SCOLIOSIS

SCOLIOSIS PHYSIOTHERAPY MANGEMENT

INTRODUCTION:-
Scoliosis is a lateral curvature of spine. it is mostly in c shape and also in s shape.

SYMPTOMS:-
Signs and symptoms of scoliosis may include:

Uneven shoulders
One shoulder blade that appears more prominent than the other
Uneven waist
One hip higher than the other

If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side.

CAUSES:-
There are three other main types of scoliosis:

Functional: In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.
Neuromuscular: In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of congenital scoliosis develops in people with other disorders, including birth defects, muscular dystrophy, cerebral palsy, or Marfan syndrome (an inherited connective tissue disease). People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.
Degenerative: Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures, and disc degeneration.

There are other potential causes of scoliosis, including spine tumors such as osteoid osteoma. This is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce the amount of pressure applied to the tumor. This can lead to a spinal deformity. In addition, researchers suggest that genetics (hereditary), muscle disorders, and/or abnormal fibrillin metabolism may play a role in causing or contributing to scoliosis development.

Risk factors:-
Risk factors for developing the most common type of scoliosis include:

Age. Signs and symptoms typically begin during the growth spurt that occurs just prior to puberty.
Sex. Although both boys and girls develop mild scoliosis at about the same rate, girls have a much higher risk of the curve worsening and requiring treatment.
Family history. Scoliosis can run in families, but most children with scoliosis don’t have a family history of the disease.

DIAGNOSIS:-


→If someone thinks he or she has scoliosis, see a doctor for an examination. The doctor will ask questions, including if there is any family history of scoliosis, or if there has been any pain, weakness, or other medical problems.
→The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves, physical deformities, or uneven waist.   →The person will then bend over trying to touch their toes. This position can make the curve more obvious. The doctor will also look at the symmetry of the body to see if the hips and shoulders are at the same height, leaning to one side, or if there is sideways curvature. Any skin changes will also be identified that can suggest scoliosis due to a birth defect. A doctor may check your range of motion, muscle strength, and reflexes.
→The more growth that a person has remaining increases the chances of scoliosis getting worse. As a result, the doctor may measure the person’s height and weight for comparison with future visits. Other clues to the amount of growth remaining are signs of puberty such as the presence of breasts or pubic hair and whether menstrual periods have begun in girls.
→If the doctor believes a patient has scoliosis, the patient could either be asked to return for an additional examination in several months to see if there is any change or the doctor may obtain X-rays of the back. If X-rays are obtained, the doctor can make measurements from them to determine how large of a curve is present. This can help decide what treatment, if any, is necessary. Measurements from future visits can be compared to see if the curve is getting worse.
→It is important that the doctor knows how much further growth the patient has left. Additional X-rays of the hand, wrist, or pelvis can help determine how much more the patient will grow. If a doctor finds any changes in the function of the nerves, he or she may order other imaging tests of your spine, including an MRI or CT scan to look more closely at the bones and nerves of the spine.
→If the curve <20 degree need observation, >20 required treatment, btween 20-40 required milwaukee brace, >40 surgical correction needed.

PHYSIOTHERAPY MANEGEMENT:-

Dog crawl
Low dog crawl
Arm streach
Deep breathing exercise
Active ROM exercise spine
Strengthing exercise to abdominal and spinal muscle
Passive streaching of the muscles on the concave side of the curves is highly effective

PHYSIOTHERAPY AFTER SURGICAL INTERVENTION:-
FIRST 4 DAYS – Vigorous chest PT, patient turn to side every 2 hour, active ROM exercise with in pain limit for shoulder and ankle,at the end full rang active and pasive movement of hip and knee joint are carried out.
AFTER 4 DAYS – With assisted guidence patient taught to sit,roll and stand and walking training.

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