If your child
cant stand up straight,
it could be Scoliosis.

What does it look like?

Signs and Symptoms of scoliosis can include:

• The body (trunk) leaning more to one side than the other.
• A rib “hump” and/or a protruding shoulder blade.
• The opposite sides of the body may not appear level.
• A tilted head that does not line up over the centre of the hips.
• One hip or shoulder that is higher than the other, causing an uneven waist.
• In developing girls, breasts appearing to be of unequal size or at different heights.
• Unequal distance between arms and body.
• Clothes that do not “hang right,” i.e. uneven hemlines.
• Standing with one knee slightly bent a lot of the time.
• There is often a family history of Scoliosis or Scheuermann’s disease, 33% are hereditary, although this may not always be the case.

Signs and Symptoms usually present during rapid growth spurts.

How can I tell if my child has Scoliosis?

A proper diagnosis has to be made by a medical practitioner, physiotherapist or scoliosis professional, but a simple two minute evaluation of your child will give you an indication if further investigation and treatment are required. Simply follow the guidelines below, and go through the questionnaire included to see if your child needs further investigation.

1. Ask your child to take of their shirt and stand in front of you.
2. Go through each test, using the pictures as a guide, then circle the “Y” for yes, or “N” for no, next to each question.
3. Once you have completed the tests, total the “Y’s” and “N’s”.
4. If you have answered “yes” to MORE THAN ONE of the questions, your child needs further investigation.
5. Take this questionnaire to your medical practitioner, physiotherapist or contact one of the numbers listed below to find out what steps to take and where to find help.

TEST 1.

Your child should stand on a level surface facing toward or back to you.

• Are the shoulders heights uneven?
  (the dominant arm/shoulder can be a little lower in a spine without scoliosis, however if the dominant shoulder is higher than the other shoulder, there is a scoliosis)
• Are the hips uneven?
• Is the distance between the arms and torso
  uneven or unequal on one side?

TEST 2.

With your child facing toward or away from you.

Arms straight out ahead with palms touching together, bend forward from the hips about 90 degrees then, clamp the hands between the knees (knees as straight as possible).

Head hanging down, neck relaxed (child looking at their knees).

• Is one shoulder blade protruding or sticking up more than
  the other?
• At the upper part of the back, is there a raised
  rib ‘hump’ on one side or the other?
• Does the rib area look uneven or unbalanced? 
• On the opposite side to the rib ‘hump’, lower down, is there another ‘hump’ near the waist area?
• Does one hip appear to be higher or not level to
  the other?
• Can you see the spine making an “S” or “C” shape?
• Does your child often stand with one knee slightly bent? 

Another adolescent spine condition, known as hyper-kyphosis (Scheuermann’s Disease), may also be detected by doing a similar test.

TEST  3.
With your child bent forward in the same way as Test 2, get him or her to turn 90 degrees away from you. You should now be looking at him/her from the side. This time, though, the hands should hang free pointing toward the floor. Now look across the surface of the back near the upper part:

• If the back does not appear smooth or even, does the back shape ‘peak’ or have a sharp angle to it?  (see pink arrow)
• Do you constantly have to remind your child to “sit up or stand straight”, or ‘pull your shoulders back’?
• Does your child complain of back ache or pain near the middle of his/her back?

How will a diagnosis be confirmed?

If you are concerned that your child may have Scoliosis, Scheuermann’s disease, or other postural deformity of the spine, consult your healthcare practitioner. They will request X-rays of the spine to confirm a diagnosis. They may wish to refer you (or you may ask them) to an orthopaedic surgeon (specialising in disorders of the adolescent spine), physiotherapist or orthotist for further treatment.

What are the treatment options?

Treatment protocol depends on several factors such as, skeletal maturity, size of the curve and other underlying conditions.
The condition may be monitored with X-rays, physiotherapy may be advised, bracing either full-time or night-time, or in large curves surgery may be recommended. This applies to both Scoliosis and hyper-kyphosis (Scheuermann’s Disease).

There is a perception that neither specific physiotherapy nor bracing is effective. This is not correct. There is lots of  research which has been conducted, proving the effectiveness of both physiotherapy and bracing. Furthermore it has been shown that general fitness exercises and some exercises can make the patient worse. However, specific methods such as Schroth method (Germany), SEAS Method (Italy) have shown favourable results and improve the signs and symptoms of the condition. These methods are conducted by therapists trained in these methods.

Conservative management of Scoliosis and Hyper-kyphosis.

The earlier the problem is detected, the more effective the treatment is.  Compliance is the key to successful treatment.
The approaches in each condition follow:

Scoliosis:

• Spinal curvatures under 10 degrees are generally monitored every  6-12  months  for signs of progression. Above 10 degrees specific physiotherapy exercises are recommended.
• 15-25 degrees: as above, but night-time bracing may be suggested to correct the curve and retard progression and a specific physiotherapy programme.
• 25 & ABOVE degrees: full time bracing and a specific physiotherapy programme.

Scheuermann’s Hyper-kyphosis:

• The normal thoracic curve value is between 20 – 50 degrees.
• Curves above 50 degrees can be closely monitored by 6 monthly X-rays for signs of progression and given a specific exercise programme.
• Curves over 60 degrees and kyphosis in the presence of Scheuermann’s disease need to be braced with a specific physiotherapy programme.