Bodily deformity- SCOLIOSIS

Meaning

A lateral (side-to-side) curvature of the spine that is abnormal is a defining feature of the medical condition of scoliosis. When the spine is viewed from behind, it assumes an S- or C-shaped curve rather than seeming straight. Growing periods in childhood or adolescence can lead to the development of scoliosis, whose exact etiology is frequently unknown (idiopathic). Scoliosis can cause discomfort, a reduction in lung capacity, and even aesthetic issues, depending on how severe the curve is. Observation, bracing, or, in extreme circumstances, corrective surgery are all possible forms of treatment. Preventing the curvature’s advancement and its related problems requires early detection and management.

Scoliosis is usually defined by the following characteristics:

Shape of curve
Location
Direction
Magnitude
Causes

Types of scoliosis

Scoliosis is mainly of two types

Functional scoliosis
Structural scoliosis

1. Functional scoliosis

It is also known as non-structural scoliosis. It is then divided into types:

Neuromuscular scoliosis

It is the curvature is the spine affects that the spinal muscles leading to weakness of muscles.

Degenerative scoliosis

It occurs mostly in adults and is more common in the lumbar spine. The curvature gets worse as time progresses.

2. Structural scoliosis

It is a fixed lateral curve of the spine. It is further classified into two types:

Idiopathic scoliosis

The cause of such type is not known. It is the most common type of scoliosis and is found in both adults and children. About 80% of patients with scoliosis have idiopathic scoliosis. It can be further classified into three types-

Infantile scoliosis
Juvenile scoliosis
Adolescent scoliosis

Congenital scoliosis

This type of scoliosis occurs from birth or is developed within the womb. It is a rare type of scoliosis. It occurs due to failure of the formation of the spine.

Scoliosis can be classified as

Postural scoliosis (Grade 1)

This type is without any bony changes or muscular weakness. The causative factors may be the impairment of the postural reflex mechanism or wrong postural habit. E.g.- standing with stress on one leg.

Structural scoliosis (Grade 2 & 3)

In this type of scoliosis, there is a defect in the bone which results in contractures of the soft tissues on the concave side of the curve and reciprocal stretching on the convex side.

Causes of scoliosis

Idiopathic: Unknown cause.
Neuromuscular condition: These are the condition that affects the nerves and muscles. The conditions such as cerebral palsy and muscular dystrophy. In such cases, the child may not be able to walk or stay upright further preventing the spines from growing properly.
Congenital scoliosis: This is rare and occurs because the bones in the spine develop abnormally when the fetus is developing in the womb.
Leg length: If one leg is longer than the other the individual may develop scoliosis.
Other causes: Bad posture, using backpacks or satchels and wrong exercises may also cause scoliosis.

Evaluation of the curve

The evaluation is done by examinations of the various spinal levels.

Levels of the ears or contour of the neck.
Shoulder level: The shoulder level is higher on the convex side of the curve.
Scapular level: The level of the inferior angle and vertebral border of the scapula is examined about the midline of the spine. Shifting of the vertebral border of the scapula away from the midline along with higher scapula and eversion of the inferior angle indicates a dorsal curve.
Position of the arms and the waistline: The arms on the side of the high shoulder hang close to the body and the waistline may be more on the opposite. The width of the back appears unequal which can be verified by measurement. The back appears wider on the convex side due to the bulging ribs.
Thorax: The ribs appear to be crowded on the concave side and further apart on the convex side of the curve. The ribs bulge backward on the convex side and appear flattened on the concave side.
Hips: The hips and the posterior superior iliac spine are higher on the concave side.
Pelvis: Forward rotation of the pelvis occurs on the concave side. The Iliac crest will be prominent and higher on the concave side.
Knees: The alignment of the knee joints and check for the joint level or deformity. Levels of both the patellae and their disposition are checked.

Exercises for scoliosis

Knee twist: lie on your back with your knee bent. While trying to keep your lower back flat, slowly let both knees fall together toward the floor. Hold for 10 seconds then go back to the starting position with knees up. Repeat for the other side.
Abdominal crunch: lie on your back. Try to keep back in contact with the ground. Slowly lift the right shoulder up 6 inches, hold for 10 seconds, and lie down. Repeat for 10 sets, alternatively for both the shoulders.
Side bend: Stand straight up with hands above your head. Slowly reach hands to the right and hold for 10 seconds, then straight up and pause, then go to the left and hold for 10 seconds, then straight up again and pause. Repeat the stretch for 10 times.
Standing straight: Stand up, place feet apart, and clasp hands behind your back. Bend slowly forward from the waist until the trunk is parallel to the floor. Hold this position for 10 seconds before standing upright again. Return to the bent position and slowly twist the torso to the left and right.
General body relaxation by using whole body relaxation technique.
The patient is trained to feel and hold the correct posture.
The posture should be corrected passively by the therapist.
General free mobility exercises to the whole spine and strengthening exercises to the spinal extensors and abdominals.
Deep breathing exercises should be incorporated.
Balance exercises.
Stretching of the tight soft tissues and their sustenance form the most important aspect of therapy. Correction of the contractures and shortening of the soft tissues on the concave side of the curve can be achieved by guiding the correct posture in lying. This substantially helps the other methods of active postural correction.
After good correction the patient should be advised to continue with exercises avoiding especially the positions and the activities prone to produce the existing deformity.