Physiotherapy is by far an innovative science. Nowadays, scientists can claim that with the help of this new science , the world can be more aware and sympathetic about idiopathic scoliosis, especially in adolescence.(AIS).Idiopathic scoliosis is a condition of one's body that the shape of it, characterized by abnormalities(medical dictionary). However, there is some scientific evidence that show that certain physiotherapeutic exercises can help minimize the effects of progression of the idiopathic scoliosis (IS). But what are the factors of triggering I.D.? Which exercises are considered to be beneficial?
To begin with, Idiopathic Scoliosis is a condition characterized by medicine as a side to side deviation more than 10o of Cobb angle. (18) Idiopathic scoliosis in adolescence is at the present time a common malformation of the spine. its characteristic are found in the "lateral deviation", "axial rotation" and reduction of the sagittal spinal curvature (1-4)Because of the malformation of the spine , certain functions of our body are changed like the biomechanics , the neuromotor and the cardio respiratory(4,5,6)
The factors triggering the start of this kind spinal deformity or abnormality are unknown. Nevertheless , as scientists, we have to find out these factors in order to stop or diminish the progression of the scoliosis and moreover to prevent it from starting .A lot of researches have been conducted at the moment for the A.I.S focusing on these different factors related with the growth of children , the nervous system and the muscular system(13,14). Still, it seems to have two categories of factors. The first ones are those pathogenetic that initiate scoliosis and the second ones, are those that can cause curve progression. Scientists claim by facts that pathogenetic factors deform the spine shape can be found in the skeletal system or inside ligaments or in the neuromuscular or in any combination of the above.(2,7,17)The second category of factors involves, the mechanism of putting load on the spine as called "mechanical process". Also involves the variety of different growth pattern between children that can affect the growth of vertebrae, of different bone shape, of the maturity of bones, of the flexibility in different muscle groups. Moreover, factors like menarche for girls or hormones for children can initiate an abnormal spurt of growth of the body. (2)Furthermore the "stress of everyday life" (9) and different action of body muscles can lead to spinal deformity so to torsion and finally to a curve: scoliotic, kyphotic or lordotic. (7, 8)
Yet, there is a general concept amongst scientists that our body has to adjust in the central nervous system (CNS) in order to control our posture and every other movement involving the trunk. What they think is that propioceptors are very important in order to have a certain posture. That awareness of our body posture and the body mechanism, I strongly believe that is significant. More researches need to be conducted on the mechanism of our body awareness in AIS. Another crucial remark is that some movements that we are doing using our trunk are coordinated but they involve a small percentage of our conscious control. (16, 17). We have to observe more the static and dynamic control of our spine by the muscles involving there .
Medical scientists, who are occupied with this medical condition, they consider that two forms of therapy as the most affective: conservative and surgical. Conservative therapy that can involve different kind of physiotherapeutic exercises and regular examination from the orthopedic doctor for IS less than 30o Cobb angle or brace applied to patients with IS from 30o and up of Cobb angle. Even so, if conservative therapy is not accepted by the patients' body and the progression of scoliosis is insufficient then surgery is a need (10, 11). Researchers of this deformity (AIS), find out two large groups of exercises. In the first group, researchers base the exercise type in the CNS dysfunction () in the second group, the exercises are elected from the "muscular imbalance" (4). Actually these two groups have been merged together because the CNS and muscular system is related one each other. What is obvious is that more researches have to be conducted in order to obtain the knowledge of neurophysiology of dynamic or static posture and gait movement in subjects with AIS.
It is very common at the present time that more and more people are diagnosed with Idiopathic scoliosis. It is not only the use of technology and of the different measurements (maturity measurement, screening measurements) that doctors are doing during examination but also the way of life we are living in. From my point of view, more researches need to be conducted on the factors of the spurt of scoliosis as this is the beginning of a vicious cycle of scoliosis. As then, physiotherapy will have the opportunity to rehabilitate patients with AIS with the very correct, suitable and effective type of exercises.
1. Veldhuizen AG, Wever DJ, Webb PJ. The aetiology of idiopathic scoliosis: Biomechanical and neuromuscular factors. Eur Spine J 2000;9(3):178 - 184.
2. Simoneau M, Mercier P, Blouin J, Allard P, Teasdale N. Altered sensory-weighting mechanisms is observed in adolescents with idiopathic scoliosis. BMC Neurosci 2006;7:68.
3. Weiss HR, Negrini S, Rigo M, Kotwicki T, Hawes MC, Grivas TB, Maruyama T, Landauer F. Indications for conservative management of scoliosis (guidelines). Scoliosis 2006;1(1):5.
4. Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, Tedeschi C, Venturin A. Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal deformities. Eura Medicophys 2005;41(2):183
5. Herman R, Mixon J, Fisher A, Maulucci R, Stuyck J. Idiopathic scoliosis and the central nervous system: A motor control problem. The Harrington lecture, 1983. Scoliosis Research Society. Spine 1985;10(1):1 - 14.
6. Negrini S, Grivas TB, Kotwicki T, Maruyama T, Rigo M, Weiss HR. Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper. Scoliosis 2006;1:4.
7. Lee LJ, Coppieters MW, Hodges PW. Anticipatory postural adjustments to arm movement reveal complex control of paraspinal muscles in the thorax. J Electromyogr
8. Krakauer J, Ghez C. Voluntary movement. In: Kandel ER, Schwartz JH, Jessell TM, editors. Principles of neural science. 4th ed. Norwalk, CT: Appleton & Lange; 2000. pp 756
9. Graziano MS, Gross CG. Spatial maps for the control of movement. Curr Opin Neurobiol 1998;8(2):195 - 201.
10.Weiss HR, Werkmann M, Stephan C. Correction effects of the ScoliOlogiC1 'Cheneau light' brace in patients with scoliosis. Scoliosis 2007;2(1):2.
11. Hawes M. Impact of spine surgery on signs and symptoms of spinal deformity. Pediatr Rehabil 2006;9(4):318 - 339.
12. Lehnert-Schroth CH. Dreidimensionale Skoliosebehandlung. 6th ed. Stuttgart: Urban & Fischer, editor; 2000.
13. MILLNER, P. A. and DICKSON, R. A.: Idiopathic scoliosis: biomechanics and biology. European Spine Journal, 5: 362-373, 1996.
14. BURWELL, R. G., DANGERFIELD, P. H., LOWE, T. G. et al.: Preface. Spine: State of the Art Reviews, 14: xii-xiii, 2000.
15. LOWDEN, M. C., BURWELL, R. G. and WEBB, J. K.: Sagittal spinal curves and their flexibility in healthy children. Proceedings of the Scoliosis Research Society, 20th Annual Meeting, Hotel del Coronado, Coronado, California, USA, 17-20 September, 1985.
16. WIDHE, T. Spine: posture, mobility and pain. A longitudinal study from childhood to adolescence. European Spine Journal, 10: 118-123, 2001.
17. RASO, V. J.: Biomechanical factors in the etiology of idiopathic scoliosis. Spine: State of the Art Reviews, 14: 335-338, 2000. www.ndos.ox.ac.uk/pzs/Group_2/Raso.html 1998.
18. Lehnert-Schroth CH. Dreidimensionale Skoliosebehandlung. 6th ed. Stuttgart: Urban & Fischer, editor; 2000.