Dr Stitzel

Scoliosis for Dummies

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by , 04-10-2012 at 08:42 PM (16831 Views)
Step #1. Don’t panic. While scoliosis can be a rapidly progressive condition it is usually measured in terms of months, not days. You should set up an appointment with a health care provider immediately for a initial full spine standing x-ray analysis. This is the only way to definitively confirm the presence of a curvature of the spine.

Step #2. Start with the end in mind. It is VITALLY important that you understand the entire process of the scoliosis evaluation and treatment process from the beginning, rather than at the end. Having an overall understanding of the complete treatment process will have a dramatic effect on the decisions you make at the beginning of treatment.

The standard medical recommendations for evaluation and treatment of scoliosis
The medical or orthopedic doctor will take a full spine x-ray to confirm the presence of a curvature of the spine and report the size of the curvature to you using a system of degrees called a Cobb’s angle. Cobb’s angles are notorious for being prone to measurement error (+/- 5 degrees at least) and doctor subjectivity, so it’s primary value to merely to confirm the presence of the curvature and provide you a general figure as to the size of the spine curvature.
The doctor will make one of 3 standard treatment recommendations based solely off the Cobb’s angle measurement as follows:

0-24 degrees. No treatment recommended! Observation only/watch and wait.

25-39 degrees. 23 hour-a-day rigid spinal bracing recommended.

< 40 degrees. Spinal fusion surgery for cosmetic purposes.

Once a treatment recommendation has been implemented the doctor generally will re-evaluate the patient with another full spine x-ray using the Cobb’s angle measurement. Again, the Cobb’s angle measurement is generally accepted to have anywhere between +/- 5 degree measurement error and the overall measurement should be confirmed on several evaluations to eliminate false positive or false negative findings.

The doctor will continue to make future treatment recommendations based off the Cobb’s angle measurement as the curvature progresses.

Step #3. Get a full spine x-ray. Again, the true value of this x-ray film is to confirm the presence of a curvature, and the size of the curvature (measured in degrees using the Cobb’s angle method) will only provide a general magnitude. It is important for you to get a copy of the actual x-ray and report (on a CD is fine) before you leave the facility each time. You will need them for 2nd and 3rd opinions and it will save you a lot of hassle tracking them down later.

Step #4. Send us the x-ray and set up consultation time. While the Cobb’s angle measurement is often unreliable, most likely it is the only measurement you will have available to you at this point. The current medical model of scoliosis treatment does not offer any treatment options for curvature of the spine less than 25 degrees, which is why an Early Stage Scoliosis Intervention program was started. These cases should set up a consultation with one of our doctors immediately to determine the best course of early stage scoliosis intervention without delay.

Curvature of the spine that measure 25 degrees or larger will be provided a 23 hour-a-day rigid spinal bracing treatment option (provided by the orthopedist) or the patient may be an excellent candidate for an Early Stage Scoliosis Intervention program (for spine curvatures 25 degrees for less) or a Scoliosis BootCamp program (for spine curvatures more than 25 degrees) which is also available at all of our clinic locations.


Patients with Cobb’s angles the measure greater than 40 degrees are often immediately referred for spinal fusion surgery. It is important to note that this procedure is recommended for cosmetic purposes only and should only be considered urgent or life threatening when organic measures of health (cardiac output/ vital lung capacity) are threatened. The determination of when a spinal curvature is becoming life threatening should NEVER be determined solely by a Cobb’s angle measurement. Patient’s with spinal curvatures larger than 40 degrees should contact one of our scoliosis treatment locations immediately and inquire about the highly customized 10 day Scoliosis BootCamp program designed for these severe cases.

Step #5. Set up immediate evaluation appointment with an Early Stage Scoliosis Intervention specialist. Delaying the onset of scoliosis treatment is the single biggest and most common mistake parents make when their child is diagnosed with scoliosis, especially while the curvature of the spine is still less than 25 degrees. Here is a common sense rule of thumb. Smaller spinal curves in younger patients respond to treatment better than larger spinal curves in older patients. Many times parents delay the onset of treatment because the orthopedic doctor has yet to recommend a viable treatment option, or only a treatment option including a rigid brace that offers no hope of curve reduction and destroying the child’s self esteem and body image. This principles seems elementary, but time and time again parents continually “watch & wait”, while their child’s scoliosis becomes worse and worse.

Step #6. Work with the doctor who respects your and/or your child’s individual treatment needs. Like snowflakes, there are no two curvatures of the spine alike. Your child is an individual and so is their condition. Rigid bracing programs only provide 2-3 different versions of braces for an incalculable number of possible spine curvatures. The truly skilled scoliosis doctors recognize that your child’s personal needs cannot simply be boiled down into one or two Cobb’s angle measurements. The treatment plan needs to be customized for each patient with specific in office and home spinal rehabilitation programs based on the patient’s unique needs and presentation.

Step #7. Creating a home rehab routine and schedule is the most critical aspect of your child’s successful participation in the home rehab portion of an Early Stage Scoliosis Intervention program. While no one routine is successful for all patients, we have found that most of our patients chose to develop a weekday routine schedule and a weekend routine schedule. On a daily basis, some patients find that completing a round of rehab immediately after school and right before bed works better than in the morning (before school) and in the evening. Either schedule is acceptable as long as the patient’s muscles have adequate recovery time between sessions.

Step#8. Re-evaluations and treatment plan changes are a necessary part of the continual treatment and management of any scoliosis case, especially until the patient reaches skeletal maturity. Generally the re-evaluation times are every 4-6 months for adolescent patients and 1-3 years for adult patients. All scoliosis patients are encouraged to continue with the prescribed home scoliosis exercise program on a daily basis in between re-evaluation periods. It will most likely be necessary to make minor treatment plan changes to the home scoliosis exercise program after each re-evaluation in order to remain maximum effectiveness with the patients ever changing needs.

Step#9. Continued in office treatment may be necessary in the event the curvature shows significant signs of the condition regressing during one of the regularly scheduled re-evaluations. Generally speaking, there are four common reasons why a patient’s curve reduction/correction would begin to regress.

Non compliance with the home rehab program
Rapid growth spurt (more than 1” in two months time)
Significant spinal trauma (whiplash, falls, trampoline accidents)
Repetitive compression type activities (horseback riding, weight lifting, running on hard surfaces, ect)

Significant regression of the spinal curvature is a serious concern and should be treated immediately, before the disease can gain momentum through the “coil down effect” again. Often this does not require a full scale program and lost gains in curve reduction can be regained in “mini” Scoliosis BootCamp sessions.

Another common concern is when curvature of the spine is showing signs of a treatment plateau. This is when the re-evaluation demonstrates no further correction from the home rehab program alone. Again, an additional “mini” Scoliosis BootCamp program is often utilized to “re-stimulate” the spine curvature into a corrective state again.

Step#10. Caution; Bumps in the road ahead. Scoliosis is a highly progressive condition that manifests it’s self in dormant and active periods. Generally, curve reduction gains are achieved during the dormant periods and hopefully maintained during the active periods. The current “gold” standard, of the orthopedic community, for scoliosis treatment is considered curve stabilization, not curve reduction, so it is most important to understand the “roller coaster” type nature of treating this disease through the adolescent years. Many patients experience some episodes of curve progression during the disease’s active period, but generally can regain the treatment losses and make continued improvements during the dormant periods. A wise man once said, “the only people who get hurt on roller coasters are the ones who jump off”. It is absolutely critical for a patient (and parents) to remain calm, supportive, and persistent when they hit the inevitable bumps in the road. Further treatment may be necessary to gain control over the progressing curvature of the spine, and the patient should be prepared to re-commit their efforts to overcoming their spinal health crisis. However, continual communication, compliance, and follow through of treatment recommendations will provide you and your child with a successful outcome in the future.
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  1. Dr Kalla's Avatar
    Hi Kim

    Best for you would be to visit a clinic that deals with exercise based scoliosis treatment.
    This would allow them to exam your daughter and then figure out what approach/exercises would be most appropriate for her.
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