alone, I believe a structured scoliosis-specific exercise program can be very effective when combined with good bracing compliance or used independently for milder curves.
The key principles behind scoliosis exercises are:
Active self-correction
Specific back stretches help the patient consciously become aware of their asymmetrical spinal posture and learned muscle patterns. Gentle stretches are performed while visualizing straightened alignment.
Core and back strengthening
Targeted low-impact exercises condition the paraspinal, abdominal and shoulder girdle muscles to better support the spine. Planks, bird-dogs, supermans, and shoulder/scapular exercises are commonly prescribed.
Spinal stabilization
Posture-intensive activities like Tai Chi, yoga or Pilates work on maintaining corrected positioning during functional movements.
Postural re-education
Simple reminders are provided to reinforce proper standing, sitting and sleeping postures throughout the day. Clothing, backpacks, and orthotics may help.
Psychological support
Positive reinforcement emphasizes learning healthy posture habits rather than focusing on curves. Support groups help with treatment adherence and build self-confidence.
Regular adherence to a home scoliosis exercise program under a physical therapist’s guidance is key. These self-care techniques aim to strengthen the spine’s ability to bear weight correctly, interrupt the vicious cycle of muscle imbalances, and stabilize posture alignment over time.
While research studies on exercises alone managing curves are still emerging, my clinical experience over 15+ years shows exercises can successfully:
- Maintain mild 10-20 degree curves that would otherwise require bracing with progressive exercises.
- Stabilize moderate 20-30 degree curves when combined with bracing part-time instead of full-time wear.
- Improve spinal mobility, muscle symmetry, posture and reduce back pain reports in many patients.
I therefore strongly recommend including an exercise component as part of a multidisciplinary scoliosis treatment approach where possible. With dedication, positive results can be achieved naturally without surgery through exercise and bracing alone for curves under 35 degrees.
Let me now share some specific scoliosis exercises clients can try incorporating into a home program. Remember to always check with your treating medical team first before starting any new activity.
Sample Scoliosis Exercise Plan
WARM UP – 5 minutes of light stretching or walking in place to prepare muscles before starting the following dynamic exercises:
STRETCHES
- Standing side bend stretch – Gently lean sideways reaching opposite arm up and look up to stretch back muscles. Hold for 30 sec each side x2.
- Cat/Camel – 4 way spinal extension/flexion to improve mobility. x10 reps
CORE STRENGTHENING
- Plank – Front or side planks with proper spinal alignment holding 30-60 seconds x 2.
- Bird-Dog – On hands and knees lift opposite arm and leg. Hold x 10 each side.
- Supermans – Lie prone with hands by ears, lift chest and legs off floor simultaneously. Hold x 10.
BACK STRENGTHENING
- Single kneeling rows with exercise band – Keep spine straight as you pinch shoulder blades back and down. x 10 each side.
- Reverse flyes with light weights – Seated with straight spine, lift arms out to sides like wings. x 10 reps.
- Exercise works by re-educating the muscles that control spinal alignment. Imbalances develop over time as the curve progresses, and exercises help “retrain” the muscles to support the spine properly again.
- Specific scoliosis exercises also stretch and strengthen the back to improve mobility and circulation. This relieves tension that can otherwise cause pain.
- Core stabilization is key, as a strong core literally forms the foundation for good posture. Plank variations are especially effective at building the deep muscles around the spine.
- Proper form and technique must be taught for each exercise to work the muscles correctly. Having an experienced physical therapist design the program and monitor progress is important.
- Consistency is difficult but critical for success. Most patients see curve stabilization within 3-6 months of regular physiotherapy and home exercise routines.
- Layering different types of exercises—stretches, strength training, yoga—makes the routine more enjoyable to stick to on a long-term basis.
FAQs
FAQ 1: How do I know if my child needs to see a doctor about their scoliosis?
Look out for early signs like uneven shoulders, shoulder blades that stick out unevenly, or a visible curve in the spine. You can do a simple back check by asking your child to bend forward at the waist with their back exposed. Check for any evident curves. If you notice anything abnormal, it’s best to see your pediatrician or orthopedist who can further examine and refer for x-rays if needed. Early diagnosis gives more treatment options.
FAQ 2: How often should my child do their scoliosis exercises?
Most physical therapists will prescribe exercises to be done daily, even on rest days from school sports. A good guideline is 2-3 times per day, totaling 30-45 minutes each session. Consistency is key for exercises to slowly correct posture alignment habits over months. Stretches and stabilization moves like Pilates or yoga can be added into the daily routine seamlessly.
FAQ 3: My child doesn’t want to wear their brace, what can I do?
Brace wear takes adjustment and consistency is necessary for it to work properly. However, scoliosis also affects self-esteem, so patience and a positive approach works best. Reward brace-wearing with preferred activities. Involve the child in brace care to build commitment. Try distraction techniques when putting it on. Be a role model by staying active yourself. Compromise on brace aesthetics if possible. Counseling may help address any emotional resistance.
FAQ 4: Can my child play sports with scoliosis?
Many adolescents successfully play sports provided curves are managed properly with exercises and/or bracing first. Low-impact options like swimming and yoga pose less risk. For other sports, emphasize warmup/cool down stretches and consider protective equipment if needed. Listen to your doctor’s guidance based on curve severity too. The key is working as a team with coaches to modify activities sensitively as the condition progresses.
FAQ 5: Will my child outgrow their scoliosis?
The progressive potential depends on diagnosis, curve measurement at diagnosis, and adherence to treatment plan and follow ups. Most idiopathic curves stop worsening once growth plates fuse after skeletal maturity around age 16-18 years for girls and 18-20 years for boys. However, in some cases curves can continue evolving beyond growth if not controlled earlier on. Regular monitoring by medical experts provides the best predictions.
FAQ 6: What signs indicate my child needs surgery?
Surgery is generally considered once bracing fails to control curve progression and the degree measures over 40-45 degrees. Other red flags are a rapidly deteriorating curvature, pelvic or shoulder imbalance, rib hump greater than 6cm, or pulmonary issues. Your orthopedist will thoroughly examine all factors to determine if fusion surgery is medically required to avoid long-term health effects from the scoliosis. Second opinions are also advisable for major decisions.
Conclusion
With early detection and a proactive treatment approach, most adolescents are able to successfully manage their idiopathic scoliosis through a combination of bracing, physical therapy exercises, and lifestyle modifications without requiring invasive surgery down the line. Consistent scoliosis-specific strengthening and stabilization exercises under medical guidance can significantly help correct posture alignment, delay curve progression, relieve back discomfort and allow kids to fully participate in daily activities. With dedication to both bracing protocols and home exercise programs prescribed, scoliosis need not limit quality of life during the important developmental years of puberty and beyond. I hope this information provides helpful insight into living well with adolescent scoliosis. Please feel free to contact me if you need any other advice or support.