Revisiting exercise and scoliosis management

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From Biomechanics Magazine February 2005

Revisiting exercise and scoliosis management

As physical therapists specializing in the treatment of spinal conditions, we

were

pleased to read a physiotherapeutic perspective on adolescent idiopathic

scoliosis featured in the BioMechanics supplement, Scoliosis Management

(September).

In the article by s and Cassella ( " Exercising Options, " page 14), the

authors review two studies that examined the effects of exercise and a

complement of other interventions for the reduction of curve progression in

patients with idiopathic scoliosis. An important omission from this brief

overview

is the work of Vert Mooney, MD, and colleagues who have demonstrated in two

peer-reviewed articles the effectiveness of exercise in the management of the

scoliotic adolescent.

Importantly, this research challenges the closing statements by s and

Cassella in which the authors conclude, " Existing evidence does not suggest

that

exercise alone can prevent curve progression in adolescent idiopathic

scoliosis.

Designing a study involving exercise alone, therefore, would be ethically

questionable. "

Although deemed preliminary, the data reported by Mooney et al suggest that

truncal strengthening to address rotary strength asymmetry can prevent or

partially reverse curve progression when used as the sole intervention.

In the first study (Mooney V, Gulick J, Pozos R. A preliminary report on the

effect

of measured strength training in adolescent idiopathic scoliosis. J Spine Dis

2000;13[2]:102-107), Mooney and coworkers studied 12 adolescents with

idiopathic scoliosis who had curvatures ranging from 20 degrees to 60 degrees .

Patients were tested on a computerized torso rotation dynamometer.

In addition to rotary strength asymmetry, asymmetric myoelectric activity was

found in all patients. Following the torso rotation strengthening program of

four

months, asymmetries were completely corrected and significant strength gains

were found (12% to 40%). Moreover, four of the patients had a reduction in

their curvatures and seven had no further progression. One patient with a 60

degrees curve required surgery.

Combining data from the first study, Mooney and Brigham completed a second

study (Mooney V, Brigham A. The role of measured resistance exercises in

adolescent scoliosis. Orthopedics 2003;26[2]:167-171) with a total of 20

adolescent participants examining the benefits of a progressive resistive

training

program for torso rotation and lumbar extension.

The major curve of each participant, which ranged from 15 degrees to 41

degrees , was investigated. The study revealed that 16 of 20 patients

demonstrated a reduced curve while none of the participants had an increase in

their curves. Pre- and post-treatment mean curvatures were 28 degrees and 23

degrees , respectively. In addition, no patient required surgery or bracing.

Our results using an identical testing and treatment protocol as described in

the

aforementioned studies reveal equally promising results. For example, one

12-year-old female graduate of our program radiographically demonstrated a 5

degrees curve reversal without the use of bracing.

While we await the results of larger studies currently under way that address

exercise-based management of adolescent idiopathic scoliosis, it is intriguing

to

contemplate that the muscle imbalances associated with scoliosis may be more

causative than consequential.

Such a possibility provides additional promise for conservative management of

adolescent idiopathic scoliosis due to the plasticity of muscle tissue,

particularly

in the young adult.

Thank you for a most welcome publication on a topic of great interest for the

conservatively minded practitioner.

Greg E. Bradley-Popovich, DPT, CSCS

N. Geiger, DPT

Northwest Spine Management

Portland, OR

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