The Unseen Dangers of Scoliosis – Jonathan Goh

Actual patient of mine who was diagnosed with a right thoracic curvature of 50 degrees in 2009 and put in brace (hard bracing) for two years, but no proper follow-up was done after brace was removed and curve was allowed to worsen. Saw him in 2013 with a curvature of 78 degrees. Surgical solution was recommended. X-Ray published with patient’s consent.

In the three years of working as a physiotherapist, no cases that I have seen or treated has touched me on a personal level more than patients suffering from scoliosis. What is scoliosis you may ask? Scoliosis is an abnormal presence of a lateral (side) curve within our spines.  Think of our spines as a straight rail way tracks; notice that tracks are meant to be made leveled and that a single bump or twist within a track can be a dangerous thing to trains? Well, scoliosis is akin to those bumps or twist in your spine.  The severity of the condition can be categorized by measuring the degree of the curvature of the spine on an X-ray film. Mild scoliosis can range from 10°-15° where as moderate scoliosis will range from 26° to 40° and finally, severe scoliosis is above 40°.

Why do I say that I take it personally when I see young adults aged of 15 to 24  come in through my office doors with their parents who will later say, “I saw my daughter’s back has a hump when she took off her shirt this morning” or the usual, “my son has back pain”? It is because the progression of scoliosis if detected earlier can be halted. Studies have been proven that the best time to treat scoliosis is during the stage of the adolescent growth spurt (rapid growth in the vertebral end plates of the spine) which happens around the ages of 10 to 14. Therefore treating children at that age will yield a better outcome compared to that of young adults whose spines are fully matured.

I feel a deep sense of sadness when I see these patients, not because their parents have failed to detect the condition or that it was allowed to go from a mild scoliosis to a severe category in just less than a year but because we as the medical community have failed to raise awareness. The public should be empowered with the knowledge to send children for spinal screenings. They should be informed that scoliosis will lead to secondary complications such as back pain from imbalanced musculature or early onset of arthritis in the spine, joint pains especially in the knees and hips from improper gait patterns, compressed nerves and even breathing difficulties where the curve is 70 degrees or above.

Adam’s Forward Bent Test: Sit behind the child with her/his back facing you. Instruct the child to bend forward as far as possible with both hands either be placed between the knees or fingertips touching the shoulders. Look at the rib cage and follow through towards the lower back. A normal spine will not have any humps or imbalanced shoulder blades.
Source: http://nwchiroclinic.com/blog/?p=124

Currently, treatments for scoliosis involve a tandem of specialist based on the severity of the curvature. Mild scoliosis can be corrected via specific exercises catered for patients with scoliosis like The Schroth Method and core muscle strengthening exercises. Moderate scoliosis requires a combination of the physiotherapy exercises and application of bracing for correction. Finally, if deemed necessary by a surgeon, surgical solutions maybe prescribed for patients whose curvature are too severe preventing the patient from carrying out activities of daily living (ADLs). 

Famous Polish physicist and chemist, Marie Curie, said “One never notices what has been done; one can only see what remains to be done”. I think there is so much we, the medical community, can do by not only  offering state of the art treatments for the people but also constantly educating and reminding the people the importance of spinal health. More spinal screenings to be done in schools, more community based talks in halls and also empowering every adult with the knowledge of how to use the quick and simple Adam’s forward bent test are among the simple screening and educational methods that can have a big impact.

Mr. Jonathan Goh is a physiotherapist currently working in Sarawak. He is passionate about increasing public awareness on important issues such as spinal health.

This is the personal opinion of the writer and does not necessarily represent the views of The Malaysian Medical Gazette.

References

• http://www.southfloridascoliosiscenter.com/wisfeed.html
• http://www.posna.org/education/StudyGuide/ScoliosisUnder40Degrees.asp
• http://www.nhs.uk/Conditions/Scoliosis/Pages/Complications.aspx
• http://www.schrothmethod.com/

[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.] 

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