Scoliosis Awareness Month Interview with Stacie, DPT, PT
Interview with Stacie Schaidle, DPT, PT about June is Scoliosis Awareness Month
Welcome, Stacie! Thank you for doing this interview. First of all, what brought you to Lowcountry Therapy Center?
I wanted to do pediatrics, and after school I liked the location and I started talking to Jessi and liked the company and decided it was a good match for me.
June is Scoliosis Awareness Month, so I wanted to ask you a little bit about scoliosis. First of all, what is scoliosis?
Scoliosis is a curvature in the spine, the majority of the time it happens in the thoracic lumbar region which is the lower part of the spine, but it can also occur in the upper thoracic and cervical regions. Typically you’ll see what most people look at straight from behind is a lateral curvature of the spine, but it actually has a rotational component, too, meaning that the vertebrae are twisted, and typically parents don’t recognize that because it’s not as visual as the lateral curvature.
How does scoliosis affect function in everyday life?
What happens with scoliosis is you get a tightness of the core muscles on one side, leading to weakness on the other side. And so a lot of times, kids will have decreased core strength, which can lead to asymmetrical movement patterns and decreased function on whichever side happens to be weak. And so you’ll see a lot of delays in coordination skills and it also can lead to pain with higher movements with athletes or active kids.
How is scoliosis normally diagnosed? Do you need x-rays?
Checkups with pediatricians is the most common way it’s diagnosed. All pediatricians should be doing the forward bend test with kids to check for that. Some kids get checked in schools, too, but it’s not as typical anymore as it used to be. Kids get checked during sports physical exams, too. You do need x-rays to determine if it’s more than a 10 degree curve - you won’t get a diagnosis until its 10 degrees, and the only way to measure the specific degrees is via x-rays.
Can scoliosis be fixed?
It can be corrected to a degree. Physical therapy wise, we look at managing it. We cannot necessarily correct that curve. We’re not going to decrease the degrees on the x-rays. We can manage it to where it’s not going to worsen. We’re trying to maintain it through strengthening and stretching to keep that curve from progressing. Bracing is an option, they usually do that at 20-25 degrees and up, depending on your maturity level, as in if your bones are still growing or if you’re done growing. Some studies have shown that bracing can take away about 5 degrees at most, correction-wise. So if you’re at a 25 degree curve, bracing may bring you back to a 20 degree curve. They have shown studies that bracing with physical therapy is the most effective for reducing that curve. Surgery is an option, typically not until 45 degrees, and they typically want the child to be skeletally mature to do it. After surgery, there’s more following that needs to be done because they put rods into their back and fuse some of their vertebrae. Once that happens you’ll notice the vertebrae above and below where the rods are placed will get way too much motion so that can lead to more problems down the road with pain or discomfort with positioning. You have to be careful that they build that core strength to prevent that from happening.
What is the difference between structural and functional scoliosis?
Structural is when there is an actual change in the structure without movement. When you look at them they’re always going to have that offset. Functional you’ll only notice come out during movement patterns, so when they bend forward or start to do trunk rotation activities, you’ll notice they have scoliosis, but in standing they’re fine. Typically it’s due to low tone kids that don’t have core strength to maintain that posture.
Are they treated differently?
Yes, they would be. Structural is a lot harder to change once it’s already to the point. Surgery or bracing is often needed. For functional, we do stretching, strengthening and muscle training (when to activate certain muscles and postural awareness). We do a lot of stretching initially to start to lengthen the muscles on the shortened side. And then after you start to see that muscle lengthen you can start strengthening, now that you have them in a more optimal position to try to maintain their posture in better alignment. A lot of it is core strengthening.
Why does it need to be addressed early; what long term impact will you see from letting it go unaddressed?
If it’s not addressed early, you will see it continue to progress and worsen until they’re done growing - that curvature can get worse. So typically once they’re diagnosed with scoliosis they are followed every 6 months or a year depending on their age and if they still have growth plates, and they will keep doing x-rays to make sure it’s not progressing, and do the bracing or surgery if need be. Once they’re done growing, it comes back to whether or not they are going to have pain because of changes in their movement patterns and asymmetries.
Is there anything else you think is important to share?
Scoliosis is idiopathic, which means they’re not certain on the cause of it. They have linked some of it to genetics. So if there is a family history of it, it might be worthwhile to inform your pediatrician and have them monitor it closely. If an athlete is complaining of back pain, and they’re still growing, it’s always a good option to check that and make sure it isn’t due to scoliosis.
Author: Krista Flack, MS OTR/L