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SEAS in adults

Over the past 13 years or more, we have published dozens of posts and thousands of comments on our blog dedicated to scoliosis.
The Isico blog is a dedicated space where patients can ask questions and swap experiences, but it is also a place where those involved in treating scoliosis can take a more in-depth look at a series of topics and also engage with patients.


SEAS in adults

“You’re too old now”, “Your scoliosis has stopped now that you’ve finished growing”, “If you want to, do some exercise”… How often do adults with vertebral deformities like scoliosis or hyperkyphosis hear things like this?
Our patients often tell us that on reaching adulthood they become aware of physical changes, in their back, their balance and their height, and these patients therefore start looking for answers and treatments.
The natural ageing process does not spare our back and changes are quite normal and to be expected: when they occur, it is important to get active in order to restore elasticity and strength to joints and muscles. But ageing is an entirely different situation compared with the occurrence of deviations of the spine in young people, in whom we seek to modify the bone structures and consequently reduce the degrees of curvature.
 
Scientific studies in recent years have clarified a number of aspects, that are worth bearing in mind:

1. Scoliosis exceeding 30 degrees at bone maturity, generally reached between 17 and 19 years of age, is at risk of progressing over the years, resulting in a worsening of the existing curves: and the higher the measurement, the greater the risk of worsening.
2. Will scoliosis inevitably lead to back pain? Absolutely NOT!
3. Does having a correct lateral spinal profile (lordosis-kyphosis) protect us against reduction of our quality of life due to disability and pain? YES, it does.

In the light of all this, it is important to know that in adults, too, it is possible to intervene both to correct postural abnormalities and to prevent and/or slow down worsening of scoliosis over time: our approach (SEAS) aims to do just this.
As an effect of the force of gravity, and also the curves that are already present, a scoliotic back will tend to drop down in the direction of the curve, and in many cases, there will also be a forward shift of the trunk. Simple physical activity alone, however useful and beneficial this might be, is not sufficient to counteract this phenomenon.
This can only be achieved through specific exercises designed to provide support for the structures of the spine in the opposite direction, and these reinforcement exercises must have precise and individual characteristics, in other words, they must be tailored to the individual patient.

The movements to be carried out must be chosen according to very specific priorities, and this is why it is necessary to turn to qualified professionals who have expertise in dealing with these conditions in adults, using approaches that have been shown to be effective.
The SEAS method requires constant collaboration on the part of the patient and seeks to make him “responsible for himself”.
The exercises are carefully worked out for each individual patient. They are initially performed under the guidance of the therapist and then performed independently, with the patient doing daily repetitions, at home.
Sessions with the therapist are initially scheduled monthly, although this frequency is subsequently reduced, possibly even to only once every three months, and patients are given exercise sheets to follow at home.
It takes at least six months to obtain appreciable results, sufficient to motivate patients to continue and thereby ensure they remain fit well into old age.

Scoliosis: situations to beware of in adulthood

The importance of keeping scoliosis under control through regular specialist check-ups is well known, and this is also true in adulthood when the condition can continue to evolve, albeit slowly and gradually (by half/one degree per year according to the literature).

Although curves measuring less than 30° are unlikely to progress (and a progression becomes less and less likely the further below this threshold the measurement is), curves greater than 50° will often worsen in adulthood. Accordingly, the frequency of medical check-ups is decided by the specialist on the basis of the individual patient’s clinical situation.

Idiopathic scoliosis – the form most frequently found in children and adolescents – affects females in particular. It is important to remember that there are certain times in the life of an adult woman when her body undergoes major transformations that make it necessary for her to take particular care of her back.

The first is pregnancy: it was once thought that scoliosis was most at risk of worsening during pregnancy, due to the body’s production of the hormone relaxin in preparation for childbirth; it was thought that this hormone, in addition to softening the ligaments of the pelvis ready for delivery, also had the same effect on the ligaments that help to support the spine, thereby temporarily reducing the level of trunk support.
Now, however, it is understood that the postnatal period and early months in the child’s life are the trickiest time for the mother. Indeed, in the first year of life, babies often need to be held or carried, and in the space of just a few months, they become considerably heavier. Furthermore, as they learn to walk, the mother often finds herself having to adopt a forward bent position. Obviously, all this can have a negative effect on the back, affecting posture and giving rise to pain. At the first sign of back support problems (pain, difficulty getting through the day, frequently needing to lie down), women with scoliosis, particularly if it is a severe form, would be well advised to do specific self-correction exercises prescribed by an expert physiotherapist; these exercises strengthen the back and help it to support the spine.

Finally, in menopause and beyond, the clinical situation is at increased risk of sudden worsening.
The body changes and the aging process, which accelerates with the onset of the menopause, can cause a worsening of existing curves and even the appearance of new ones, so-called de novo scoliosis. 

Although men are less often affected by idiopathic scoliosis and are of course spared the major physical and hormonal changes that women go through, they are just as likely as women to experience aging-related scoliosis.
This form can cause postural imbalances severe enough to leave the affected individual with marked forward and/or lateral flexion of the trunk.
In this stage of life, a specialist medical examination is warranted in the presence of the following: onset of pain, an increasingly bent posture, worsening of postural asymmetries, loss of height, and difficulty supporting the trunk, relieved only when lying down.