Adolescent scoliosis: Early detection is important
Baby boomers and Generation Xers may recall the days of being screened for scoliosis in elementary or middle school. While this practice was common in states across the U.S. for a number of years, it has stopped in many communities.
Some may also remember when kids diagnosed with scoliosis -- the medical term for an abnormal curvature of the spine -- wore heavy-looking metal braces. This full-torso brace extended from the pelvis to the base of the skull. Designed by Milwaukee-area physicians and commonly referred to as "The Milwaukee Brace," it was the most popular bracing approach in past decades.
Today, screenings and treatment approaches are varied.
Wisconsin is one of more than 25 states where school screenings are not currently mandated. Yet many organizations recognize the benefits of screening programs including the American Academy of Orthopedic Surgeons (AAOS), Scoliosis Research Society, and American Academy of Pediatrics.
Most physicians perform screenings during annual check-ups. Yet, a challenge exists because many adolescents do not have routine wellness doctor visits.
Screenings take as little as 30 seconds and are commonly performed on children between 10 and 15. A trained health care professional views the spine in both standing and bending positions. Children with suspicious findings should see a physician who often orders an x-ray. Parents may also want to have a child examined by a physical therapist (PT) to discuss exercise-based approaches to treatment.
Most children with scoliosis have mild curves and won't need aggressive treatment. When a curve is suspected or confirmed, routine screenings are critically important. Some parents opt for screenings every three months rather than semi-annually or yearly, especially during times of rapid adolescent growth. Information about a curve's progression is important in determining the best treatment approach.
Medical organizations publish treatment guidelines. The decision to treat scoliosis is based on many factors, including age, maturity, sex, family history, curve size and how much the child is likely to grow.
Traditionally in the U.S., treatment involved a "wait and see" approach. Physicians have most commonly monitored curve progression and initiated treatment if the curve passed a certain threshold. Typically, physicians recommend bracing or surgery, or both. Scoliosis surgery involves techniques to fuse or join the vertebrae along the curve.
Bracing options have expanded. The most commonly used brace is a thoraco-lumbo-sacral orthosis (TLSO), or underarm brace. It is more easily concealed under clothing than the Milwaukee Brace. Additional bracing approaches have emerged in recent years with some options including (insert list).
In the U.S., PT has also recently emerged as a valuable treatment. In past decades, while PT has played a minor role in scoliosis treatment in America, it is now becoming more popular among a growing number of patients.
One PT-based approach has seen increased popularity in the U.S. within the past five years. The Schroth method is a conservative, non-surgical, exercise-based approach developed in Germany in the 1960s. In Europe, more than 3,000 patients are treated with Scroth annually. Today, fewer than 20 therapists in the US are Schroth-certified; three are on staff at our Milwaukee area clinic which draws patients from across the U.S.
Many physicians from the United States say research is inconclusive for bracing or physical therapy. With Schroth, most patients report a benefit of being empowered to take action in addressing scoliosis, and many report improved postural deformity.
Decision about screening for and treating scoliosis are always individual choices of families. Parents and children should be aware of the importance of screening and explore various treatment options if scoliosis is present.
I wore a brace for three years when i was in junior high. Although the scoliosis improved I think the brace affected by back negatively in other ways. I'm 43 and looking at my 2nd back surgery. I think I lack core strength becasue I was not required to have any while wearing the brace. I also think it change my shape in general. I have an extremely hour glass figure and a flat tummy and butt not because of heredity but because my body couldn't put fat cells in areas where my brace was tight. Okay the flat butt thing might be hereditary from my dad, but that's all. I'm really not the same shape as any woman on either my mom or dad's side of the family. They are all more straight than curvy and where they tend to gain weight is in the stomach. I've always had a relatively flat stomach and it' not from doing tons of crunches. Has anyone else out there had similar results from weaing the brace?
I wore the brace for some time. In the mid 80's kids could be cruel. It was the worst thing to happen to me but I am grateful that it did work somewhat, plus, the constant nagging and name calling made me a better person today.
This is a great story. I have scoliosis but was not diagnosed til age 19 and thus was unable to be treated. Looking back, those 8-second tests in gym class where the nurse rolled that thing down my spine was so ridiculous. I sure hope they do it better now in the schools. Thanks again for the story, Doc.
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