Postural Rehabilitation for Adolescent Idiopathic Scoliosis during Growth

Abstract

Long-term follow-up of untreated patients with adolescent idiopathic scoliosis (AIS) indicates that, with the exception of some extremely severe cases, AIS does not have a significant impact on quality of life and does not result in dire consequences. In view of the relatively benign nature of AIS and the long-term complications of surgery, the indications for treatment should be reviewed. Furthermore, recent studies have shown that scoliosis-specific exercises focusing on postural rehabilitation can positively influence the spinal curvatures in growing adolescents. Experiential postural re-education is a conservative, non-invasive approach, and its role in the management of AIS warrants further study. This article reviews current evidence for the inclusion of various forms of postural reeducation in the management of AIS. Recent comprehensive reviews have been researched including a manual and PubMed search for evidence regarding the effectiveness of physical/postural re-education/physiotherapy programs in growing AIS patients. This search revealed that there were few studies on the application of postural re-education in the management of AIS. These studies revealed that postural re-education in the form of exercise rehabilitation programs may have a positive influence on scoliosis; however, the various programs were difficult to compare. More research is necessary. There is at present Level 1 evidence for the effectiveness of Schroth scoliosis exercises in the management of AIS. Whether this evidence can be extrapolated to include other forms of scoliosis- pattern-specific exercises requires further investigation. Because corrective postures theoretically reduce the asymmetric loading of the spinal deformities and reverse the vicious cycle of spinal curvature progression, their integration into AIS programs may be beneficial and should be further examined.

Keywords: Physiotherapy; Rehabilitation; Scoliosis; Treatment.

Fig. 1. The Augmented Lehnert-Schroth classification as used for postural rehabilitation and for scoliosis pattern specific brace adjustment as well. From Weiss et al. [7], with kind permission from Lambert Academic Publishing.

Fig. 2. Correcting exercise position (A) for a functional 3-curve pattern (see below) in comparison to the relaxed scoliotic posture (B). From Weiss et al. [7], with kind permission from Lambert Academic Publishing.

Fig. 3. Correcting ADL position (A) for a functional 3-curve pattern in comparison with the relaxed scoliotic posture (B). From Weiss et al. [7], with kind permission from Lambert Academic Publishing.

Fig. 4. Correcting exercise position (A) for a functional 4-curve pattern in comparison with the relaxed scoliotic posture (B). From Weiss et al. [7], with kind permission from Lambert Academic Publishing.