scoliosis is defined as lateral curvature of the spinal curve.If we can identify at early stage, it can be treated.Identifying the cause and treating it plays an important role in correcting scoliosis.Normal cobbs angle is less than 10 degrees.More than 40 degees is severe scoliosisStructural/Non-structural Rt handed individuals,there is mild rt thoracic curve,left lumbar S-curve,or a mild left thoracolumbar C-curve. Assymmetry in the hips,pelvis, and lower exremities. Forward bending-rib hump posteriorly present.EXERCISE PROGRAM: stretching of tight myofascia and muscular tissue by- a)Hanging on roman rings or overhead bar b)Lateral bending towards convex side in sitting position. Strengthening for strength and endurance of the weaker muscles on the convex side scoliotic curve can be divided into primary and secondary curves.there also exist major double curves and thrible curve.Adult idiopathic scoiliosis is the commonest type of scoliosis.This type of scoliosis is divided into infantile, juvenile,adolescent type.limb length discrepancy is one of the main cause of acquired scoilosIs.2 types of scoliotic curves can commonly be seen,Primary curve and secondary curve. Primary curve has 1 structural curve.secondary curve has 2 structural curves. one may be primary and other may be secondary.Postural scoliosis can be corrected easily if identified early. Adams test is done to find out postural curve from structural curve. scoliometer is a device used to find out rib hump.The scoliometer is an inclinometer designed to measure trunk asymmetry, or axial trunk rotation. It’s used at three areas: at upper thoracic (T3-T4), main thoracic (T5-T12) and at the thoraco-lumbar area (T12-L1 or L2-L3). If the measurement is equal to 0°, there is a symmetry at the particular level of the trunk. An asymmetry at the particular level of the trunk is found, if the scoliometer measurement is equal to any other value.Moderate-cobb’s angle 20-40 Severe-cobbs’ angle>40 Investigation:-x-rays 1)Cobb’s angle measurement-Line passing through the upper border of the upper limit vertebrae of the deformity and another line passing through the lower border of the lower limit vertebrae of the deformity is drawn.1)Associated with rotation of vertebrae 2)Forward bending test shows the presence of rib hump. 3)On side bending, the curve persists Secondary curve disappears on forward bending,primary curve remains Mild-cobb’s angle<20 Perpendiculars are drawn on these line. The angle of deviation of these lines from a straight line is the cobb’s angle. 2)Nash and Moe’s method to measure vertebral rotation-Position of pedicles on a PA x-ray indicate the vertebral rotation. TREATMENT:1)Cobb’s angle<20-repeated follow-up and observation. If no increase in curve-no treatment 2)Cobb’s angle>20 and non-progressing-Milwaukee brace 3)Cobb’s angle>40 and progressing-surgical fusion. Cobb’s angle>60-surgical fusion If no increase in curve-no treatment 2)Cobb’s angle>20 and non-progressin

1. SCOLIOSIS
PRESENTED BY DR.ESWAR REDDY KOLLI,MPT,MIAP
PROFESSOR,SIMS COLLEGE OF PHYSIOTHERAPY

2.  Scoliosis is defined as the lateral curvature of
the spine in the upright position more than 10
degrees.
TYPES OF SCOLIOSIS:
A) BASED On Level:1)cervical 2)dorsal 3)dorso-
lumbar 4)lumbo-sacral
B)Based On etiology:1)congenital 2)paralytic
3)spastic

3. 4)traumatic5)pathologic6)idiopathic7)postural
C)Based on type of curve:a)primaryb)secondary
D)Based on changes in vertebrae:a)structural
b)non-structural(pos)
E)Based on degree of deformity:
 a)mild b)moderate c)severe

4. Problems with scoliosis
 Cosmesis
 Abnormal force transmission
 Jeopardises functions of vital organs
NOTE:Lateral curvature in excess of 10 degrees
is called scoliosis.

5. IDENTIFICATION OF STRUCTURAL
SCOLIOSIS
 1)Associated with rotation of vertebrae
 2)Forward bending test shows the presence
of rib hump.
 3)On side bending, the curve persists
 Secondary curve disappears on forward
bending,primary curve remains
 Mild-cobb’s angle<20

8. PLUMB LINE

9.  Moderate-cobb’s angle 20-40
 Severe-cobbs’ angle>40
Investigation:-x-rays
1)Cobb’s angle measurement-Line passing
through the upper border of the upper limit
vertebrae of the deformity and another line
passing through the lower border of the lower
limit vertebrae of the deformity is drawn.

10. Cobbs angle

11.  Perpendiculars are drawn on these line.
 The angle of deviation of these lines from a
straight line is the cobb’s angle.
2)Nash and Moe’s method to measure
vertebral rotation-Position of pedicles on a PA x-
ray indicate the vertebral rotation.
1. TREATMENT:1)Cobb’s angle<20-repeated
follow-up and observation.

12.  The scoliometer is an inclinometer designed
to measure trunk asymmetry, or axial trunk
rotation. It’s used at three areas: at upper
thoracic (T3-T4), main thoracic (T5-T12) and
at the thoraco-lumbar area (T12-L1 or L2-L3).
If the measurement is equal to 0°, there is a
symmetry at the particular level of the trunk.
An asymmetry at the particular level of the
trunk is found, if the scoliometer
measurement is equal to any other value[2].

13.  If no increase in curve-no treatment
 2)Cobb’s angle>20 and non-progressing-
Milwaukee brace
 3)Cobb’s angle>40 and progressing-surgical
fusion.
 Cobb’s angle>60-surgical fusion

14. 4 os
 Cobbs angle<20- observation
 Cobbs angle-20 to 40 degrees- orthosis
 Cobbs angle-More than 40 degrees-operation
 Cobbs angle-20 to 40 degrees-
excercises,electrical stimulation.

15. PHYSIOTHERAPY MANAGEMENT IN
POSTURAL SCOLIOSIS
 Correction of posture is the primary objective.
1)Teaching the right posture to the patient using
mirror feedback technique.
2)Proper proprioceptive stimulation and
feedback by constantly assuming the right
posture.

16. EXERCISE PROGRAM:
i. stretching of tight myofascia and muscular
tissue by-
a)Hanging on roman rings or overhead bar
b)Lateral bending towards convex side in sitting
position.
Strengthening for strength and endurance of
the weaker muscles on the convex side

17. medicine balls,balancing sitting over the
therapeutic balls maintaining right posture
 Side-lying on the convex side with a pillow
under the apex of the curve and the upper
extremity on concave side being elevated.
 Bracing-Total contact spinal orthosis worn
while sitting or working.
 Bracing removed periodically for exercise
program-NO BRACING DURING NIGHT

18. Physiotherapy
 First 2 days
 3rd and 4 th day
 After 5 days:Assisted guidance,sitting,chair
sitting,standing and walking,walking

19. Complications
 Deep vein thrombosis
 Pulmonary embolism
 Paralytic ileus
 Associated stiffness of spine,neck or
shoulder.
 Wound infection
 Neuralgia,graft site pain,pressure sores

20. Surgical treatment
Indications:
 A)cord compression
 Rapid progression of the curve
 Pain
 Respiratory impairment
 Cosmetic

21. Correction of the curve
 Corrective cast
 Distraction:Halofemoral,halopelvic
distraction
 Loosening of the curve

22. Maintenance of the correction
achieved
 Spinal fusion
 Spinal instrumentation
 A)Harrington instrumentation
 B)Segmental spinal(Luque) instrumentation
 C)Spinal instrumentation
 D)Video-assisted thoracic surgery(VATS)

23. ADVANCES IN SCOLIOSIS
Structural/Non-structural
 Rt handed individuals,there is mild rt thoracic
curve,left lumbar S-curve,or a mild left
thoracolumbar C-curve.
 Assymmetry in the hips,pelvis, and lower
exremities.
 Forward bending-rib hump posteriorly
present.

24.  Non-structural changes with forward,side
bending,and with positional changes.
 Also called functional/ structural scoliosis
Potential impairments:
Mobility impairments of muscles,joints,fascia
on the concave side of the curve.
Impaired muscle perforamnce due to stretch
and weakness in the muscles on the convex
side.