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The focus of health care professionals<\/h2>\n
Yes, there are structural changes that occur to the spine with relative anterior spinal overgrowth (RASO) regularly cited in the literature. The obvious lateral deviation that comes with scoliosis makes it very easy for health professionals to fixate on the Cobb angle, which is a 2D measurement taken from an X-ray however scoliosis is a 3D condition. There is also a focus on the posterior-anterior view of the X-ray, however health professionals must remember that scoliosis encompasses changes in all three planes, but particularly in the transverse plane because rotation of the spine will exist with scoliosis.<\/p>\n
Questioning the traditional approach<\/h2>\n
Health professionals have a wide variety of training, expertise, and experience when it comes to scoliosis. The more traditional approach in the medical profession has been the \u2018wait and see\u2019 approach, which is waiting to see if the Cobb angle progresses to 50 degrees or more so that surgery can be recommended. This has stemmed from a lack of strong evidence to show that bracing and scoliosis-specific exercises are effective in treating scoliosis and also a fixation on the reduction of the Cobb angle being the goal of treatment, but this is rapidly changing. We now have a situation where there is more evidence emerging to support bracing and scoliosis-specific exercises.<\/p>\n
This support for conservative treatment is not just about changing the Cobb angle. Patients are also seeking conservative treatment options and are frustrated by the \u2018wait and see\u2019 approach (1). We need to recognize that there are many more reasons beyond the Cobb angle to \u2018treat\u2019 the patient with scoliosis.<\/p>\n
Why do we treat scoliosis?<\/h2>\n
A consensus paper by international scoliosis experts gives us some strong insight into why health professionals treat scoliosis and why patients seek treatment (2). These experts in scoliosis assessment and treatment agreed that patients will often need to address many factors beyond the Cobb angle, including but not limited to:<\/p>\n
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- aesthetics<\/li>\n
- pain<\/li>\n
- function<\/li>\n
- minimizing the need for treatment later in life (2).<\/li>\n<\/ul>\n
Unfortunately, it\u2019s easy to become trapped in focusing on the Cobb angle alone<\/a>. This may have evolved from a medical tendency to \u2018wait and see\u2019 if the Cobb angle progresses to the point of surgical recommendation. It\u2019s not always easy to navigate appropriate recommendations for scoliosis when there is still a large push from some untrained medical professionals to seek inappropriate treatments for patients. It can be easy for these health professionals to also overlook the emotional and mental impacts that scoliosis has.<\/p>\n
How is lifestyle affected?<\/h2>\n
When we look at the impacts of scoliosis on the individual, it\u2019s quite clear that these can extend beyond the spine. As health professionals, it\u2019s vital that we don\u2019t catastrophize scoliosis and also that we are aware of whether or not the patient is catastrophizing the situation. This can easily happen as a result of other influences such as knowing a friend who had a negative treatment outcome. A holistic approach is always necessary. Let\u2019s look at a few examples of lifestyle considerations for patients:<\/p>\n
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- The impact of the postural asymmetry can be significant for teens that are wanting to head to the beach on the weekend or wear a particular outfit.<\/li>\n
- Children may be fearful of wearing a brace to school.<\/li>\n
- They may be wondering how their sport will be affected.<\/li>\n
- The pain that is associated with some cases of scoliosis also needs to be addressed.<\/li>\n
- The change in biomechanics of the trunk may be significant for an elite tennis player who is finding that their serve style is changing as the deformity in the trunk changes.<\/li>\n<\/ul>\n
The structural changes caused by scoliosis may affect the way the trunk moves. Think about this in terms of impact on sports, posture, and daily activities.<\/p>\n
How do the structural changes affect patients’ lives?<\/h2>\n
The asymmetry that results from RASO needs to be addressed in the treatment of scoliosis. For example, the rotating rib cage can affect the range of motion of the shoulders. This might not be significant for some people but for others, it can create huge problems.<\/p>\n
Let\u2019s look at a teen tennis player example (you can extrapolate this to many other scenarios). If a tennis player is starting to lose tennis matches because their serve is losing impact but the doctor or other health professional they are seeing is not assessing the impact of the scoliosis posture on the child, this might lead to one very unhappy teenager!<\/p>\n
Think about it. This teen turns up to practice for many hours per week. They are used to having a powerful serve and then slowly this starts to change. The coach is trying to help to manage the changing serve stroke but can\u2019t work out \u2018why\u2019 the teen just can\u2019t produce the right swing anymore. A missed underlying scoliosis or a failure to address biomechanical changes occurring may be the missing piece of the puzzle. This can be incredibly frustrating! Teens are already navigating an often turbulent and challenging period of their lives. Teens with scoliosis may have these challenges compounded.<\/p>\n
Mental health and scoliosis<\/h2>\n
Let\u2019s now think about the psychological state of the person with scoliosis. In rare instances, patients realize that they can live totally unaffected by their scoliosis. However, we must always be aware that this isn\u2019t always the case. Sometimes the patient doesn\u2019t realize that they are affected mentally and emotionally by their scoliosis. Perhaps you can check in with the parents of a teen patient with scoliosis.<\/p>\n
Has a parent reported to you that their teen daughter stopped wearing jeans because they don\u2019t \u2018fit\u2019 properly? Is the patient reluctant to head to the beach because they don\u2019t want people to see the uneven rib cage while wearing a pair of swimmers? As isolated instances, these may not be significant, but over time or combined with other challenges such as strained friendships at school or difficulties at work, these issues may compound.<\/p>\n
It\u2019s important for the person with scoliosis to feel \u2018heard\u2019 by their family members and their scoliosis health professional. Not all health professionals are trained or have the expertise to treat the scoliosis spine and the impacts of the scoliosis on the individual. If you are not specifically trained in scoliosis assessment and management then it is important to refer the patient for appropriate assessment.<\/p>\n
Can conservative scoliosis treatment help the \u2018whole person\u2019 not just the spine?<\/h2>\n