Scoliosis, Spinal Curves, and Bracing
What is scoliosis?
Although the spine does curve from front to back it should not curve sideways very much. A side-to-side curve, called scoliosis, may take the shape of an "S" (double curve) or a long "C" (single curve).
Scoliosis is more than just a curve to the side. The scoliotic spine is also rotated or twisted. As the spine twists it pulls the ribs along with it, so that one side of the chest becomes higher than the other, or the shape of the breastbone may change. You may have noticed that one of your shoulders is higher than the other or that your clothes hang unevenly at the waist because one hip is higher than the other.
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Observation: Keeping watch on curves
Idiopathic scoliosis, which accounts for 80-85% of scoliosis cases, doesn't happen all at once, it develops gradually over time, and may worsen rapidly during rapid growth in the pre-teen and teen years.
Early detection of abnormal spinal curves by school screening programs and pediatricians is intended to find scoliosis early enough to begin brace treatment and avoid surgery. Once an abnormal spine curve has been detected, it is important to monitor the curve during growth. Your physician will decide on your treatment plan and follow-up based upon your x-rays and physical exam. Even though your curve may not bother you now, it should be watched throughout growth.
Why treat scoliosis: avoiding future problems
Scoliosis rarely seems a problem to the child or adolescent who has a curve. Why then do we bother to monitor and treat curves? Adults with moderate or severe scoliosis can have progressively worsening curves which cause cosmetic disfigurement, back pain and in worse cases, difficulty breathing. Treatment after the curve has already become severe in adulthood is much less successful than treatment during childhood or adolescence. By finding progressive curves early, we hope to keep them from becoming problems in adulthood.
Treatment without surgery: exercises and braces
Treatment of scoliosis depends on the location and degree (severity) of curvature.
- Slight curves (curves measuring less than 20°), usually requires no treatment, but must be watched carefully for worsening during growth.
- If your curve shows significant worsening or is already greater than 30°, and you are still growing, your physician may recommend a bracing program.
A scoliosis brace is designed especially for you and your particular curve. It works by holding your spine in a straighter position while you are growing to try and partly correct your curve or prevent it from increasing.
A bracing program may help you avoid surgery. You will need to wear your brace almost all the time until the end of growth. Most braces can be hidden beneath normal clothing, and you can continue to do all athletic activities. A bracing program can be difficult and you may need help in organizing your daily activities. Your physician works with a team of professionals who will help you adjust to this treatment.
This team includes a physical therapist to evaluate your posture, muscle strength and flexibility. Your therapist will provide you with a home exercise program designed specifically for you. This program helps to stretch and strengthen your muscles so that you are more comfortable in your brace. A nurse will help you and your parents with all of your questions and your appointments. The nurse will also teach you how to care for yourself and your brace, give you a schedule to follow, and helps plan your day-to-day activities.
bracing examples (left: Boston brace, right: Charleston bending brace)
Despite everyone's best efforts some curves do not respond to bracing, and some curves are just too large to begin with (greater than 40-45°). If you have this type of curve, you may need surgery.