Knowledge of Adolescent idiopathic scoliosis (AIS) is controversial and incomplete; however, there is enough information out there for patients and parents to make an informed decision about management options. The list below offers noninvasive and surgical options: 1,2
- Specific education
- Awareness of postural defects
- Encourages active spinal movements over passive movements
- Postural training activities of daily life
- Truck stabilisation
- Muscular strength
- 3-dimensional self-correction
- Increase joints range of motion
- Increase neuromuscular control of the spine
- Avoid spinal extension or flexion during exercise
Non-invasive treatments (points 1-6) have the purpose of reducing the warrant for surgery by preventing curve progression.3
The management of AIS is dependent on two points:
- Size of the curve (Cobb’s angle) and
- Skeletal maturity (Risser sign)
Appropriate management with the corresponding Cobb’s Angle:
Cobb’s Angle of 10-25°
- Monitoring for curve progression until bone-maturity
Cobb’s Angle of 26-40°
- Physical therapy (physiotherapy or chiropractic),
- Scoliosis intensive program (SIR)
- A back brace may be prescribed by an orthopedic doctor
Cobb’s Angle of 50°
- Surgery may be required
- Active upper back (thoracic) mobilization, promoting kyphosis
- Active lower back (lumbar) mobilization
- Active lumbar correction, promoting lordosis
- Active thoracic shift exercise with a dowel
- Active thoracic shift exercise with a Swiss-ball
- Active thoracic shift and de-rotation exercise
- Balance and proprioception exercises on a Swiss-ball
- Balance and proprioception exercises on a balance board
- Spinal stabilization exercises
- Active exercise in plaster cast promoting core strength, breathing, and thoracic shift, and elongation
- Active exercises in a plaster cast promoting postural correction and core strengthening
- Mobilization of the costovertebral joints
“Untreated, adolescent idiopathic scoliosis does not increase mortality rate, even though on rare occasions it can progress to the >100° range and cause premature death. The rate of shortness of breath is not increased, although patients with 50° curves at maturity or 80° curves during adulthood are at increased risk of developing shortness of breath.” 4
Approximately, 1 in 10 scolioses progresses and warrant bracing as a management, and 1 in 25 scoliosis individuals will warrant surgery. 4
Although there is no high-quality evidence to recommend the use of exercise5 or brace6 for AIS, “exercises were also shown to be effective in reducing brace prescription.” 7
1.Berdishevsky, H., Lebel, V. A., Bettany-Saltikov, J., Rigo, M., Lebel, A., Hennes, A., Romano, M., Białek, M., M’hango, A., Betts, T., de Mauroy, J. C., & and Durmala, J (2016). Physiotherapy scoliosis-specific exercises–a comprehensive review of seven major schools. Scoliosis and Spinal Disorders, 11(1), 20.
2.Białek, M. (2011). Conservative treatment of idiopathic scoliosis according to FITS concept: presentation of the method and preliminary, short term radiological and clinical results based on SOSORT and SRS criteria. Scoliosis, 6(1), 25.
3.Weinstein, S. L., Dolan, L. A., Cheng, J. C., Danielsson, A., & Morcuende, J. A. (2008). Adolescent idiopathic scoliosis. The Lancet, 371(9623), 1527-1537.
4.Asher. M.A. & Burton, D. C. (2006). Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis, 1(1), 2.
5.Romano, M., Minozzi, S., Zaina, F., Saltikov, J. B., Chockalingam, N., Kotwicki, T., Hennes, A., & Negrini, S. (2013). Exercises for adolescent idiopathic scoliosis: a Cochrane systematic review. Spine, 38(14), E883-E893.
6.Negrini S, Minozzi S, Romano M. (2010). Braces for idiopathic scoliosis in adolescents. Spine;35(13):1285–93.
7.Negrini S, Fusco C, Minozzi S, Atanasio S, Zaina F, Romano M. (2008). Exercises reduce the progression rate of adolescent idiopathic scoliosis: Results of a comprehensive systematic review of the literature. Disabil Rehabil;30(10):772–85.