Scoliosis in Adults

What Can Be Done For Scoliosis In Adults?

The short answer to what can be done for scoliosis in adults is a lot, but it’s important to understand the concepts behind the treatment.

Finally, there are solutions for adult scoliosis that do more than just mask your symptoms with medications. These treatments work to reduce the underlying cause of the pain, the collapse of the spine. These treatments work together to help naturally restore your body’s motion, stability and balance and have helped thousands of other adults with scoliosis relieve their pain and avoid scoliosis surgery.

When combined they offer you the greatest chance of improving your curvatures, even as an adult. If you are an adult with scoliosis related pain or disability it’s possible that they can help you too but before we talk about these innovative solutions, let’s first discuss why conventional medical treatments for adult scoliosis often falls short of producing results.

Failure of Conventional Medical Treatment for Adult Scoliosis

The biggest challenge with the conventional medical treatment approach for scoliosis in adults is other than surgery, treatment is pretty much just a palliative approach with pain medications that only temporarily mask the symptoms but does not address the underlying cause of the problem.

If that does not work then a referral for physical therapy for scoliosis or chiropractic is often made but in most cases the exercise treatment provided is bilaterally, which means that they do the same treatment or exercise on both sides of the body. The problem with that is scoliosis has such a profound muscular imbalance that treating it in a balanced way does not improve it and may actually aggravate your scoliosis. For instance, you can do one exercise that will open up the curvature, which is good for scoliosis but if you do the exact same exercise in the opposite direction it can actually make your curve worse!

The next step in the medical model is a referral to an orthopedic specialist for a scoliosis surgery consultation. However, since scoliosis surgery is such a major procedure often surgeon’s are reluctant to do surgery on adults because of the poor outcomes due to the reduced flexibility of their body and longer recovery time. So surgery is usually held as the treatment of last resort for adults and is only considered when their pain is intractable.

So what other options are available for scoliosis in adults to help reduce the pain caused by curvatures to the spine? To better understand these options it is essential to first have some knowledge of the important features that contribute to the progression of scoliosis in adults.

When Does Scoliosis Start In Adults?

Although you may have never had any symptoms from your curves until later in life, most adults have had their scoliosis since their adolescence. Adolescent Idiopathic Scoliosis accounts for 85% of all scoliosis cases, but it is often asymptomatic in youth, which is why many cases may go completely un-diagnosed until later in life when the spine degenerates and causes pain in adulthood.

When scoliosis begins the body is often able to adapt to the abnormal changes in the spine because the body has many overlapping systems of support that help local tension to be dispersed throughout the body, so that if one system fails the others will take up the slack to support the body. However, over time these other support systems may also begin to fail under the collapse of the strain and this eventually leads to pain.

Scoliosis can also start in adulthood and is known as Degenerative Scoliosis or Adult Onset Scoliosis. This type of scoliosis usually occurs after menopause due to bony changes in the vertebra that leads to collapse and the same type of progressive downward spiral that occurs in adolescent idiopathic scoliosis.

Scoliosis Progression in Adults

What causes progression of scoliosis? Progression of scoliosis curves in adults can result from a number of factors depending on the type of progression that occurs. There are two types of scoliosis progression that occur in adulthood. Rapid progression which is hormonally influenced and Gradual Progression which is caused by uneven forces applied to an imbalanced body by gravity.

Rapid Scoliosis Progression

Scoliosis, especially in females can change rapidly during times of life where there is a significant shifts in hormonal balance that has an impact the bone growth, ligament strength and bone density.

For a woman with scoliosis there are 3 times in her life that she is at the greatest risk for rapid progression of her scoliosis and they all involve sudden shift in hormonal changes.

1. Puberty
2. Pregnacy
3. Menopause

Puberty has the added stressor of a period of rapid growth that can cause a sudden progression of scoliosis. Pregnancy has bio-mechanical stressors of a rapidly changing center of gravity in the 3rd trimester combined with the mix of the hormone Relaxin that causes ligamentous laxity in the pelvis to allow for passage of the baby. Relaxin doesn’t just affect the ligaments of the pelvis, it affects all the ligaments of the spine, thus can cause progression of scoliosis if a woman is doing nothing to support her spine. Menopause causes demineralization of the spine which can result in sudden bony changes in the spine due to osteopenia and osteoporosis.

Gradual Scoliosis Progression

Also, for scoliosis curves that have advanced to 30° or more in adolescence have a greater risk of slow progression into adulthood at a rate of about 1° per year, which can add up over time. This type of progression occurs due to gravity taking advantage of the postural imbalances caused by the shift in weight by scoliosis. The greater the movement is away from the midline, the greater the imbalance, the harder the body has to work just to hold itself up.

Supporting An Adult Spine With Scoliosis

Addressing the biomechanical abnormalities in order to stabilize the spine is key to successfully stopping the progressive deterioration of scoliosis in an adult and relieving it’s associated pain. Every scoliosis has both a structural component and a postural component. Since an adult is done growing the structural component is relatively stationary and cannot be changed, but the postural component, which is the collapse of the spine over time is quite changeable in an adult. The postural component can be up to 20% of the total curve and it usually the part of the curve that causes pain in adulthood.

Postural collapse occurs in scoliosis due to the significant right to the left imbalance in the trunk. This can be seen when you look at your back and you see the muscles on the outside of the curve are bulged out and tight because they are straining to hold the body up, while the muscles on the other side are flattened and weakened.

Fortunately, in most cases of adult scoliosis, the postural component of scoliosis can be improved with conservative treatment and that helps the body move back towards the mid-line which in most cases helps relieve the pain.

How Movement Affects Spinal Structure Over Time

Studies done at the Katharina Schroth Spinal Deformities Rehabilitation Center in Germany have shown that scoliosis patients have abnormal movement patterns that greatly contribute to scoliosis causes. If these aberrant movement patterns stay in place long enough they begin to adversely affect the person’s entire posture. When postural changes stay uncorrected they will eventually cause structural changes in the body that lead to further aberrant movement patterns. This downward spiral is commonly found in scoliosis and must be corrected to avoid a future of pain and disability.

Degeneration occurs in the body’s attempt to stabilize the abnormal structure of the spine caused by scoliosis. The degenerative changes in the bone and subsequent nerve irritation are what causes the pain. They will continue to progressively worsen and cause more pain unless something is done to stabilize the spine.

Poor posture is to a scoliosis patient what sugar is to diabetic, a huge problem. Unfortunately, it is not as easy as telling someone with scoliosis to simply sit up straight. The abnormal muscle patterns have been developing over years and are not that easily overcome. In scoliosis muscles and the surrounding connective tissues have shortened to adapt to the changes in the structure of the spine. These shortened tissues (blue) are less elastic and less freely movable compared to the other side, which is lengthened (red).

The chronic changes in tension of the muscle chains have also resulted in what is known as plastic remodeling and results in deforming of the surrounding connective tissues. This further binds up the affected tissues causing localized hypoxia of the structures.

Since the tissues are not getting enough oxygen theses structures eventually adapt producing tough, dense scar tissue in the affected area. As this scar tissue builds up it ties down the structures keeping them from moving freely, muscles become even shorter, tension on tendons and bones causes deformation of the skeleton causing nerves to become trapped and eventually causing pain.

In order to reverse this process and make postural corrections and finally rebalancing the muscular components involved in scoliosis it is important that you first make changes in the structural components of the body that have been adversely affected by scoliosis. This process of restoring structural integrity and proper function to the body is a concept called “retracing”. It involves taking the body back through the same pathway it took to get where it is today, just in reverse. Starting at the end (i.e.: a progressive scoliosis curve) and working backwards toward a more balances spinal structure is a process we call Structural Re-balancing. Our non-surgical scoliosis treatment alternatives are all designed to help the body restore its structural balance.

Corrective Movement Therapy For Scoliosis In Adults

In order to help correct the progressive collapse of a scoliosis it’s important to address the above issues your body’s balancing systems. The following treatments are designed to encourage your body move into a corrected position to improve the postural imbalances by re-calibrate your brain awareness to this new and improved position.

Exercises for Treatment of Scoliosis in Adults

The Schroth Method is a self-help method of scoliosis treatment that was developed in Germany by Katharina Schroth who founded and developed the Schroth Method. This physiotherapeutic approach is designed to reshape the rib cage and de-rotate the spine with breathing techniques and isometric exercises. Since 1927, the Schroth Clinic for Scoliosis has accepted Scoliosis and Kyphosis patients on an in-patient basis, effectively managing the deformity associated with scoliosis without bracing or surgery.

Once a patient has learned and mastered these exercises after repeatedly doing them on a daily basis they begin to develop new and improved patterns in their nervous and muscular systems that will help improve their curvatures. There are three main upright positions patients are taught to correct are: Standing, Sitting and Walking. The focus is to teach a patient how to reduce your curvatures in each of these positions and then have you repeatedly practice these healthier, more anatomically correct positions until they become habituated into the predominant patterns of movement.

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With scoliosis as the spine curves laterally the ribs on the Concave side will flattened as they move closer to each other while the ribs on the convex side will form a rib hump as they spread farther apart. The Schroth method teaches how to open up the space between the ribs on the concave side so that a person can begin the process of correcting this rib cage deformity which in turn helps correct the curvatures in the spine.

Because of years of mal alignment a mature spines require more intensive methods to re-educate movement patterns and mobilization techniques to help reshape the rib cage. The Schroth Method helps correct these chronic postural patterns by teaching the body a corrected pattern of movement that will eventually replace the old abnormal pattern.

SpineCor Adult Pain Relief Scoliosis Brace

The SpineCor dynamic bracing system has been used successfully for years in children has now been successfully adapted for treatment for adults with scoliosis. This unique patented soft flexible brace is based on a revolutionary scientific approach that was developed by Dr. Charles Hilaire Rivard and Dr. Christine Coillard, a team of orthopedic surgeons at St. Justine’s Hospital in Montreal that specialize in the treatment of adolescent idiopathic scoliosis.

Although this dynamic brace moves with the body it still applies corrective forces three dimensionally where they are needed while still allowing freedom of movement. The dynamic brace consists of corrective and adjustable elastic bands which are interconnected to three static components that create a modular system. This allows physicians to customize treatment and it can be worn beneath the patients clothing.

Unlike a rigid brace, SpineCor allows for an adult to be treated without interfering with or preventing their normal daily activities. This innovative approach allows a dynamic range of activities while still correcting the curvatures.

Scoliosis in adults should be cared for by a doctor with knowledge in specialized treatment protocols in scoliosis, dynamic bracing and Schroth Method exercises. Treatment for the adult spines should be based on a comprehensive evaluation which should include an Orthopedic/Neurological examination. Recent upright X-rays and other functional assessments are also needed to evaluate other causes of pain.

Once properly evaluated and the patient has been determined to be candidate for dynamic bracing, the Spinecor Adult Brace can be fitted. This dynamic brace is designed to help relieve pain created by spinal translation by de-weighting the adult spine in areas of structural instability caused by the scoliosis. This type of corrective movement therapy can help adults of all ages.

The treatment objectives in Adult Scoliosis are to provide pain relief and to improve Activities of Daily Living (ADLs). Curvature reductions can often be achieved through improved postural stability but changes in bone shape are not realistic in the adult spine. Studies of Adult Spinecor bracing by our doctors have shown reductions in Cobb angle measurements in all types of curvatures regardless of curvature location or length time the curvature has been present.

The treatment outcomes for other of our adult patients like Kathy based on satisfaction surveys confirms that the vast majority of our adult patients are very happy with the results and they strongly recommend our program to other adults with scoliosis.

The treatment protocols and schedule for wearing the SpineCor brace varies depending upon the patients scoliosis and treatment objectives.A gradual building up of time of wearing the brace is recommended as initially fatigue may limit brace use in the first few weeks of treatment, but the majority of adults find they can build up to full time wearing within the first couple of months. Most adult patients wear the SpineCor brace somewhere between 8 – 16 hours a day. They will put it on in the morning after a shower and wear it throughout the day and take it off sometime before they go to bed.

Patients who have chronic pain are typically fitted in an Adult SpineCor configuration which is designed to shift the posture of the spine and reduce pain. Changes in the brace configuration are based upon clinical measurements that are specific to each patient. Brace fittings are then designed to restrict and re-educate movement patterns are typically used in patients without pain.

The Spinecor Adult Scoliosis is indicated for use with people who either have adult onset Scoliosis or Adolescent Idiopathic Scoliosis in adulthood. Patients suffering from pain, fatigue or weakness as a result of scoliosis are typically considered candidates for bracing. Other indications include patients who are interested in improving the cosmetic appearance of their waist angles and ribcage. Patients with respiratory conditions that are secondary to Scoliosis may also be considered for treatment if there is no significant reduction in vital capacity or blood oxygen levels with the brace properly fitted.

The first and currently the only flexible dynamic brace for scoliosis in adults, SpineCor is most effective when curvatures are treated early; however, when used in conjunction with a comprehensive rehabilitation program, Spinecor can be effective with adults with larger curves as well.

Hip Flexor Imbalance

Scoliosis in adults is often a severe manifestation of a rotation dysfunction that can influence a lumbar scoliosis by frequently involving the powerful hip flexor muscles. If one side of your hip flexors is imbalanced compared to the other than it will pull the spine where it attaches toward that direction causing a torque in the spine that will extend all the way up causing a rotation of the spine that is characteristically found in scoliosis.

The Schroth Method uses mobilization techniques that are designed to expand the flattened areas of the ribcage, while de-rotating the spine with specific breathing exercises. The Schroth Method combined with the SpineCor brace gives a patient the best opportunity to avoid surgery for scoliosis since both are attempting to de-rotate the spine through the use of muscle memory and postural awareness, but sometimes the adaptive shortening of these muscles and other connective tissues limits how much mobility is able to be restored. In cases like that additional treatments targeted at lengthening the specific shortened structures is needed.

Active Release Techniques for Scoliosis

Specific applications of a myofascial therapy called Active Release Techniques, (A.R.T.) have been found to be very beneficial in helping lengthen the adaptively shortened tissues that can relieve the pain of scoliosis and improving bio-mechanical function of the spine. A.R.T. is the treatment of choice for relieving muscular imbalances involved in scoliosis because of its specificity for each of the involved tissues (there are over 500 specific ART moves involving the structures of the body) and we find that it produces the best results.

ART treatment is applied to help assist in correcting of the involved shortened tissues. It becomes crucial to break this abnormal neuromuscular pattern by releasing the fascial adhesions surrounding these muscles and allowing them to re-establish normal movement patterns. This achieved with ART by shortening the affected tissue then applying tension with your manual contact in the direction that lengthen the tissue or releases it allowing it to restore its normal slide relative to the adjacent tissue.

ART is effective at restoring proper biomechanical function in chronic musculoskeletal conditions, like scoliosis because it releases tissue adhesions between the muscles, fascia and nerves of the body caused by prolonged abnormal postural dysfunctions. The power of Active Release Techniques in scoliosis treatment lies in its ability to effectively resolve chronic tissue adhesions that have not responded to other forms of therapy.

Over the course of treatment a, gradual release and remodeling of the taut tissues in the shortened spiral line allows for restoration of normal muscle function in that line. Once this is achieved then the constant strain to the opposite line is relieved and body can begin the process of rebalancing. Through specific, unidirectional exercises specifically designed for scoliosis the provider can now begin to set new postural patterns that hasten the process of retracing. By first freeing up these specific adhesions these newly learned postural patterns can more easily become habit and positively impact the overall movement patterns of the body. This greatly helps stop the progression of the curves that have contributed to the scoliosis in the first place.

Summary:

The old school medical model for treatment of scoliosis is really only designed to provide temporary pain relief without addressing any of the underlying causes of scoliosis. Fortunately, now there are far better solutions to help relieve your pain by re-educating the musculature surrounding the spine to move your body back towards midline where it is better balanced and does not cause strain to the supporting structures. This can provide lasting relief in your pain and allow you to enjoy to your usual activities without the fear that they will flair up your scoliosis.

Find Out If Our Treatments Are Right For Your Scoliosis

The good news is that you no longer have to settle for learning how to live with scoliosis pain. Find out if you are a candidate for our treatment protocols by contacting us.