Spinal Deformities Overview

Spinal Deformities Overview

• Spinal deformities encompass various conditions affecting the spine's structure and function.
• Muscle imbalance involves an unequal relationship between agonist and antagonist muscles (length & strength), impacting normal movement and function.
• Janda's work highlights how static/tonic muscles tend to tighten, while dynamic/phasic muscles weaken.
• Tonic muscles (static, postural) are more active during movements and thus more likely to tighten.
• Phasic muscles (dynamic), less active, tend to weaken.

Classification of Muscles

• Muscles prone to tightness are categorized by upper and lower quarters.
• Upper quarter tonic muscles include suboccipitals, pectorals, upper trapezius, levator scapulae, SCM, scalenes, latissimus dorsi, upper extremity flexors and pronators, and masticators.
• Upper quarter phasic muscles include the middle and lower trapezius, rhomboids, serratus anterior, deep cervical flexors, upper extremity extensors and supinators.
• Lower quarter tonic muscles include iliopsoas, rectus femoris, hamstrings, erector spinae, tensor fascia lata, quadratus lumborum, piriformis, calf muscles, and hip adductors.
• Lower quarter phasic muscles include rectus abdominals, transvers and obliques abdominals, gluteus Maximus, medias, and minimums, vastus latralis and medialis, tibialis anterior and posterior, and peroneus longus.

Muscle Imbalance

• Muscle imbalance results in an impaired relationship between muscles prone to tightness and muscles prone to inhibition.
• Imbalance leads to changes in tissues, inappropriate movement patterns and pain/inflammation.
• Janda connects this to immobile conditions and repetitive tasks.

Upper Crossed Syndrome

• Upper crossed syndrome occurs due to muscle imbalance affecting the upper body.
• It's characterized by tightness in the upper trapezius, suboccipitals, SCM, and levator scapulae (dorsally), pectoralis major and minor (ventrally).
• This is accompanied by weakness in the deep neck flexors, rhomboids, serratus anterior, and the middle & lower trapezius.
• Common symptoms include neck pain and affect other parts of the upper body.

Lower Crossed Syndrome

• Characterized by overactivity and tightness of hip flexors and lumbar extensors coupled with weakness/underactivity of deep abdominal muscles and gluteus maximus and medius.
• This imbalance leads to joint dysfunction (ligamentous strain/increased pressure) at L4-L5 and L5-S1 segments, SI joint, and the hip joint.
• Common symptoms include lower back pain, hip pain, and knee pain.

Scoliosis

• Scoliosis is a three-dimensional deformative abnormality of the spine, most commonly seen during pre-puberty growth.
• Defined by Cobb's angle measuring lateral curvature in the frontal plane.
• Often associated with vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane.
• Rotation starts pronounced as the scoliosis worsens causing abnormalities in the spine, costal-vertebral joints, and the ribcage.
• Scoliosis can appear at any age. Often presents between ages 10 and 12 or during a person's teens.

Types of Scoliosis

• Structural curves are irreversible lateral curvatures with fixed rotation. A posterior rib hump is detected on forward bending.
• Nonstructural curves are reversible, and the spine is functionally/posturally normal, often changing with positional adjustments.

Causes of Scoliosis

• Idiopathic is the most common (80% of cases).
• Neuromuscular conditions (e.g., cerebral palsy, muscular dystrophy, spina bifida) or congenital birth defects impacting spine bone development are other possible causes. Injuries or infections can also lead to scoliosis.
• Leg-length discrepancy, muscle guarding/spasm from back/neck pain, and habitual postural deviations are additional factors.

Scoliosis Impairments

• Mobility impairment in joints, muscles, and fascia is present on the concave side of curves.
• Stretch and weakness occur in musculature on the convex side of curves.
• Advanced structural scoliosis can limit rib expansion, impacting cardiopulmonary function and breathing.

Rotation of Vertebrae in Scoliosis

• Vertebral bodies rotate towards the convexity of the curve, while spinous processes face the concavity.
• Thoracic ribs rotate with vertebrae creating prominence posteriorly on the convex side and anteriorly on the concave side.

Pedicle Method for Rotation Estimation

• Examiners check pedicle position relative to lateral vertebral margins.
• Normal pedicles are equidistant from vertebral margins, while rotated pedicles move toward concavity.

Cobb Angle Measurement

• Cobb angle measurement helps quantify spinal curvature for scoliosis severity diagnosis.

Scoliosis Diagnosis and Stages

• Diagnosis confirmed when Cobb angle is 10 degrees or higher along with axial rotation assessment.
• Severity stages include 10-25 degrees needing screening, diagnosis, & prevention interventions, 25-45 degrees requiring support from physical therapy and/or orthopaedics, and over 50 degrees indicated for surgery.

Clinical Presentation of Scoliosis

• Symptoms include uneven shoulders, waist, hips, pelvis, and lower extremities; one more prominent scapula than the other.
• Curves worsening often lead to spinal rotation and twisting.
• Muscle fatigue, ligamentous strain, nerve root irritation (concave side), and facet irritation (concave side) are related symptoms.
• Specific spinal observations can reveal adductor muscle decrease on the adducted hip side and increased flexibility, along with opposite effects in contralateral extremities; also larger spaces from the arm to the side of the body on one side when compared to the other.

Conservative Treatment Considerations

• Girls are at higher risk of progression compared to boys.
• Larger curves often worsen with time.
• Double curves (S-shaped) tend to worsen more than C-shaped curves.
• Curves located in the thoracic segments are more likely to worsen.

Conservative Treatment Objectives

• Preventing curve progression at puberty (or potentially reducing it)
• Preventing/treating respiratory dysfunction
• Preventing/treating spinal pain syndromes
• Improving appearance via postural correction.

Bracing

• Brace methods include the Boston Brace (TLSO - thoraco-lumbo-sacral orthosis).

Physiotherapeutic Scoliosis Specific Exercises (PSSE)

• This method focuses on three-dimensional scoliosis treatment.
• PSSE involves auto-correction, patient education, postural stabilization, and daily living activity training.
• PSSE aims at preventing progression.
• Aims include improving quality of life, aesthetics, pain reduction, vital capacity, and ADL.

Surgical Treatment

• For severe scoliosis, surgeries like spinal fusion are crucial.
• Surgeons connect two or more vertebrae to immobilize movement .