Scoliosis in the elderly: why exercises are important

When talking about scoliosis, one often immediately thinks of a condition that affects young people, but that is not always the case. In a study of 554 people aged between 50 and 84 years, scoliosis was diagnosed in 70% of cases, showing that this is also a common condition in older people, too.However, there are certain distinctions to be drawn, and it is important to understand when scoliosis in an older person first developed. This is possible only if the patient is able to supply previous X-rays that document the period of onset.

Scoliosis in the elderly can be divided into three types.

– Primary degenerative scoliosis, also known as the “de novo” form, is scoliosis that occurs as a result of disc degeneration, and it causes considerable pain and stiffness. This makes it very difficult for the patient to create curves able to compensate for the lateral or forward bending of the spine inevitably seen in those affected by this condition.  

–  Progressive idiopathic scoliosis in adults is scoliosis that they have had since they were  young, as it is the form that is diagnosed in adolescence. With this type of scoliosis it is important to bear in mind a couple of parameters, because the likelihood of the condition worsening depends on the severity of the curve.

According to literature data, scoliosis with a Cobb angle greater than 50° will almost inevitably worsen; instead, a curve measuring less than 30° will give little cause for concern in adulthood.

–  Secondary degenerative scoliosis can have various causes, some found directly in the patient’s back (such as a lumbosacral abnormality) and others (such as hip disease) found elsewhere in the body. Metabolic disorders and osteoporosis leading to multiple fractures are also among the causes of this type of scoliosis.

Regardless of their causes, all these forms of elderly scoliosis have certain characteristics in common.

Elderly people affected by scoliosis inevitably experience postural changes. Particularly prominent is forward or lateral bending of the back: in other words, their back seems to be “falling” forward or to one side.

These changes can result in loss of the normal inward curvature (lordosis) of the lower back, causing the trunk to bend forwards and leading to accentuated dorsal kyphosis.

A further characteristic of all these types of scoliosis is pain, and it is one of the main reasons why individuals with elderly scoliosis decide to try to do something in order to improve their back and, as a result, their overall health. 

Another type of alteration observed in elderly scoliosis is a lateral collapse of the spine caused by an increase in the scoliotic curve that the patient is unable to counter; this results in a lateral imbalance.

To try to improve the situation, it is necessary to undertake a course of rehabilitation involving specific exercises for the spine.

These exercises have several purposes; the main one is to reduce pain. The therapist will  “explore” the patient’s back, performing assessments and seeking to identify pain-free positions that can be taken as a starting point both for providing some relief and for starting to plan a programme of work designed to help the patient’s back cope with more active exercises.

As with youngsters, with elderly people, too, it is crucial to teach self-correction, even though, in this case, the objectives will be different.
An elderly person with scoliosis, by definition, has a stiff back and can therefore have mobility problems; obviously in these circumstances self-correction should not be seen as a means of obtaining the best possible correction of the back, but rather as a way of supporting it and countering, as far as possible, the abnormalities that have developed.  

In the presence of lateral bending, the aim will be to support the back as much as possible against the direction of the curve, whereas forward bending will be tackled by attempting to restore lordosis and mobility of the lumbar spine, so as to move the patient’s back into an upright position. A key element in both these cases is an axial extension of the spine, which serves to reduce dorsal kyphosis and open, as much as possible, the scoliotic curve.

However, when embarking on a rehabilitation pathway, patience is always the key, because exercises, unlike drugs, cannot eliminate or reduce pain in the space of a few hours.

The very term “pathway” implies the need to allow a certain amount of time in order for the desired results to appear.
In fact, the treatment demands not only patience but also constancy over time, as patients have to do much of the work on their own, having first been taught the exercises and instructed to do them independently at home.

It is also important not to make the mistake of becoming complacent as soon as there is some improvement; indeed, it is crucial to continue following the programme consistently so as to consolidate the results achieved.

All this is the only way of obtaining the kind of results that, over time, will lead to improvements in different areas of the patient’s life.

The first positive result perceived by the patient will be a reduction of the pain experienced; subsequently, he/she will become aware, both in the course of the day, but also when standing in front of a mirror, that his/her posture has also improved.

An equally important development will be better general physical conditions and a better quality of life, as the patient, starting to feel better and happier about his/her appearance, will start resuming his/her previous activities.

The specific exercises prescribed are very important for preventing/limiting possible deterioration over the years, and patients will therefore need to go on doing them for the rest of their lives: since these are patients who have difficulty supporting their backs, it is essential to work on strengthening all the relevant physical abilities. And this can be achieved solely and exclusively through specific exercises.
All the other treatments that exist for scoliosis have other objectives, e.g. to provide pain relief (drugs) or to replace lost function (bracing or surgery), and they are, in any case, more invasive.