Thoracic scoliosis treatment

[Thomas_1980]

Hi all, i'm new here and just after some people's opinion on treatment of a patient i am currently seeing.
-Female 16 years of age who is complaining of 3 week history of right sided thoracic pain.
-X-ray revealed mild thoracic scoliosis
- Objectively poor right thoracic rotation and extension

Treatment has consisted of soft tissue therapy to the right upper trapz, levator scap and paravertebals. I have also given some gentle extension exercises and corrective taping as she has poor sitting posture.

Has anybody here had success with a particular form of treatment for this condition. i.e a particular exercise or form of treatment.

Many thanks in advance.

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[physiofixme]

Hi

You haven't mentioned any manual therapy techniques ie; joint mobilisation. From my experience joint mobilisation to the intervertebral joints and facet joints through the thoracic spine work a treat. Also check the costo-vertebral joints for any hypomobility. I'd do most of your mobilisations in prone, however seated SNAGS ( a Brian Mulligan technique) are also fantastic at restoring range of motion. Good luck.

[estherderu]

Dear Thomas,

Just a short answer.
How is the bone development/ossification (Risser Scale) status of your patient?
Was het whole spine on the X-ray?
I would certainly want to know more and check her whole body.

I suggest you start reading the articles related to thoracic scoliosis on the Scoliosis
Lots of information there.
Of course the pain has to be addressed but the best means of doing so just might be exercising a lot!


kind regards

Esther

[Dr Damien]

Dear Thomas_1980

You have described a non capsular spinal limitation...I agree with the other two comments above...if a teenager is having issues with scoliosis, this might be due to rate of bone developement...scoliosis however does not always result in pain...what side is her scoliosis convex towards?
the non caps presentation might mean a dysfunction in a particular vertebra or group of vertebrae... causing excessive movement one side greater than the other...three week onset is quite recent...how did it start?
any aggravating movements? flexion. extension, rotation, combination movements, where is the pain? how does it behave morning, during the day and at night? what tests have been done? what happens with upper limb movements? does this pain go anywhere? what relieves this pain? is it constant? what activities is she involved in...sports etc? any pain killers? what kind? does breathing or coughing influence her pain? whats the description of the pain? how much is it...is it localised or diffused/non specific

are you getting any joy from your input so far?

just at the top of my head, I would suspect that if the issue was muscular, with regards the limitation...shouldnt it be restrictions on the other side that would make these movements poor?
The traps... attach to spine, scapular spine..if the upper traps are tight...my guess is that this would affect neck movments to the other side, flexion and upperlimb movements on the same side. this shouldnt influence the poor movements in the thoracic region on the same side...the question however is why are they tight?

Taping: what are you taping and what is the aim? to correct poor sitting posture...how do you mean poor sitting posture...

Being a growing teenager, i would take care in using my manual techiques...but i think before any treatment advice can be given, a more detailed assessment is required to be honest....

Sorry i havent been of much help...lol

[alophysio]

Hi Thomas_1980.

I agree with the replies above...some additional questions i have...

1. Did she have decreased rotation before her 3 week hx of symptoms?
2. Was the XR taken before or after she developed symptoms? Perhaps her "scoliosis" is a reaction to pain rather than one that was there before...i have seen many cases of a "scoliosis" being diagnosed but it was due to muscle spasms and adaptation to pain. I often ask questions like "do you look like this in photos?", "ask your mum/dad/wife/husband if you usually look like this"
3. I see lots of these and i am in Sydney...if you ever want to bring your patient for a consult, i would be happy to show you what i do and how I assess etc. She just has to book in and you are more than welcome to come observe. I would then provide an assessment, demonstrate treatment and give you a plan to follow (if you want) - i am planning on marketing to other physios next year for such consultations but i do them now anyway!

Cheers!