Exercise for Idiopathic Scoliosis Flashcards
Cue when addressing kyphosis:
bring your bra line back
All autocorrection exercises integrate:
- elongation
- pelvis corrections
- side-shift
- derotational breathing
- shoulder corrections
With muscle dysfunction, _____-_____ affected.
length-tension
With scoliosis, muscles are _____ on concave and ______ on convex side.
- shorter
- longer
There is a lack of research to document ____ of _____ _____ that could be targeted by interventions.
- deficits
- muscle dysfunction
Why is there a lack of research to document deficits?
- most studies were cross-sectional
- unknown if imbalances are causal or symptomatic of the curve
- unknown if treating the imbalances will improve the curve
Studies on AIS differences vs controls showed:
- prolonged EMG activity during gait in AIS
- increased contralateral:ipsilateral activity ratio during side bending in AIS
- weakness in paraspinal or abdominal muscles in AIS group
Studies on AIS side to side asymmetry vs controls showed:
- increased contralateral EMG activity during side bending in AIS
- different patterns of asymmetry during isokinetic contractions
- prolonged latencies on the side opposite to he curve in AIS
Studies on associations between muscle impairment and curve progression showed:
- larger convex:concave EMG ratios can predict progression
- correlations are more pronounced for EMG measured in sitting postures
- prolonged latency can predict progression
AIS model =
adolescent idiopathic scoliosis model
Theoretical AIS model consists of what 3 components?
- postural component
- sensory integration deficits
- structural component
What questions are asked when AIS is being classified?
- other exercise related dysfunctions in play?
- is there soft tissue hyper/hypomobility?
- motor control issues?
Motor control issues can include:
- balance control
- latency issues
- neural representation of the body (Body Schema)
The issue with a heterogenous diagnostic category:
many factors may be in play
PSSE =
physiotherapeutic scoliosis-specific exercises
SRS RX guidelines for Cobb Angle of 15-20 degrees:
observe + early bracing in cases
SOSORT RX guidelines for Cobb Angle of 15-20 degrees:
educate + early bracing in cases + PSSE
SRS RX guidelines for Cobb Angle of 25-45 degrees:
brace
SOSORT RX guidelines for Cobb Angle of 25-45 degrees:
brace + educate + PSSE
SRS RX guidelines for Cobb angle of 45-50 degrees:
surgery
SOSORT RX guidelines for Cobb angle of 45-50 degrees:
surgery
SRS RX guidelines for adult scoliosis:
N/A or surgery
SOSOT RX guidelines for adult scoliosis:
PSSE + optional bracing prior to surgical decision
Potential goals of using exercise in combination with bracing:
- to stop curve progression at puberty (or reduce it)
- to prevent or treat respiratory dysfunction
- to prevent or treat spinal pain syndromes
- to improve aesthetics via postural correction
The use of a rigid brace always implies the associated use of:
PSSE
Using exercise alone depends on:
Risser and Curve severity
Immature curves:
between 11 degrees and over 30 degrees
Mature patients:
curves 11 to 45 degrees
Exercise alone or combined is incorporated for _____ maturities (____ ____).
- all
- all rissers
Exercise alone or combined is used for curves between ____ and over _____ if non-surgical.
- 11 degrees
- 50 degrees
Objectives of PT treatment:
- slow/stop progression
- prevent or treat respiratory dysfunction
- control pain and eliminate cause
- correct posture
PTs correct posture via:
- balanced muscular tension (flexibility, facilitation, etc.)
- balance exercises
- static and dynamic sensory integration
Is PT used in North America?
only 15% of patients with AIS were referred to PT
Characteristics of those referred to PT in North America:
- average age at time of referral: 16 years
- largest mean Cobb angle at time of referral: 26 degrees
PSSE treatments:
Schroth approach
Schroth approach is aka…
Barcelona Scoliosis PT School (BSPTS) approach
Common elements among PSSE treatments:
- individualized 3D self correction
- isometric and stabilization-type contractions of the torso muscles in a corrected posture
- integration of corrections into ADLs
Individualized 3D self correction consists of:
self-attaining the best possible correction through muscle contraction with some use of external aids
3 types of correction through muscle contraction:
- side shift of the torso towards the concavities
- self-elongation with derotational controlled breathing exercises
- derotation and creation of kyphosis
What treatment goals are PSSE dosages consistent with?
- strength
- endurance
- motor control
Schroth approach since _____ , _____.
- 1924
- Germany
Schroth approach consists of specific exercises progressed from:
- lying to sitting and standing
- static to dynamic
- with progressively less and less feedback
Schroth approach used to help patients…
understand and maintain corrected postures and break the progression cycle
4 principles of Schroth Approach:
- self-elongation
- corrections in 3D (pelvis, side shifts, shoulder corrections)
- breathing control (expand concavities/depress convexities)
- stabilization
All autocorrection exercises integrate:
- elongation
- pelvis corrections
- side shift
- derotatonal breathing
- shoulder corrections
Aim of Schroth exercises aim to ______ the curve ….
- overcorrect
- past midline
SETS =
Schroth Exercise Trial for Scoliosis
SETS study supervised:
1 weekly or 8-10 visits a year front loaded then spaced out
SETS study home program:
- with handouts or videos
- daily or 4-5x/week for 15-40 min.
- 3-8 exercises
- each 3-5 sets of 4-10 breathing cycles or 5 minutes each
- progress based on correct performance
SETS take home instructions consist of:
- visual of set up and diagram of corrections
- corrective instructions with breathing steps
- dosage/frequency
- tracking compliance
SEAS =
Scientific Exercise Approach to Scoliosis
SEAS challenges the….
maintenance of autocorrections
Strength asymmetry weakness when…
rotating towards the concavity of their primary curve
Scoliosis patients were significantly weaker than healthier teens when…
rotating toward the concave-left from the midline or concave/left pre-rotated positions
Methods to improve rotation strength over time:
- 4 month supervised machine rotation training
- 2x/week for 25 min.
- 4 more months home rotation training with elastic bands 3-5x/week
Results of study looking to improve rotation strength over time:
- after 4 months supervised, strength gains of 28-50%
- after 4 months of home training, strength remained improved
- all 3 curves > 50 degrees had curve progression
- 20-40 degree curves: 100% had no curve progression at 8 months, 64% did not have curve progression at 24 months (typical)
Larger improvements for ______ and patient specific _____ _____ scores with supervised therapy.
- pain
- functional scale
No significant between group effect on _____ ____ _____ ____endurance test and ______ scores.
- prone double leg raise
- Oswestry
No between-group differences in the _____ _____ of _____ after the 8 week PT intervention.
global rating of change
How to use side-planking:
- concave side facing down
- held daisy for as long as possible
- improvement in Cobb angle by 32%
Why do we have to use caution when side-planking?
poor research methodology
What is 3D ultrasound imaging used for?
- looking at the immediate effect of exercise
- determining the in-exercise correction that can occur during postural and therapeutic positions
Curve angle:
angle between most tilted vertebrae limiting the curve
Interapical distance:
distance between the most deviated vertebrae in each curve
Thoracic curve angles were reduced in fully corrected….. positions.
- prone
- sitting
- active standing
Lumbar curve angles were reduced in the fully corrected ______ and _____ -_____ positions compared to their respective habitual and passively-corrected positions.
- prone
- side-lying
Which position had the lowest thoracic and lumbar curve angles?
sitting active with hip flexion
What positions reduced max AVR twist compared to their habitual position?
- active prone
- sitting with hip flexion
- standing active
…. was less rotated than in passive side-laying.
active side-lying with leg left
Which position demonstrated the lowest max AVR twist?
prone active with hip flexion
Which positions with active correction significantly reduced the interapical distance compared to their habitual position?
- prone
- sitting
- standing
Which position had the lowest interapical distance?
sitting active with hip flexion
What were the results of SETS?
most remained stable
Monticone et al.’s RCT found improved Cobb angles at _____ _____.
skeletal maturity
The study that used SEAS (not Schroth) found:
- larger Cobb angle improvement
- lower risk of progression of their sample
- longer intervention
There is a lack of high-quality evidence to recommend the use of ____ for ____.
- SSEs
- AIS
We need more long term studies showing exercise can:
- prevent bracing and surgery in the long term
- make an impact into adulthood
There is _____ ______ to recommend scoliosis screening.
insufficient evidence
There is evidence of _____ _____ in individuals with scoliosis but we do not know if it is a _____ or a _____.
- muscular dysfunction
- symptom
- cause
AIS symptoms may really be the _____ of many different _____ from many _____.
- summation
- symptoms
- pathologies
PSSE program dosages are not truly _____ with any typical programs for physical goals.
consistent
PSSE treatment approaches have _____ components and try to _____ curves.
- similar
- correct
Evidence on exercise training for scoliosis is limited by _____ and _____ of evidence available but there is research ____ and _____.
- quality
- quantity
- ongoing
- improving
