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 (https://www.ncbi.nlm.nih.gov/pubmed/29435499), 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 – stefano.negrini@unibs.it

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!”

Bracing also works in patients who are overweight

According to the Isico study entitled “Overweight is not predictive of bracing failure in adolescent idiopathic scoliosis: results from a retrospective cohort study”, published in the European Spine Journal, bracing can give excellent results in overweight or obese patients, too.

This research started from a question: is overweight really a factor that can jeopardise the outcome of bracing treatment in scoliosis?
Scoliosis is a three-dimensional deformity of the spine that, in over 80% of cases, is diagnosed in adolescence.
Seven out of every 10 scoliosis patients are female, and the condition affects around 3% of the population, even though severe scoliosis is rare (occurring at a rate of 0.5 per thousand patients).
Scoliosis is more likely to affect thin or underweight subjects, or to be more aggressive in these cases. However, it is also found in overweight subjects, in whom diagnosis of the condition may be more difficult or delayed.
“The traditional view has always been that bracing in overweight or obese youngsters doesn’t work” says Dr Fabio Zaina, an Isico physiatrist and author of the study. “However, the scientific literature contains only one study, now rather dated, with data supporting this view, and that study was conducted in patients who wore their braces for just 14 hours per day. This is precisely why we decided to undertake this retrospective study, examining the data of 351 patients with curves of 25° to 50° and an age of 10-15 years at the start of treatment, all of whom had been prescribed the Sibilla or the Sforzesco brace at their first consultation, with bracing doses of over 20 hours per day. And we found that the reality is actually very different”.
Indeed, the data collected showed that it is not being underweight or overweight that determines a positive or negative treatment outcome: “Patients affected by scoliosis are usually thinner than their unaffected peers, but overweight individuals, too, can develop the condition. According to a study that has just been published” Dr Zaina goes on, “the diagnosis can be delayed in obese individuals, and when they are diagnosed, they more frequently already show more pronounced curves. Treating them is therefore more difficult. Furthermore, from a technical point of view, it is more difficult applying a brace in overweight subjects, to the point that some are induced to lose weight. But in any case, the thing that determines a more or less valid outcome is the level of adherence to the treatment, or so-called patient compliance. Obviously, the therapeutic team (consisting of physician, orthopaedic technician and physiotherapist) plays an important role, but so too does the patient’s family, because with their support the patient is more likely to wear the brace for the prescribed number of hours: our patients, unlike those taken into consideration in the old study, were wearing their braces for between 18 and 23 hours a day, with an average of 20 hours”.

Why aren’t all braces the same?

How important, in scoliosis treatment, is the type of therapeutic instrument used? Obviously, both the treatment itself and the instrument chosen are very important factors. After all, while it is true that one brace may not be as good as another, it is also true that even an excellent one must be managed through an adequate therapeutic approach, which determines how, and how much, it should be worn.

Obviously, the physician plays a key role in mediating this relationship, but the tolerability of the brace and the patient’s acceptance of it are fundamental elements, too. All these factors combined can increase the final effectiveness of the therapy.

Let’s examine this one step at time. First of all, what is scoliosis?    
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine and trunk. Even though it is a fairly common disorder, affecting about 1–3% of the population, only about 10% of diagnosed cases require treatment, and only 0.1–0.3% require surgery. The most important parameter when deciding on the type of treatment is the Cobb angle, which is measured on an upright full-spine radiograph. The therapeutic approaches to scoliosis range from observation alone to specific exercises, bracing and, in the most serious cases, surgery.
Bracing is an effective method of treating scoliosis, used for moderate and severe curves or when a patient refuses surgical treatment.

What exactly is a brace (the therapeutic instrument)?
A brace is a device (technically an orthosis) that applies external corrective forces to the trunk in order to correct the deformity.
According to guidelines published by SOSORT (International Society on Scoliosis Orthopaedic and Rehabilitation Treatment) in 2016, the aims of bracing as a treatment for scoliosis are to stop the disease from progressing during puberty, improve the patient’s appearance, prevent or treat pain, and prevent or treat respiratory dysfunctions.

How is a brace made?
Brace construction techniques have evolved over the years, but the objectives remain the same: to obtain maximum reduction of the curve through a design that can be well tolerated.
The construction process begins with a plaster cast or a 3D optical scan if CAD/CAM technology is being used, or alternatively with trunk measurements and the use of theoretical reference models.
In traditional construction, a plaster cast of the patient’s body is made and then split open to be used as a “mould” serving to reproduce the patient’s trunk. The resulting replica of the trunk is then modified manually in order to produce a model of the “corrected” trunk on which to construct the brace. If, instead, CAD/CAM technology is being used, the image is captured by scanners and then modified using software. Once the replica has been modified, it is sent to a milling machine which finishes the corrected “positive” model.
From this point on, the procedure is the same for all techniques: a plastic sheet is heated and wrapped around the positive model. The thickness of the plastic used may differ (ranging from 2 to 5 mm), as may its stiffness. Even though they are all made using similar methods, there exist different types of brace and they don’t all work in the same way.

A classification of braces
Braces work in different ways because they apply different biomechanical principles. What is more, they are custom-built devices, and so each one is unique!
A classification was recently developed based on the mode of action of different braces. There exist the following types:
    ⁃    traction braces: for obtaining upward vertical elongation of the spine (e.g. the Milwaukee brace);
    ⁃    Three-point braces: these act at three points in two or three planes of space (Boston, Lyon, PASB, Sibilla braces);
    ⁃    postural braces: these have a three-dimensional action (Cheneau, RCS, ART braces);
    ⁃    hypercorrective nighttime braces: these are used only at night (Charleston, Providence braces);
    ⁃    braces that push in a down-up direction: these braces produce a three-dimensional elongation, which is obtained by pushing the spine in a down-up direction. The Sforzesco brace, developed at the Isico centre by Prof. Stefano Negrini, is an example of this type of brace;
    ⁃    elastic braces, like SpineCor, which are used to treat mild-moderate scoliosis (between 20° and 35°) and to delay the use of a rigid brace. SpineCor is a dynamic brace based on the principle of the corrective SpineCor movement; this movement is maintained over time by means of the elastic bands. Unlike a rigid brace, it is practically invisible under clothes, and permits all trunk movements. However, it is less effective than other treatments.            
It is very difficult for doctors to assess and manage all these different bracing options, even if they are experts in this condition. To increase the quality of the intervention and enhance the outcome for the patient, the best thing is to work with few models and only a few orthopaedic workshops.

The fundamental importance of the therapeutic approach
Whatever type of brace the physician recommends, the management of the therapy is still the most important thing.
Prescriptive protocols envisage that treatment should be started with a very high dosage (21-23 hours of brace wearing per day), before gradually reducing this, in such a way as to allow the spine to grow, and the postural control system to adapt and get used to maintaining the correction imposed by the brace. This latter aspect is supported by specific exercises, which enhance the spine’s ability to maintain the correction.
Bracing is an effective therapy providing the brace is worn for the number of hours prescribed by the physician.
Until a few years ago, the only way of checking that patients were using their braces correctly was to rely on information provided by family members and the patients themselves at follow-up appointments. Nowadays, however, we can use heat sensors to obtain accurate assessments of compliance (i.e. to assess the extent to which the patient and his/her family have adhered to the prescribed treatment).

A well-constructed brace
According to the five rules set out by Prof. Sibilla in 1995, a brace will work well if it is properly prescribed, properly made, properly tested, properly worn, and accompanied by appropriate exercises.
We would add a further rule: brace treatment must be carefully monitored by a complete, expert and vigilant team of professionals.
A brace must be worn for the prescribed number of hours; for this to be possible, it must be tested by qualified medical staff who have the ability to make the small changes necessary to avoid any need to interrupt the treatment. Each patient and his/her family must then be followed up over time by a physician, physiotherapist and orthopaedic technician. Each of these professionals plays a crucially important role in helping patients to complete the course of treatment, minimising its impact on their daily lives.

The revolutionary SFORZESCO brace
The Sforzesco brace, named after the Medieval Sforza family to recall its links with the city of Milan where it was developed, was created in 2004 by Prof. Stefano Negrini, scientific director of Isico, and Gianfranco Marchini, an orthopaedic technician. Their aim? To find a solution, based on some of the characteristics of the Risser plaster cast and the Lyon, Sibilla and Milwaukee braces, that would make it possible for severe scoliosis patients to avoid having to wear a plaster brace. To correct the curve, it acts mainly by pushing the spine in a down-up direction.
It is an effective but also a readily acceptable brace, given its optimal wearability.
The Sforzesco is a “super-rigid brace”. It has an external envelope that reproduces the natural shape of the human body, and the corrective action of this brace is enhanced by the addition of several pushing pads (which exert a pushing action).
According to published scientific evidence (particularly that contained in the 2011 paper Brace technology thematic series – The Sforzesco and Sibilla braces, and the SPoRT Symmetric, Patient oriented, Rigid, Three-dimensional, active concept), the Sforzesco brace is more effective than the Lyon brace and as effective as the Risser cast in the presence of severe curves. It has also been found to be effective from an aesthetic point of view, helping to improve the appearance of affected patients. Its action is different from that of other brace types, being based on traction, posture, three-point correction and movement-based correction. It was in fact created according to the SPoRT (Symmetric, Patient-oriented, Rigid, Three-dimensional, active) concept of bracing.
In the process of developing this new brace type, the concept of symmetry was gradually superseded. Nowadays the external envelope is no longer perfectly symmetrical, although it remains unobtrusive and therefore an aesthetically valid solution.
The fact that patients come to see it as an extension of themselves helps us to make this treatment more readily accepted by them; and ready acceptance translates into increased compliance and greater effectiveness. The material used and the type of construction confer high rigidity, which means more effective pushing compared with that provided by other brace types.
The Sforzesco brace has a three-dimensional action on the spine. It grants the four limbs total freedom of movement, and allows the patient maximum freedom in activities of daily living. The trunk moves inside the brace in accordance with the direction of the correction, while movements in the direction of progression of the deformity are completely prevented. This is why these brace types are defined active.
Whatever type of brace the physician recommends, the management of the therapy is still the most important thing.

From this point on, the procedure is the same for all techniques: a plastic sheet is heated and wrapped around the positive model. The thickness of the plastic used may differ (ranging from 2 to 5 mm), as may its stiffness. Even though they are all made using similar methods, there exist different types of brace and they don’t all work in the same way.

How important, in scoliosis treatment, is the type of therapeutic instrument used? Obviously, both the treatment itself and the instrument chosen are very important factors. After all, while it is true that one brace may not be as good as another, it is also true that even an excellent one must be managed through an adequate therapeutic approach, which determines how, and how much, it should be worn. Obviously, the physician plays a key role in mediating this relationship, but the tolerability of the brace and the patient’s acceptance of it are fundamental elements, too. All these factors combined can increase the final effectiveness of the therapy.

Whatever type of brace the physician recommends, the management of the therapy is still the most important thing.
Prescriptive protocols envisage that treatment should be started with a very high dosage (21-23 hours of brace wearing per day), before gradually reducing this, in such a way as to allow the spine to grow, and the postural control system to adapt and get used to maintaining the correction imposed by the brace. This latter aspect is supported by specific exercises, which enhance the spine’s ability to maintain the correction.

Swimming is not a treatment option

Swimming is not a treatment option

Swimming is not a treatment option for scoliosis; on the contrary, if practised competitively it can, in many cases, be detrimental. And it carries the risk of causing low back pain.

This was confirmed by our study Swimming and spinal deformities: a cross-sectional study published in the Journal of Pediatrics.

The study compared a sample of 112 competitive swimmers (who swam 4-5 times a week) with an age-matched population of school students, both males and females, who swam recreationally or did not swim at all.

In both groups (the competitve swimmers and the students) we measured the following parameters: the prominence, caused by vertebral rotation kyphosis and lordosis. The youngsters were also administered a questionnaire collect data on low back pain.

The swimmers, especially the girls, showed more marked trunk asymmetries and were more likely to show hyperkyphosis (excessive curvature of the thoracic spine on the sagittal plane ) and, as a consequence, hyperlordosis (excessive inward curvature of the lower spine on the sagittal plane) and low back pain.

From a postural point of view, swimming will cause the spine to collapse” explains Fabio Zaina, a physiatrist at Isico, “because it is an activity that mainly trains the arm and shoulder muscles while the spine in unloaded. Its effect in terms of low back pain is already known: competitive swimming, precisely because it involves intensive training schedules causes low back pain.

On the basis of our data, we can certainly say that swimming should not be recommended as a treatment for scoliosis. Too much swimming can have a detrimental effect on posture and lead to low back pain”.

Obviously it all depends on the individual’s physique and how much he/she swims.

“It’s one thing doing 4-5 training sessions per week, and another doing recreational swimming. As for individuals affected by low back pain, or even scoliosis, who have been told for years to ‘go swimming as it will help’, well, that’s just not true!” says Dr Zaina.

Eurospine’s education program

Isico’s Dr Zaina is part of the team contributing to the new EUROSPINE Diploma in Interprofessional Spine Care (EDISC) course.

The 2018 Eurospine Congress held in Barcelona saw the unveiling of the new EUROSPINE Diploma in Interprofessional Spine Care (EDISC). The non-surgical task force given the mandate to develop the curriculum for this non-surgical interprofessional diploma includes Dr Fabio Zaina, who is responsible for the spinal deformities module of the course.
The aim of the EUROSPINE course is to optimise the prevention and treatment of spinal disorders and the care of affected patients, facilitating the exchange of knowledge and ideas in this field of research.
The education programme developed by the task force will benefit spine care professionals, the health care system and, more importantly, the patient. Among its outcomes, the diploma programme is expected to motivate participants to change their practice and implement evidence-based, patient-centred and collaborative care.
Two pilot modules are scheduled to take place in 2019 during the EUROSPINE Education Week in Geneva, Switzerland. Preliminary programmes and information about registration for these modules are available on www.eurospine.org.