INTRODUCTION
Basically, scoliosis is derived from a Greek word and it is known as a medical condition in which an individual’s spine loses its position and it is curvy from one side to another. To define precisely, the shape of the spine or the back is changed from normal to abnormal. Some patients may have had brace treatment during adolescence while others may have never sought treatment during their teenage years. This can occur in the thoracic (upper) and lumbar (lower) spine and has the same basic appearance as that seen in teenagers. (Scoliosis Research Society (SRS)) The conservative treatment is very much effective in the management of idiopathic scoliosis when only if it is not progressing. Rapidly progressing of idiopathic scoliosis in youths, children, and adolescents requires different surgeries to overcome this back or spinal deformity problem.
However, different strategies which are used for the treatment of this medical condition, idiopathic scoliosis, usually depend on the deformity of the spine’s pattern and size of an individual. Although there may be any other strategies used for this medical condition but the main goal is to drive the spine into its right alignment. The different methods and strategies used are well researched from the relevant databases.
- Kowalski, K., Zaborowska-Sapeta, Giżewski,T., et al.( 2012). Effectiveness of Cheneau brace treatment for idiopathic scoliosis: prospective study in 79 patients followed to skeletal maturity. Scoliosis,7(Suppl 1):O44.
In this article, it has been discussed that Scoliosis basically is a diseases of the spinal cord which causes certain abnormalities in it. Furthermore, the article shows different symptoms of scoliosis and its recent widespread in the society.
The Chêneau braces treatment for idiopathic scoliosis has proved as a very effective and efficient treatment for the individuals who are facing this back deformity. Many studies and researches have shown that the progressive idiopathic scoliosis treatment can also have a negative influence on the working, functioning, and development of about 2 to 3 percent of the adolescents and juveniles.
The main objective of this research and study is to evaluate and assess different ways of Chêneau braces treatment for the people who are going through the idiopathic scoliosis. Therefore, the aim of brace treatment is to stop deterioration of the deformity, which is a natural history of progressive scoliosis beyond 25 degrees in immature adolescents. (Zaborowska-Sapeta, Kowalski M, Kotwicki, Faldowska P, Kiebzak, 2011).
It was basically an observational study conducted according to the recommendations of SOSORT and SRS. It was conducted on the 70 patients, who suffered from progressive idiopathic scoliosis and treated with Cheneau Brace and physiotherapy. They did not receive any previous brace treatment. It was followed by one year of follow-up after the patients wore the brace. The research study followed the standard recommendations and conducted on the good number of patients to develop the efficacy of the treatment.
The results showed considerable improvement in halting the progression of scoliosis. This strategy or treatment provides great assistance to its patients with according to its strengths and limitations. Limitations can be found anywhere today, even in the minutest thing. And same is the when it comes to the strengths of this Chêneau brace. The major positive feature of this treatment is that it gives pain relief, improves the movement and help general posture and strength. Such treatments must be encouraged so that any individual can be provided with its great assistance with specific pain, posture, and mobility issues. It is theorized that by using intensive exercise therapies that are tailored to the individual's curve that spinal mobility and muscle strength can be maintained and that as a result correction seen in the brace is better maintained and progression is better controlled. Therefore, it is said that when a patient deal with this type of treatment, the presence of Chêneau brace would not enforce any kind of limitations on the young patients’ personal and social life because he is allowed to walk, sit, run, play a little, perform some exercises etc.
When the patients of this kind of medical abnormality were successfully treated with the brace treatment and physiotherapy, there were good results in the end for a few patients while some of them were on the road of recovery process. At follow-up 20 patients (25.3%) improved, 18 patients (22.8%) were stable, 31 patients (39.2%) progressed below 50 degrees and 10 patients (12.7%) progressed beyond 50 degrees (2 of these 10 patients progressed beyond 60 degrees). Progression concerned the younger and less skeletally mature patients. (Scoliosis Research Society (SRS))
Hence in a nutshell, the study has showed that the conservative treatment with Chêneau braces and physiotherapy is very effective in stopping this medical abnormality in about 48.1 percent of the patients.
- Kowalski, I.M., Torres,M.A.T., Kiebzak,W., et.al. (2009). The Effect of Lateral Electrical Surfaces Stimulation(Less) On Spinal Deformity in Idiopathic Scoliosis. J. Elementol. 2009, 14(2): 289–297.
The effect of LESS was not abrupt and required time to show change. This process involved time and the changes observed were quite less.
During the years of 2003 till 2008, there were many clinical studies carried out in Poland which comprised of a group involving youths and children facing back deformity progression in idiopathic scoliosis of about more than 5 degrees per year according to the Cobb scale. The study was carried out on about four hundred and fifty patients, further divided into three groups of 150 patients each. Lateral Electrical Surface Stimulation(LESS) treatment was given to the experimental groups for different time periods. Group I received 2-hours and Groups II received 9 hours of LESS treatment. The Control group got only the corrective exercises twice a day for 30 minutes. The treatment of LESS was given for 24 months by making use of battery operated SCOL-2 Stimulator.
LESS treatment has halted the progression in idiopathic scoliosis in the last twenty years and the results are pretty much effective. The strength of this treatment was that there were several ways to carry out this procedure with the patients but the time duration did not matter. People who used to go through the LESS treatment overnight had the same result that used to do it 2 or 3 hours a day. However, patients who did not undergo with this treatment overnight will face fewer symptoms of these treatments if any. Therefore, LESS has a clear limitation related to its duration, since there is limited evidence of the effectiveness of braces when compared with no treatment. In addition, limited evidence was found for the effectiveness of bracing in reducing the spinal curve when compared with electrical stimulation.
Therefore, each of the three groups was treated differently than the other. Group I and group II received 2 hours and 9 hours treatment of Lateral Electrical Surface Stimulation (LESS) respectively. But group III was treated with only corrective exercises for 30 minutes twice a day. As this treatment (LESS) was a 24 months treatment, therefore, the results and effectiveness can be measured and determined after the treatment is completed over the time. The studies showed that the LESS treatment was significant enough to have a positive impact and effect on 75.5 percent when it comes to small spinal deformities. However, only 0.3 percent of change was measured when it comes to the 20 to 29 degree of spinal deformity progression in idiopathic scoliosis. All in all, the therapeutic effect in the group of 30 to 39 degrees of back deformity should VERY less change.
In the group of scoliosis treated with LESS, the best therapeutic effect was obtained in patients with an initial spinal scoliosis angle below 20o according to Cobb method. Therefore, the conclusion is
- Study has showed a positive and good effect on the nervous muscular system that the LESS method treatment provides usually within the youths and the children with idiopathic scoliosis.
- According to the Cobb scale, the back deformity of about less than 20 degrees can have great results and LESS method is very much effective for such patients.
- Short duration of LESS method treatment provides the same effects to those who obtain this treatment overnight (about 9 hours)
- Morningstar,M.W., Woggon, D., and Lawrence, G. (2004). Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. B MC Musculoskeletal Disorders ,5:32
A positive result was obtained as a reduction of 17 degree was observed by those who were treated through this method.
Different studies have shown that using a combination of manipulative and rehabilitative therapies to cure the curvatures associated with idiopathic scoliosis is ineffective and have been largely unsuccessful as well. The main aim and objective of such procedures and therapies is usually to relax, stretch, or strengthen the muscle or ligaments structures.
A study was carried out of a total of 22 patients, out of which 19 patients met the given criterion beneficial for such treatments. The group’s age range was between 15 years old to 65 years old and they were selected from three different chiropractic facilities in the United States. Each of these patients was examined radio graphically for location and severity of scoliosis. Before the intervention and 4-6 weeks following the intervention, Anterioposterior radiographs of participants were taken. By drawing Cobb angle, comparisons and analysis of each radiograph was made before and after the study.
The age range of the patients is quite broad in the study which might cause difficult to generalize the results on wide range of population and raise a question about the reliability and validity of the result findings.
The treatment of scoliosis using a combination of manipulative and rehabilitative therapy was carried out for 4 to 6 weeks and the results were pretty impressive as the treatment of group averaged a 17 degree reduction according to the Cobb scale. And those groups of patients Cobb angle did not increase as well. Hence in a nutshell, within the design limitations of the present study, the combined use of manipulative and neuromuscular rehabilitation seemed to reduce scoliosis curvatures in 19 subjects by an average of 17°. This reduction took place within a 4 to 6-week period. (Scoliosis Research Society (SRS))
The strengths of this treatment were often to relax, strengthen, or stretch muscle and/or ligament structures. In the spine, lateral spinal displacements may occur when the normal spinal curves are flattened, reversed, or accentuated. These curves are necessary for the overall strength and flexibility of the curved spinal column, according to the Delmas Index
However, the study also has certain limitations. Due to the lack of a control group, comparative data and conclusions cannot be made. Additionally, a retrospective design does not blind the practitioners to treatment. Within the design limitations of this treatment, the altogether use of manipulative and neuromuscular rehabilitation seemed to reduce scoliosis curvatures in 19 patients by an average of 17°.
- Pugacheva,N.( 2012) . Analysis of Six Weeks Efficiency– Pilot Study . Corrective Exercises in MultimodalityTherapy of Idiopathic Scoliosis in Children – Analysis of Six Weeks Efficiency – Pilot Study. Research into Spinal Deformities, T. Kotwicki and T.B. Grivas (Eds.), IOS Press.
The research provided by Pugacheva clearly states that the results have been tremendous and treatment has been quite efficient in for the cure of Scoliosis in young children
The research was conducted on the 21 patients who were evaluated using the Schroth method in H.R. Weiss modification which was carried out in multimodality conservative therapy of idiopathic scoliosis in the clinic. It was a six week physiotherapy program. Instrumental diagnostic techniques were used to evaluate the efficacy of the therapy and state of musculoskeletal system. The instrumental diagnostic techniques included the computer optical topography, the electromyography of paravertebral muscles and the stabilometry.
The research method used make use of the latest technology to evaluate and analyze the results of the treatment. The research method should have included more participants in the study to generalize and make the results more reliable. the research was conducted in clinical settings which acts as one of the limitations of this research.
The therapeutic exercises are considered as on the best ways to cure idiopathic scoliosis conservative treatment. The concept of therapeutic exercises based on three dimensional spine correction preserving postural balance with application of special breathing exercises were first elaborated by Christa Lehnert-Schroth and Hans-Rudolf Weiss. Both of these individuals were German.
The main aim and objective and the goal was to evaluate efficacy of the «Best Practice» Hans-Rudolf Weiss (Germany) therapeutic exercises program in multimodality therapy of idiopathic scoliosis in children treated in our clinic. (Pugacheva, 2012)
There are many limitations when it comes to dealing patients with spinal deformities. Rehabilitation is the process of providing assistance to someone which improves and recovers a lost function after an event, illness or injury that has caused functional limitations. However, this treatment also helps with the the improvement of the muscle strength (satisfied and moderate) in almost 80% of the children while the correction of the curve was small in approximately 42.1% of cases. Hence all in all, an exercise program helps chest mobility, muscle strength, proper breathing flexibility in the spine, correct posture and keeps muscles in tone so that the transition period after brace removal is easier.
According to the data of clinical investigation and instrumental testing the Schroth program of therapeutic exercises modified by H.-R.Weiss improves efficacy of therapy in children with idiopathic scoliosis and it is well-correlated with the system of conservative treatment of idiopathic scoliosis practiced in Russia and improves the efficacy of the therapy in children with this pathology. (Pugacheva, 2004)
- Otman, S., Kose,N. & Yakut,Y.(2005). The efficacy of Schroth’s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Saudi Med J. Sep;26(9):1429-35.
The study of Otman, Yakut and Kose show that a positive change has been observed amongst those who have been treated by the treatment for this disease. The main objective of this study was to measure and determine the effectiveness of the three dimensional therapies in the treatment and management of adolescent idiopathic scoliosis. However, if an individual is being treated with three dimensional therapies and is left untreated in the future, then this deformity may sentence the younger patient to either adult life of pain, disability, low self-esteem etc.
The study was conducted on 50 patients. The study was conducted from 1999 till 2004. The average age group of the patients was 14.15 ± 1.69 years during that period, at the Physical Therapy and Rehabilitation School, Hacettepe University, Ankara, Turkey. For initial 6 weeks they were treated as outpatients. They used to attend 4 hours program for 5 days a week. After 6 weeks, they conducted the same exercise plan at their homes. The patients were evaluated before treatment, after 6 weeks of treatment, 6 months and then one year of treatment.
This research method employed by the study helps to provide more reliable and consistent results as it spanned over an extended time period and provides a better analysis and evaluation of the treatment methods.
Schroth’s three dimensional exercise therapies improved the Cobb angle, vital capacity and muscle strength of the patients. However, it was observed that an increase in muscle strength and recovery of the postural defects in all patients. Schroth’s technique positively influenced the Cobb angle, vital capacity, strength and postural defects in outpatient adolescents.
The average Cobb angle, which was 26.10º on average before treatment, was 23.45º after 6 weeks, 19.25º after 6 months and 17.85º after one year. The vital capacities, which were on average 2795 ml before treatment, reached 2956 ml after 6 weeks, 3125 ml after 6 months and 3215 ml after one year. Similarly, according to the results of evaluations after 6 weeks, 6 months and one year, we observed an increase in muscle strength and recovery of the postural defects in all patients. (Otman, Kose, Yakut, 2005)
However all in all, Schoth’s technique and method is effective and it positively influenced the Cobb angle, vital capacity, strength, and postural defects in the patients of spinal deformity.
SUMMARY
All the articles which are mentioned above greatly influence the treatment of back deformity in patients. The articles has a strong bond and relation with each other, also they greatly support the guiding question as well. In my paper, I have thoroughly discussed five articles which support the guiding question and proves with several studies and cases that how methods and any other strategies used helps an individual overcoming the spinal deformity to some extent.
However, the conservative treatment is very much effective in the management of idiopathic scoliosis when only if it is not progressing. Rapidly progressing of idiopathic scoliosis in youths, children, and adolescents requires different surgeries to overcome this back or spinal deformity problem. Every of the treatments mentioned above such as Chêneau brace treatment, the lateral electrical surface stimulation, a combination of manipulative and rehabilitative therapy, corrective exercises in multimodality therapy, and the efficacy of Schroth’s 3-dimensional exercise therapy had a positive and great influence when it comes to curing and healing and reducing the idiopathic scoliosis in youths, children, and adolescents.
All different therapies and strategies were carried out in different ways affecting positively. The methodology used for every study was different from the next one, hence, providing the same result which was a positive infecting in curing idiopathic scoliosis in children and adolescents to some extent. But the main objective of every case study was to evaluate how different methods and strategies can positively influence the patients who are facing the spinal abnormality and deformity of idiopathic scoliosis. Hence in a nutshell, they were proven to be beneficial for numerous patients.
Reflection on the Process
The conservative treatment is very much effective and helpful in the management of idiopathic scoliosis in the initial stages and in the mediocre stages as well. However, if this spinal deformity keeps on increasing according to the Cobb’s measurements, an individual could need surgery! However, the strategies, methods, and treatments mentioned and elsewhere are a real challenge for an individual and patients to go through as it is not an easy process for everyone. If these therapies and methods are not carried out correctly, it could further put an individual to disabilities etc.
References
Kowalski, K., Zaborowska-Sapeta, Giżewski,T., et al.( 2012). Effectiveness of Cheneau brace treatment for idiopathic scoliosis: prospective study in 79 patients followed to skeletal maturity." Scoliosis,7(Suppl 1):O44. Retrieved on 12 September 2013 from http://www.scoliosisjournal.com/content/7/S1/O44
Kowalski, I.M., Torres,M.A.T., Kiebzak,W., et.al. (2009). The Effect of Lateral Electrical Surfaces Stimulation(Less) On Spinal Deformity in Idiopathic Scoliosis. J. Elementol. 2009, 14(2): 289–297.
Morningstar,M.W., Woggon, D., and Lawrence, G. (2004). Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. B MC Musculoskeletal Disorders ,5:32
Otman, S., Kose,N. & Yakut,Y.(2005). The efficacy of Schroth’s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Saudi Med J. Sep;26(9):1429-35.
Pugacheva,N.( 2012) . Analysis of Six Weeks Efficiency– Pilot Study . Corrective Exercises in MultimodalityTherapy of Idiopathic Scoliosis in Children – Analysis of Six Weeks Efficiency – Pilot Study. Research into Spinal Deformities, T. Kotwicki and T.B. Grivas (Eds.), IOS Press.
