Explanation of Scoliosis
What is scoliosis?
Scoliosis is an abnormal curvature of the spine. The normal spine has a backward curvature in the shoulders and a forward curvature in the waist. Typical scoliosis includes three-dimensional deformities of the spine and ribs. According to changes in degree, the spine bends laterally, and sometimes there is slight rotation of the vertebrae, leading to imbalances in the hips or shoulders. It may develop into the following situations: mainly lateral curvature (similar to the English letter C) or two curvature (one primary curvature and one secondary curvature, resulting in the formation of an S-shape), with scoliosis most commonly occurring between the upper back (thoracic region) and lower back (lumbar region). It is also possible that side bending only occurs on the upper or lower back. Scoliosis is relatively common in the general population (2-3% of people in the United States are affected by scoliosis) and is related to the angle of spinal curvature. Approximately 10% of adolescents have some degree of scoliosis, but less than 1% require corrective treatment for scoliosis (University of Maryland Medical Center). According to reports, 1.5 out of 1000 people in the United States have scoliosis exceeding 25 degrees. 60% of curvatures increase rapidly before puberty. Generally, curvatures less than 30 degrees do not continue to develop after adult bone maturity. Why does scoliosis occur?
The causes of scoliosis include congenital, acquired, or degenerative problems, but most of the causes of scoliosis are unknown, which we call idiopathic scoliosis.
There are many types of scoliosis, and the following are the four most common: scoliosis deformity. Congenital scoliosis: This is a relatively rare congenital spinal deformity. This condition usually occurs when the spine is already deformed during childhood.
Neuromuscular scoliosis: This condition is generally caused by weakness of the spinal muscles or bending of the spine to one side due to neurological problems. This type of scoliosis is particularly prevalent in individuals who are unable to walk due to underlying neuromuscular issues, such as muscle atrophy or cerebral palsy. This is also known as degenerative scoliosis. Degenerative scoliosis: When the joints of the spine degrade, scoliosis can also gradually occur, causing the back to bend. This condition is sometimes referred to as adult scoliosis. Idiopathic scoliosis: Currently, the most common type of scoliosis is this one (80% of scoliosis cases belong to this category, and there is a significant gender difference, with females having a ratio of 7:1 compared to males). It often occurs during adolescence, especially during rapid growth, and its development accelerates. The manifestations of scoliosis
• The head tilts and is not in line with the hips • The scapula protrudes • One hip or shoulder is higher than the other, resulting in inconsistent hem of the clothing • Tends to one side more than the other • In developing girls, breast sizes vary • When a child bends forward with their knees together and arms naturally droop, the upper back of one side is higher than the other. How to evaluate scoliosis in children with scoliosis using a scoliosis chart
After discovering or suspecting problems with your spine, it is important to promptly seek examination and treatment at a reputable institution! To evaluate scoliosis, we need to first understand the normal position of the spine.
Spinal dorsal position, spinal lateral position, and spinal frontal position
Physical assessment
So how should we evaluate scoliosis through posture? Simply put, we can observe whether our neck, breasts, shoulders, ribs, waist, and buttocks are symmetrical in an upright position! It can also be detected through the Adam Sign flexion test. When bending forward, the highest point of spinal kyphosis, and the asymmetry of the trunk is most pronounced at the top of the main arc. The height of the bulge reflects the degree of rotation of the vertebral body in the top segment. If the spinal problem is caused by pelvic tilt or unequal length of the lower limbs, the lower limbs can be elevated/seated for ADAM test examination. In addition to conducting posture analysis, it is also important to collect medical history, including the time of onset of scoliosis, the progression of scoliosis, family medical history, and so on. Imaging assessment
After analyzing physical signs, imaging examinations are usually needed to help us better determine the degree of scoliosis.
Standard standing full spine X-rays (upright and lateral) can help us analyze the Cobb angle and rotation angle of scoliosis.
Generally speaking, scoliosis is divided into non structural scoliosis and structural scoliosis. A simple method of judgment is to observe the curvature of the spine when lying on one's side. If the curvature of the spine changes when lying on one's side, it can be simply determined as non structural scoliosis; If the curvature of the spine does not change much when lying on one's side, then we can simply determine that it is structural scoliosis. When we change the curvature of the vertebral body, there may also be pain. At this time, we must consider whether there are spinal canal lesions, joint displacement, tumors, and other issues. Scoliosis at the thoracic spine may also indicate the presence of diseases in the body. A comprehensive investigation is necessary to better guide us in spinal correction. The etiology of scoliosis
Due to prolonged study and desk work, more and more modern people (including many teenagers) are hunched over.
The deformation of thoracic vertebrae, disorder of small joints, ligament and muscle strain are the main causes of persistent pain in thoracic vertebrae and back, and may also cause many diseases such as palpitations, chest tightness, premature beats, stomach pain, etc.
The ancients said, 'A straight back is the key to not getting sick.' That's the truth. Hunchback can lead to narrowing of the spinal nerve foramen, where the nerve roots are compressed or stimulated, resulting in many diseases.
Spinal curvature
(1) Physiological curvature refers to the four anterior posterior directions of curvature in a normal human spine, namely slight anterior convexity of the cervical spine, slight posterior convexity of the thoracic spine, significant anterior convexity of the lumbar spine, and significant posterior convexity of the sacral spine, resembling an "S" shape, which is called physiological curvature. A normal person has no scoliosis when standing upright. The method for checking for scoliosis in the spine is as follows: the examiner uses their fingers to apply appropriate pressure from top to bottom along the tip of the spinous process of the spine. After applying pressure, a red congested line appears on the skin, which is used as a standard to observe whether the spine has scoliosis. (2) Patients with pathological deformities should stand up and carefully examine for any abnormalities. Usually, three basic types of deformities can be seen: 1. Kyphosis refers to excessive backward curvature of the spine, also known as hunchback. Mostly occurs in the thoracic spine. (1) Pediatric spinal kyphosis: often caused by rickets, characterized by a significant and uniform backward curvature of the chest segment when sitting, which can disappear when lying down. Rickets kyphosis (2) spinal tuberculosis: It often occurs during adolescence, and the lesions are often in the lower thoracic spine. In the early stages, only a slight protrusion of the local spinous process was observed, resembling a button; In the future, it will gradually become larger and bulge, forming angular deformities such as a "hump" like bulge. When sitting, in order to alleviate tenderness towards the affected vertebrae, the torso is often supported with both hands; When walking or standing, also adopt a posture of tilting your head and torso backwards as much as possible.
Spinal tuberculosis kyphosis deformity (3): Uniform kyphosis deformity of the thoracolumbar segment in adolescents can be the result of poor posture during development or spinal cartilage inflammation. Spinal kyphosis (4) in adults with curved (or arched) thoracic segments: seen in rheumatoid spondylitis, often with spinal rigidity fixation, and the spine cannot be stretched flat when lying down. (5) Spinal kyphosis in elderly people: It mostly occurs in the upper part of the thoracic segment, with the trunk slightly leaning forward, the head extending forward, and the shoulders moving forward. It is a degenerative change in bone structure, caused by compression of the thoracic vertebrae. (6) Spinal kyphosis caused by spinal fractures due to trauma can occur in any age group. 2. Lordosis refers to the excessive forward protrusion and curvature of the spine. It mostly occurs in the lumbar spine. Excessive anterior convexity of the lumbar spine is most clearly observed when standing. The upper abdomen bulges noticeably forward, the buttocks protrude noticeably backward, and the pelvic inclination increases; If the back and buttocks are against the wall, it can be seen that the gap between the back of the lumbar spine and the wall has increased. Lumbar lordosis can be seen in: (1) conditions such as back weakness caused by poliomyelitis, forward slippage of the fifth lumbar vertebra, rickets, progressive malnutrition, and obesity; (2) Compensatory lordosis caused by abdominal heaviness, such as late pregnancy, excessive ascites, and large abdominal tumors; (3) Compensatory lumbar lordosis caused by hip dislocation, hip eversion, late stage of hip tuberculosis, knee flexion deformity, excessive thoracic kyphosis deformity, etc. Scoliosis refers to the deviation of the spine from the midline to both sides. According to the different locations of occurrence, it can be divided into chest scoliosis, waist scoliosis, and combined chest waist scoliosis. Scoliosis (1) There are several methods for observing scoliosis: 1) Observe the patient standing based on the spinous process line. The examiner uses the index finger and middle finger to quickly press down on the patient's spinous process from top to bottom. A red line can be seen on the skin, which can be used to determine whether there is scoliosis and the location and direction of the scoliosis. 2) Observe the elevation of the upper back on one side of the scoliosis and the fullness of the chest based on the changes in the shape of the chest and back
Full, pelvic descent; On the opposite side, the upper back and shoulders are lowered, the chest is flattened, and the pelvis is elevated. Specific signs include: ① elevation of the highest point of the acromion and posterior axillary folds on one side of the scoliosis, as well as the lower angle of the scapula; ② The shoulder humeral angle (the angle between the upper arm and the chest wall) decreases or disappears; ③ The iliac rib space becomes longer, and the iliac crest and posterior superior iliac spine descend; ④ The concave curve of the waist disappears; ⑤ The highest point of the anterior axillary crease, nipple, and lower edge of the breast are elevated, and the chest is full. On the opposite side of scoliosis, the height and position of the above markers are opposite, and there is a deep depression above the iliac crest
Skin wrinkles. Scoliosis: Height changes on both sides of the trunk. 3) Vertical line observation method: Use a long line with a heavy hammer attached below, and press the upper end of the line at the midpoint of the occipital protuberance
The spinous process of the neck 7 is lowered naturally at the lower part of the line, but the patient's standing posture needs to be adjusted so that the perpendicular line is aligned with the buttock fissure. If the spinous process deviates from this line, it indicates scoliosis, and the type, location, and degree of the lateral process can be observed.
Scoliosis examination method (2) clinical significance: According to the nature of the scoliosis, it can be divided into two types: postural and organic scoliosis: 1) Posture scoliosis is characterized by a variable curvature of the spine (especially in the early stages), and changing the position can correct the scoliosis. Scoliosis can disappear when lying flat or bending forward. The reasons for postural scoliosis include: ① Children often have improper sitting and standing postures during their developmental period; ② One lower limb is significantly shorter than the other; ③ Intervertebral disc herniation; ④ Sequelae of poliomyelitis, etc. 2) Organic scoliosis is characterized by the inability to correct the curvature by changing position. The causes of organic scoliosis are: ① Rickets; ② Chronic pleural thickening and pleural adhesions;
③ Abnormalities in the shoulders or chest. What are the hazards of scoliosis?
Harm 1: Scoliosis affects the morphology and psychology of patients. Scoliosis is generally difficult to detect in the early stages, and many patients wait until obvious deformities appear, such as spinal curvature, asymmetrical back protrusion, and chest and back bulging. Many patients only discover this when their chest and back protrude a rib peak, also known as a razor back. At this time, the patient's body shape is significantly affected, their self-confidence is frustrated, and it is not conducive to mental health. Harm 2: Scoliosis can cause patients to have short stature and not grow long. Suffering from scoliosis, the growth of spinal curves can affect body shape. Harm 3: Scoliosis can also affect the patient's cardiovascular health. This is also a common hazard of scoliosis. As scoliosis mostly occurs in the thoracolumbar region, it may compress the lungs and cause pulmonary dysfunction. As scoliosis worsens, it may also affect circulation and lead to cardiac dysfunction. A slight increase in physical activity can result in palpitations and shortness of breath. Hazard 4: Scoliosis may affect lifespan. Patients with severe scoliosis generally have greatly impaired health levels, and over time, there is a risk of lifelong paralysis, significantly reduced quality of life, and a shorter average lifespan than normal people. Treatment of Scoliosis
The treatment of scoliosis aims to correct the deformity and prevent its further progression, restore the physiological curvature of the spine, achieve stability, maintain trunk balance, change the appearance of deformities, minimize fusion range, alleviate or relieve lower back pain, and maximize improvement and maintenance of the heart and lungs.
It is divided into non-surgical treatment and surgical treatment. Non surgical treatment principle: Early treatment is the basic direction of scoliosis treatment. Non surgical treatments include exercise therapy, electrical stimulation, massage, suspension traction, braces, and beauty therapy
Timely and appropriate application of methods such as spinal therapy can achieve satisfactory results. Appropriate correction can be chosen based on the patient's age, severity of scoliosis, and progression
The law. The general principles of handling can be summarized as follows:
1. Early detection 2. Close outpatient examination 3. Active correction
Basic method: Perform segmental scoliosis exercises in a lying or crawling position, so that the scoliosis formed during the exercise cancels out the original scoliosis. When one arm is raised and the shoulder strap tilts to the opposite side, the thoracic spine protrudes to the same side. When one leg is lifted and the pelvis tilts to the opposite side, the lumbar spine protrudes to the opposite side. When one side of the upper and lower limbs are lifted simultaneously, a compound scoliosis is formed where the thoracic vertebrae protrude towards the same side and the lumbar vertebrae protrude towards the opposite side. This can correct compound scoliosis in opposite directions and avoid aggravating the other scoliosis when correcting another one. The advantageous segments for different postures are: knee chest position - third thoracic elbow knee position - eighth thoracic finger knee position - eleventh thoracic kneeling position with hands off - second lumbar kneeling position with back tilt - fourth lumbar spine
Electrical stimulation
01 is mainly suitable for mild idiopathic scoliosis in children and adolescents. The mechanism of action is that electrical stimulation acts on the relevant muscle groups on the convex side of scoliosis, causing them to contract and generate an internal corrective force on scoliosis. This gradually makes the muscles on the convex side thicker and stronger than those on the concave side, leading to unbalanced contraction and tension on both sides of the spine, achieving the goal of correction. Idiopathic scoliosis: Bobechko et al. first reported successful treatment of this disease using a system controlled by implanted electrodes and radiofrequency emission in 1979. Due to the risks and side effects of implanted electrodes, surface electrodes have been used since the 1980s. Stimulus location: Identify the rib connected to the top vertebra, mark the intersection point of this rib with the posterior axillary line and the midline of the axilla, and use it as the center reference position for placing the electrode plate. Mark the center of the electrode plate 5-6cm vertically from the center reference position, and the center distance of the same group of electrode plates should not be less than 10cm. Stimulus intensity and duration: Stimulus intensity and duration: generally starting from 30-40mA, half an hour per day, two weeks later should reach 60-70mA, about 8 hours per day, and should be adjusted appropriately according to the patient's tolerance. Massage technique reset
02 has the function of peeling off ligament adhesions, improving muscle nutrition, strengthening metabolism in muscles, and enhancing muscle elasticity. It can activate meridians, improve blood circulation, and soften soft tissues and ligaments. Operation steps: The patient is placed in a prone position and the surgeon applies a rolling technique to the affected area, but the amount of manual stimulation should be appropriately increased,
The focus is on the curved area. During the rolling process, insert kneading and bouncing techniques. When doing the plucking method, it should be moved perpendicular to the muscle fibers, with heavy pressing and light bouncing, and a balance between rigidity and flexibility.
At the upper and lower parts of the side bend, perform repeated adversarial pressing and pushing with both hands simultaneously. To correct scoliosis deformity, hold the affected area with your palm and perform a slow push while letting the patient exhale through their mouth. Repeat this process for 10-15 minutes.
Relax traction
The surgeon places one palm on the scoliosis of the waist and lifts the lower limb on the opposite side with the other hand. Both hands exert force simultaneously, and some can hear a sound. The surgeon changes positions and moves the lower skin on the opposite side. Side pulling method
04 Place the patient in a lateral position, taking the right side as an example. Take the right lateral position, the right lower limb in an extended position, and the left lower limb in a flexed position on the right lower limb. The surgeon stands in front of the patient, placing one elbow on the patient's shoulder and the other elbow on the buttocks. Both arms are simultaneously exerting force in opposite directions, and a crisp sound can be heard from the waist. The surgeon flips the patient to the left and repeats the above method. suspension traction
05 can increase the gap between the vertebral bodies, allowing the adhered tissue to peel off and achieve the goal of reduction. There are many methods of traction, such as neck traction, inclined table neck traction, cervical pelvic sleeve traction, head pelvic ring traction, supine anti suspension traction, etc. Self suspension traction is an active exercise, while pelvic traction is a passive exercise. Patients with scoliosis have poor physical fitness, and active exercise is beneficial for enhancing their physical fitness and improving their immunity. Conventional pelvic traction requires hospitalization. Due to the different weights of patients, the traction weight and time need to be adjusted, and nursing staff need to closely monitor to avoid symptoms of nerve over traction; And self suspension traction can
At home, the traction weight is proportional to the patient's body weight. The patient can adjust the traction force on the scoliosis spine by contracting the muscles in the abdomen and lower back. During traction treatment, only one family member is needed to assist with the treatment.
Spinal corrector
06 Indications for orthopedic braces: Mild scoliosis between 20 ° and 40 °, idiopathic scoliosis in infants and early childhood, occasionally between 40 ° and 60 ° can also be treated with braces, and adolescent scoliosis above 40 ° should not be treated with braces. Children with immature bones should be treated with braces. When two structural bends reach 50 ° or a single bend exceeds 45 °, it is not advisable to use braces for treatment. Combining anterior convexity and scoliosis should not be treated with braces, as braces can worsen the anterior convexity deformity and further reduce the anterior posterior diameter of the chest cavity. After traction, necessary braces are used to force the reduced spine to remain stable without any retraction changes, and also to expand the intervertebral space. Exercise therapy for scoliosis
The first group of exercises: Stretching exercises. Do stretching exercises slowly until you feel the muscles tighten, and maintain for 10 seconds. 1. Stretch the deep muscles of the head and back, lie on your back, lift your head and neck, retract your chin, and pull your knees closer to your chin for 10 seconds. 2. Stretch your chest and abdominal muscles and lie prone, bend your knees, grip your feet tightly with both hands, and lift your head, neck, and knees for 10 seconds. 3. Stretch your lateral muscles and sit or stand, raise your left arm, place your right hand on your waist, and slowly bend your body to the right for 10 seconds. Repeat the action towards the other side. 4. Stretch your chest muscles while standing or sitting, grip your hands tightly on your back, then lift and hold for 10 seconds. 5. Stretching the oblique muscle of the abdomen
Lie on your back, bend your feet, and move both knees to the left until they are close to the bed. Maintain this position for 10 seconds, then repeat the movement to the right.
6. Stand with deep hip flexors, keep your upper body straight, bend your right knee, and stretch your left leg as far back as possible until you feel the muscles in front of your left hip joint tighten, maintain for 10 seconds, and repeat with your right leg. 7. Stretch the thigh muscles and sit on the bed, with the left leg straight and the right leg bent. Stretch both hands forward as much as possible until they touch the left foot, and maintain this position for 10 seconds (keeping the body straight and the left knee straight). Repeat with the right foot. Group 2: Strengthen muscle exercises. When doing muscle strengthening exercises, maintain normal breathing and do not hold your breath. Each action should be maintained for 5 seconds. 1. Control the coccyx with abdominal muscles, lie on your back, flex your knees, place one hand in a bent position on your back, tighten your abdominal muscles, and press your waist against the back of your hand for 5 seconds. 2. Exercise the rectus abdominis muscle by lying on your back, contracting your chin and bending your knees, crossing your hands in front of your chest, contracting your abdominal muscles, lifting your head and shoulders until your elbows touch your thighs, and maintaining this position for 5 seconds. 3. Exercise the oblique muscle to lie on your back, contract your chin and flex your knees, cross your hands in front of your chest, contract your abdominal muscles, lift your head and shoulders until your left elbow touches your right leg, maintain for 5 seconds, slowly return to your supine position, lift your head and shoulders until your right elbow touches your left leg, maintain for 5 seconds. 4. Exercise the back muscles and lie prone. Place your hands on the back pillow, contract your chin, straighten your feet, and then lift your head and feet simultaneously for 5 seconds. 5. Exercise chest muscles by lying prone, with palms on the ground, elbows extended to support the body, keeping the body straight, elbows slowly bent, and then extended. Group 3: Stretching Back Muscles Exercise 1. Scoliosis: Kneel down on the ground, stretch your hands forward, keep your body close to the ground, keep your thighs vertical, and maintain
10 seconds. 2. C-bend to the right: Kneel down, extend your left foot backwards, cross the midline, extend your left hand forwards, cross the midline, and move to the right
Crawl in an arc and maintain for 10 seconds. 3. C-bend to the left: Kneel down, extend your right foot backwards, cross the midline, extend your right hand forwards, cross the midline, and turn to the left
Crawl in an arc and maintain for 10 seconds. 4. S-shaped person: Kneel down, extend left foot backwards, cross the midline, extend left hand forwards, cross the midline, and move to the right
Crawl in an arc, maintain for 10 seconds, return to center, stretch your right foot backwards, cross the midline, stretch your right hand forward, cross the midline, crawl to the left in an arc, maintain for 10 seconds.
Group 4: Deep breathing exercises should be performed at least three times a day, with each movement performed five times. 1. Abdominal deep breathing: Keep your back straight, relax your shoulders, place one hand on your abdomen, take a breath through your mouth first, then inhale through your nose. Your abdomen should expand simultaneously for 5 seconds, then relax and exhale through your mouth. 2. Lower chest deep breathing: Keep your back straight, relax your shoulders, place your hands at the bottom of your ribs, breathe through your mouth first, then inhale through your nose. Your lungs should expand simultaneously for 5 seconds, then relax and exhale through your mouth. Group 5: Improving Posture Exercise: In addition to exercising every day, it is important to maintain good posture. 1. Stand with your back close to the wall and feet 8cm away from the wall. Keep your body straight, relax your shoulders, tighten your abdomen to control your coccyx, and keep your back slightly curved to allow your palms to pass through. 2. If the spine is tilted to the left or right, it should be moved in the opposite direction. 3. Improve neck posture, relax shoulders, look forward with your eyes, and slowly tuck your chin in. How to prevent scoliosis
1. Don't hunch over when standing, don't stand for 37 steps
2. 3. Avoid carrying heavy objects on the left and right shoulders for a long time. 3. Correct sitting posture (90/90/90), that is, the back is perpendicular to the thighs, thighs are perpendicular to the calves, and calves are perpendicular to the feet. 4. Regularly stretch the waist and back, which is beneficial for joint muscles, such as swimming and hanging on the horizontal bar. 5. Drink more milk, eat dried small fish, and bask in the sun appropriately to help the body produce vitamin D3, which is beneficial for calcium and magnesium absorption.
