What Does Scoliosis Mean?
When viewed from the back of a healthy spine, it is seen that the vertebrae are lined up in a straight line. When viewed from the side, there are slightly inward folds in the neck region, outward folds in the back, and inward folds in the waist region. These are functional curvatures of the spine.
Angular deviations of these functional curvatures from normal cause some problems in the spine. The vertebrae in the back have an anatomical structure with an outward angle of 20-45 degrees. When this angle exceeds 45 degrees, a hunched image occurs on the back. This condition is called hyperkyphosis. It is usually seen together with lordosis (lumbar pit increase).
Another deformity is the condition called scoliosis, which develops with lateral bending and rotational deviations in the vertebrae.
What are the Causes of Scoliosis?
It may be congenital. (congenital) This condition is usually due to a defect in the spine or fused ribs.
It can occur as a result of paralysis of the muscles due to conditions such as polio (polio), cerebral palsy or muscular dystrophy.
It may be idiopathic (cause unknown). It may occur later on for an unknown reason in a previously smooth spine. Idiopathic scoliosis can be seen at any stage of the growth period. (Infancy (0-3 years), Juvenile (3-10 years), Adolescent (from 11 years to skeletal maturity)) The risk of disease progression depends on age and degree of curvature.
What are the Symptoms of Scoliosis and What Should Families Pay Attention to?
● Children do not have to have low back pain. If there is low back pain, it should definitely be investigated by the physician.
● Lateral curvature of the spine should be observed.
● It should be observed whether the ribs and scapula protrusion are higher on one side.
● It should be observed whether the shoulders and hips are symmetrical.
● It should be observed whether the body stands crooked.
● It should be observed whether there is a posture disorder in the form of asymmetry in the waist recesses.
● Shortness of breath (in severe curves (>70-80 degrees)) may be an important sign.
● It should be observed that the clothes that can be worn before do not fit the body properly and that the lines of the clothes are asymmetrical.
During physical examination, the curvature is more pronounced when the patient leans forward. X-rays of the spine and scoliometer (a device that measures the amount of curvature of the spine) measurements in different positions are tests that can be done to determine the amount of scoliosis.
Scoliosis Treatment and Scoliosis Grades
The treatment method is determined by the degree of curvature and the stage of bone growth.
Specific scoliosis exercise therapy between 10-20 degrees (Scroth-FITS SEAS)
Corset + exercise therapy at 20 degrees and above
Surgical evaluation is required at 40-45 degrees and above.
Schroth – 3D Scoliosis Exercise Therapy – Basic Principles of Scoliosis Exercises
The basic principles of SCHROTH – 3D SCOLIOSIS EXERCISE TREATMENT, which is the most valid treatment method of scoliosis today;
● rotational breathing,
● pelvic correction,
● core stabilization,
● correct positioning,
● appropriate mobilization, massage, stretch applications,
● It includes activities of daily living focused on symmetrical awareness.
Images from our patient-specific Schroth 3D Scoliosis Treatment applications performed in our Istanbul scoliosis and spine center within Sportomed:
Core Stabilization and Pelvic Correction
In people with scoliosis, the asymmetrical posture is corrected with appropriate supports, and the core region, which is the balance center of our body,
positioning, stabilization and strengthening are aimed.
A strong and stable core area is the basis for the correction of spinal deformities.
While healthy people stabilize the spine and rib cage with symmetrical breathing, symmetrical breathing applied in people with scoliosis increases the rotational deformity of the vertebrae.
Spinal deformity is corrected with rotational and asymmetrical breathing, which is a special technique applied to people with scoliosis.
With rotational breathing, the restricted ribs are activated and the less ventilated areas of the lungs are activated.
Mobilization, Massage, Stretch
With the mobilizations applied to a correctly positioned spine, it is aimed to gain both rotational correction and symmetrical posture. While massaging and stretching the right muscles support the symmetrical posture, it also increases the success of the exercise.
Symmetrical Awareness and Adaptation to Daily Living Activities
The spine, which is forced to an extreme correction during the exercises, tends to settle in the asymmetrical posture where it is most comfortable in daily life. For this reason, patients should correct their postures at every opportunity and adapt this awareness to their daily lives. Corrections in sitting, walking, lying and resting positions during the day should be explained to the patients and they should be motivated to establish awareness.
What is Kyphosis?
A normal spine appears straight when we look at our body from behind. When viewed from the side, the spine has some functional curvatures.
There are inward folds in the neck region, outward folds in the back region and inward folds in the waist region. If these functional curvatures go beyond their normal angles, it is called kyphosis or lordosis.
When viewed from the side, we see an outward curvature in our vertebrae in the dorsal region. This angulation, which is accepted within the normal limits between 20-40 degrees, is called hyperkyphosis when it exceeds 45 degrees. As the degree of curvature increases, other health problems can also be seen. Forward rounding of the shoulders, protruding head, collapsed thoracic cage can cause back and neck pain, respiratory problems, and disc pathology in the vertebrae over time.
First of all, the patient is evaluated by physical examination.
A 3-way (anterior, posterior and lateral) posture analysis of the patient is performed.
Starting from the feet, knee hip waist back shoulder and head positions are examined.
With the forward bending test, the patient’s lateral back view is evaluated.
Radiographic imaging is requested. Here the degree of kyphosis is measured. It is determined whether the kyphosis is structural or postural.
If deemed necessary, MRI, neurological tests and respiratory tests can also be performed.
Types of Kyphosis
It can be structural or postural (posture dependent).
It is the increase in the angulation of 40 degrees, which should be in the normal standing position in the vertebrae in the back region, and it is above 55 degrees. It mostly develops due to bone or soft tissue pathology. It may be due to congenital spinal anomalies, some bone diseases, spinal tumors or fractures.
In cases of congenital kyphosis;
It is one of the causes of structural kyphosis. It is a disease of the growing spine, especially in adolescence, and its cause is unknown. It occurs more in boys than girls. It causes wedging as a result of the deformity it creates in the vertebrae. Initially, pain and fatigue are felt. The most common type is kyphosis, which develops with wedging of the vertebrae in the dorsal region. Sometimes this curvature may be at the junction of the back and waist region. In some cases, it is accompanied by scoliosis.
What are the Treatment Methods to Follow in the Diagnosis of Scheuermann Kyphosis?
The aim of treatment is primarily;
Correcting the degree of kyphosis or preventing its increase
Increasing respiratory capacity
is in the form.
Regardless of the degree of kyphosis, exercise therapy should be started in the early period. Schroth exercises are the most valid exercise model applied to spinal problems. In addition, posture exercises, breathing exercises and clinical pilates practices to be performed in the correct positions should always be a part of their treatment for these patients.
In cases of mild and moderate kyphosis (between 50-75 degrees), corset is applied. In order to prevent the increase in curvature in children who are still growing, a suitable corset supporting the correct posture should be selected. The purpose of the corset application is primarily to prevent the increase in the degree of kyphosis. With the corset used in addition to exercise applications, it is aimed to correct the angle of kyphosis and prevent it from reaching the surgical dimension. The continuation of the child’s growth, regular use (such as 20-22 hours a day), continuing appropriate exercises such as swimming-pilates-Schroth increase the effectiveness of the corset.
Although there are different opinions about the degree of curvature for surgery, surgical applications are generally preferred for curvatures of 70 degrees and above. Although it varies according to the surgical technique, the patient is usually stood up the next day after the operation, discharged after 1 week, and if necessary, a corset is used for up to 3 months. Generally, after 3 months, activities such as swimming and walking can be started. At the end of the first year, he can return to his normal life.
Postural (due to poor posture) Kyphosis:
It develops due to posture disorder. It is usually more common in adults. It is progressing slowly. In today’s conditions, many factors such as long hours spent at the desk and in front of the screen, work conditions, flat feet, weak abdominal and back muscles, being overweight, and decrease in bone density with age cause postural deformities.
Today, its incidence in children is also increasing considerably. Keeping children away from games that increase their body awareness, not doing enough sports, school conditions and long time spent in front of the screen (computer, television, etc.)
It plays an important role in the formation of postural kyphosis.
IS IT POSSIBLE TO PREVENT POSTURAL KYPHOSIS?
The best way to prevent this postural kyphosis that may occur in children is to correct the habit of sitting first, and to place the desk and chair, computer monitor and keyboard in the most ergonomic positions at appropriate heights and angles. Directing children to appropriate sports (swimming, gymnastics, ballet, yoga, etc.) will both increase their physical condition and enable them to have a healthier spine. The greatest responsibility in this regard falls on the parents.
In the same way, it is important for adults to pay attention to ergonomic working environments and to do sports appropriate for their age in order to prevent postural kyphosis.
POSTURAL KYPHOSIS TREATMENT METHODS
If there is pain, first of all, pain should be relieved with physical therapy applications and posture analysis should be performed. Besides;
Respiratory assessment etc.,
Posture exercises should be started in the early period.
These exercises and their goals are;
To strengthen the abdominal – back muscles,
Stretching exercises for the leg, hip, waist and chest muscles,
and directing the person to a sport suitable for his/her age.
What is the recovery process like after scoliosis surgery?
Will I have pain after scoliosis surgery? Can I do sports after scoliosis surgery?
Scoliosis surgery may be the only treatment to prevent some scoliosis from getting worse. Spinal fusion surgery is the most commonly used surgical method in this type of scoliosis. In spinal fusion surgeries, it is performed by placing bone between the vertebrae in the front or back of the spine. These surgeries are major surgeries that usually give effective results and take months to fully recover.
Post-operative recovery period;
During this post-operative recovery period, activities and movements are restricted. It is desirable to avoid movements such as leaning forward, lifting something, turning to the side. After this healing process is completed, the person can return to his normal daily life. If the person starts sportive activities early in the recovery process or makes unpermitted movements, it may lead to a situation that requires surgery again, since the union of the fusion is not completed. The times recommended by your surgeon must be strictly followed.
Will I have pain after scoliosis surgery?
During the recovery period after fusion surgery, the person will feel pain. After the person returns to his daily life, no pain is expected. In case of pain, the cause of the pain should be determined first. Afterwards, the pain can be reduced by applying a physical therapy program suitable for the problem. After pain treatment, people can start the exercise program again under the guidance of a physiotherapist. Exercises performed with incorrect loading on the vertebrae outside the surgical area can put a bad load on the other discs, disrupt the structure of the discs and cause them to herniate. Therefore, choosing the right exercise is very important.
Can I do sports after scoliosis surgery?
After the healing process is completed after scoliosis surgery, it is necessary to be careful when choosing sports. Exercises that involve violence, require heavy lifting, rotate the spine to the side, twist or bend excessively should not be preferred.
Exercises that will create pressure on the spine should not be preferred. Lifting heavy weights for bodybuilding, fighting and defense sports, hard sports such as American football, and exercises such as sit-ups and squats that require bending the spine and neck forward should be avoided. These exercises can increase pressure on other spinal discs other than the surgical area.
Softer paced sports such as swimming, walking, cycling, and less one-to-one contact should be preferred. In the exercise, light body weight exercises and mild stretching can be done, which avoids putting a load on the other discs.