SCOLIOSIS MANAGEMENT

By
Neha Dhobale
(PT)

MANAGEMENT
Most important aspect- early detection of the curve.
Curve that is obvious in standing position; has already
approached 30 to 40 degrees.
Curves over 20 degrees tend to progress.
Treatment depends on age and severity of the curve.

NON- SURGICAL
TREATMENT

Observation for curves <20.

Orthosis - for curves between 20-40.
Operation for curves > 40.
Other measures exercises, electrical stimulation etc.

Curves < 40
Mild Postural Curves ( till 20)
Active correction - Moving and placing the legs or trunk in
such a position that optimal self-correction of curve is achieved.
Passive correction Unequal traction: Instruct the patient to hang from
suspension with
one hand.
Hanging in the head suspension apparatus.
Axial traction: Patient in supine. 1 PT grasps the pelvis
and gives
traction towards the leg, other PT grasps the chin
and occiput and
stretches the spine in opp. direction.
Maintenance of correction by active efforts.

 Management of Postural Scoliosis (Progressive reeducation of bad posture)

Whole body relaxation techniques
Passive correction by physiotherapist
Repeated sessions of maintenance of corrected posture
till it becomes
automatic
General free mobility exercises
Deep breathing exercises
Balance exercises
Soft tissue stretching
Patient trained to feel and hold corrected posture.

Management of structural
scoliosis(Curves25-45)
Active self-correction as well as maintenance of
braced (orthosis)
Braces for spine
i. TLSO: Thoracolumboscaral orthosis (Boston brace, Wilmington TLSO
ii. CTLSO: Cervicothoracolumboscaral orthosis (Milwaukee brace)
iii. CTO: Cervicothoracic orthosis
iv. Other Charleston bending brace.

Exercises
i.
ii.
iii.
iv.
v.

Mobility exercises
Deep Breathing exercises
Exercises to reduce and correct the anterior pelvic tilt.
Stretching of hip flexors and hamstrings
Hanging in head suspension apparatus or on stall bars effective

Charleston Bending Brace

Milwaukee Brace

Boston Brace

Wilmington Back Brace

Severe structural curves

(Curves >40)
Pre-operative assessment and
training.
Various forms of traction
Surgical treatment

Pre-op PT assessment and training

Measurement of the rib hump in prone.
Assessment of the pulmonary function.
Muscle charting of the body and limbs especially below the

level of fusion.
Detailed neurological examination to detect compression of
spinal cord.
Vigorous ATM, isometrics to gluteal and quadriceps muscles
taught.
Gait analysis and functional status assessed and
requirements of normal gait explained
Postural Guidance
Spinal stretching and mobility

Various forms of Traction

Skeletal traction in form of:
i.) Halofemoral traction
ii.) Halopelvic traction
iii.) Halo-wheelchair traction

Non-skeletal methods of traction:

i.) Intermittent traction followed by sustained traction - Low
back pain patients.
ii.) Cotrel traction Superimposition of continuous and
intermittent traction.
iii.) Gravitational traction Twice as effective as effective as the
Cotrel traction.

Surgical Treatment
Indications
Curves > 60
High degree Thoracic curve which is inflexible
and associated with secondary changes in the rib.
Spinal cord compression.
Pain
Respiratory problem
Cosmetic reasons.

Spinal
Instrumentation

POST-OP PT MANAGEMENT
During the First 4 Days
1. Vigorous chest physiotherapy improve the reduced vital
capacity of the lungs
2. Patient is turned to the sides every 2 hours to reduce on
the back.
3. Active ROM- shoulder and ankle joints
Passive ROM to lower limbs to relieve pain and stiffness.
4. By end of 4th day Active and Passive ROM - Hip and
Knee joints.

 After 4 Days
With assisted guidance patient is taught to sit, roll and
stand.
1.Getting out of the bed:
Reverse climb down technique.
Log rolling Prone Position Prone Kneeling
Getting down
slowly from the foot end of the bed
Climbing up the bed is done in reverse manner
2. Sitting - Initial sitting should not exceed 15 minutes.
Initially with
support and back rest.
3. Standing - Unsupported sitting should precede
standing.
4. Walking Initiated in parallel bars. Later, provided

 Additional physiotherapy
measures
1.For one level anterior fusion
- Corset or POP jacket for 3 months
- Isometrics to back muscles
- After 3 months, back exercises are begun

2.For two level anterior fusion

- Corset or POP jacket for 3 months
- Isometrics to back muscles
- After 3 months, back exercises are begun

3.Posterior fusion
- Corset or POP jacket is advised for 6 months
- Hip Spica if L5- S1 joints are fused.

4.Combined anterior and posterior

fusion
- Log rolling and later table tilt activity
- POP jacket or corset for 6 months.

5.If anterior and posterior fusion is

done with a gap of 2 weeks,
hydrotherapy is suitable as there is
considerable muscle weakness.

Rest of the measures are the same as

Reference
Essential of Orthopaedics and applied Physiotherapy Jayant Joshi
Essentials of Orthopaedics for Physiotherapists John
Ebnezar