ISSLS: Isico will be in Kyoto, too

Isico will be at the forthcoming ISSLS Annual Meeting in Kyoto (June 3 to 7), a training event of the highest scientific and cultural level aimed at those dealing with spinal disorders. 

Founded in 1974, the International Society for the Study of the Lumbar Spine (ISSLS) is a non-profit organisation whose purpose is to bring together those individuals, throughout the world, who, by their contributions and activities both in the area of research and clinical study, have, or are developing, an interest in the lumbar spine in health and in disease.

With just 260 members worldwide, it is an exclusive society in which Isico is represented by Prof. Stefano Negrini as a member since 1997 and Dr Fabio Zaina since 2010. These two specialists will present different studies in Kyoto: Prof. Negrini will be giving an oral presentation (Identification through movement analysis of chronic low back pain pathological spinal movement patterns and their sensitivity to change during exercise treatment) and presenting a poster, and Dr Zaina will also be giving a poster presentation. In addition, both appear as co-authors of other posters being presented at the event.

ISYQOL performs better than SRS22

An Isico study entitled  The Italian Spine Youth Quality of Life questionnaire measures health-related quality of life of adolescents with spinal deformities better than the reference standard, the Scoliosis Research Society 22 questionnaire, by Antonio Caronni, Sabrina Donzelli, Fabio Zaina and  Stefano Negrini, was recently published in Clinical Rehabilitation.

The aim of this cross-sectional study was to compare the validity of the Italian Spine Youth Quality of Life questionnaire (ISYQOL) with that of the Scoliosis Research Society 22 (SRS22) questionnaire, the criterion standard instrument for health-related quality of life (HRQOL) measurement in adolescents with spinal deformities.

The Scoliosis Research Society–22 questionnaire (SRS22) is the most common measure of quality of life in scoliosis patients. It is a five-domain questionnaire developed according to the classical test theory and, in this framework, it showed satisfactory psychometric properties such as concurrent validity and reliability. SRS22 is the criterion standard instrument for measuring quality of life in adolescent idiopathic scoliosis and it is also widely used for measuring quality of life in hyperkyphosis. 

“We considered 742 idiopathic scoliosis patients aged between 10 and 18 years of age, 542 of whom were brace wearers”, explains Dr Fabio Zaina, one of the authors of the study. “The ISYQOL is the first instrument developed by using the Rasch analysis to measure quality of life in spine deformity patients during growth. ISYQOL is a quality of life measure that fully complies with requirements of a fundamental measure

ISYQOL consists of 20 items, each assigned a score of 0, 1 or 2. By means of Rasch analysis, the ordinal ISYQOL total score is converted to an interval measure (i.e. ISYQOL measure), which is expressed on a scale of 0%–100% (with 100% indicating great quality of life). Seven ISYQOL items assess the impact of bracing on quality of life and are to be administered only to people wearing a brace. Thanks to the Rasch analysis, it is possible to compare the ISYQOL score of people not wearing a brace (who answer only 13 of the 20 items) with the ISYQOL score of those wearing a brace (who complete the full questionnaire).  The Spearman’s correlation coefficient (rho) between ISYQOL and SRS22 was used to assess ISYQOL concurrent validity. Sex, age, severity, bracing, trunk appearance and deformity type were assessed for known-groups validity.  

 “The concurrent validity analysis showed the high validity of the ISYQOL measure with respect to the criterion standard measure of quality of life” concludes Dr Zaina. “Moreover, ISYQOL performs better than SRS22, having better known-groups validity and (contrary to SRS22) detecting the impact of disease severity on HRQOL.”

Bracing herself to dance! A video experience

Bracing herself to dance! A video experience

Alessia Mancini, 17,  a patient at our centre since she was just 10 years old, has become the star  of a brief video recounting her exciting and remarkable journey. Although the video last only a few minutes, this is long enough to convey the  heartwarming story of this young patient, a dancer who loves nothing more than dancing en pointe!

Despite the uphill battle she faced, Alessia, her head full of dreams and fortunate enough to be able to draw on great strength of character, proved equal to the challenge. Now, through a collaboration with a young director, Riccardo, and a young director of photography and video operator, Sophia, a video has been made telling Alessia’s inspiring story.

“It all began years ago, when my parents noticed that my back, which had three scoliotic curves, the worst one measuring 40 degrees, was getting worse” Alessia begins. “We consulted Isico, where I was prescribed a brace, to be worn for 23 hours a day”.

For Alessia, who was already passionate about dancing, it was like being told to wear a suit of armour.  

“I love dancing” Alessia goes on, “and in fact I hope to dance professionally. In the end, I can say that I have been helped, in my pursuit of this ambition, both by my dancing and by my treatment, which came to an end a month ago, when I was finally told I could leave the brace off for good”.

For Alessia, living day in day out with her brace has been like living constantly in the company of both a friend and an unwelcome companion, an experience that she first recounted a few years ago when she entered, and won, the “Concorsetto”, a national competition organised  by Isico and open to our brace-wearing patients.

“I have always felt best able to express myself through art” Alessia tells us. “It was wonderful to be invited by Sophia and Riccardo to make this video about my story, and the important part that dance has played in it. Working with them was a fantastic experience. They are both wonderful artists who really managed to bring out my qualities, both as a dancer and as a person. In this way, they helped me to connect with the audience, and I hope I may serve as an example for the many others that find themselves in a similar position”.

The director. Riccardo, 22, from Naples. “I study directing and screenwriting at the national film academy in Bologna and I directed this video” Riccardo says. “I was struck by Alessia’s story and by what a strong person she is. Thanks to her outstanding qualities, it proved easy to create a story that conveyed, through music, dance and expressions, the many challenges this girl has overcome. All this has been a new experience for me, different and very stimulating”.

Riccardo’s meeting with Alessia came about thanks to Sophia, 23, a young mother and photographer: “I was fascinated  by the idea of  taking true stories, like Alessia’s, and bringing them to life through cinema. Late one Sunday night — it was midnight —, I called Alessia and Riccardo and told them that I had decided that, rather than doing the planned photoshoot, two days later we would instead be filming a video. I had realised that simple photos were not enough. I wanted to recreate Alessia’s seven-year experience through a full range of audiovisual stimuli.

Even though it was all a race against time, both Riccardo and Alessia did an absolutely wonderful job, giving it their very best” .

Thank you so much, Alessia, for sharing your story, and Riccardo and Sophia for making such a beautiful video!

Scoliosis: Isico, too, took part in the first international conference in Istanbul

Scoliosis: Isico, too, took part in the first international conference in Istanbul

Isico was among the participants at the 1st International Conference on Scoliosis Management that took place on April 12-13, 2019 in Istanbul.

This important scientific event, held at the Akıngüç Auditorium and Art Center of Istanbul Kultur University, Istanbul, was the first international conference on scoliosis to be organised in Turkey.

Dr Fabio Zaina, an Isico physiatrist, and Michele Romano, Director of physical therapy at Isico, both spoke at the event: “The world’s leading experts on conservative treatment were invited, including us, representing Isico” says Dr Zaina. “I presented a report on our scientific exercises-based approach to scoliosis (SEAS) and our Sforzesco brace, which attracted much interest”. Michele Romano PT, on the other hand, looked at SEAS from a more practical perspective, by holding a workshop.

Putting on a brace properly

Putting on a brace properly

What’s the best way of fastening a rigid brace (Cheneau or Sforzesco type) by yourself? Is it best to do it standing up, or lying down? And, most important, is it even possible?!

Let’s start by making one thing clear. When a person with scoliosis is standing up, their curve will be more marked than when they are lying down, because in the recumbent position the spine will be straighter as an effect of the absence of the compressive force of gravity.

And this is a good reason to fasten your brace lying down: it means your spine will be   blocked in a straighter position, and held in that position for all the time you keep the brace on .

If, on the other hand, you do up your brace standing up, then you will be blocking your spine in a less corrected position. 

Another good reason for doing up your brace lying down is that you will be able to position it better on your pelvis; basically, before fastening it, you will need to bend your legs, raise your pelvis slightly and slide your body down a bit: this will allow you to position the brace perfectly; furthermore, in this way, you will often find that you eliminate the minor discomfort you can get when your brace doesn’t sit perfectly at certain points of your body.
To begin with it can seem tricky doing up a brace lying down, but in actual fact, if you do it properly, it is the easiest way.

First of all, don’t look at what you’re doing!

This may sound like strange advice, but, if you think about it, in order to look at what your hands are doing you obviously have to raise your head, and this is probably why you are having trouble doing up your brace: after all, in this position, your abdominal muscles will be contracted, and this has the effect of increasing the volume of your tummy, making it impossible to close the fastenings; what’s more, the more you struggle, the more you will raise your head, making the task even more difficult for yourself!

So, it’s important to relax and try doing it the following way: 

Lie down, bend your legs, keeping your feet flat on the floor. Pressing down with your feet, slide your trunk downwards. Now straighten your legs. Remember, you don’t need to look at your hands, or at the straps, as you can easily feel these with your fingers without needing to raise your head. Start by closing the middle one, then, still feeling with your fingers, find and close the bottom one. Feel to see whether these first 2 already need to be tightened, and when you have checked that all 3 are tightly closed, without raising your head, close and secure the sternal fastening, using either the Velco or the screw provided. At this point, if you lift your head and raise yourself up you will find, like magic, that the brace is perfectly closed and that all the black markers are in the right place, confirming that the brace is correctly closed: perfect!

Why not try it? After all, if you can learn to do this by yourself, you can be freer to come and go as you please without needing to ask for help. Lying down really is the way to get the better of your scoliosis!

An Isico study on the cover of Annals

The cover of the March issue of Annals of Physical and Rehabilitation Medicine is devoted to the Isico study entitled Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: A practical clinical trial. “

To be featured on the front cover of an international journal is a first for us, and a source of great satisfaction as it underlines, in a very immediate way, the scientific value of the study we published a few months ago” remarks Prof. Stefano Negrini, scientific director of Isico.

“Indeed, the fact that one of the world’s three most prestigious and important journals in the field of rehabilitation should have chosen a study by us to grace its cover has the effect of turning the spotlight on a disease — scoliosis — that generally tends to attract less attention than other conditions”. 

Briefly, the study in question is the largest on this topic conducted to date, given that the case series numbers 327 patients observed over more than a decade’s work. It is a crucial study, given that few others in the field of spinal diseases have verified the factors capable of reducing the risk of scoliosis worsening.

On the one hand, it demonstrates the effectiveness of doing specific exercises compared with doing nothing, and on the other it shows that those whose treatment consists of a therapeutic plan of the kind we have developed at Isico will have better results than those who do normal exercises in the gym a couple of times a week. 

Furthermore, the study shows that those who adhere to the therapy continuously, without interruptions right through to the end, are rewarded with clearly better results. 

Sport is good for scoliosis: an Isico study in the running for the SOSORT Award

It’s a fact: full-time brace wearers who do sport are more likely to see their scoliosis improve compared with those who don’t do sport. This is the result of the study entitled “EFFECT OF SPORT ACTIVITY ADDED TO FULL-TIME BRACING IN 785 RISSER 0–2 ADOLESCENTS WITH HIGH DEGREE IDIOPATHIC SCOLIOSIS,which will be presented at the forthcoming SOSORT meeting, taking place in San Francisco from 25 to 27 April.

Conducted in over 700 patients, the study, which is the only one of this kind in the literature, has been shortlisted, along with another Isico study, for the prestigious SOSORT Award. 

“Our study included 785 patients with a mean age of 12 years, presenting curves averaging 40°, who wore their brace for more than 20 hours a day” explains Alessandra Negrini physiotherapist at Isico , who conducted the research. “We assessed them through X-rays taken 6 and 18 months after they were prescribed bracing therapy and specific exercises for their scoliosis.” 

Exactly a year ago, Alessandra Negrini presented another study at SOSORT which focused on patients with milder curves (up to 25°), who did not wear a brace: “That research provided confirmation that sport reduces the chances of scoliosis worsening” Alessandra Negrini says. “Instead, in the present study, which involved a larger sample of patients with more severe curves, we calculated odds ratio (OR) values (i.e. the likelihood of improvement) in order to compare the results recorded by patients who did sport at least twice a week with those of patients who did not do any sport, or did sport just once a week. A curve reduction of more than 5 Cobb degrees was taken as an improvement”.  

“Thanks to this large sample, we were able to show, beyond doubt, that the impact of sport, albeit slight, is positive” Alessandra Negrini says, adding, “in other words, the improvement obtained by those who do sport compared with those who do not was small, but cannot be ascribed to chance. We can thus say that sport, while not constituting a therapy, does contribute to improvements recorded by patients who wear a rigid brace (the Sforzesco or Sibilla types)”. 

The study did not show any one sport to be superior to others in terms of having a positive impact: “We weren’t able to analyse the impact of volleyball as opposed to swimming or dance, for example, because youngsters make their own choices and often change sports,  or practise more than one sport at the same time, and at present we still know little about this aspect” says Alessandra Negrini. “What we plan to do soon, however, is evaluate what happens over time. Judging by the data collected to date, we can say that patients who wear a brace full time benefit from doing sport; in addition, at the 18-month follow-up, we found that the chances of improvement increased with increasing weekly frequency of sporting activity. On the basis of these results, which support recently published guidelines on scoliosis treatment (, doctors can certainly recommend regular sporting activity in these patients”.

Calling Scoliosis Bracing Experts: how to participate

Aim: To create a classification of braces, with the help of a panel of super experts from all over the world. 
This initiative, born of the synergy between three scientific societies, SOSORT, SRS and ISPO , is being coordinated by Prof. Stefano Negrini, scientific director of Isico.

We are appealing to scoliosis bracing experts to join in this multi-society effort geared at producing a new classifica-tion system for braces. 
“Today’s braces are still named after those who invented them, and as such they are not organised into a logical classification of any kind. Although there exists an anatomical clas-sification, it doesn’t provide any data on the features of the different types of brace” explains Prof. Negrini. “We therefore need to find true experts for this project”.

What are the requirements to participate? “There will be a first group of top experts, those who have been prescribing or constructing braces at a rate of at least 500 a year for at least 15 years, and who also have documented experience at international conferences” Prof. Negrini goes on. “This group will meet and compare notes with a second group of ex-perts, who, for the past decade, have been prescribing at least 300 braces a year”. 

Anyone who meets these requirements and wants to apply to take part is invited to contact Prof. Stefano Negrini –

Tennis doesn’t hurt your back

The Isico study “Adolescent agonistic tennis and spinal diseases, what’s the connection? Results from a cross-sectional study” contradicted the idea that asymmetrical sports are harmful: in the literature, tennis, like other asymmetrical sports, is considered a possible cause of back pain and, in the worst cases, a cause of worsening scoliosis.

“Tennis is played by many adolescents the world over” says Dr Fabio Zaina, an Isico physiatrist and author of the study, “and despite the lack of available relevant data, it has always been considered risky for individuals affected by scoliosis, and in any case a cause of back pain. We set out to verify whether spinal disorders really are more common in competitive tennis players compared with those who do not practice this sport”.

The study compared 100 competitive tennis players (50 girls) with 200 young students of the same age (12 years). The data collected showed no differences between the two groups. 

“Another study of ours has already shown that swimming, which has always been considered one of the best sports for those with back pain or scoliotic postures, can in fact induce back pain”  – Dr Zaina points out – “In that study, we therefore disproved a commonly held belief, just as we have done here. Another aspect worth taking into account is that nowadays players usually use very lightweight racquets, and there is also much more recourse to compensatory gymnastics. All this means that asymmetrical exertion is much less of a problem than it was in the past”.

So what is the ideal sport we should be getting our kids to practice?

There is no such thing as an ideal sport”  – Dr Zaina tells us – “However, there are a few things we can say, namely: there are no prohibitions with regard to who can participate in asymmetrical sports; swimming is not a panacea for all ills; artistic and rhythmic gymnastics can encourage the progression of curves or give rise to back pain in those who are already predisposed to these problems; and, finally, neither soccer nor volleyball present particular problems. Obviously, we recommend that individuals with a family history of scoliosis have specialist check-ups, at least from the age of nine years onwards, and as a rule we suggest they avoid, if possible, those sports that can favour the progression of scoliotic curves.

Basically, we need to remember that the best thing is to get plenty of physical exercise, while bearing in mind that sports involving considerable mobilisation of the spine (artistic and rhythmic gymnastics and swimming, for example) will put us at greater risk, especially if there is a predisposition there, whereas weight-bearing sports will help us to strengthen the spine as they require us to overcome the force of gravity”.

Juvenile scoliosis: what it is and how it is treated. The Isico experience

Juvenile scoliosis is defined by an age at diagnosis of between 4 and 9 years; the form appearing earlier than this is termed infantile, while the one detected later is referred to as adolescent scoliosis. The juvenile form accounts for between 12% and 21% of all cases of idiopathic scoliosis occurring in youngsters.

Exercises and bracing can radically alter the natural history of juvenile scoliosis, stabilising the curvature (which tends to worsen markedly during the pubertal growth spurt, i.e. between the ages of 10 and 13 years), preventing further worsening, maintaining (after growth is complete) the correction achieved, and avoiding the need for surgery in the most severe cases. Adopting, a priori, an aggressive approach to the treatment of scoliosis can be counterproductive, as it can lead to a risk of over-treating the condition, and therefore reducing the youngster’s quality of life.

It is incorrect to say that juvenile scoliosis is always more aggressive than the adolescent form; in both, there probably exist rare cases of curves with a high potential to deteriorate. However, there is no doubt that, both in adolescent and in juvenile cases, the period of greatest risk is the pubertal growth spurt, which naturally favours a progression of scoliotic curves. It is therefore important to seek the support of a team of experts able to provide correct clinical and radiographic monitoring of the youngster’s conditions; the therapeutic team must also be committed to ensuring that the patient always receives the treatment that, for the same level of effectiveness, will least affect his/her quality of life.

The natural history of juvenile scoliosis teaches us that the curvature will worsen to more than 50°-60°, meaning that affected individuals are destined to require surgery. This view is so widespread that, as the lack of relevant literature shows, very little attention has been paid to the potential of conservative rehabilitation treatment in this form.

Very often, it is deemed best to “wait and see” what happens after the pubertal growth spurt. However, on the basis of the common knowledge that scoliosis tends to worsen in puberty, we argue that conservative rehabilitation treatment in juvenile cases can potentially produce positive results, which can be maintained after growth is complete. 

An Isico study published a few years ago, shows precisely this. The article, entitled “In favour of the definition “adolescents with idiopathic scoliosis”: juvenile and adolescent idiopathic scoliosis braced after ten years of age[1] do not show different end results, reports, in particular, that 92% of the patients studied got through adolescence without needing surgery. The study involved two groups. The first group comprised 27 youngsters with a diagnosis of juvenile scoliosis (based on clear X-ray evidence of scoliosis before the age of 10 years), who had started treatment after the age of 10 years. The second group was made up of 45 patients with a diagnosis of adolescent scoliosis. The patients in both groups presented curves of between 25° and 45°. The results obtained at the end of the treatment (bracing in all cases) were found to be comparable between the two groups.

“The study showed that it is possible to contain the natural tendency of scoliotic curves to worsen during puberty” – says Isico physiatrist Claudia Fusco – “What is more, the improvement was found to be greater in those cases whose treatment was started earlier, and was more challenging because of the severity of the curvature (greater than 30°). Take, for example, the case of one patient, a girl, who we had been treating solely with exercises ever since she first came to us as a child with mild scoliosis. Her bracing treatment began with a Cheneau brace and then, as she grew, this was replaced first with a Lyon and then a Sforzesco one; meanwhile, her brace wearing time was gradually increased from 12 to 18 hours per day. The progression was greatest at the age of 12 years, after which her condition stabilised, while the severity of the curve has decreased. At the age of 16 years, this patient had a 34° curve, down from a peak of 41°: a great success!”