The Latest on Scoliosis Research
I had the immense pleasure of being able to attend the SOSORT International Congress in Boston, MA, a few weeks back. If you’re unfamiliar, SOSORT stands for the Society on Scoliosis Orthopaedic and Rehabilitation Treatment. It’s made up of healthcare professionals, scientists and researchers dedicated to advancing non-surgical treatment of scoliosis. Every year, the society receives thousands of submissions and selects the most innovative and informative research to present to the society. This was my first year attending since specializing in scoliosis-specific exercise a few years back, and it was so amazing to be in the room with people I’ve learned with before and the big names in scoliosis treatment from across the globe.
For 4 straight days, the room was filled with:
Doctors
Physiotherapists (or physical therapists, as we say in the US)
Orthotists - the people who make scoliosis braces
Researchers
…and more people precisely as passionate about scoliosis as I am.
Every time I go to a conference like this, I get more fired up. There aren’t many people in the world I can truly nerd out with, when it comes to what I do. If you’ve been following me for any length of time, you’ll already know I’m a giant nerd and learning more about the body and upcoming technologies is one of my favorite things. I brought my laptop and took 60+ pages of notes. Yes, you did read that right.
So what do you need to know about scoliosis?
(I’ll have you know I agonized about how to best synthesize and summarize all of this for you in the easiest to read way possible.) I hope it all makes sense… but I love a good question in the comments if you’re unclear about anything!
Also, in case you’ve got questions about scoliosis or what we know already, check out more in this blog.
How We Measure A Curve Matters
You may not be surprised to know there can be some measurement error when we are assessing someone with scoliosis. Making sure our measurements are standardized is crucial - particularly when we’re looking at a growing kid and whether our interventions (bracing, scoliosis exercise, etc) are working. That said, there were a number of studies and papers looking at how we can make sure we are getting as accurate and reproduce-able measurements as possible.
A group out of Canada analyzed x-ray measurements alongside ultrasound imaging of the spine and found the ultrasound measurements were relatively reliable and accurate for mild and moderate curves. It was less accurate for larger curves
A different group from China used AI software and an algorithm to create 3D reconstructions of spines with scoliosis and found it to be relatively reliable for up to moderate curves. They were even able to determine which spinal segment was the most rotated. Further research still needed from more centers and more individuals.
Several groups looked at the ability of surface topography (3D imaging) to detect types of curves and spinal balance, and it was mostly found to be accurate though more research is needed.
A researcher out of Poland discussed his findings on how to standardize posture pictures for optimal monitoring of kids as they grow to decrease risks of measurement error and allow for earlier identification of curve worsening.
How Our Muscles Fire Matters
As you can imagine, scoliosis can impact our muscle size and symmetry. The theory is, a larger asymmetry can lead to a faster curve progression in the growing spine. Until now, however, there haven’t been many studies to look at this specifically.
A group from China were able to use a cellular imaging technique called immunofluorescence to prove there are differences in the types of muscle fibers around the spine (on the curve side vs. the opposing side) in scoliosis as compared to controls.
Research out of the UK shows promising results in using EMG biofeedback in muscle retraining in participants with scoliosis to improve their movement patterns and train out of compensatory movements that could lead to curve progression.
One group of physios from Australia did multiple studies on how muscles on either side of the spine are recruited - meaning, do they fire at once or at different times? do muscles on both sides of the curve contract equally? Some takeaways:
One of the studies showed that the muscles closest to the spine at the largest part of the curve (known as the apex) had the greatest asymmetry
Another study compared the muscle recruitment of participants with idiopathic scoliosis to those without scoliosis and were able to show differences in how the muscles fire in those with scoliosis, that asymmetries exist but are different than those without scoliosis.
All of these studies will be expanded and research is ongoing, but looking into how the muscles themselves play a role is relatively new in the world of scoliosis research. Stay tuned!
The Braces We Choose Matter
If a child is growing and needs a brace for their scoliosis, the family has more options than ever before. There are rigid braces - typically made out of a type of plastic - and there are soft braces, made out of different elastic materials such as neoprene and other fabrics. The evidence is strongest for the rigid braces according to the SOSORT 2016 guidelines, which are the gold standard for scoliosis treatment around the world. As I mentioned earlier, the skilled professionals who can evaluate and fit these braces are known as orthotists.
The type of brace and the skill of the orthotist are important in order to get the best possible results. One of the main variables that we consider is what we call in-brace correction, and obviously we want as close to a straight spine as we can get.
There are many different types of braces, some provide what we call over-correction (such as a Providence night brace which aims to get the spine completely straight), and others that seek to provide 3-dimensional postural correction. You may have heard of the Boston brace, maybe not of the WCR brace - short for Wood Cheneau Rigo brace - which is my personal preference for growing spines.
There were numerous studies about bracing and how to make sure we are providing the best correction possible. To summarize:
A group out of China showed full time bracing (~17 hours) plus daily scoliosis-specific exercise to be effective in moderate to severe curves. The combination of treatments improved the curve angle in 58% of participants & stabilized the curve angle in 36%
Another Chinese group showed that participants with a curve lower in their spine had good outcomes with a different type of brace (less material higher up on the trunk) which led to better quality of life and satisfaction among the participants.
Multiple groups from across the world presented on the effectiveness of bracing (when used as prescribed) even for larger curves or older kids, particularly when paired with scoliosis-specific exercise, to decrease curve angle and prevent or prolong need for surgical correction.
Bracing was proven by groups from around the world to be effective in all ages, genders and curve severity. Generally, each team found the kids who wore their brace most consistently for the recommended time showed the biggest improvement of their curve. Maybe this sounds a bit like common sense, but now we have the numbers to back it up!
Conversely, a Chinese study in boys with scoliosis proved that those who were less consistent with their brace wear were more likely to progress to surgical ranges. Also, the younger they were diagnosed, the more likely their curves were to need surgical correction.
Finally, multiple research teams from around the world are investigating how to improve in-brace correction, optimize the design to help kids & teens feel more comfortable in the brace, and therefore get better results for everyone.
How We Teach Our Exercise Matters
Now, this was one of the most interesting parts of the conference for me. Because of the highly skilled nature of scoliosis-specific exercise, it can still be incredibly difficult to find a local therapist to work with. In my work in the online space, I have found there are entire regions of the world that don’t have a single physio trained in this method.
Because of this, many patients and families may choose to travel for intensive scoliosis-specific exercise training or, thanks to the pandemic, telehealth (or virtual visits) may be an option for them as well. Here’s a smattering of perspectives from various individuals:
One physio out of Greece touted the benefits of telehealth visits for:
Higher compliance with exercises
Less time away from work/ school
More accessible care even with long distance from the clinic
A teacher of mine and researcher based in Italy presented the limitations of telehealth including:
A therapist’s inability to use their hands to help someone find their best corrected position
Limitations of visibility to see if the person has maintained their corrections or performed appropriately
Unreliable measurements from family members who monitor for improvement or curve worsening
Lack of rapport and therapeutic relationship between the physiotherapist and the patient
On a more personal note, I’m a big proponent of virtual sessions despite the drawbacks. For as common as scoliosis is worldwide, unfortunately the number of physios that can provide this specialized exercise is still limited. Until such a time where everyone can work with a specialist in person, I will advocate for people to access scoliosis exercise virtually.
There were also a number of presentations on the exercise we choose and how they impact the spine. A quick summary:
Several groups are looking into how to decide the best parameters for scoliosis-specific exercise (how long, how frequently, etc) that yield the best results. Many groups are looking to collaborate & partner with other centers in different parts of the world to have an even bigger sample size.
A scoliosis warrior and exercise physiologist in South Korea is developing her own method to help people learn how to find their most neutral spine position with a ball under their tailbone.
A team out of China found that even if participants did require surgery, doing scoliosis specific exercise improved spinal flexibility which allowed for better surgical correction.
Emerging Technologies and Ideas
There are so many thought leaders investigating new and existing technology as it relates to diagnosing, treating and optimizing outcomes for those of us with scoliosis. Research is ongoing, and with every study and project, the care for those of us with scoliosis truly improves. Many of these options are very new and young, but no doubt will be game changing in the future…
Overall, I left this conference feeling hopeful and excited for the future of scoliosis. It was so amazing to see the forward movement of the scoliosis rehabilitation world and I’m so honored to be able to do this work. The future is truly bright!
I have links to directories to find a local scoliosis specialist near you in the resources section of my website. You can also schedule a personalized virtual consult with me for insight on your specific spine!
Was there something in particular that surprised you, or that you learned? Have a question? Drop it in the comments below!
