Scoliosis in children: how to prevent and can it be cured?

Spinal scoliosis in adults: symptoms

The leading manifestation of lateral curvature is back pain, the intensity of which depends on its degree. The early stages of deformation do not cause pain, and the destructive process can be recognized only by external signs. Even with minor scoliotic changes, the symmetry of the shoulders and shoulder blades is disrupted, and the pelvic crests also shift relative to the horizontal axis. One shoulder blade sticks out on the side in which the spine has deviated.

The stage of deformation is determined by the angle of the scoliotic curve and includes 4 degrees:

• 1st degree, ∠10° and less. A slight stoop, the head is slightly lowered forward, there is asymmetry in the waist and shoulders;
• 2nd degree, ∠11–25°. There is a persistent curvature of the spine, which is noticeable in any position. The pelvis on the side of the top of the arch drops, the shoulder girdles are asymmetrical, a bulge appears on the back on one side and a depression on the other. A roll of spasmed muscles is felt in the lumbar region;
• 3rd degree, ∠26–50°. The ribs begin to protrude, especially in the front, and the intercostal hump is noticeable when tilted. The abdominal muscles weaken, muscle contractures form, reducing range of motion;
• 4th degree, ∠50° or more. Severe deformation with the presence of all the signs described above. The muscles in the curvature zone are greatly stretched, there is an intercostal hump, and the ribs are sunken on the sunken side of the back.

For reference! Most often, the scoliotic curve is localized in the thoracic and lumbar regions.

Treatment

Clinical recommendations for identifying disorders are comprehensive. The main goal of therapy is to form a strong muscle corset and develop the correct stereotype of body position. For this purpose they prescribe:

• Physical therapy, gymnastics . Adequate physical activity according to age is an important part of therapy. Exercises help strengthen muscles, form a strong frame that will fix the spinal column in the correct position. Source: Exercise therapy for postural disorders, scoliosis and flat feet. Aliverdieva M.S., Demyanova L.M., Smirnova O.S. Psychology and pedagogy: methods and problems of practical application, 2021.
• Massage . The patient is selected the necessary type of massage: general, orthopedic, back, chest, lower back, etc.
• Physiotherapy . Good effects are demonstrated by electrophoresis, electrical stimulation of the spinal muscles, thalassotherapy, peloid therapy and other procedures that are carried out in courses as prescribed by a doctor.
• Manual therapy . Sessions help correct the position of the spine by releasing compressed nerve fibers, normalizing nerve impulses, and removing blocks.
• Hydrotherapy . Involves the use of water procedures that stimulate blood circulation, relieve spasms, and correct curvature.
• Therapeutic swimming . Allows you to naturally unload the spine, establish symmetrical muscle function and strengthen them, improve coordination of movements. Source: Correction of poor posture in school-age children. Danilenko L.A., Artamonova M.V., Artemyeva E.M. Medicine: theory and practice, 2021. p. 181.

Kinds

Scoliosis is classified according to the presence of structural changes in the spine, the causes of its occurrence, as well as the location and rate of progression. According to the first classification, curvature can be structural or non-structural. The latter is easier to cure, since there is every chance of eliminating the root cause.

Types of non-structural scoliosis:

• postural, caused by poor posture. If you take an X-ray in the supine position, you will not be able to diagnose scoliosis due to the absence of structural deformation. The curvature is not visible even when a person bends forward;
• reflex, which appears as a result of a long stay in a forced position due to a pain symptom;
• compensatory, when the misalignment of the back equalizes – compensates – for the difference in leg length;
• hysterical, having a psycho-emotional nature and occurring in rare cases.

Types of structural scoliosis:

• congenital, caused by underdevelopment, wedge-shaped vertebrae, fusion of ribs and/or transverse processes;
• neuromuscular, occurring against the background of spinal cord injuries, myopathies, cerebral palsy, multiple sclerosis;
• dysplastic, the cause of which lies in connective tissue dysplasia. Diagnosed with Marfan and Ellers-Danlos syndromes;
• post-traumatic, provoked by fractures, surgical interventions, scar contractures. It can develop after burns, as a result of purulent complications and after operations on the chest organs;
• rare species caused by impaired bone formation, osteomyelitis, homocystinuria or tumors;
• idiopathic, when the cause cannot be determined. This type accounts for 80 to 90% of all cases of scoliosis.

What diseases can cause pathology?

Deformation of the rhomboid, trapezius, and serratus anterior muscles can occur with progressive muscular dystrophy. Usually it becomes a manifestation of some hereditary diseases - Erb-Roth disease, glenohumeral-facial dystrophy of Landouzy-Dejerine, Pompe disease. In these pathologies, due to genetic mutations, a decrease in muscle tone and atrophy occurs3.

Sometimes the syndrome occurs due to polio or very rare damage to the long thoracic nerve3.

How to find out if there is a curvature of the spine

There is a special test that can detect signs of scoliosis in adolescents and children. To pass it, the child must stand up straight and lower his arms along his body. The curvature will be indicated by:

• asymmetry of the left and right sides of the body;
• different heights of shoulders and shoulder blades;
• protrusion of one of the shoulder blades more strongly than the other;
• deviation from the vertical of the cervical, thoracic and/or lumbar vertebrae;
• different levels of dimples on the upper back of the buttocks;
• difference in the height of the ears, ridges of the pelvic bones;
• skewed triangles at the waist, noticeable by the unequal distance between each arm and the waist.

All these symptoms are more pronounced when the patient is in an inclined position. But they are also characteristic of poor posture. To distinguish one from the other, you need to examine the child’s body in a lying position. If the asymmetry has not disappeared, then there is every reason to suspect scoliosis.

For reference! The next step after identifying suspicious signs should be to visit an orthopedist. He will make an accurate diagnosis based on the examination results.

General description of the pathology

According to statistics, this disease is extremely common. The percentage of cases increases as people get older. If in children under three years of age the pathology is diagnosed in only 2%, then in preschool and school age more than 33% of children already suffer from it, and among adolescents the disease is diagnosed in 67% of cases.

Pathology requires timely correction. Source: Poor posture in children of primary school age. Methods for the prevention and correction of poor posture using physical education. Gorbunova T.A. Innovative science, 2021. The health of the child as a whole depends on the correct formation of skeletal structures. Incorrect development provokes an uneven distribution of load, due to which pressure on the joints increases, bones are displaced, pathologies of internal organs occur, and malfunctions in the functioning of the nervous, respiratory, and cardiovascular systems appear. Complications include scoliosis, osteochondrosis, intervertebral hernia and other dangerous abnormalities.

How to identify scoliosis: diagnosis

To recognize the curvature, examination and radiography are performed. To measure the angle of deviation of the spinal column, a scoliometer is used - today it is a digital device that is applied to the back and gives the value of the angular degree. The examination consists of checking reflexes, range of motion in joints, symmetry of body parts and muscle strength. For clarity, the patient is asked to bend forward and reach with his fingertips towards the floor - in this position the deformity is most noticeable. X-ray specifies the clinical picture and shows the structural features of the curvature. The photographs clearly show changes in the vertebrae and their position relative to their axes. X-ray examination allows you to assess in detail the condition of deformed and unchanged vertebrae and determine the degree of scoliosis.

How is the disease diagnosed?

A clinical diagnosis can often be made based on examination of the patient and his medical history. In addition to them, to ensure the correctness of the diagnosis, the doctor may prescribe projection radiography of the neck, chest, and shoulder. They help rule out structural abnormalities such as fractures2.

In some situations, a CT scan or magnetic resonance imaging may be appropriate. These techniques can be useful to exclude disc diseases and radiculopathy2.

Electromyographic testing is important to assess muscle function. It helps determine which muscle is affected and to what extent. The same technique is used to evaluate the effectiveness of treatment for pterygoid scapula. Nerve conduction studies of the long thoracic nerve2 help determine the extent of nerve damage.

Consequences of scoliosis in children - physical and psychological

Spinal deformity, especially grades 3 and 4, negatively affects the condition of all body systems. The respiratory, circulatory, nervous and digestive systems are especially affected.

The physical consequences of the disease can be:

• circulatory disorders of organs and tissues;
• pinching of nerve endings and the appearance of pain;
• decreased ventilation, difficulty breathing;
• violation of metabolic processes;
• displacement and deformation of internal organs (heart, lungs, genitourinary system and others), disruption of their functioning;
• development of secondary diseases;
• frequent headaches;
• deterioration of cognitive functions;
• numbness, unruliness and trembling of the hands and feet;
• decreased vision and hearing;
• muscle twitching;
• change in gait;
• weakening of hand grip;
• loss of some reflexes.

Curvature of the spine does not have the best effect on the mental state of children and adolescents; it causes the development of complexes, situational and personal anxiety, depressed mood, and interferes with a full life in society. A child suffering from scoliosis and experiencing constant discomfort and pain becomes excitable, capricious, and aggressive. His resistance to stress decreases. The deformity affects all aspects of a little person’s life: his academic performance, communication with peers, hobbies, and others. Therefore, we repeat once again: you should not delay a visit to the doctor if signs of the disease are detected.

Are scoliosis and poor posture the same thing?

It turns out not at all! There are clear differences between these two conditions.

1. Incorrect posture is a consequence of a violation of the symmetry of the muscles of the right and left parts of the body due to their weakness, increased muscle tone on one side (if the dividing axis is drawn along the spine). With scoliosis, pathological processes involve not only muscles, but also the bone tissue of the vertebral bodies. The right and left halves of the vertebrae grow unevenly. The spinal column deviates from the axis at one, two or even three points. The symmetry of the location of the shoulders, shoulder blades, and pelvic bones is disrupted. The head is tilted to one side.
2. Poor posture can be corrected by will, but scoliosis cannot. No matter how hard the child tries to keep his back straight, he will not succeed, since there are deep, structural changes in the vertebrae.
3. Poor posture is not accompanied by twisting of the vertebrae, there is no muscle cushion on the side of the curvature, and the rib hump is not pronounced, as in scoliosis. In a hanging position, a child with poor posture straightens the spine and parts of the body become symmetrical.
4. Poor posture does not lead to the development of scoliosis. Scoliosis is accompanied by poor posture.
5. Incorrect posture is a functionally reversible condition; with scoliosis, pathological changes are irreversible.

Acquired chest deformities

Acquired chest deformity in a child develops against the background of diseases of the lungs and ribs (including tumor-like formations). This pathology can lead to other disorders of the body, for example, improper functioning of the respiratory system or psychological problems.

The acquired deformity is characterized by weakened immunity; the child often suffers from acute respiratory viral infections.

Physiological development is inhibited, fatigue appears after weak physical exertion. There are sharp changes in blood pressure.

Acquired curvature of the chest in a child can develop after suffering musculoskeletal diseases:

• Tuberculosis;
• Rickets;
• Scoliosis (Taking into account the fact that the spine and the sternocostal complex are an interconnected system, with severe deformities of the spine, a pronounced deformation of the chest is sometimes observed. More often, the posterior chest wall is deformed in the form of a rib hump, but there are also accompanying deformities of the anterior chest wall);
• Costal osteomyelitis;
• Rib tumors.

Pathology can be provoked by purulent-inflammatory processes in the soft tissues of the chest walls and pleura, injuries and burns of the chest. In some cases, the deformity is a consequence of cardiac surgery after median sternotomy, which can change the growth of the sternum in a child.

Treatment of scoliosis without blade surgery

If a child is diagnosed with scoliosis, treatment begins immediately. But it can be carried out using conservative methods, that is, non-surgically, only for deformities less than 40°. In other cases, and especially with grade 4 scoliosis, surgical treatment of scoliosis is indicated.

So, if the disease is diagnosed in the early stages of development and it is still possible to restore the normal axis of the spine without direct intervention in it, the patient is prescribed complex therapy. Its character directly depends on the degree of scoliosis and the child’s well-being. In general, conservative treatment for scoliosis may include:

• exercise therapy;
• manual therapy;
• massage;
• physiotherapy;
• wearing an orthopedic corset;
• kinesio taping.

With grades 1 and 2 of scoliosis (most often observed in children under 5 years of age), only exercise therapy, massage and manual therapy are often sufficient. But other methods can also be used to increase the effectiveness of treatment. In more complex cases, doctors definitely recommend using all possible methods of aligning the spinal axis. Otherwise, the deformity will progress and sooner or later lead to severe complications, severe pain and an urgent need for surgery.

Scoliosis in adolescence is much more difficult to treat than in an earlier period. This is due to the spine not being as flexible as in younger children. Moreover, adolescents are often diagnosed with 2-3 degree curvature of the spine, which is accompanied by more pronounced changes in its axis and requires decisive action to eliminate the pathology.

Exercise therapy (therapeutic physical education)

Physical therapy plays a large role in correcting spinal deformities. For each patient, a set of exercises is developed individually based on the location, stage, and type of scoliosis. The child’s age and level of physical development are also taken into account.

Exercise therapy is required regularly. The first classes are conducted under the guidance of a specialist, and only later, when both the child and his parents have fully mastered the correct technique for performing each exercise, are they allowed to practice at home independently.

Regular physical therapy exercises help strengthen the muscle corset, which allows you to create reliable support for the spine and reduce the likelihood of its further curvature. Also, properly selected exercises can reduce pain and increase the possible range of movements.

Manual therapy

Manual therapy plays a huge role in the treatment of scoliosis in children. It is this method that allows you to directly influence the spine, normalizing the position of the vertebrae and releasing the pinched spinal roots. But such manipulations require a high level of qualification from a chiropractor, so you can only trust the child’s health to an experienced specialist.

Additionally, manual therapy makes it possible to eliminate functional blocks and normalize the tone of the back muscles. Also, local effects on soft tissues provoke increased blood circulation and an increase in metabolic rate.

After the first sessions, there is usually a significant improvement in the child’s well-being. The pain gradually goes away, neurological disorders are eliminated, memory and the ability to concentrate improve. But to obtain pronounced results and consolidate them, you need to undergo at least 10 sessions, and subsequently undergo preventive courses.

One of the effective methods of manual treatment of scoliosis in children is the Gritsenko method. It is based on the ability of the human body to recover independently when negative factors are eliminated, which, in combination with the high plasticity of the children’s spine, allows one to achieve maximum results.

Physiotherapy

Physiotherapeutic procedures are aimed at improving blood circulation and activating metabolic processes. They help normalize the contractile functions of the muscles and thereby reduce muscular dystrophy on one side of the back, as well as relieve increased tone from the muscles of the other half of the back.

Wearing an orthopedic corset

Special corrective corsets are prescribed for children with stage 2-3 scoliosis. They have different degrees of rigidity, which is selected depending on the severity of the pathology. Wearing an orthopedic corset can reduce the load on the spine and achieve postural alignment. This eliminates the risk of further progression of the deformity and reduces pain.

Often, orthopedic corsets are prescribed for children over 7-10 years of age.

Kinesio taping

Kinesio taping is a relatively new technique used to treat scoliosis. Its essence consists of gluing elastic bands called tapes to certain areas of the back. They help reduce the load on the necessary back muscles and reduce pain. At the same time, tapes do not hinder movements and are completely invisible under clothing.

Symptoms

How scoliosis manifests itself in a child directly depends on the location of the scoliotic curve, the severity of the curvature, the causes of the development of the disease and the age of the child. Each patient with the same diagnosis may experience different symptoms. Scoliosis in children is characterized by:

• the appearance of signs of asymmetry, poor posture, stoop;
• drooping of the head, which is already present in grades 1 and 2 of scoliosis;
• periodic occurrence of pain, and initially they are usually localized in the neck, shoulders, lower back (often occurs when the curvature progresses to the 3rd degree, although it may appear earlier);
• breathing problems with episodes of shortness of breath, which can appear even with light exertion;
• increased heart rate;
• increased fatigue;
• impaired coordination of movements;
• absent-mindedness;
• headache;
• sleep disorders;
• deterioration of general condition.

Pain of varying intensity can be present even at the earliest stages of scoliosis development in children.

Often, with scoliosis, spinal roots are pinched, which leads to disturbances in the innervation of internal organs, and subsequently to organic changes. Which ones will suffer depends on the location of the scoliotic curve. In general, the disease can provoke dysfunction of the bronchi, lungs, liver, genital organs, pancreas, etc.

Scoliosis in children is also dangerous due to the emergence of psychological problems, since when an aesthetic defect appears in a child, the attitude of peers towards him changes dramatically. This can result in long-term depression, isolation, a sharp decrease in self-esteem and difficulties in communication.