A common question I get with new scoliosis patients at my clinic in Lehi, Utah is “How are you going to “fix” my scoliosis?”. Even though scoliosis treatment has come a long way, we still can’t fix it completely. Here is why.
What causes scoliosis?
First off, we need to think about what scoliosis is and how it affects the body.
As I tell my scoliosis patients, scoliosis is a “structural” deformity. What does that mean? It means that the bones are shaped differently. This affects the structure, not just movement or function, of the spine.
Think of it this way. If you are building a tower with building blocks that are not square, what would happen? The tower would not be straight. It might lean or go off to one side. It might even fall over.
This is what happens with scoliosis. The building blocks of the spine, the vertebra, are shaped differently. They develop more of a wedge shape, which causes the curve to go to the side.
Now, why does this happen? There is a lot of debate still on this subject, but one theory is that the vertebral body grows with some rotation. This rotation then causes forces to act on the spine which causes the vertebral body to grow asymmetrically. This then causes wedging and the curve.
Whatever the mechanism, we know that the majority of scoliosis is because of the bones being shaped differently. Someday we will understand that mechanism better.
So, if the bone is shaped differently, the only way to “fix” the curve would be to reshape the vertebra. This would be very invasive and would do more harm than good.
Vertebral Body Tethering
Recently, you may have heard of a new surgical technique called VBT, that can help reshape the vertebrae. It is pretty cool, and just got FDA approval, but it still has its limitations.
A complete description of VBT is definitely beyond the scope of this blog post, but here is a basic idea. A “tether” is placed on the convex side of the curve and attached to anchors in the side of the vertebrae. Then, as the child continues to grow, the convex side is held in place while the concave side grows. This improves the symmetry of the spine.
One problem I have seen with VBT is it doesn’t seem to address the rotation as much. So, it may correct the curve to some degree, but the rotation is still there. Definitely an improvement, but not a “fix”.
To learn more about VBT, check out this Podcast Episode with one of the top scoliosis surgeons in Utah.
Scoliosis Specific Exercise
Admittedly, I am a little biased to Physiotherapeutic Scoliosis Specific Exercise or PSSE. At my clinic in Lehi, Utah we use the Schroth Method and the SEAS Approach to treat scoliosis. Even though I really like these methods, they are not “fixes” either.
The idea behind scoliosis-specific exercise is to retrain the muscles of the body to hold the spine in a more symmetrical position. This reduces the forces that cause the spine to curve.
We can expect to halt the progression of the curve in adolescents, and usually will see a reduction in the curve when done correctly. It takes work and time to see those results.
Because we are not reshaping the vertebrae we still are not fixing it. The shape of the vertebrae improves, but not completely.
It is by far the most conservative way to treat scoliosis, with no bad side effects or risks. It is just strengthening the body’s movement patterns to minimize scoliosis and fight against the forces that create it.
If a scoliosis curve progresses past 25 degrees, and the child is still growing, a brace is usually used to stop it from continuing to get worse.
Bracing has come a long way in the past 15 years. The types of braces that are available now usually address the 3D nature of scoliosis, to varying degrees.
The goal of bracing is to stop it from getting worse. So, no, this is not a “fix” either.
Even though it is not a fix, I definitely still encourage my patients who are growing with curves over 25 degrees to be braced. It has been shown in research to help avoid progression to surgery. It might be uncomfortable and really suck, but it is effective.
Other Treatment Methods
There are many other treatment methods out there for scoliosis. Most have not been studied significantly, and some are questionable. An overview of all these methods is not the purpose of this pos, however.
One thing to be very cautious about is if someone, or some method, claims to be able to “fix” the scoliosis curve. This is just not possible.
Even surgery isn’t “fixing” the curve. There is still rotation, and usually still a curve. The purpose of surgery is not to fix the curve, but to stop it from getting worse.
Anyone who claims they can “fix” scoliosis better have the research and studies to back it up. In my experience, this is just not the case.
Who knows, maybe in the next 10 years we will have a cure for scoliosis and we will be able to “fix” it. Until then, we will use the best methods we have to treat scoliosis and help those living with it improve.
Once you have scoliosis, you will most likely have it the rest of your life. But….this doesn’t mean you can’t take the reins and control it!
Most of what I have talked about in this post is in reference to Adolescent of Juvenile Scoliosis. Most of the ideas can also be used with adult scoliosis, other than the concern over growing. The adult scoliosis spine is not growing, and commonly is shrinking. This too can cause progression in the curve.
In a future blog post, I will talk more specifically about adult scoliosis treatment and what to expect.
In the meantime, if you want to learn more about scoliosis or scoliosis-specific exercise, please check out our other blog posts or grab a free report from our website.
Thanks for reading!
David Butler, Physical Therapist