What is the recommended physiotherapy management for an 8-year-old boy with mild scoliosis?

Physiotherapy Management of Mild Scoliosis in an 8-Year-Old Boy

Physiotherapy Scoliosis-Specific Exercises (PSSE) are the recommended first-line treatment for an 8-year-old boy with mild scoliosis, focusing on 3D self-correction, activities of daily living training, and stabilization of corrected posture. 1

Assessment and Monitoring

• Standing full-spine radiographs (posteroanterior and lateral views) are essential to evaluate curve severity, pattern, and sagittal balance 2
• PA (posteroanterior) technique should be used instead of anteroposterior views to reduce breast radiation exposure 2
• Lower-dose radiography techniques should be employed to minimize radiation exposure 2
• Regular monitoring is crucial, with referral to a specialist if:
  • The curve is greater than 10 degrees in a child younger than 10 years of age
  • The curve has atypical features
  • The curve is associated with back pain or neurological abnormalities 3

Physiotherapy Approach

For an 8-year-old boy with mild scoliosis, the physiotherapy management should follow a structured approach:

1. 3D Self-Correction Exercises:

   • Teach exercises that address the three-dimensional nature of scoliosis
   • Focus on correcting posture in all planes (sagittal, coronal, and transverse)
   • Emphasize active correction rather than passive stretching 1

2. Activities of Daily Living (ADL) Training:

   • Educate on proper sitting, standing, and sleeping postures
   • Modify school activities to reduce asymmetric loading on the spine
   • Train in maintaining corrected posture during routine activities 1

3. Stabilization Exercises:

   • Strengthen core muscles to maintain the corrected posture
   • Focus on muscles that support the spine in the corrected position
   • Include exercises that improve proprioception and balance 1

Specific Exercise Approaches

Several established physiotherapy schools offer specific approaches for scoliosis management:

• SEAS (Scientific Exercise Approach to Scoliosis): Focuses on active self-correction and functional exercises 1
• Schroth Method: Uses proprioceptive and breathing techniques with specific positioning 1
• BSPTS (Barcelona Scoliosis Physical Therapy School): Adapts Schroth principles with emphasis on 3D correction 1
• Side Shift Approach: Incorporates lateral shifting of the trunk to reduce curve progression 1

Treatment Goals

The primary goals of physiotherapy management for mild scoliosis in an 8-year-old boy include:

• Prevent further curve progression
• Improve trunk balance and posture
• Enhance body awareness and proprioception
• Maintain normal physical activity while avoiding activities that increase asymmetric loading 2
• Improve back asymmetry through 3D self-correction 1

Frequency and Duration

• Regular physiotherapy sessions (typically 2-3 times per week initially)
• Daily home exercise program (15-30 minutes)
• Long-term commitment to the exercise program is essential for effectiveness

Multidisciplinary Approach

The physiotherapist should work as part of a team including:

• Orthopedic doctor for medical management
• Orthotist if bracing becomes necessary
• Mental health provider for psychological support 1

Common Pitfalls and Considerations

• Delayed referral: Early intervention is crucial for optimal outcomes 2
• Inadequate monitoring: Regular follow-up is necessary to track progression 2
• Overlooking non-idiopathic causes: Rule out congenital, neuromuscular, or syndrome-related causes 3
• Neglecting psychological impact: Address body image concerns and treatment adherence 2
• Inconsistent exercise performance: Emphasize the importance of regular practice 1

When to Consider Additional Interventions

• If the curve progresses to 20-25 degrees despite physiotherapy, bracing may be considered 4, 5
• Curves greater than 20 degrees in a child 10 years or older require specialist referral 3
• MRI is recommended when intraspinal abnormalities are suspected 2

Physiotherapy management for mild scoliosis in young children has shown promising results in temporarily stabilizing or even reducing curve progression when practiced regularly, while also improving back asymmetry and preventing secondary muscle imbalances 1.