Getting the Straight Facts About Non-Surgical Scoliosis Treatment (Part 1 of 10)

By: Dr. Brett Diaz, D.C.
Contributing Writer for http://ScoliosisTreatmentAlternatives.com
Web’s Most Trusted Source for Information on Non-Surgical Alternatives for Scoliosis Treatment

Does Physical Therapy exercise for scoliosis really work? That depends largely on whether or not your physical therapist can see the hidden dimension of your scoliosis and then applies appropriate treatment.

If the physical therapist cannot see all the dimensions of the scoliosis, the therapist is acting with limited vision. The problem with limited vision in scoliosis usually begins with the x-rays that are used to diagnose scoliosis. Because x-ray films are a limited, 2-dimensional image they can only show a portion of the scoliosis, not the “big picture”. While x-rays do a good job of showing the bend of the spine from side to side, as measured by the leading measurement for evaluating scoliosis, known as a Cobb Angle (see illustration), unfortunately a deeper element in the scoliosis curve remains unseen to the therapist and as a consequence remains untreated. When only part of the problem is treated, the benefits can be expected to be limited as well.

Because results have been incomplete in the past, many orthopedic surgeons believe the popular medical dogma that exercise therapy is ineffective for treating scoliosis. Yet, despite this belief, it is interesting to note that they will still often provide a prescription for physical therapy for scoliosis in the initial stages, if you ask.

You are probably wondering: “What’s up with that? Why then would a medical doctor turn around and recommend physical therapy treatment if he believes that it is not going to be effective?”

The reason orthopedic surgeons often make the referral for physical therapy anyway is that physical therapy is considered as “the Standard of Care”. Insurance companies like to see that the doctor has exhausted all other less expensive forms of treatment BEFORE they are willing to pay for a very expensive options, like spine surgery. So when the Physical Therapy for scoliosis doesn’t work, then the surgeon is justified in saying that surgery is now the only way because they have exhausted the conservative approach and it didn’t  work.

So, is it worth going to physical therapy for scoliosis at all then?

Yes, IF you can find a physical therapist that really understands the full depth of scoliosis and is specifically trained to correct it.

What types of Physical Therapy scoliosis treatments DO NOT work ?

1. Physio-therapeutic Modalities

Physio-therapeutic modalities such as interferential current, diathermy, moist heat packs, ultrasound, etc. are often employed to treat scoliosis. Although the application of these therapies may feel good and provide temporarily relief of  pain when they are applied, they do little to correct the curves. In my opinion, solely using these modalities for scoliosis is nothing more than providing the patient with the sense that something is being done to correct the problem by providing them with temporary pain relief. Yet, none of these modalities have any documented therapeutic benefit for correcting scoliosis curvatures on their own.

2. Scoliosis Exercise Therapy

What About Exercise for Scoliosis? Is it an effective scoliosis treatment? The answer varies. It depends on whether or not the scoliosis exercises are specific to counteract the progression of specific abnormal muscle patterns found in the muscle of the spinal scoliosis. Although movement IS an essential element in scoliosis treatment it is the specificity of the movement that really counts. Doing the WRONG KIND of scoliosis exercises can actually worsen the scoliosis. To keep the curves from progressing or reducing the curves depends on doing the RIGHT KIND of movement exercises that also address the unseen element of scoliosis.

What is the “Unseen Element” of Scoliosis?
While most scoliosis curves when viewed on x-ray look like they are either shaped like an “S” that spans both the thoracic and lumbar spine, or shaped like a C. The reality is that there is far more to this lateral curve than meets the eye.

Because x-rays are a 2-dimensional representation of a 3-dimensional body, what looks like a flattened out “S” Curve on an x-ray is in reality more like helix of a spring in the body (see illustration). Having physical therapy for scoliosis with a therapist that fully understands this distinction is critical when applying exercise for scoliosis to try and stop the progression of the curves.

This helix shaped curve is caused by a unilateral rotation dysfunction of the deep postural muscle around the spine that is at the heart of scoliosis. To obtain any type of lasting correction or stabilization this muscular imbalance must be addressed.

Unfortunately this 3-dimensional twist is far too often overlooked during physical therapy for scoliosis. There is a potential for dire consequences when the type of exercise for scoliosis is prescribed by therapists do not take this into consideration.

Bilateral Exercise for Scoliosis Can Actually Worsen the Curves!

It is a common practice in physical therapy to apply corrective exercises to both sides of the spine. For instance, exercises to help stretch the deep rotation muscles of the spine might be employed on both sides. The problem with that is that is contra-indicated for scoliosis. While rotation in opposite direction of the torque will serve to help correct unilateral rotation dysfunction, doing the exercises in the wrong direction will actually re-enforce the abnormal movement patterns thereby worsening the condition.

3. Scoliosis Exercises That Only Deal With the Side to Side Element

Far too often physical therapy exercise for scoliosis takes a simplistic approach that focuses only on straightening the concave side of the curve.  This is done in an attempt to reduce the Cobb Angle in the lateral dimension by looking to lengthen the shortened muscles on the concave side of the spine that have lead to decreased range of motion, joint fixation and lack of mobility of the spine on that side. They also work to strengthening the muscles on the convex curve that are over stretched and have resulted in joints that are hyper-mobile causing pain. The problem is that although they do address the lateral aspect of the curve this simplified approach totally fails to address the rotation component of the curve.

The rotation of the spine in scoliosis is one of the key elements of its formation. Most scoliosis curvatures are a severe manifestation of a rotational dysfunction of the spine and this element must be addressed if you are looking to succeed in halting the progression of the abnormal curves.

Here is an analogy to illustrate the inadequacy of this approach is to think of trying to straighten out a metal spring. Much like a spring, the spine in scoliosis is in a coil formation that not only curves side to side but also twists forward and back. If all you do is try and bend the spring from side to side you are never going to be able to effectively straighten it unless you also address the spiral bend in the coil.

Types of Scoliosis Exercise Therapies that DO Work

Scoliosis exercise programs that are specifically designed to correct the unilateral rotation dysfunction in the spine are critical to the success of managing the abnormal curves. Those seeking  therapy should search out a therapist who is specially trained in re-establishing proper movement patterns that are a significant problem in scoliosis is the one you want to seek out.

These properly trained therapists can help affect a positive change in the curvature through postural reeducation, muscle memory and activation of reflex systems through correctly applied scoliosis exercise programs. Exercise for scoliosis that specifically target the unilateral rotation dysfunction are most effective.  Such programs as the Schroth Method and S.T.A.R.T. SMART Programs do address this critical component and should be a part of any scoliosis exercise rehabilitative program.

In addition, depending on the severity of the curves, a flexible dynamic brace like the SpineCor Brace is often used in conjunction with these exercises to provide a constant, gentle reinforcement of the corrective motor patterns needed to de-rotate the spine keep the curve from progressively falling into the abnormal patterns that worsen the curvatures.

There are other types of alternative  scoliosis treatments available (ie: chiropractic, yoga, etc.) that have not been discussed here. Some forms of therapy are more effective than others. For a comprehensive list of the most current scoliosis treatment alternatives go to http://scoliosistreatmentalternatives.com/ for a free copy of Parent’s Guide to Current Treatment Options in Scoliosis.