What is Scoliosis? 

The word scoliosis is derived from the Greek word “skol” which means twists and turns, and is defined as a lateral curve of the spine with a rotational component.  With scoliosis, the spine moves laterally, forming an “S” (or “C”) curve and rotates at the same time. The ribs follow both this lateral and rotational movement of the spine. On this lateral curve side, the ribs and intercostal muscles between the ribs move sideways, spread apart and rotate backwards with the spine [this is called the convex side of the back]. On the opposite side of the lateral curve, the intercostal muscles are underdeveloped and the ribs are compressed. Because of the rotation of the spine, the ribs are pushed forward forming a flat back. [this is called the concave side of the back].

As a result of these lateral and rotational movements, there is postural misalignment: the ribs are rotated, the shoulders can be at different heights with one shoulder blade more prominent than the other, and one hip may be higher than the other, resulting in an uneven waist. The head is sometimes not centered directly above the pelvis and the entire body can be leaning to one side. The most obvious symptoms of scoliosis are cosmetic, yet pain and discomfort are also common. In extreme cases, there can be cardiopulmonary complications.

Structural & Functional Scoliosis 

Scoliosis can be either structural or functional (non-structural).

a. Structural scoliosis is much more serious and develops as a result of unequal growth of the two sides of the vertebral bodies. Usually appearing during adolescence, its causes are not well understood by medical science.

b. Functional (Non-structural) scoliosis only affects the muscular back and does not alter the body structurally. It can result from such things as poor posture or repeated unbalanced activity such as carrying heavy books or any heavy object always on one side. It is much more common than structural scoliosis, and usually much less noticeable, since the degree of curvature is less and almost always reversible.

A simple way to determine whether someone has a structural or functional scoliosis is to have them bend forward into a forward bend. This is a standard screening test given in junior high to determine if students have adolescent structural scoliosis. If a lateral curve is visible in a standing position yet disappears in a forward bend, the scoliosis is functional. If it remains and the rotational component becomes more obvious, it is within the structure of the ribs and spine and is a structural scoliosis.

Approximately 80% of all structural scoliosis are idiopathic, meaning doctors do not know why or from where it comes. Idiopathic scoliosis first develops in girls between the ages of 10 and 14; and in boys between the ages of 12 and 15. Other causes of structural scoliosis are: congenital where the vertebrae fail to separate, or neuromuscular, such as polio or cerebral palsy and also from accidents that involve the spine and/or ribs. In some cases, leg differentiation can cause scoliosis in the lumbar ( lower back) region. This results in uneven hips.

The Major  Scoliosis Curve Patterns

Curvature can take place anywhere along the length of the spinal column, however there are four most common patterns of curvature. To be able to use yoga and exercise effectively for your scoliosis, find out what pattern you have from a qualified manal medicine practioner (Physiotherapist, osteopaths, chiropractors, orthoapedic surgeons and soft tissue therapist).

a. Right thoracic Scoliosis indicates that the major scoliosis is concentrated in the thoracic (mid-back) region and curves to the right. In the right thoracic scoliosis there may also be a counter curve to the left in the lumbar (lower back) region, but this is a less severe curve.

b. Left lumbar Scoliosis indicates that the major curve is to the left and is concentrated in the lumbar region. There may be an opposite curve less extreme to the right in the thoracic region.

c. Right thoraco-lumbar Scoliosis indicates that the major curve is to the right in the thoracic and lumbar region. This is commonly known as a “C” curve.

d. Right thoracic-left lumbar Scoliosis. The last type of curvature is the combined curve where the major curve is in the thoracic region with an equal counter curve to the left in the lumbar region. This is commonly known as an “S” curve.

For unknown reasons, 90 percent of thoracic and double curves are right convexity (curve to the right); 80 percent of the thoraco-lumbar curves also are right convexity; and 70 percent of the lumbar curves are left convexity. There can also be triple curves with an additional lateral curve in the cervical or neck region. Also two or more lateral curves can be in the thoracic region of the back with a major lumbar curve. With a more severe scoliosis, seven times as many women as men have scoliosis.

IMPORTANT TIP

When doing any exercise, be aware of whether your pelvic floor holds or if it pushes down.  If it pushes down, then that exercise is too difficult for your pelvic floor, and you need a more suitable activity.

The above infomation was obtained from Mary O’Dwyer’s book.  She is a Pelvic Floor Physiotherapist using a blend of her extensive clinical knowledge with recent scientific evidence to bring relief to women suffering from Pelvic floor Dysfunction.  Please e-mail me if you are interested in purchasing her book (a fantastic read about pelvic floor for both patient and health professionals.

Craniosacral therapy uses non-intrusive and indirect methods for treatment the majority of the time. The indirect techniques encourage movement in the direction of ease whereas the direct technique assists movement through the relaxation of an abnormal restriction barrier.

A restriction in the craniosacral system is defined as an impairment to normal physiological motion within the body. A release occurs when there is a softening of the restriction. Normal motion is able to return. A resistance barrier is a perceptible point of resistance to normal motion. The body has a hesitation or has to exert more effort to pass by the barrier. The barriers can be rigid or elastic. Rigid barriers result when bones are jammed together whereas elastic barriers result from abnormal membrane tension which prevent normal motion.

When a person’s craniosacral system is assessed, a therapist will palpate for the rhythm at several key points: the feet, thighs, pelvis, ribs, shoulders, and head. From observations based on the rate, quality, symmetry, and amplitude of the movement, areas of restriction can be identified and located. Specific treatment can then begin.

• Pelvic, bladder or bowel pain 
• Weak pelvic floor muscles after childbirth
• Urine loss when running or sneezing
• Persistent sacro-iliac and low back pain
• Bladder urgency after gym workout
• Vaginal prolapse after childbirth or at menopause
• Difficulty with emptying or controlling the bowel
• Recurring urinary tract infections 
• Less sensation with intercourse and orgasm

Physiotherapist can help you by teaching you how to:

• Find and control your pelvic floor muscles
• Regain bladder control
• Recover after pelvic floor surgery
• Prevent & control vaginal prolapse
• Control your stomach muscles after childbirth

When the adhesions and organ movement is restored, proper function is available with the diaphragm. Lateral costal expansion increases and CO2 levels rise to normal levels.

Visceral Manipulation consists of light, gentle, specifically placed manual forces that encourage normal mobility, tone, and inherent tissue motion of the viscera and their connective tissues. These gentle forces can potentially assist the body into a better state of harmony. The body is freer to move with less effort to do activities due to the reduction of the restrictions in the connective tissues. The body is then able to achieve better state of health.

Trained practitioners use the rhythmic motions of the visceral system to evaluate how abnormal forces interplay, overlap and affect the normal body forces at work. These gentle manipulations can potentially improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body.

A recent Cochrane review concluded that pelvic floor muscle training was an effective treatment for women with stress and mixed incontinence and recommended that it should be offered as the FIRST choice of treatment for stress incontinence. A recent Australian study ahs reported that an episode of physiotherapy care, consiting of five visitsm produced a cure rsate of 84% in patients with stress urinary incontinence; a small outlay of time and money for a successful outcome.  Other studies in Melbourne have investigated the effectiveness of physiotherapy intervention for older men and women, for patients with chronic respiratory disease and the effectiveness use of real-time ultrasound to measure and provide feedback about pelvic floor muscle activity. 

The Australian Government has recognised the benefits of physiotherapy intervention for incontinence by providing patient access to treatment for this condition under the Chronic Disease Management program.  By combining evidence-based physiotherapy and enhanced accessibility to this treament, outcomes for patients with this condition can be maximised

For more than TWO WEEKS have you:

1. Felt sad, down or miserable most of the time?
2. Lost interest or pleasure in most of your usual activities?

If you answered “yes” to either of these questions, complete the symptom checklist below.  If you did not answer “yes” to either of these questions, it is unlikely that you have a depressive illness.

1. Lost of gained a lot of weight? OR Had a decrease or increase in appetite?
2. Sleep disturbance?
3. Felt slowed down, restless or excessively busy?
4. Felt tired or had no energy?
5. Felt worthless? OR
   Felt excessively quilty? OR
   Felt guilt about things you should not have been feeling guilty about?
6. Had poor concentration? OR
   Had difficulties thinking? OR
   Were very indecisive?
7. Had recurrent thoughts of death?

Add up the number of ‘yes’ responses for your total score

What does your score mean?

(assuming you answered “yes” to question 1 and/or 2.)

4 or less:   Unlikely to have a depressive illness

5 or more: Likely to have a depressive illness

For further assessment, please contact your family doctor.  For more information about depression, visit the beyondblue website at:  www.beyondblue.org.au or call 1300 22 4636

References:  American Psychiatric Association.  Diagnostic and statistical manual of mental disorders, 4th ed (DSM-IV). Washington, DC: APA, 1994; and , International classification of diseases and related health problems, 10th revision.  Geneva, World Health Organisation, 1992-1994.

Fitting a sling

To ensure maximum protection for your back, wear your sling so that:

• your baby is held close to your body
• your baby’s bottom is approximately level with your waist
• the shoulder straps are crossed between your shoulder blades

Your sling in action

To protect your back while wearing your sling:

• tighten your lower abdominals to maintain your normal lumbar curve
• keep your shoulders level and low
• walk with a shorter stride than normal
• walk and stand with ’soft’ knees

If you’re having problems with your back, contact us on 6112 8981.  Remember, you don’t need a doctor’s referral to see a physiotherapist.

Central causes can include reduced blood supply or damage to some parts of the brain or central nervous system associated with balance.  The most common peripheral cause is Benign paroxysmal positional vertigo (BPPV).Some of the other peripheral causes can include neck injury such as

1. Whiplash

2. Nerve damage from the inner ears

3. Reduced local blood circulation

Treatment of vertigo must be specific to the particular cause of the vertigo.  For some causes of vertigo, such as BPPV in particular, treatment can be realistically directed to eliminating the vertigo itself.  For other causes of vertigo treatment may be directed at reducing some of the symptoms using medications, as well as improving the persons strategies for improving balance and day to day function.

Occasionally the cause of vertigo or dizziness is combination of 2 or more causes and therefore treatment or management may involve a combination of different strategies.  Here at Elite Physio we can test whether the condition is central or peripheral with reasonable accuracy and are able to offer treatment procedures for BPPV (to eliminate or reduce the vertigo) if indicated.  We can also offer balance training, if the vertigo can not be eliminated.