a.

SCOLIOSIS
GENERAL MEDICAL BACKGROUND
I.

II.

DEFINITION
It is the lateral curvature of the spine usually
accompanied with rotational elements.
It may be either nonstructural or structural
characterized by asymmetrical side bending.

It is usually identified by the direction of the

convexity.
The major curve is the most significant of all.

It usually occurs in the thoracic region

between T4 and T12.

b.

CLASSIFICATION
Scoliosis is classified according to:
a. Shape
b. Severity
c. Description
d. Etiology/ Origin

A.

B.

C.

Shapes
a. Long C- Curve
As a single primary side-to-side curve (C)
It sually extends from the thoracic to lumbar
spine
It is often uncompensated, leading to a high
shoulder on the convex side of the curve
and high pelvis on the concave side.
Maybe due to asymmetric positioning,
muscle weakness, or inadequate sitting
balance
b. S- Curve
Or as 2 curves a primary curve along
with a compensatory secondary curve that
forms an (S)
Most common type seen in idiopathic
scoliosis
It is usually right thoracic and left lumbar
curve
It involves a major and compensatory curve
It is usually associated with structural
changes in the vertebrae of the major
curve
Severity of Curve
a. Mild curve
<20 degrees
Curves within the limits of 10 degrees are
considered normal in general population
and does not warrant treatment
b. Moderate curve
20-40 degrees
It is associated with early structural changes
in vertebrae or ribs
c. Severe curve
>40 degrees

It involves significant rotational deformity of

vertebrae and ribs
In adults, curves from 40 to 50 degrees are
associated with pain and degenerative joint
disease of the spine
In adults, curves from 60 to 70 degrees are
associated with significant cardiopulmonary
changes and decrease life expectancy
Description of curves
a. Primary Curve
st
- 1 curve to appear
b. Secondary Curve
- the next curve to appear in response to the
primary curve

c.

d.

Compensatory curve
Less severe and develops in opposite
direction above or below the major
curve
corrects the primary curve
level shoulder & pelvis but in x-ray, has
S curve)
It maybe structural or non-structural
curve
Decompensated curve
If the sum of the degree of
compensatory curve does not equal to
the degree of the major curve
secondary curve did not correct the
primary curve
The amount of decompensation is
measured as horizontal distance from
gluteal cleft to plumbline dropped from
occipital protuberance
The shoulders are not level and there is
lateral shift of trunk to one side
Double major curve
If two major curves of equal severity
and significance develop
Both curves are usually structural
Transitional vertebra
This is the neutral vertebra at each end
of the curve that makes the transition
from one curve to another.
The vertebra that is the greatest
distance from the midline of the spine
identifies apex of the curve.
It is referred to as apical vertebra.

Scoliosis in the thoracic and cervical regions tend to

be most rigid and deforming

D.

Etiology/ Origin ( For details, see Etiology )

A. Structural scoliosis
1. Idiopathic
Divided further according to chronology
Infantile
Juvenile
Adolescent
2. Congenital
Wedge vertebrae
Hemivertebrae
Congenital bar
Block vertebrae
3. Neuromuscular
4. Scoliosis with vertebral diseases
B.

III.

Nonstructural scoliosis
1. LLD
2. Spasm In Back Muscle
3. Habitual Asymmetric Posture
4. Nerve root irritation
5. Hip contractures

EPIDEMIOLOGY

It is commonly seen in adolescence but can

also occur in adults

Commonly diagnosed in children 10-15 y.o.

Adolescent idiopathic scoliosis- most

common type of scoliosis appearing at the
age of 10.

8 times more frequent in girls than boys

Idiopathic scoliosis- accounts for 75-85% of

cases

Family history- 30% of cases

Other etiologies- 20% of cases

IV.
A.

ETIOLOGY

a.
b.

STRUCTURAL SCOLIOSIS
-an irreversible lateral curvature of the spine with
fixed rotation of the vertebrae.
- The vertebral bodies rotate towards the
convexity of the curvature and the spinous
process away from the convexity.
-The greatest rotation occurs at the apical
vertebra.
-As curvature increased, rotation also increases.

c.
d.

Wedge vertebrae- unilateral partial

failure of vertebral formation
Hemivertebrae- unilateral complete
failure of vertebral formation
Congenital bar- complete or bilateral
failure of vertebral segmentation
Block vertebrae- partial or unilateral
failure of vertebral segmentation

Rotation:
Vertebral body goes to the convex side
resulting to posterior rib hump on convex
side, ant. Rib hump on concave side
Rotation & Assessment

Displacement of Pedicles:
One pedicle rotates toward midline and other
to the lateral border of the vertebra

Displacement of Spinous Process:

20 to 29 degrees brace after 25 degrees
>40 degrees
surgery
3)

Neuromuscular
the result of congenital or acquired
neurogenic or myopathic paralytic disorders
or diseases that causes asymmetrical
paralysis of trunk musculature.
Can progress to severe collapse if the spinal
column, impairing respiration
spinal deformity is common and often
severe in patients who do not walk because
of their underlying neurological disease or
spastic disorders
Paralysis of the muscles of arms or legs and
associated contractures may aggravate the
spinal deformity.
Non-surgical means may be difficult and
ineffective
Causes:

Nash- Moe (Pedicle Method)

Grade

0
=
No Vertebral Rotation

+1
=
Pedicle going to midline

+2
=
Pedicle 2/3 to midline

+3
=
Pedicle at the midline

+4
=
Pedicle Beyond Midline

1)

2)

Idiopathic scoliosis
about 75-85% of scoliosis have no known
cause and progresses with skeletal growth
Divided further according to chronology
a. Infantile- develops from birth to 3 years
of age and is often found in girls than
boys
b. Juvenile-develops from age of 4 to 9
years and is often found in boys than
girls
c. Adolescent- from age of 10 years to end
of puberty or end of skeletal growth and
is the most common type of scoliosis
Congenital scoliosis
caused by disturbances in vertebral
development during the third and fifth week
of embryonic life, there are structural
anomalies in the vertebrae that can cause a
severe curative the child may have other
anomalies and neurological complications to
the spine is involved.
is caused by abnormal vertebral formation
partial formation or lack of separation can
cause asymmetrical growth and resultant
deformity.
Treatment must happen much earlier
compared to idiopathic scoliosis

4)

neuropathic causes is often a long Cshaped curve from the Cervical-Sacral region

congenital
a. cerebral palsy there may be severe
deformity that makes treatment quite
difficult
b. myelomenigocele
c. neurofibromatosis

acquired
a. anterior horn cell diseases
b. traumatic paraplegia

myopathic causes usually not sever

congenital
a.
amyotonia congenita static
b.
muscular dystrophy
progressive

osteopathic

congenital
a.
secondary hemivertebra

acquired
a.
osteomalacia
b.
fracture
c.
dislocation of spine

Scoliosis with vertebral diseases

B.

1)

NONSTRUCTURAL SCOLIOSIS
also known as functional or structural
scoliosis.
It is a reversible scoliosis that tend to be
dynamic or postural in nature without
rotational changes in the alignment of
vertebrae.
LLD
a. True actual difference in bony length
b.
Apparent measurable difference because
of a dislocated hip, asymmetric leg of foot
postures or rotated innominate bone
c. Congenital/acquired deformities can cause
asymmetric variations that lead to pelvic
obliquity (high pelvis on one side) and a
compensatory curvature of the spine

2)

Spasm In Back Muscle

a. Splinting of the back muscle may occur in
response to injury of any tissue in the back
b. Sciatic scoliosis often accompanies a
posterolateral disk protrusion in the lumbar
spine

3)

Habitual Asymmetric Posture

a. Sitting with weight shifted onto one
hip/standing with weight and supported
on one leg results in symmetric flexibility and
tightness in soft tissue of the trunk and hips.
b. In children, continued asymmetric
postures may affect remodeling of bone and
adaptation of soft tissue.

4)
5)

Nerve root irritation

Hip contractures

V.

PATHOPHYSIOLOGY

Concave side compressed side

Convex Side Normal or lengthened side

Apical Vertebra most rotated vertebra

Transitional Vertebra this is the neutral

vertebra at each end of the curve that makes
the transition from one curve to another

Lateral flexion of scoliotic spine shifts trunk

away from midline and alter center of gravity.
Simultaneously, the trunk rotates around its
longitudinal axis.
The vertebrae became permanently wedgeshaped
Has an effect on the IV disk
ALL is thickened on the concave side and
thinned on the convex side
Ossification of ligaments may occur in the
long run
Since there is the presence of malalignment
of the spinal joints, this may lead to
degeneratice arthritic changes later in life
Scoliosis is increased by the following factors:
Weight of the trunk itself
The muscles on the concave side have
more mechanical advantage contributing
to greater force generation.
Altered normal biomechanical motions
Changes in the shape of the rib cage
The thoracic cavity on the concave side
is narrowed.
The ribs fail to move in normal planes of
motion that allows normal expansion of
lungs.
If untreated, this may cause cardiopulmonary
disturbances, degenerative arthritis, and low
back pain.
Psychogenic problems may be seen relating
to body image and result in social problems.

VI.

CLINICAL MANIFESTATIONS

CONVEX SIDE
High Shoulder
Posterior rib hump
shortened structures
Vertebral body on this side
Prominent scapula

CONCAVE SIDE
High Hip Pelvis
Anterior rib hump
Tight structures
Spinous process on this side

Other presenting symptoms:

1. Presenting complaints
a. poor posture
b. one shoulder higher than the other
c. hemline hanging unevenly
d. one hip that seems more prominent
e. crooked neck
f. rib hump
g. waist line uneven
h. one breast appearing larger
i. decrease in height
j. prominent scapula on the convex side of the
curve
2. visualization of deformity
3. back pain
4. cardiopulmonary failure
5. malalignment of spinous process
6. asymmetry of the flanks
7. asymmetry of the thoracic cage
VII.

COMPLICATIONS

decrease in vital capacity with an angle

more than 60%

pulmonary hypertension with an angle

more than 80%

back pain, chronic fatigue, spinal nerve

impingement

shortness of breath as a result of

diminished chest expansion

GIT disturbances from crowding of

abdominal organ

Progressive spinal curvature

accompanied by decrease hright

Cardiopulmonary failure

cosmetic deformity

VIII. DIAGNOSIS

History and family medical history

Physical examinations
Radiographic findings
Forward Bending Test let the patient bend
forward to a 90 degrees angle and allow to hang
loosely. The examiner notes asymmetry of
prominence of the ribs or scapula on the convex
side of the curve. This also determines if structural
changes are present.
Lateral bending test this test determines
whether the curve corrects or reverses.
Assessment of the neurologic status of the lower
extremity.
Inclusion of clinical photographs in the record for
future reference.
X-rays of the spine to identify and measure
primary and compensation curves.
Intravenous pyelography for children with
congenital scoliosis because of high evidence of
associated renal anomalies
Moire Topography a form of photography that
detects asymmetry on opaque surfaces. Shadow
are produced on the opaque surfacing by light
shining through a screen on their parallel strings.

MEASUREMENT OF TECHNIQUES ON
SCOLIOSIS
A.

B.

IX.

x-ray measurement of lateral curvature of

the spine
a. Cobb Method found to be more
reliable and recommended by Scoliosis
Research Society of North America. A
line is drawn perpendicular to the upper
margin of the vertebra that inclines most
toward the concavity. A line is also
drawn on the inferior border of the lower
vertebra with greatest angulations
toward concavity. The angle of these
transecting lines is noted and recorded.
b. Risser-Ferguson Method you find
vertebra that inclines toward the
concavity then you look for the apex.
Lastly, look for the vertebra with the
greatest angulation towards concavity.
measurement of the rotational deformity
a. position of the pedicles is noted on a
postero-anterior X-ray normal
pedicles are symmetrically positioned
on either side of each spinous process.
In scoliosis the pedicles are
asymmetrically positioned toward the
side of concavity.
b. The degree of rotation of pedicles is
noted on X-ray by 0 to +4

Generally:
Severity depends on curvature of severity
affects vital organs especially heart & lungs
a.

b.

c.

Mild scoliosis
not serious, requires no treatment other than
monitoring
Moderate
not clear whether untreated moderate scolio
causes significant health problems later on
Severe
severe twisting & occurs in structural scoliosis
cause ribs to press against lungs (restricts
breathing & oxygen levels)
General Rule:
o <20 degrees =
o >25
=

monitor the condition

requires treatment

DIFFERENTIAL DIAGNOSIS

GENERAL HEALTHCARE MANAGEMENT

Scoliosis can be differentiated or associated with

the following abnormalities of affectation of the
spine.

I.

1. Klippel-Feil syndrome or Congenital

Synostosis of the Cervical Spine
2. Cleido cranial Dysostosis
3. Congenital High Scapula or Sprengels
Deformity
4. Scheuermanns disease (juvenile kyphosis)
5. Vertebral epiphysis
6. Vertebral plana (eosinophila granuloma
and Calves disease)
7. Pigeon breast (Pectus Carinatum)
8. Funnel Chest (Pectus Excavatum)
9. Costal Chondritis
X.

Poor
Late adolescent with severe scoliosis

Severe scoliosis- greater than 50

degrees

Scoliosis with co-morbidities

Curves in the thoracic and

cervicothoracic areas have poorer
prognosis because of their tendency to
become fixed and to cause severe
deformity

PROGNOSIS

Good- when initial diagnosis is mild and

effective treatment is initiated early

Increase chances of progression

If the individual has a positive family
history for scoliosis, the risk for the
occurrence of scoliosis is greater.

If the curve is greater than 20 to 30

degrees with several years for skeletal
growth as in children

Curves greater than 40 degrees at

maturity as in adult may continue to
progress but at a slower rate

Thoracic and double primary curves

more likely to progress that lower
curves.

idiopathic scoliosis has a significant

progression of the curvature
spontaneously cessation of vertebral
growth

Without treatment, idiopathic curvatures

in growing children may increase to
cause severe deformity and disability. In
general, the younger the patient and the
earlier the onset, the guarded must be
the prognosis.

Curves with more than 100 degrees are

likely to lead to cardiopulmonary
disability

Medical, surgical, & pharmacologic

MEDICAL MANAGEMENT
Surgical intervention is preferred with the
following conditions:

Curves greater than 40 to 50 degrees

Curves resistant to correction with nonoperative measures
For decompensated curves
For deformity considerable back pain
When scoliosis leads to cardiopulmonary
function and putting the health at risk
Preoperative correction
- Goal: to elongate the spine and decrease
the severity of deformity prior to surgery
in curves of 60 degrees or more

Traction or cast may be used preoperatively to

maximize correction prior to spinal fusion

Halo-femoral traction
- A form of skeletal traction attached to a
weight and pulley system and applies
while patient is in a prone or supine
position on a bed frame. The halo is
attached directly to the skull with pins
and counter-traction is applied through
the skeletal pins at the distal femur.
Maximum correction is attained for
several weeks
Halo-pelvic (Dewald) traction
- Upright bars are attached to a halo
superiorly and to a pelvic hoop inferiorly.
The pelvic hoop is placed with rods that
penetrate the iliac crests. The upright
bars can be lengthened to elongate the
spine. The patient is ambulatory prior to
surgery.

Exercise
- Normal range of motion should be
maintained in many of the joints for
patients are at risk for developing knee
extension and plantar flexion
contractures and restriction of movement
of the femur.

SURGICAL MANAGEMENT
Surgical intervention and with instrumentation and
spinal fusion

II.

Other healthcare management

Physical Therapy interventions:

Cast

Traction

Spinal bracing

ES

Exercises

Patient education

Physical activities
1)

Cast
-

Used for severe cases that has progressed to

40 degrees or beyond at the time of diagnosis
or when curves of a lesser degree are
compounded with imbalance or rotation of the
vertebrae. The goal of this surgery is for
stabilization.

SURGICAL METHODS:

Harrington rod and posterior spinal fusion

A distraction rod is attached to the posterior
aspect of the spinal column on the concave
side of the curvature and ocassionally a
compression rod in convex side. It is
employed without preoperative corrections in
curves less than 60 degrees. Requires a
longer period of postoperative bed rest.
Harrington Rod: Internal Fixation
Elongates the concave side of the curve and
veritably jacks up the spine; inserted to the
lamina. As the rod elongates, the curve
decrease and followed by operative fusion of
the curve.
Spinal Arthrodesis by Hibbs
Most effective means of permanently
maintaining correction of the curve. May be
done in one or more stages after maximum
correction of the curvature by brace or cast
has been obtained; carries out surgical fusion
of a long segment of the spine with
reinforcement by autogenous iliac bone. It is
followed by a period of immobilization in a
plaster cast or brace for 6-9 months.
Dwyer (or Zelike) instrumentation and
anterior spinal fusion
Is difficult because the anterior fusion
requires a transthoracic and retroperitoneal
approach which is through the rib cage and
pulmonary cavity. Major benefit is gained in
thoracolumbar and lumbar curves but not
recommended for high thoracic curves. This
procedure is not advocated in severe
osteoporosis.

2)

Traction - may be used prior to surgery

TYPES OF TRACTION
a.
Passive traction
This procedure requires prolonged
positioning, usually the spine on a frame and
give sno better correction of moderate
curves than bracing.
b.

Cotrel traction
it is primarily used to gain greatest
flexibility possible prior to spinal fusion
but has also been used with limited
success as a nonoperative method of
treatment of moderate curves.
Spinal traction as applied nightly and
has a head halter and pelvic girdle which
are attached to a weight and a pulley
system.
Rigorous routine exercises consisting if
elongation, derotation and lateral flexion
of the spine is performed when child is
not on traction.
After several weeks of traction and
exercise a cast is applied and worn for
several weeks.
A cycle of traction exercise and casting
is repeated until correction of scoliosis is
achieved.
Skeletal traction
prolonged skeletal traction usually up to
3 weeks and is used pre-operatively with
sever or persistent curves to elongate
the spine as much as possible prior to
spinal fusion.
Cephalocaudal traction
- This traction plus localized lateral pads in
traction frame facilitate correction of
scoliosis for ultimate casting or surgery
-

c.

d.

PHARMACOLOGICAL

uses pressure pads that are localized

over the apices of the curves.
It provides passive correction of the
scoliosis. The cast is applied while the
child is supported supine on a scoliosis
frame.
The spine is elongated and the ribs are
derotated as much as possible during the
application of the cast.
The cast is primarily for pre-operative
correction or post-operative control after
spinal fusion casts are ordinarily required
for 6 moths to 1 year following spinal
fusion.

Aspirin and ibuprofen

e.

Used if back pain is present. These medicines

may relieve the symptoms of back pain
temporarily but they do not heal scoliosis or back
injuries

3)

Halo-pelvic traction
In severe scoliosis, halo is pinned to the
skull and a pelvic band to the iliac of the
pelvis. Upright bars connect the two
bands and as they are elongate the
spine is also elongated and scoliosis
corrected. Traction is continuous and
permits ambulation of the patient.

Spinal bracing
the major goal of bracing patients with
scoliosis is to prevent progression of a curve
or give permanent correction and
stabilization of the curve.

TYPES OF BRACES
a.

b.

4)

5)

Milwaukee brace
is used to immobilize the spine after a
Harrington rod is inserted or a Dwyer
procedure is performed.
It is the most common form of treatment of
mild and moderate idiopathic scoliosis in
patients with 2 or more years of remaining
skeletal growth.
It is also used for paralytic or congenital
scoliosis and children under age 10 with
severe curves who are not yet candidates of
spinal fusion.
Milwaukee brace is a high-profile brace that
fits closely to the body and is based on a 3
point principle fixation.
A dorsal pad is placed at the apex of the
thoracic curve on the convex side to
decrease the rotational deformity.
The brace is worn 23-24 hours daily for
several hours daily for several years until
patient reaches full skeletal growth.
Younger patients with milder curves have
the best chance for correction
Boston brace
is a low profile spinal brace with no metal
suprastructure.
It is a molded plastic jacket and used for
low thoracolumbar and lumbar curves and is
not recommended with apices above T8.
Electrical stimulation
a non-operative development in the
treatment of mils and moderate scoliosis
electrically stimulating the trunk muscles on
the convex side of the curve. An alternative
to surgical implantation of electrodes is
called lateral electrical surface stimulation.
The surface electrodes are places laterally
on the convex side of the curve over the
midaxillary line with an intermittent
stimulation.
Exercises
Although exercise has been used to stretch
tight trunk and hip musculature and
strengthen muscles od the trunk, it has also
been shown that exercise alone will not halt
the progression or to correct and existing
moderate to severe structural scoliosis.
Exercise used in conjunction with other
methods of correction, such as bracing or
traction has been shown to be beneficial.

Exercise done in the brace

same exercises are repeated in the brace as
were done out of the brace
patient actively shift away laterally from the
pad to correct the curve

Pre-operative exercise prior to spinal fusion

Rationale: by increasing the flexibility of the trunk

with exercise prior to surgery the best possible
correction at the time of surgery can be achieved.

Goals:
increase the mobility structures of the spine
that have become tight because of the spinal
curvature
improve pulmonary function as much as
possible prior to surgery
improve postural control with general
strengthening of trunk musculature

Exercises for mild idiopathic scoliosis

Rationale: school screening programs are

identifying adolescents between ages 11 and 14
with mild curves. Each of these children must be
monitored for several months. It is suggested that
placing the adolescent on a monitored pd exercise
program may have a possible effect on the halting
the progression of the curve or even improving it.

Goals:
improve the strength and postural control of
trunk musculature
increase the mobility of any tight structures of
the trunk
improve the overall posture of the child

Specific exercises
strengthening the abdominal and trunk
extensors
stretching structures on the concave side of
the curve
strengthening lateral trunk flexors on the
convex side of the curve
stretching tight hip flexors and erector spinae
muscles associated with an increasd lumbar
lordosis
posture training

Exercises with Milwaukee Brace

Rationale: the milwaukee brace is a form of

dynamic correction of scoliosis which patient must
actively participate in the correction of the
deformity with a daily routine exercises. The
effectiveness of the brace depends on the
patients both wearing the brace 23 hours a day
and carrying out a specific set of exercises.

Goals:
it strengthens the muscles that provide the
stability of the trunk and actively decreases and
corrects the spinal curves and related deformities.

Specific exercises done out of the brace

posterior pelvic tilt in supine with hips and
knees flexed
posterior pelvic tilt in supine with hips and
knees extended
partial sit up with knees flexed
posterior pelvic tilt while standing
trunk extension in the prone position
deep breathing exercises

Exercise has been used in conjunction with

Cotrel traction prior to spinal fusion to
minimize the curve. It was suggested that
prior to surgery exercise and traction are
done for elongation, derotation, flexion of the
spine which is referred to as EDF.
Preoperative stretching stretching the
following structures prior to surgery.
tight structures on the concave side of
the curve
tight hip flexors
tight erector spinae
tight hamstrings
Deep breathing exercises decreases
postoperative pulmonary complications and
increases chest mobility on the concave side
of the major curve.

Specific exercise for treating scoliosis

Chest mobility

Proper breathing

Muscle strengthening

Flexibility of the spine

Correct posture

Patients must go on with ADLs even

with the brace

Exercises to increase flexibility of tight structures

and elongate the trunk
stretch tight structures on the concave side of
the curve
elongate the trunk
stretch tight neck shoulder or hip musculature
Exercises to symmetrically strengthen trunk
muscles necessary for postural control and
trunk stability
strengthen abdominal muscles
strengthen the thoracic and lumbar extensors
strengthen the hip extensors
strengthen the hip and back extensors
simultaneously

Exercises to strengthen the trunk musculature on

the convex side of the curve
patient side lying on the concave side with
the therapist stabilizing the iliac crest. With
patients lower arm across the chest having
the patient derotate the trunk, lift up the head
and shoulders and slide the top arm down to
the knee

Deep breathing exercises to improve pulmonary

function
diaphragmatic breathing during abdominal
strengthening exercises
segmental breathing to expand lungs on the
concave side of the curve during unilateral
stretching of the trunk
deep breathing with bilateral stretch of the
pectoralis muscles
Derotation of the trunk

Klapps Exercises for scoliosis

Klapp determined the initial positions for the
maximum strengthening effect on the precise
point of the spinal axis. He showed that when
a lateral flexion was carried out in the
quadruped position, there was a constant
relationship between the site of the summit in
the lateral flexion of the spine and the
previous direction of the plane of the back
with respect to the ground as follows:
Fetal position (lowered)- T3
Prone on elbows (semi-lowered)- T6
Horizontal quadruped- T8
Prone on finger tips (semi-erect)- T11
Tall kneeling (erect)- L2
Reversed- L4

6)

Patient education teach patient proper body

mechanics and postural training

7)

Physical activities
the child should be encourage to participate
in a variety of physical activities and
recreational sports like volleyball and
swimming
only contact sports are contraindicated

PHYSICAL THERAPY EXAMINATION,

EVALUATION, & DIAGNOSIS
I.

ORTHOSES

Apex at/above T6 = milwaukee

Apex below T6 = Miami

Below T8 = Boston, Wilmington, Yamamoto

b.

Crossed-walk
Usually applied to simple curves
The subject first advances the UE of one side
(right) and the LE of the opposite side (left);
next the patient advances the UE of the other
side (left) and followed by the opposite LE
(right)
Ambling walk
Usually used in S curves
This is done by simultaneously advancing
(left) UE and LE of the same side; then both
the (right) other UE and LE and so on in a
regular manner.

1.

Postural assessment
a. Anterior, posterior and lateral postural
assessments are done with the child
standing and a plumb line is used to
denote any deviations are noted.
b. A surveyors plumb line is used to note
any deviations in alignment(string is held
at the base of the occiput and the
plumb weight below the gluteal crease;
the lower end of the string bisects the
sacrum). The lat. deviation of the string
from the midline can be measured.
c. In scoliosis the ff. deviations can be
noted:

Asymmetric shoulder level

Prominence of the scapula on the side

of the convexity

Protrusion of the hip on one side

Pelvic obliquity

Increased lumbar lordosis

2.

Evaluation of Muscle Strength

musculature on the side of the lateral

curve weakens

abdominals and trunk extensors also

weaken

hip muscles may also weaken if there is

faulty pelvic posture

3.

Flexibility of the curve

this is done to determine if the curve
straightens upon bending and to
identify visible rotation of rib cage
a) Lateral Bending Test
b) Forward Bending Test
c) The ff. structures may be limited if
asymmetry is noted during
flexibility testing:

Muscles

Two techniques in a quadruped position

a.

Points of emphasis on examination

Erector spinae
Oblique abdominals
Intercostals and quadratus lumborum
Hip muscles may also be involved if there is
faulty pelvic posture

Ligaments

II.

Anterior and posterior longitudinal

Ligamentum flavum
Interspinous ligament

PROBLEM LIST

Poor posture

Tightness at concave side

Weak convex side

LBP specifically at the lumbar region

SOB

III.
PT DIAGNOSIS
(Refer Preferred Practice Patterns)

PHYSICAL THERAPY PROGNOSIS, PLAN OF

CARE & INTERVENTIONS
Problem list
Poor posture

Plan of care
Improve overall
posture through
strengthening of
abdominal and
paraspinal
muscles
Stretch the tight
side of the spine

Intervention
Hip bridge: 10-15
sec. hold 3 sets
Superman: 10-15
sec hold 3 sets
Planking: 10-15
sec. hold 3 sets
Klapps Exercise
Crossed-walking in
quadruped
position- to
increase the
flexibility of the
tight structures and
elongate the trunk

Weak convex
side

Strengthen and
improve tone on
the weak side of
the spine

Klapps Exercise
Crossed-walk in
quadruped
position- to
strengthen trunk
muscles necessary
for trunk stability
and postural
control

LBP specifically
at the lumbar
region

Decrease pain on
the low back

SOB

Improve
ventilation and
breathing

Apply HMP at the

lumbar region(not
directly on the
spine) 15 min.- to
mask the pain and
possibly prevent
recurrence
Deep breathing
and Chest
mobilization
exercises 2 repsto improve
pulmonary function

Tightness at
concave side