The unwanted curve

With more pre-teens vulnerable to scoliosis, the sideways curvature of the spine, there is an urgent need for a school-driven early diagnosis program says Dr. Gopi Kitnasamy:

by Carol Aloysius

Scoliosis is a common spine condition affecting mostly school going children. The danger is that it often goes unnoticed till the child's spine curve becomes aggravated. Specialists in the field believe if Scoliosis can be diagnosed before the child experiences a growth spurt it would be much easier to manage his/her condition with the proper treatment. Early diagnosis is thus the key.

Chartered Physiotherapist, Dr. Gopi Kitnasamy, who has had hands on experience in treating Scoliosis both in children and adults, discusses this common but little understood condition with the Sunday Observer.

Excerpts...

Q: Although Scoliosis is now a common physical ailment especially among children. Not many people know much about this condition. Tell us what this condition is.

A: Scoliosis is a musculoskeletal disorder in which there is a sideways curvature of the spine, or backbone. When viewed from the front or back, the spinal column should be straight. When scoliosis is present, you will see a sideways shift of the spine to the right or left.

Q: Why are more children now being afflicted by this condition? Do you have any national statistics to indicate how many children have this condition in Sri Lanka?

A: Nowadays, definitely there are more children being diagnosed with Scoliosis. One reason could be the overloaded school bags that are up to double the size of those carried ten years ago, which is contributing to the surge. In Sri Lanka, we don't have a national statistics but it is possible to conduct a Nationwide Scoliosis Screening in schools. The children can be screened for scoliosis in early adolescence. Typically, girls are evaluated in the 5th or 6th grade and boys in the 6th or 7th grade.

Q: What causes Scoliosis? Is it genetic? Does it run in families?

A: In most cases, the cause of scoliosis is unknown (idiopathic).This is called the Idiopathic Scoliosis, which is the most common type. Scoliosis may be caused by the following reasons:

-Neuromuscular conditions, such as cerebral palsy or muscular dystrophy

-Birth defects affecting the development of the bones of the spine

-Injuries to or infections of the spine

There is at least one gene, CHD7, has been associated with the idiopathic form of scoliosis. It tends to run in families.

Q: School children today pack much more items into their school bags than in the past. Recent research by the Ministry of Health has shown that carrying heavy school bags is a contributory cause for scoliosis. Your comments?

A: Yes, the children are overloading the school bags, which is double or more the weight they are supposed to carry. They should take only the necessary books according to the timetable and if possible leave the heavier books at their desk in the school.

Carrying a heavy backpack may or may not cause scoliosis, but carrying it carelessly could lead to back or neck problems. The most important advice to the children is selecting the right bag and carries it correctly.

Q: What is the correct weight that a child should carry in his bag?

A: The medically advised weight of the school bag with books should not be more than 10 percent of the child's body weight, but due to various reasons this is not followed.

Q: How can one select a bag that is suitable for their child?

A: When choosing the right bag, look for the following:

Lightweight yet durable construction that doesn't add to the load.

Two wide, padded shoulder straps, as narrow straps tend to dig into the shoulders.

A padded back, which not only boosts comfort, but also protects against sharp objects in the pack.

A waist strap, to help distribute weight more evenly across the body.

Multiple compartments, which can also help distribute weight more evenly.

Although a rolling bag with wheels can be a good option, it's important to remember that it may be difficult to pull up stairs.

Q: Do you have any guidelines as to how it should be packed and carried to avoid more strain on the child's back?

A. Carrying it correctly, can not only keep the weight distributed evenly across the back, but even help strengthen the muscles that help support the spine.

Pack lightly -The combined weight of the bag and its contents should not exceed 10 % of the child's body weight.

Organise- Pack heavier items closest to the back. Pack items in compartments so that the weight is evenly distributed.

Use both shoulder straps - To distribute the weight evenly across the back.

Tighten the straps - To keep the bag close to the body and make sure the bag does not extend below the low back

Squat down, bending at the knees, not at the waist, when lifting or lowering a heavy bag.

Q: Is Scoliosis preventable? Is it curable?

A: Except for neurological and osteoporosis related scoliosis, most cases of scoliosis cannot be prevented. Treatment is aimed at preventing the curve from getting worse.

Q: What are the signs parents should look for in order to detect the condition early in their children?

A. There are a number of signs that parents can notice:

One shoulder higher than the other

One shoulder blade (scapula) more prominent

One hip higher than the other

One leg appears longer

Asymmetry of the waist

Trunk and ribcage shifted to one side

Head not centered over middle of hips

Clothing hangs unevenly and when child bends forward at the waist, one side appears higher

Q: Once these signs of scoliosis have been identified, what is the next step?

A: The first step is to get an evaluation by the child's pediatrician or family doctor. An x-ray will be required to confirm the diagnosis of scoliosis. To best assess the overall alignment of the spine, a whole spine x-ray should be taken rather than obtaining individual films of each region.

Q: Available treatment options?

A: Treatment of scoliosis depends on the patient's age and sex, the severity of spinal curvature, the location of the curve, the type of scoliosis, and in girls, whether the patient has started to menstruate. The age at which menstruation begins is an indicator of the stage of bone growth, which helps determine the risk that the disease will progress.

Most cases of scoliosis are mild and require no treatment. However, to make sure that the curve does not get worse, the person should be examined regularly by a doctor. More severe cases that cause discomfort or other symptoms and mild cases that are likely to get worse often require treatment, which may include back-strengthening exercises. For the worst cases of scoliosis, special back braces and even surgery may be recommended.

Q: As a Physiotherapist tell us how you treat your patients?

A. The goals of our treatment is to facilitate correction of the asymmetric posture and maintain the corrected posture in daily activities

A. The spine can be considered as building blocks, similar to the figure above. The long side of the block represents lengthening (stretching) of your muscles. The short end of the block illustrates shortening (contracting) of your muscles. Both extremes affect your ability to use your back muscles appropriately for posture and functional activities. Therefore, it is important to attain and maintain a straight spine for your muscles to be used at their full functional level. To do so, you must become more aware of your body, especially your spine, to use self-correction to change your spine's position during daily activities. Scoliosis exercises should be done carefully and performed with proper technique.

Before starting your exercise program, discuss with your Physiotherapist about the side of the curve.

Q: What is a brace and how does it help in Scoliosis?

A: Brace is a device that is used to support a weaker part of the body. A brace is needed when curves are progressive and there is enough skeletal growth remaining that bracing might be effective in preventing further progression. The goal of bracing is to halt progression and avoid surgery.

Q:Can early detection prevent the ailment or only help in managing the condition better?

A: In general, the younger, less skeletally mature the patient and the bigger the curve(s) at the time scoliosis is identified, the greater the potential for progression, so early detection is very important.

Q: Your message to the public

A: Whether it is getting used to the idea of wearing a brace or recovering from surgery, accepting this situation may be extremely difficult and requires patience, encouragement, and a positive attitude, both from the child and from the parent Acceptance of the situation and a positive attitude can hasten whatever treatment is required.