Bracing for Scoliosis
August 26, 2010
How many types of braces are available for scoliosis?
In general, there are 2 main types of braces: hard brace and soft brace.
Hard braces are made of thermoplastic. It has been the main brace prescribed over the last a few decades. Common types of hard braces are Boston’s, Charleston’s, and Milwaukie’s etc.
| Hard Brace | Soft Brace |
Like what its name suggests, it is hard and non-flexible, and wearing which limits movements of the spine. Hence it greatly affects one’s sports participation and causes significant comfort and tolerance issues. Additionally, hard brace is usually bulky and heavy, and shows under the clothes, it is not easily accepted by image-conscious teenage girls. Besides, it also creates much stiffness of the spine, weakness and tightness of the spine muscles.
Soft brace on the other hand, allows movement of the spine when worn. Therefore, the spine is much more mobile during and after the treatment, there is also much less muscle imbalance and joint stiffness of the spine.
Currently the only available soft brace for scoliosis is SpineCor brace. You can get more information on SpineCor brace by following this link: http://www.spinecorporation.com.
How different are the two types of braces? Is one definitely better than the other?
It’s hard to say which brace is definitely better than the other, they work on different principles. Hard braces are designed to hold against spine deformity statically, soft brace on the other hand, is designed to use dynamic force to target on bone deformity and muscle re-training and balancing.
Both hard and soft braces can be effective before the bones of the spine reach maturity, which is usually between 13-15 years old for girls and 15-17 years old for boys. Hard braces can be used for any types of scoliosis such as neuromuscular scoliosis, congenital scoliosis, and idiopathic scoliosis. SpineCor brace is designed for idiopathic scoliosis only.
Both braces need to be worn regularly throughout the day (16 hours per day). Soft braces are lighter and more comfortable to wear; it is more cosmetically acceptable as it can be well hidden under the clothes. It also allows better posture & muscle development, and is able to promote good mobility of the spine while correcting the curve. Hard braces are usually much heavier and hotter to wear and may result in a poorer compliance compared to soft braces.
For people who participate in sports like dancing, gymnast, running or badminton, soft brace is of a much more practical choice. Soft brace is also recommended for individuals who are more prone to skin problems or who are likely to have compliance issues.
What can be done for Scoliosis?
August 2, 2010
Must I have surgery if I have scoliosis?
No. Surgery is usually only indicated when the curve is bigger than 50 degrees, or is severely affecting one’s everyday activities or his / her quality of life. Majority of scoliosis cases do not require surgery. Surgery will only be considered when the curve continues to worsen in spite of bracing or exercises, and is progressing near or beyond 50 degrees.
The degrees of scoliosis curves are measured by Cobb’s angle.
One must be aware that there are complications with scoliosis surgery, such as stiff spine, spine muscle weakness and possible rods breakage. The spine will no longer grow again after scoliosis surgery, so if it is to be performed in growing children, it should be delayed as much as possible in order to preserve the growth of the developing spine.
What else can help control scoliosis besides surgery?
Besides surgery, the most common treatment is bracing and physiotherapy.
The purpose of using a brace is to control the progression of a curve, but not to eliminate it. Bracing is indicated when the scoliosis curve is between 25-40 degrees, and when the spine has not yet reached full maturity, which is usually between 13-15 years of age in girls, and 15-17 years in boys. In the case that though the curve is smaller than 25 degrees, but worsens more than 5 degrees within a period of 6 months, a brace is also recommended. To ensure the effectiveness of the brace, it needs to be worn 18-20 hours a day through the growing years.
Physiotherapy works to strengthen the weak muscles, to improve the flexibility of the shortened & tight tissues. It helps slow down the development of muscle imbalance and joint stiffness, and helps reduce back pain. It benefits individuals with scoliosis either are or are not on braces. The stiffer the curves are, the more strongly physiotherapy is recommended. Furthermore, physiotherapy enhances the correction achieved by braces during the bracing and after the brace is weaned off.
Exercise and Scoliosis
July 23, 2010
We often hear people say that if one has scoliosis, they can’t participate in exercises, is that true?
The answer is no. One can usually participate in any type of exercises with scoliosis. Note we are only talking about participation here, not being GOOD at it. Due to the posture and muscle changes in scoliosis, some movements will be harder to achieve, and some will be restricted due to poor flexibility or poor muscle control. For example, one can still play golf, but turning of the trunk may be slightly restricted and that makes a swing slightly harder to perform. Another example is when someone with scoliosis runs, his/ her running pattern may be different due to the posture change.
Exercise endurance sometimes can be affected by reduced lung capacities but this is rare in individuals with idiopathic scoliosis. The main reason for reduced exercise endurance is believed to be a result of lack of regular sports participation. For those who hesitate to participate in sports because they worry about their curves may be worsened by exercises, they can be well assured that it is unlikely that exercises would have any adverse effects on the curve. The reason is that in order for the spine’s growth to change, one needs to exercise continuously for up to 18 hours a day, which is almost impossible for any sports.
If exercises that did not hurt before are now giving you pain, please tune down on the intensity of exercises for a few days. If the pain does not go away, you may need to consult a Dr. or a physiotherapist. Most likely the cause of the pain is that the exercises you are doing has aggravated the muscle imbalance too much, which creates too much joint compression on one side, and too much joint traction on the other side.
Can swimming help reduce the curve of scoliosis?
Swimming is frequently recommended for patients with back problems because the spine is less loaded in the pool with the help of buoyancy. That makes it a natural question “is swimming also recommended for patients with scoliosis?”
The answer is people with scoliosis do benefit from swimming. Besides the fact that swimming is good for general strengthening of the back muscles, it is also good for breathing function. This makes swimming exceptionally suitable for scoliosis as lung capacity and exercise endurance are likely to be affected among the individuals with scoliosis.
Scoliosis involves uneven development of the spine and the back muscles, as swimming targets generally on the whole back, it would not be able to specifically help reduce back pain caused by muscle imbalance. It does not help reduce the curvature too.
Does sitting slouched and slanted cause scoliosis?
July 20, 2010
Question: My daughter sits with a slouch, and sometimes sits with her body slanted to one side, will that cause scoliosis?
No. Sitting with a slouch or in any other bad posture does not lead to scoliosis. When we discuss about scoliosis, we typically mean idiopathic scoliosis, a form of scoliosis caused by genetic factors which lead to uneven growth of the spine. Curvature of the spine from bad posture is known as postural scoliosis and is reversible.
Posture and scoliosis
Human skeletons are mainly supported by muscles and ligaments. The center of gravity of the skeleton varies when its alignment changes, which in turn affects how much the muscles have to work to maintain its stability. Therefore, “bad postures” refer to postures in which the body structures need to work harder in order to maintain a particular position, and “good postures” refer to postures in which the muscles work the least.
- In an upright posture, the ideal posture is one that if looked from the side, the ear is right above the shoulder, and the shoulder right above the hip. Any posture that deviates from which would be requiring more effort from the muscles. So, sitting slouched or slanted to one side would require more muscle work on one side of the body, which may lead to overuse and tightness of those muscles.
- In the case that one stays in a faulty posture for long and causes muscle imbalance, the spine may be slightly curved due to uneven muscle tension. This type of curve is called postural scoliosis, which is not the same with scoliosis that is caused by bone deformities. If taking a spine X-ray in lying, this type of scoliosis will disappear on the X-ray film.
So, bad posture may cause postural scoliosis, but it will not cause bone deformity. The good news is that postural scoliosis is completely reversible by exercises and posture re-training.
How do I know if I have scoliosis?
July 14, 2010
What is scoliosis?
Scoliosis refers to a medical condition in which the spine curves sideways. On an X-ray film, the normal spine looks straight, but the scoliosis spine will look like a “C” or “S”.
I suspect that I have scoliosis, how do I tell?
Besides looking at X-rays, one can look at his or her posture in order to look for possible signs of scoliosis.
Signs that may indicate scoliosis are:
- Head not centered to the body Uneven shoulders (either one is in front of the other or one’s higher than the other)
- Uneven shoulder blades: one is more prominent or higher
- Uneven waist angle: the gap between arm to trunk is wider on one side
- One hip is more prominent than the other or the hips are not leveled
- The spine line is not straight
One can use the picture below for a quick self test of scoliosis:
You can also perform a Forward Bend test (also called “Adam’s test”) to detect for possible scoliosis.
- Standing with the feet together, then bend forward as far as you can with your palms together, fingers pointing at between your toes.
- Look at the back, one side of the back (either upper or lower back region) will be higher than the other side
Hard Core Muscles for Mummies (Part 2)
July 10, 2010
In the previous article on "Hard Core Muscles for Mummies (part 1)", we have touched on the importance of strong core muscles. Now let us look at some simple exercises (that do not require equipment) people can do at home to help strengthen their core muscles.
Exercises should be done daily for 3 -4 weeks to see results.
Hard Core Muscles for Mummies (Part 1)
June 29, 2010
Recently our physiotherapist Cheryl Ng was interviewed by Young Parents Magazine and published in the July version on why having a "hard" core can save your neck and back from daily activities.
Do you have neck and back aches during pregnancy or after delivery? Do you really think it is part and parcel of parenthood? Think again.
What are the core muscles and why are they important?
Core muscles stabilize your body and the pelvis during dynamic movements, such as walking and running. The core muscles include the transverses abdominis (TA), multifidus, pelvic floor muscles and the obliques. These muscles are attached to the inner portion of your thorax, (the trunk region below your ribs to your pelvis), allowing them better control of your spine and pelvis while you move. Imagine a tree trunk that has been cut into half. The rings of the tree represent the layers of your core strength. The transverses abdominis (TA) is the innermost ring, acting as a thick corset around your spine. It gives stability to the trunk and support your spine to help maintain a correct upright position.
All movements of the trunk activates the core muscles, so even when you are lifting your hand, the core muscles in your back and abdominals are recruited to assist the movement. Hence, it is crucial that your core muscles are activated before movement occurs, in offer to offer support and strength to your spine, as failure to do so will result in excessive or faulty loading to your spine, leading to low back strains and pelvic dysfunctions. Fortunately, our core muscles are normally already activated when we are in good posture, the problem comes when we deviate from good posture or sustain back injuries, thus deactivating the normal auto-recruitment of the core muscles.
How are they related to persistent back and neck pains?
Weak or inefficient core muscles are one of the contributing factors to persistent back and neck pains. We are constantly loading our spine with our activities of daily living, such as, working at the desk or computers prolonged, and carrying laptop bags or groceries. These activities stress the spine and the muscles that worked to support it may strain and get injured. This results in faulty postures which either avoid or aggravates the pain, hence, changing the normal activation of the core muscles, thereby reducing the protective function of these muscles. This may eventually set in motion a vicious cycle, in which faulty posture lead to incorrect muscle activation and less protection of spine, which lead to pain, and eventual muscular weakness , which lead to more faulty postures and pain and eventual degeneration of the spine, with persistent and recurring back and neck pains.
What are the negative effects weak core muscles can have on pregnant women and parents (who spend a lot of time bending over to take care of the baby, carrying children etc.)?
During pregnancy, your core requires greater stabilization due to changes in your weight, posture and centre of gravity. As your pregnancy progresses, the muscles that make up your core, plus the muscles that support you and your growing baby become stressed and extremely challenged. In addition, relaxin, a hormone emitted during pregnancy, ‘loosens’ your joints and ligaments in preparation for birth; as a result your supporting muscles have to work harder to achieve adequate stability. This in turn may lead to overstraining of your core and supportive muscles. A weak core will then result in higher probability of back and pelvic strains, which can be debilitating. Hence, strong core muscles play an important role in supporting your spine during pregnancy and also in assisting recovery from child birth.
The same goes to parents who spend a large portion of their time nursing and doing other back-breaking tasks, such as carrying children, lifting heavy cradles or large bags. Since such tasks are repetitive, the stress in the back accumulates over time and may eventually lead to fatigue of the supporting back muscles, resulting in back sprains. Again, having strong core muscles will help in better supporting the spine and back, thus reducing the likelihood of injury.
Understanding changes to an expectant woman’s body
May 19, 2010
Extensive physical and physiological changes take place in an expectant woman through the actions of the hormones, oestrogen, progesterone and relaxin. These changes create challenges, which should never be undermined, and hence it is important to understand the effects on the woman’s body during pregnancy to learn to cope with the challenges.
Respiratory system
The demand of oxygen is increased because the basal metabolic rate and the mass of the expectant woman increase as well. It is estimated that a woman will require about 20% more oxygen than normal at term. She also exhales more carbon dioxide which triggers the already sensitive respiratory system to increase the respiratory rate slightly. Hence, it is this lowering of the carbon dioxide that leads to pregnant women to become breathless on activity. Also, many expectant women will experience the ascending uterus which progressively obstructs the descent of the diaphragm, which is needed for deep breathing. It can force the diaphragm upwards by at least 4cm towards the end of pregnancy. Hence this rising pressure pushes the rib cage out sideways and forwards, resulting in pain in the front of the lower ribs, also known as ribflare. Furthermore, rib-flaring make expectant women breathe with the top part of her chest, thereby causing breathlessness even during mild exertion during pregnany but especially so, towards the end of term.
The cardiovascular system
During pregnancy, a woman’s blood volume increases by at least 40%. However, the plasma volume increases more than the red cells, hence possibly resulted in dilution anaemia, leading to tiredness in the early weeks of pregnancy. She may also feel faint when lying on her back. This is due to enlarging fetus compressing the aorta and inferior vena cava against the lumbar spine, thereby restricting blood flow. This condition is known as pregnancy supine hypotensive syndrome and can be relieved by turning onto her side. Such a condition tend to happen more in the 3rd trimester, though it can occur any time after the 4th month of pregnancy.
Varicose veins of the legs may occur during pregnancy or worsen during this period. This is due to reduction in vascular tone and changes in collagen structure in the body (due to progesterone and relaxin) .
For the same reason, “water retention” or swelling in ankles, feet and hands in late pregnancy may lead to joint stiffness and nerve compression syndromes, such as carpal tunnel syndrome.
The musculoskeletal system
The hormone, relaxin, is produced about 2 weeks into pregnancy. Relaxin alters the composition of collagen, which exist in joints, ligaments and connective tissues. As a result, the modified collagen is more elastic and flexible, leading to more movement in joints, and thus less stability of the system. The weight bearing joints, such as the pelvis, bear the brunt of the increased stress and loading during pregnancy, and with the instability that relaxin cause, the pelvis is susceptible to injury and pain, one of the conditions known as symphysis pubis diastasis. Also, ligaments of feet become lax and with the additional weight of pregnancy, causes discomfort. This results in aching and flat feet. Hence, comfortable yet supportive foot wear is strongly recommended during this period.
Posture-wise, her centre of gravity will move forward, leading to increased lower back curvature, compensatory curving of the upper back, rounding of shoulders and forward chin position. This incorrect posture exerts excessive strain and fatigue on her body, particularly in the spine, pelvis and other weight bearing joints (i.e. knees), resulting in aches and pains, such as lower back, with the pain spreading to the buttocks, thighs and down the legs.
Other muscular changes, such as the separation of the abdominal muscle, known as rectii diastasis, is associated with low back strain, as the abdominals are no longer able to support core and the spine as efficiently as before.
Therefore, with all the extensive changes in the expectant woman’s body, it is obvious that the healtier and fitter she is both before and during pregnancy, the more easily she can cope with pregnancy. If possible, she should prepare to be fit physically and emotionally before each pregnancy and maintain the fitness during the pregnancy, thereby enhancing recovery after delivery. In the next article in this series, we will look at the common physical problems affecting women during pregnancy and it’s solutions.
Tiger Wood’s real source of championship withdrawal – Inflamed Cervical Facet Joint
May 15, 2010
Recently Tiger Wood's unprecedentedly withdrew with a sore neck in Round 4 of The Players Championship, 2010. Rumour mills have been suggesting he wasn't playing to expectation and pulled out to save him from further embarrassment or maybe the sore neck came from the infamous car crash.
Regardless, an inflamed cervical facet joint as was confirmed by his MRI can cause symptoms serious enough for a typical office worker to take sick leave, let alone a professional athlete playing at the highest level.
Symptoms from an inflamed facet joint are limited range of motion due to pain and stiffness especially in rotation, muscle spasms and radiating pain. Cervical headaches can also occur as described in a previous article. http://mcr.coreconcepts.com.
So what caused Tiger's injury?
As explained by Tiger previously, he ramped up his training intensity to get himself ready for the Master's 2010 but his body was not conditioned enough to withstand the demand of high level sports. Similar to our weekend warriors, playing at a high intensity when the body is not conditioned to the sport causes excessive wear and tear and as a result, overuse syndrome.
How does a facet joint get inflamed?
A facet joint gets inflamed from excessive wear and tear especially when the joint mobility is limited or stiff. Limited joint mobility either from being in a prolonged static position like a deskbound job or when the muscles are tight and inflexible, limiting joints from moving through its full range. In fact most neck pains are caused by stiff facet joints which explains why the deskbound worker forms the largest proportion of our neck pain clientele.
Physiotherapy treatment for would include mobilisation techniques to the affected stiff facet joints to encourage mobility, stretching and strengthening exercises. Aggravating factors like prolonged static sitting position will have to be avoided and proper ergonomics advise will be given to prevent a recurrence.
Cervical Spine and Disc Anatomy
May 9, 2010
In this post, we will look at what are the musculoskeletal structures in our neck.
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