Thank You Heidi Christian!

Governor Tina Kotek of Oregon has officially proclaimed June 2024 as National Scoliosis Awareness Month due to the incredible efforts of Heidi Christian, whose heartfelt letter to the Governor served as the catalyst for this important proclamation. Heidi’s personal journey with scoliosis is a living example of why early detection is so crucial and why further research is needed. Her dedication to raising awareness and advocating for the scoliosis community has truly made a difference. Her passion and commitment inspire us all to continue our efforts in advocacy, education, and public awareness. Thank you, Heidi, for your unwavering support and advocacy!

Read Heidi’s letter to the Governor:

Governor Tina Kotek
Oregon State Capitol
Salem OR

Dear Governor Kotek:

As a constituent and a person living with Scoliosis, I am writing to ask you to please declare June 2024 to be National Scoliosis Awareness Month in Oregon and sign the attached proclamation request.

National Scoliosis Awareness Month is observed in June to disseminate information about Scoliosis and highlight the need for education, early detection, and public awareness of the physical, emotional, and economic impact of this condition. With recent studies showing the benefits of bracing, early detection is more important than ever, as is increased public awareness.

Currently Oregon has no screening mandate for Scoliosis in public schools. I am hopeful, as you look toward improving the outlook for Oregon’s children, Governor Kotek, you will consider Scoliosis screening, too.

Scoliosis has affected my life. First diagnosed as a junior high student in 1974, I was prescribed a Milwaukee brace. My “S” curves which were stabilized, yet not corrected, held steady from the time of treatment through a routine x-ray taken in 2008. However, by 2012, those curves made a surprising progression to demand an eight-level (T9-L4) anterior and posterior fusion surgery at age 52.

This 8-hour surgery involved two procedures to lessen the Scoliosis curves and correct the twist with two twelve-inch titanium rods, fourteen pedicle screws, and a discectomy with PEEK cage placement. It required six days in OHSU Hospital, four months of convalescence at home in a TLSO brace, physical therapy, and one full year of gradual healing; it cost $180,000 in 2013 just for the surgery and hospital stay, plus more for doctor visits, radiology, medication, etc.; it meant a change in career for me, too.

By officially signing the National Scoliosis Awareness Month proclamation for Oregon, you will help highlight the need for education, early detection, and awareness of Scoliosis. The goal is for every state to officially declare, by proclamation, their observance of National Scoliosis Awareness Month during the month of June and I am hoping our State of Oregon will again join in!

Thank you for your consideration.

Sincerely,

Heidi Christian

The Official Proclamation from the State or Oregon

The post Oregon has officially proclaimed June 2024 as National Scoliosis Awareness Month first appeared on National Scoliosis Foundation.

As many of our readers know, the Scoliosis Research Society, the American Academy of Orthopaedic Surgeons, and over 23 states suggest or require school screening for abnormal spinal curvatures. In September of 1992, Dr. William P. Bunnell, Professor and Chairperson, Loma Linda University Medical Center, presented his paper, “Outcome of Spinal Screening” to members of the Scoliosis Research Society; his findings will also be published in an upcoming issue of Spine. Dr. Bunnell is a developer of the Scoliometer, a hand-held device used in assisting spinal screening programs across the country. What follows are excerpts from an interview that the NSF conducted with Dr. Bunnell about his study:

Q: Dr. Bunnell, would you start by giving us some background information about spinal screening as it pertains to your study?
A: The major criticism of spinal screening, as it is being practiced today, is that schools are referring too many students who do not require treatment. The primary cause of over-referral is lack of objective screening criterion; in the state of California, for example, any amount of asymmetry of the thoracic ribs or the lumbar area is an indication for referral. As a result of over-referral, many screening programs are cost ineffective. Youngsters who are referred–whether they need treatment or not–will be sent to a doctor for a medical consultation; they may have several x-rays taken; and then they’ll be asked to return to the doctor six months or a year later for another consultation. All of this adds up to skyrocketing costs.

Q: What were some of the goals you wanted to achieve by undertaking this study?
A: One of my many goals was to determine the prevalence of scoliosis–i.e., how many in the general population presently have it. Another was to use the data on prevalence in combination with previous studies to determine what is a reasonable level orcriterion for recommending referrals.

Q: What were some of your findings?
A: In our study of 1,000 physically mature high school students–in which we used the Scoliometer as the screening device–we found that only 16 out of 1,000 students (1.6%) had a clinically straight spine. Eighty percent had three or more degrees of rotation at one or more levels of the spine. We also learned that within this population, if “any degree of deformity” (i.e. one degree) is used as the criterion, then 98.4 % of students will be referred.

Q: Would you explain the criterion–the degree of deformity–that screeners currently look for, and tell us why you feel this criterion should be changed?
A: When I first started out in practice, everybody thought we should treat 20 degree curves with low profile braces. There is a direct correlation between 20 degree curve and a 5 degree Angle of Trunk Rotation (ATR), so screeners referred anybody with 5 degrees of ATR or greater, and they’re sill using 5 ATR as the criterion. Today, we know that at least 4 out of 5 kids with 20-degree idiopathic (causes unknown) curves will never get any worse. In fact, most doctors wait until a youngster with this type of curvature reaches 30 degrees before starting treatment. So it’s clear that we should be screening for these children in the 30 degree and above category.

Q: Based on the data from your study, what are some of your recommendations?
A: We know that spinal screening programs must have defined referral criteria and “treatment-eligible” degrees of scoliosis in order to judge their effectiveness. The ideal criteria will minimize both the number of referrals and the number of false-negative examinations. In view of the new prevalence data from my study and the current recommendations to wait until scoliosis approaches 30 degrees (Cobb angle) before starting brace treatment, I am recommending changing the screening referral criterion to seven degrees ATR at any level of the spine and changing the definition of false-negative (treatment-eligible curves that are missed) to 30 degrees Cobb angle for the purposes of spinal screening.

Q: If it is implemented in screening programs across the country, what will your new recommendation accomplish?
A: It will accomplish a referral rate of 3% and detect 95% of all “treatment eligible” curvatures, thus preserving an acceptably low false-negative rate and helping maintain cost effectiveness of spinal screening programs.

Q: What about youngsters whose curves are below that “treatment eligible” line–let’s say, between 20 and 25?
A: Those youngsters should be rescreened within six months or a year. Rescreening would take place at school, which would keep it a public health issue.

Q: In light of your findings, how do you now view the importance of screening for spinal deformity?
A: Screening is vitally important, but we do not want to screen out a whole bunch of people who don’t need medical attention because it’s very costly. We’re not looking for the cheapest way to screen–we’re looking for a better quality outcome for our patients.

The post Outcome of Spinal Screening first appeared on National Scoliosis Foundation.

1. Can exercise correct or stop the progression of the scoliosis curve?
2. Are recreational exercise and sports participation advised?

In this article, we will present some of the advantages and limitations of exercise for adolescents with scoliosis. Adults with scoliosis, including those with corrective surgeries, often also seek advice about exercises, especially if they begin experiencing discomfort and stiffness in their backs. Therapeutic and recreational exercise for adults will be presented in a future article.

Programs

Several programs aimed at correcting or arresting scoliosis have been proposed over the decades. Through these programs one attempts to exert corrective forces on the spine by active contraction of trunk muscles in directions thought to reverse the scoliosis curves. Some approaches seek positions and postures which are noted to reduce the scoliosis deformity.
Additionally, stretches are often performed, which aim to increase the mobility of the spine in a corrective direction. After mastering these exercises, postures and stretches under the supervision of a physical therapist, attempts are made to maintain corrective muscle tone and postures during daily activities.

Some programs also include breathing exercises. Chest movements noted during deep breaths cause temporary rotation of the thoracic vertebrae in a corrective direction in some people with scoliosis. Minor reductions in measurable lung capacities are often found in people with scoliosis and large thoracic curves, and breathing exercises have also been directed at improving this.

Bracing and Exercise

Exercise programs have often been prescribed for those wearing corrective scoliosis braces. These are intended to help the wearer adapt to the brace, to encourage the active correction of the spinal deformity, and to maintain the trunk musculature during the bracing program. This is done by actively shifting laterally in the direction of the correction (away from the brace pad), by extending the trunk while in the brace, and by taking deep breaths.
Other trunk and pelvic exercises are also taught and the brace-wearer is instructed to perform these several times per day. Most programs are initially supervised by physical therapists, and are followed by the development of daily home exercise regimens.

Benefits of Exercise

In general, little scientific evidence exists about the effectiveness of exercise programs for preventing progression of scoliosis curves, or for reversing curves to any clinically or cosmetically significant degree.

By scientific evidence we refer to carefully designed clinical studies where a true effect of exercise has been demonstrated. Some short-term reduction of curve angles (by several degrees), and minor improvement in breathing volumes have been observed for small groups of people with scoliosis who have undergone exercise programs.

Others in these programs, however, were not helped, and some were noted to have curve progression during exercise. For those with slight improvement in curves, it was not determined whether these changes had any lasting effect, nor were these noted to be cosmetically or functionally noticeable.

Even for exercise programs directed at improving the results of scoliosis bracing, the results have been disappointing. Bracing alone has been found to be as effective as bracing and exercise.
Because of this, therapeutic exercise programs are not universally recommended by scoliosis experts. When prescribed, exercise programs are usually initiated in addition to, and not instead of bracing treatment. Careful monitoring of curve angles remains essential, regardless of exercise.

Therapeutic exercise should never be considered as an alternative to recommended surgery when a scoliosis curve is severe and progressive, and the patient and family have decided on surgical correction.
Fortunately, most people with scoliosis are completely normal in their ability to participate in sports and recreational exercises. For some with severe deformities leading to respiratory function changes, and for those post-scoliosis surgery patients, some sports restrictions may be advised. Your scoliosis specialist can make recommendations concerning these. No information exists to suggest that recreational exercise and sports participation worsens, or in any other way affects scoliosis curves.

“Scoliosis is not caused by a deficiency of strength or flexibility, and therefore exercise is relatively ineffective in correcting scoliosis. Equally important, scoliosis is not a result of exercise, and therefore normal physical activities can be enjoyed by people with scoliosis without concern”.

Children and adolescents with scoliosis can be expected to participate in organized sports, school physical education programs, and normal neighborhood recreational activities. For most, resistive exercise training to build muscle strength and endurance training to improve cardiovascular conditioning can be performed when desired.

Children enrolled in a scoliosis bracing program are generally allowed out of the brace for organized sports. In addition to the lack of adverse effects and improved fitness, regular recreational exercise can reinforce that one is normal and healthy despite scoliosis.

The causes of scoliosis appear to be independent of exercise. Scoliosis is not caused by a deficiency of strength or flexibility, and therefore exercise is relatively ineffective in correcting scoliosis. Equally important, scoliosis is not a result of exercise, and therefore normal physical activities can be enjoyed by people with scoliosis without concern.

The NSF would like to thank co-authors, James Rainville, M.D., and Frank Rand, M.D., for their work on this article. Dr. Rainville, a Physiatrist, is Assistant Clinical Professor, Department of rehabilitation Medicine, Tufts University Medical School-Boston, and also Director of rehabilitation, New England Spine Care Center, Chestnut Hill, MA. Dr. Rand is Instructor in Surgery (Orthopedics), Harvard Medical School, Boston, and Director of Orthopedic Programs, New England Deaconess Hospital, Boston

The post Exercise for Adolescents first appeared on National Scoliosis Foundation.