Scoliosis Specific Exercise and Adolescent Idiopathic Scoliosis
Highlight from the 30th Annual Meeting of the North American Spine Society (NASS) in Chicago
Presented by Cindy L. Marti, PT
Scoliosis specific exercise (SSE) is part of the conservative management of scoliosis in adults and adolescents, explained Cindy L. Marti, PT during the 30th Annual Meeting of the North American Spine Society held in Chicago, IL. Ms. Marti is Founder and owner of Spinal Dynamics of Wisconsin. Ms. Marti discussed the goals of SSE in patients with adolescent idiopathic scoliosis (AIS), and results from a survey involving members of the Scoliosis Research Society (SRS).
Scoliosis Specific Exercises Does Not Replace Bracing
In adolescents with idiopathic scoliosis, the goal of SSE treatment is prevention or reduction of curve progression, respiratory dysfunction, spinal pain, and improved appearance through postural correction. SSE teaches patients auto-correction three-dimensionally, and pays particular attention to restoration of sagittal alignment and stabilization while static and during activities of daily living. There are different types of SSE.
Marti stated, “It's very important to understand that exercise does not take the place of bracing when curve severity dictates bracing is indicated.” The outcome of the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAiST) corroborated Marti’s statement, which she pointed out to be “an absolute landmark study." The study compared bracing to observation in prevention of curve progression to 50-degrees or greater; a common indication for spine surgery. BRAiST findings demonstrated an impressive lower rate of surgery among braced patients.1
Attitudes Explored by SRS Member Survey
“The families of patients with scoliosis are seeking more options, and there is, very happily, an increase in direction between the SRS—traditionally a surgical society, and SOSORT [Society on Scoliosis Orthopaedic and Rehabilitation and Treatment], a nonsurgical society,” stated Marti. Marti et al designed a survey, and after receiving Investigational Review Board approval, sent the survey to all members of the Scoliosis Research Society. The purpose of the survey was to evaluate attitudes toward physical therapy (PT) and Physiotherapeutic Scoliosis Specific Exercise (PSSE) in the treatment of AIS.
The survey received a 22% response rate with the greatest response from SRS members in North America.2 “Of the respondents, the majority of them prescribe neither PT nor scoliosis specific exercise for AIS,” Marti commented. Overall, the referral rate for PT and/or SSE (PSSE) was low among survey responders. “The reasons for not prescribing were cited as a lack of evidence in both cases; a belief that it had no value in both cases [PT, SSE]. And, in the case of SSE, a lack of access—which is a reflection of the fact that in the United States, we do not have many therapists yet trained in the scoliosis specific exercises,” reported Marti.
- Fifty-eight surgeons (22%) indicated they referred AIS patients for PSSE.2 Their prescribing behavior was consistent with the usual indications for prescribing bracing.
- The most common goal of therapy chosen was the alleviation of pain. However, the survey reported only 25% (n=67) prescribed physical therapy as a pain treatment.
- The greatest reasons why surgeons do not prescribe scoliosis specific exercise included lack of evidence, value and access to SSE.
- “Surgeon age didn’t influence the referral rates to physical therapy in this study,” stated Marti. Furthermore, she said, “Older surgeons were more likely to prescribe SSE, which may be rooted in the idea that tradition was more accepted in that generation compared to today, where there’s a higher demand for evidence.”
“So in conclusion, there's a low rate of referral for SSE and PT combined. The most common reason for not referring is because of lack of evidence. The most common reason for referring was for small curves and as an adjunct for bracing, which is consistent with accepted indications. Improving aesthetics was the most commonly shared goal,” stated Marti.
While there may be a lack of awareness about scoliosis specific exercise in the United States, the BRAiST study results have heightened interest in nonsurgical treatment of adolescent idiopathic scoliosis. The study by Marti et al revealed the support for SRS-funded research in this area may benefit patients with AIS.