Is physiotherapy indicated for Scoliosis?

From the Guidelines

Physiotherapy is a recommended treatment approach for scoliosis, particularly for mild to moderate cases, as it can help improve posture, strengthen core muscles, and potentially slow curve progression. When considering the management of scoliosis, it's crucial to differentiate between various types, such as idiopathic, congenital, and those associated with neuromuscular disorders 1. The diagnosis of idiopathic scoliosis, which accounts for at least 75% to 80% of childhood scoliosis, is one of exclusion, involving the exclusion of underlying structural abnormalities or accompanying syndromes 1.

Key Considerations for Physiotherapy in Scoliosis

• The Schroth method, a three-dimensional corrective technique, is often recommended as part of a comprehensive physiotherapy program for scoliosis, tailored to each patient's specific curve pattern.
• Other beneficial approaches include the Scientific Exercise Approach to Scoliosis (SEAS), core strengthening, and postural awareness training.
• Initial physiotherapy sessions should be attended 2-3 times weekly, transitioning to a daily home exercise program of 30-45 minutes for optimal results.
• Physiotherapy works by addressing muscle imbalances, improving body awareness, and enhancing spinal stability, which can contribute to slowing curve progression and improving function in patients with scoliosis.

Importance of Early Intervention and Monitoring

Early initiation of physiotherapy, combined with appropriate medical monitoring of the curve, is crucial for maximizing the benefits of treatment 1. While physiotherapy alone may not correct severe curves that require surgical intervention, it can be valuable for pain management, improving function, and potentially slowing progression in growing adolescents. The clinical relevance of intraspinal abnormalities detected by MRI, even in the presurgical setting, is often unclear, but their presence can influence the management approach 1.

Conclusion is not needed, and the answer continues directly to address the question without a summary.

Physiotherapy's role in scoliosis management is supported by its potential to improve quality of life and reduce morbidity associated with the condition, particularly when integrated into a comprehensive treatment plan that includes regular monitoring and, when necessary, surgical intervention 1.

From the Research

Indications for Physiotherapy in Scoliosis

• Physiotherapy Scoliosis Specific Exercises (PSSE) are a therapeutic intervention accepted by the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) for idiopathic scoliosis during growth 2
• PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, and produce a temporary and significant reduction of the Cobb angle in non-progressive scoliosis 2
• Physiotherapy can also produce benefits in subjects with scoliosis other than reducing the Cobb angle, such as improving back asymmetry, secondary muscle imbalance, and related pain 2
• In more severe cases of thoracic scoliosis, physiotherapy can also improve breathing function 2

Role of Physiotherapy in Scoliosis Management

• Physiotherapy is part of a scoliosis care model that includes scoliosis specific education, scoliosis specific physical therapy exercises, observation or surveillance, psychological support and intervention, bracing, and surgery 2
• The physical therapist works as part of a multidisciplinary team including the orthopedic doctor, the orthotist, and the mental health care provider, according to the SOSORT guidelines and Scoliosis Research Society (SRS) philosophy 2
• Physiotherapy can be used alone or in combination with bracing or surgery according to individual indication 2

Evidence for Physiotherapy in Scoliosis

• A case report found that physical therapy significantly improved muscle strength, relieved pain, improved spinal mobility, and postural control in a patient with adolescent idiopathic scoliosis 3
• Another case report found that a pattern-specific conservative treatment approach, including physiotherapy and part-time bracing, improved chronic low back pain and lumbar Cobb angle in an adult patient with late-onset idiopathic scoliosis 4
• A review of treatments for painful scoliosis suggested that physiotherapy and exercise programs should be tried first to manage pain, before considering other options such as injections or surgery 5