Physical Rehabilitation in the Management of Symptomatic Adult Scoliosis

Abstract

Scoliosis is prevalent in elderlies over the age of 60. Of the different curve types, the thoracolumbar curve is the most common curve type operated upon, as it is associated with marked trunk shift and disability. Current physiotherapy treatments consist of electrotherapy, aquatic exercises, core-strengthening exercises, and dry needling. Outcome of these treatments has not been satisfactory. Longterm successful rate of conservative treatment of symptomatic adult scoliosis is low, as the treatment addresses symptoms but not the biomechanics involved in adult scoliosis. Recent studies have shown that physiotherapeutic scoliosis-specific exercises (PSSE) and bracing stabilized the curves in 80% of the subjects. Thus PSSE and bracing should be added to the standard physiotherapy care in the management of symptomatic adult scoliosis. For asymptomatic patients with thoracolumbar curve that has an increased risk of progression, PSSE should be considered as preventative exercises. Patients who do not respond to conservative treatments and have significant spinal stenosis should be referred for surgery.curves progressed 3° per year [13] and that apical vertebral rotation ≥ III (according to the Nash-Moe classification), a Cobb angle >30°, lateral vertebral translation >6 mm, and L5 above the intercristal line predict curve progression [13,14]. Osteoporosis, a coronal Cobb angle <30°, lumbar lordosis, and degenerative spondylolisthesis are not risk factors for curve progression [14].With increase in life expectancy of the population [2,15], it follows that the prevalence of adult scoliosis increases [2,15] and with it the morbidity.