We are often asked “what are the principles and theory behind our approach to scoliosis treatment and management?” In short: how do we know what we recommend is correct?
All Health Professionals should follow well researched, evidence based techniques and approaches when implementing treatment plans with patients. Scoliosis Clinicians are no exception and at ScoliCare clinics we pride ourselves on adhering to the highest standards of patient care.
The International Society on Scoliosis Orthopaedic and Rehabilitation Treatment, otherwise known as SOSORT, is an international organization that guides health professionals on the most up to date, evidence-based recommendations in relation to the conservative treatment of idiopathic scoliosis.
The latest guidelines were developed in 2011, and are always under revision as new evidence comes to light. Our clinicians regularly attend SOSORT meetings, are active members in the organization, and follow the SOSORT guidelines for scoliosis treatment.
According to SOSORT, each treatment approach has specific guidelines relating to the size of a patient’s scoliotic curve and also the maturity of the patient (based on bone age indicators). This means that a patient’s treatment plan should be individualized or their specific situation.
Certain scoliosis treatments have not been endorsed by SOSORT because of the lack of substantial evidence that scoliosis can be cured or improved by these treatments. Examples include foot orthotics (when used in isolation), oral supplements (neurotransmitter, mineral or vitamin), jaw bone positioning treatments and many others. These all lack substantial evidence that they can arrest or improve scoliosis.
Recent research has been published that strongly supports bracing for adolescent idiopathic scoliosis patients with a high risk of progressing to surgery and SOSORT supports bracing as a recommended intervention in the treatment of adolescent idiopathic scoliosis in many cases.
The earliest that bracing is prescribed in adolescent idiopathic scoliosis cases is where the patient has a young immature spine, usually before the age of 12 (however this can vary) and has a curve of greater than 15 degrees according to the Cobb method of radiographic measuring. The recommended treatment includes part-time rigid bracing.
According to SOSORT, full time rigid bracing should be prescribed when 20 degrees or greater scoliosis is seen.
Scoliosis specific exercises can also be introduced into a patient’s treatment plan. These are generally prescribed when curves are over the 10-degree mark for adolescents. If, however, the patient is a juvenile (below the age of 10), then curves under 10 degrees are recommended to begin a treatment plan with scoliosis specific exercises.
The exercise approach for treating scoliosis which most prescribed by SOSORT is the SEAS method (Scientific Exercise Approach to Scoliosis). This method incorporates the use of corrective movements that are in the opposite to the patient’s scoliosis. In this, the curved spine is essentially ‘untwisted and straightened’ and the action is then incorporated into activities of daily living for maximum long-term benefit.
Patients and their parents should always be given freedom of choice when selecting a Scoliosis Clinician. A reputable scoliosis clinic should be able to provide a range of treatment options for scoliosis ranging from scoliosis specific exercise to 3 dimensional bracing techniques. A good clinician will recommend the most appropriate treatment option(s) for each individual case – not simply try to fit every patient into the single treatment method they offer.
The SOSORT recommendations we outlined above are readily available to refer back to when researching clinics and health professionals. It’s important to also take note of treatments which may be offered by some clinics, but are not supported by substantial evidence or research or supported by the SOSORT guidelines.
The diagnosis of scoliosis can be a confusing and overwhelming time for the patient and in many cases their parents too. Choosing a Scoliosis Clinician who follows SOSORT guidelines and who can explain the evidence behind all available treatments will help ensure the best chance at good results.
Information about SOSORT and their guidelines can be found at http://www.sosort.mobi/index.php/en/
Reference –  Effects of Bracing in Adolescents with Idiopathic Scoliosis – The New England Journal of Medicine