Introduction
Figure 1 X-ray image of a patient with AIS and his spine (Paria et al., 2015).
Scoliosis can be described as an abnormal curvature of the spine. The Cobb angle (figure 2) and the Risser sign are commonly used to assess the degree and progression of curvature. Adolescent idiopathic scoliosis (AIS) is a type of idiopathic scoliosis.
Prevalence of AIS
AIS is a common disorder with an overall prevalence of 0.47-5.2% in the current literature [1]. It occurs between the ages of 11-18 and accounts for 90% of idiopathic scoliosis cases in children. The female to male ratio varies from 1.5:1 to 3:1 and increases significantly with age. genetic factors play a role The same goes for characters. [1]
Back Pain in AIS
The prevalence of back pain in AIS patients is approximately double that of non-scolitic patients [2][3][4]
In AIS, in both men and women, back pain most commonly occurs in the lower back, followed by the chest. [2][3][4] There is a statistically significant association between chest pain and thoracic scoliosis in patients with AIS. [2]. Most AIS patients with back pain report that their pain is Moderate to mild intensity[2][3][4]. It has also been shown that back pain lasts longer and occurs more frequently in patients with AIS than in patients without scoliosis. [3]
Back Pain and Cobb Angle
There was no statistically significant evidence between pain intensity and Cobb angle severity. [2] [5] [6] However, it has been suggested that patients without pain tend to have smaller curves; more severe curves (>40°-45°) are associated with a higher incidence and intensity of back pain.
According to the Scoliosis Research Society (SRS), the presence of back pain may be due to decreased trunk strength or hamstring flexibility. However, there is no evidence to support this claim.
Back Pain and Quality of Life in AIS
Low back pain (LBP) in patients with AIS can lead to decreased quality of life for patients. In addition to pain patients’ self-image, such as attitude, their own appearance is also a factor in the reduced quality of life. [7]
Respiratory Dysfunction in AIS
Patients with scoliosis often present with dysfunctional and asymmetrical breathing patterns. [8] Torso rotation is increased due to the inhalation force directed down to the convexity of the spinal curvature. [8] There is also a link between respiratory dysfunction and LBP or neck pain. [9] [10]
Conservative Treatment
Various methods and exercises have been documented to help reduce the Cobb angle in AIS, but as noted above, reducing the Cobb angle does not necessarily reduce pain.
General Exercise
Patient-specific exercises have been shown to be effective in the initial management of patients with AIS. These may include:
- Spinal mobility/ flexibility exercises
- Trunk strengthening exercises[11]
- stretching hamstrings or other tight lower body muscles
- Gait re-education
- Compound functional exercises, such as squat lunges and up and down the floor
- Tips on cardiovascular exercise and fitness
- Pilates/yoga[12]
- Patient-specific rehabilitation, that is, training related to optimizing function in the patient’s preferred sports
Schroth Method
The Schroth Method is a set of exercises designed for people with scoliosis, especially idiopathic scoliosis. [13] It was developed by Katharina Schroth in Germany. The Schroth method aims to prevent curve progression before the end of growth by Goals [14][15][16]:
- Active Spinal Correction to Avoid Surgery
- Avoid or slow progression of postural exercises
- Information to support the decision-making process
- Home-exercise program
- Support network
- Pain Prevention and Coping Strategies
A review of the literature showed that the Schroth and the Scientific Exercise Approach to Scoliosis (SEAS) approach had positive results in improving the Cobb angle in patients with AIS compared to no intervention [17].
Braces
In systematic reviews few studies measured back pain in patients with AIS this study showed that bracing did not affect back pain in the long term[18].
Another systematic review showed that bracing had no effect on back pain compared with observation, but this review reported conflicting evidence. [19]
Osteopathic manipulation
There is currently no evidence to support osteopathic manipulation for the treatment of AIS [19].
Taping
It has been suggested that Kinesio Taping may reduce back pain and improve quality of life in patients with type 1 AIS under the Lenke classification of scoliosis. This is a randomized controlled trial and the only study of kinesio taping for AIS. So the evidence is insufficient. [20]
Surgical Treatment for AIS
Surgery may be recommended if scoliosis worsens and other treatments do not respond, or if scoliosis is severe and the adolescent stops growing.
Surgery is required when the Cobb angle is greater than 45 to 50 degrees. [21] For idiopathic scoliosis, a posterior fixation fusion is usually performed. [twenty one]
Conclusion
Back pain is common in adolescent idiopathic scoliosis, which affects quality of life for these patients. There are many causes of back pain in patients with AIS, including changes in anatomy and breathing patterns. A lot of research has been done around the best way to manage Patients with AIS should take a holistic approach, always keeping in mind patient-specific goals to improve pain function and overall health.
References
- ↑ Jump up to:1.0 1.1 Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. Journal of children’s orthopaedics. 2012 Dec 11;7(1):3-9.
- ↑ Jump up to:2.0 2.1 2.2 2.3 2.4 Théroux J, Le May S, Fortin C, Labelle H. Prevalence and management of back pain in adolescent idiopathic scoliosis patients: a retrospective study. Pain Research and Management. 2015;20(3):153-7.
- ↑ Jump up to:3.0 3.1 3.2 3.3 Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, Tanabe N. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan. European Spine Journal. 2011 Feb 1;20(2):274-9.
- ↑ Jump up to:4.0 4.1 4.2 Joncas, J., Labelle, H., Poitras, B., Duhaime, M., Rivard, C. and Le Blanc, R. Dorso-lumbal pain and idiopathic scoliosis in adolescence. Annales de Chirurgie. 1996;50 (8), pp. 637-640.
- ↑ Balagué F, Pellisé F. Adolescent idiopathic scoliosis and back pain. Scoliosis and spinal disorders. 2016 Dec;11(1):27.
- ↑ Rigo M. Differential diagnosis of back pain in adult scoliosis (non operated patients). Scoliosis. 2010 Sep;5(1):O44.
- ↑ Makino T, Kaito T, Kashii M, Iwasaki M, Yoshikawa H. Low back pain and patient-reported QOL outcomes in patients with adolescent idiopathic scoliosis without corrective surgery. Springerplus. 2015 Dec 1;4(1):397.
- ↑ Jump up to:8.0 8.1 Weiss HR, Moramarco MM, Borysov M, Ng SY, Lee SG, Nan X, Moramarco KA. Postural rehabilitation for adolescent idiopathic scoliosis during growth. Asian spine journal. 2016 Jun;10(3):570.
- ↑ Bradley H, Esformes JD. Breathing pattern disorders and functional movement. International journal of sports physical therapy. 2014 Feb;9(1):28.
- ↑ Kiesel K, Rhodes T, Mueller J, Waninger A, Butler R. Development of a screening protocol to identify individuals with dysfunctional breathing. International journal of sports physical therapy. 2017 Oct;12(5):774.
- ↑ Zapata KA, Wang-Price SS, Sucato DJ, Thompson M, Trudelle-Jackson E, Lovelace-Chandler V. Spinal stabilization exercise effectiveness for low back pain in adolescent idiopathic scoliosis: a randomized trial. Pediatric Physical Therapy. 2015;27(4):396-402.
- ↑ Blum CL. Chiropractic and Pilates therapy for the treatment of adult scoliosis. Journal of Manipulative and Physiological Therapeutics. 2002 May 1;25(4):E1-8.
- ↑ Berdishevsky H, Lebel VA, Bettany-Saltikov J, Rigo M, Lebel A, Hennes A, Romano M, Białek M, M’hango A, Betts T, de Mauroy JC. Physiotherapy scoliosis-specific exercises–a comprehensive review of seven major schools. Scoliosis and spinal disorders. 2016 Dec;11(1):20.
- ↑ Kim MJ, Park DS. The effect of Schroth’s three-dimensional exercises in combination with respiratory muscle exercise on Cobb’s angle and pulmonary function in patients with idiopathic scoliosis. Physical Therapy Rehabilitation Science. 2017 Sep 30;6(3):113-9.
- ↑ Schreiber S, Parent EC, Moez EK, Hedden DM, Hill D, Moreau MJ, Lou E, Watkins EM, Southon SC. The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis—an assessor and statistician blinded randomized controlled trial:“SOSORT 2015 Award Winner”. Scoliosis. 2015 Dec;10(1):24.
- ↑ Lee HJ, Seong HD, Bae YH, Jang HY, Chae SH, Kim KH, Lee SM. Effect of the Schroth method of emphasis of active holding on Cobb’s angle in patients with scoliosis: a case report. Journal of physical therapy science. 2016;28(10):2975-8.
- ↑ Day JM, Fletcher J, Coghlan M, Ravine T. Review of scoliosis-specific exercise methods used to correct adolescent idiopathic scoliosis. Archives of physiotherapy. 2019 Dec 1;9(1):8.
- ↑ Negrini, S., Minozzi, S., Bettany-Saltikov, J., Chockalingam, N., Grivas, T., Kotwicki, T., Maruyama, T., Romano, M. and Zaina, F. Braces for idiopathic scoliosis in adolescents. Cochrane Database of Systematic Reviews. . 2015. Issue 6, art. no.: CD006850.
- ↑ Jump up to:19.0 19.1 Balagué F, Pellisé F. Adolescent idiopathic scoliosis and back pain. Scoliosis and spinal disorders. 2016 Dec;11(1):27.
- ↑ Atici, Y., Aydin, C., Atici, A., Buyukkuscu, M., Arikan, Y. and Balioglu, M.The effect of Kinesio taping on back pain in patients with Lenke Type 1 adolescent idiopathic scoliosis: A randomized controlled trial. Acta Orthopaedica et Traumatologica Turcica. 2017;51 (3), pp.191-196.
- ↑ Jump up to:21.0 21.1 Maruyama T, Takeshita K. Surgery for idiopathic scoliosis: currently applied techniques. Clinical medicine. Pediatrics. 2009 Jan;3:CMPed-S2117.
