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SEAS: A New Study Demonstrates Its Greater Effectiveness Compared to Other Methods

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The SEAS approach, developed over 20 years ago by ISICO in Italy, has emerged as the most effective in reducing the Cobb angle, according to a significant meta-analysis recently published by Wang et al., “Comparative efficacy of six types of scoliosis-specific exercises on adolescent idiopathic scoliosis: a systematic review and network meta-analysis” (2024).

This study compared six of the most widely used scoliosis-specific exercise methods worldwide for adolescent idiopathic scoliosis: SEAS (Italy), Schroth (Germany), DoboMed (Poland), Side-shift (United Kingdom), Active Self-Correction (Italy), and FITS (Poland).

It is important to note that various exercise-based scoliosis treatment methods and approaches originated in Europe in the last century and have since spread globally. While the effectiveness of bracing in preventing scoliosis progression and the need for surgery is well-documented, the definitive effectiveness of specific exercises has yet to be fully proven.

Out of 465 studies initially identified in the meta-analysis, only 24 met the rigorous inclusion criteria, analysing a total of 1,069 subjects. The meta-analysis highlights that SEAS achieves the best results in reducing the Cobb angle, while Active Self-Correction and the Schroth method are more effective in reducing the Angle of Trunk Rotation (ATR) and improving quality of life.

SEAS exercises themselves are based on an active form of self-correction, enabling SEAS to deliver positive results on multiple fronts: reducing both the Cobb angle and ATR, while also ensuring a good quality of life for the patient. This was confirmed by a study published a few years ago, “Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: a practical clinical trial”, which also contributed to lowering the risk of requiring a brace and/or experiencing scoliosis progression.

“These results confirm the importance of the SEAS approach in the conservative management of adolescent idiopathic scoliosis,” says Alessandra Negrini, physiotherapist at ISICO. “However, for SEAS to be definitively recognised as a treatment capable of altering the natural progression of scoliosis, further high-quality studies with long-term follow-ups are needed.”

This study marks a significant step forward in research on the effectiveness of scoliosis-specific exercises. The findings are encouraging and reinforce the importance of an evidence-based approach in the conservative treatment of adolescent idiopathic scoliosis.

Degrees of curvature and height: is there a relationship?

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The questions our patients ask us are often opportunities to provide useful information to them and others.

Francesco’s questions prompted us to examine the possible correlation between scoliosis, degrees of curvature, and height growth. 

“Let me start by describing my particular experience: at the age of 17 and a half, in a skiing accident, I injured my patellar tendon, which was operated on and then put in a brace for 30 days. Once I had recovered and regained full mobility, I had a physiatrist colleague of my father who examined me. During the examination, he measured my height (178 cm) and checked my back, remarking that I perhaps had very mild scoliosis (there was no talk of X-rays, much less of degrees of curvature and so on). Let’s just say that I took the information on board and left it at that.

This year I had a checkup with the same physiatrist, and on seeing me he was immediately struck by how much taller I had grown: he measured me, and I was 184 cm.

I’m sure I’m not unique, but I would guess it’s quite rare for a boy of 17 and a half to gain another 6 cm.

He looked at my back and told me it was “a bit worse”. I was quite upset about that because, being completely ignorant on the subject (like anyone who has no direct experience of this deformity), I had imagined it was something that could be remedied by improving my posture or through physical activity. He reassured me, telling me that by now it should have stabilised (“stable until proven otherwise” as you say) and not to worry about it too much. This time, though, he recommended an X-ray. 

What I learnt from the X-ray was that my latest growth had done me more harm than good and had seemingly affected the scoliosis more than anything. Also, at the initial examination I’d had a much chubbier, more child-like physique, which at the time might have helped to mask the scoliosis somewhat. Functionally, though, I have no pain (since, as you have told me, my curve is moderate), and fortunately, aesthetically it is not too noticeable.

So, here are my two questions:

  • Given that the human body generally declines with age, does that mean I am at risk of becoming, in the future, one of those old men you see with a walking stick, bent over and crooked? In other words, even though my scoliosis shouldn’t get worse in adulthood, am I more likely than someone without scoliosis to end up like the kind of elderly person I just described?  
  • Is there a relationship, however approximate, between the number of Cobb degrees and the number of cm lost in height? I have read that you lose 1 cm in height for every 10° of Cobb angle, and therefore that you can divide your degrees of curvature by 10 to work out how much height you’ve lost”.

Here is our response.

First of all, it’s not unusual for males to gain a few more centimetres after reaching the age of 17. In fact, height growth is linked to skeletal maturation, a process that in boys begins and therefore also ends a few years later than in girls. Scoliosis is a pathology that, to worsen, exploits bone growth, accentuating the vertebral deformity; this could explain the clinical findings from your latest examination.

As regards height “lost” due to scoliosis, I would say that having reached around 1.85 m, you can’t really complain …! That said, to answer your question, with a 30° curve you lose 1–1.5 cm at most.

Some international scientific journals have published mathematical formulas for calculating centimetres lost due to scoliotic curvature(s) of the spine.-

These calculations also take into account the ratio between height when seated (trunk and head) and height when standing.

The studies published on this topic evaluated scoliosis cohorts (between 140 and 1500 subjects enrolled) and reported an average height loss of 3.38 cm for females and 2.86 cm for males.

The formulas providing the most valid estimates of height loss are those of Kono and Stokes, according to which a scoliotic curve of 80° seems to lead to a loss of between 3.5 and 5.5 cm, while one of 100° appears to correspond to between 4.5 and 8.5 cm in lost height. The greater the curve, the more the estimates produced by the two formulas differ; instead, they give comparable results for smaller curves.

Patients with severe curves also tend to ask surgeons about height, but in terms of gain, asking: “How many extra cm of height will this operation give me?” The answer to this question is less certain, because there are too many factors at play, so many in fact that no pre-surgical prediction can be considered reliable.

As for your concerns about adulthood and old age, you will understand that I can only reply in very general terms. With curves of around 30° at the end of growth, the risk of the condition worsening over future decades is very low.

It’s like someone with slightly raised cholesterol or high blood pressure asking me: am I going to have a heart attack in a few decades’ time? Although high cholesterol levels, systemic arterial hypertension, a sedentary lifestyle and other factors are associated with increased cardiovascular risk, it isn’t possible to translate estimates of the risks associated with a specific disease into a clear prediction for an individual case.  

In terms of prevention, in adults with scoliotic curves similar to yours, regular physical activity is recommended in order to maintain good general muscle tone, able to counteract the worsening effect that gravity would otherwise have on the curves over the years.

SEAS: How it trains active self-correction

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Physical exercises, whether in a sporting or rehabilitative context, are motor actions repeated to improve a function or skill. This function may be as simple as muscle strength or joint mobility or as complex as balance or coordination.

SEAS, our approach to scoliosis-specific exercises, was conceived with a different perspective compared to most other specific treatment methods.

In other approaches, unlike SEAS, the exercise involves adopting a position to achieve the maximum possible spine realignment and reduction of curves. This correction is typically static and passive, focusing primarily on achieving the best geometric realignment of curves, with little regard for movement.

Achieving this outcome often necessitates external aids, such as unusual body positions or physical supports. In other treatment methods, tools like pushing against a rigid instrument such as a stick, hanging from wall bars, or placing a support under the pelvis are commonly used to assist in aligning the scoliotic spine. These actions are identified as exercises and serve as a shortcut to achieving the best passive correction of the curves.

In the SEAS approach, the focus is on training active self-correction of curves. Exercises are designed to progressively destabilise this active (rather than passive) correction, compelling the patient to stabilise and regain it when necessary.

Correct and Controlled Exercises

The key role of the experienced therapist is selecting the appropriate level of destabilisation. As in any active training, the exercise should progressively increase the challenge of the targeted action.

An exercise is “correct” when it is selected after a thorough assessment of the level of destabilisation the patient can handle. It is “controlled” when it is neither excessively destabilising—risking loss of correction control—nor insufficiently destabilising, rendering it ineffective for training the ability to maintain correction in more complex situations.

The World Organisation for the Conservative Treatment of Scoliosis (SOSORT) recommends exercises focused on self-correction: movements that counteract spinal curves, stabilising and integrating them into daily life. In the SEAS method, exercises involve actively reaching and maintaining the self-corrected position despite various challenges. Gradually, through continuous practice, patients learn to integrate self-correction into everyday activities such as eating, walking, or doing homework.

A Practical Example

Long-term training, gradually increasing both distance and speed, is essential to prepare for a marathon and build sufficient strength and endurance to run 42 kilometres.

In our approach, exercises represent progressively chosen challenges to destabilise appropriate corrections. If the correction becomes too simple and the disruption fails to adequately destabilise it, the exercise cannot effectively train the ability to manage self-correction in more complex situations.

How Much Time Should Be Spent on Exercises?

The recommended daily practice is 20 minutes, with one rest day per week, totalling approximately two hours per week. Although this represents a significant commitment, especially given the duration of therapy, keeping a balance is crucial. Some parents, especially at the start, ask whether more practice is possible. Our response is that the training should be sustained without causing fatigue in a therapy that may span years.

Learning a musical skill is a practical comparison that illustrates the importance of consistency. A pianist cannot master complex pieces in a week but must practice daily with dedication, gradually progressing. Similarly, the SEAS approach requires continuous and progressive training, continuing until skeletal maturity reduces the risk of scoliosis progression.

Through the SEAS method, patients can actively train self-correction, transforming it into a stable and enduring skill that supports their daily life.

The Body

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Chiara Castiello is a psychologist expert in adolescence and social innovation, with a deep passion for photography, writing, and jazz music. Chiara wore a brace for many years, from the age of ten until she was 18. Even today, she continues to care for her back and is one of our adult patients.
Chiara has shared with us her experience as a young girl wearing a brace, but above all, she has offered a reflection as an adult and psychologist on the importance of body perception and both physical and mental health. Thank you!
Below is her text, “The Body” by Chiara Castiello.

“Are you an only child?”
To my astonishment, it was the second time I repeated, “Yes, I am.”
And it couldn’t be otherwise. It was either a blessing or a necessity that I was. At ten years old, the vertebrae in my spine decided not to align perfectly but instead to take on a C-shape, like the initial of my name. After narrowly avoiding a plaster cast, an orthopaedic brace was the treatment recommended by doctors from a Northern region of Italy. Long and repeated car journeys, endless waiting times, and fittings of this “garment” made of rigid plastic and aluminium, with pressure applied to the hips and behind one shoulder.

At first, it really feels like a tailored outfit, and the sensation is even somewhat pleasant. Standing in a room with your arms resting on two poles that help keep them supported and away from your chest. A tight-fitting gauze in a butter colour is slipped onto you, and then warm plaster strips are applied, shaping your body. The “garment” takes shape, solidifies, and suffocates you in a very short time. Then scissors cut it under the armpit, opening it like a door, and you emerge, naked and cold.

The orthopaedic brace teaches you endurance. It teaches you to sleep on your back on the hard surface of the plastic, to bear the cold touch of the aluminium in winter. To appreciate shade and cool places in the summer. It teaches you discipline; in my case, I could only remove it for one hour a day for a long time. It teaches you not to scratch mosquito bites, as they are unreachable, locked inside your “box”! It instils moderation, compressing your stomach if you eat too much.
It teaches you to cover yourself for fear of being found out. Not to follow fashion, because you can’t. To button the collars of your polo shirts, buy them in a larger size. To pick up things from the floor with your feet so you don’t have to bend too often. To quickly dart through security gates at museum entrances to avoid setting off alarms. To dodge hugs from boys, while secretly yearning for them.

It denies you a comparison with others because they are healthy, normal, and free. It deludes you into always feeling like a child and prevents you from thinking about your body, which is there but invisible. Artificially supported, it grows under compression. Its development, except for the worsening of the spine, remains imperceptible. And when the “garment” becomes tight, you rush back north to get a new one.

During these endless visits, my parents and I were transported by car for 620 kilometres, my body and its black-and-white photographs: the X-rays on which doctors, in white gowns with rulers and red pencils, recorded numbers and the degrees of curvature, marking the positive or negative progress of my condition. This body-object, so medicalised, observed, and adjusted, was a stranger to me. It grew, changed, betrayed me, worsened without my control and, after great effort and many years, healed.

As a patient and adolescent (now an adult) with scoliosis, I wish to shed light on the importance of working in parallel with one’s perception of body image. To perceive: to become aware of oneself. I am my body; it belongs to me, and I relate to the world through it. Despite the plastic “box,” I can live, connect, and experience this non-object outside its cage.
And there is more. The “Self” cannot be put on hold while waiting for the body to heal because the two are not separate entities. Put differently, it is essential not to neglect the wholeness of a person as the union of body and psyche. The well-being or suffering of both travels in the same carriage of the same train; they are interdependent. Sartre wrote that the “body is the ultimate psychical object, the only psychical object” (1943, p.429).

If this was understood, one wouldn’t feel so unprepared at the end of treatment, so afraid, fragile, defenceless, fragmented. Medicalising and isolating the body is a mistake still too often made in care practices, but the body lives and breathes as part of its whole being. We are our history, our experiences, from birth onwards; we are unique and, as such, deserve to be welcomed.
Only in this way can we truly consider ourselves healed and free.

Is Life Turning You Kyphotic? Here’s How to Prevent It

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The spine supports the torso and allows the head to stay upright, keeping the gaze towards the horizon. Proper alignment in the sagittal plane helps maintain the torso in the correct position with minimal energy expenditure and optimal load distribution along the spine.

Over time, particularly in older adults, a forward imbalance tends to develop, causing the torso to lean forward. Researchers have identified the age range of 50 to 60 as the period when this imbalance typically begins to manifest, progressively worsening with age. Compensatory mechanisms then come into play, creating a vicious cycle involving the pelvis and the entire spine, leading to specific degenerative changes.
The pelvis tilts backwards, lumbar lordosis decreases, and the upper torso bends forward. In some cases, these changes in sagittal alignment occur rapidly and progressively, developing into pathological conditions.
Certain factors may exacerbate this, such as the presence of scoliosis, disc disorders leading to reduced lordosis, or stiffness in the spine. Severe kyphosis or kyphosis resulting from vertebral fractures also contributes to forward collapse, as does weakness in the spinal extensor muscles, leading to forward lean.

Now, let’s consider our daily activities.
Most of what we do involves looking downward or at least keeping the head tilted forward. For example, how much strain is placed on the cervical vertebrae when the head is tilted forward at 30 degrees? (Remember that we usually tilt our heads much more than 30 degrees when we look at our phones.)

At this angle, the discs experience 400% more stress than when the head is upright and looking forward. The natural tendency towards forward collapse, combined with daily activities that increasingly involve static, flexed postures and potential degenerative spinal conditions, accelerates the forward tilt of the torso. This forward imbalance results in pain, reduced spinal functionality, fatigue, aesthetic concerns, and, most importantly, a decline in quality of life.

What Can We Do?

  1. Resist Gravity: Throughout the day, whether standing or sitting, try to sit or stand up straight and hold this position for a few seconds.
  2. Engage in Regular Physical Activity: Any exercise is beneficial, but activities that engage the trunk extensor muscles are especially helpful. Don’t stop moving! It’s also a good idea to vary your exercises over time, which will benefit your back as well.
  3. Seek Medical Advice: If you notice yourself leaning forward when tired, especially in the evening, or if those around you point out that you’re becoming more stooped, it’s time to seek a medical evaluation.

…And if life pushes us forward? Let’s straighten it out!

Artificial Intelligence: A Revolution in Rehabilitation?

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Artificial Intelligence (AI) is transforming how medical professionals approach rehabilitation, offering innovative tools that enhance the quality of treatment. At ISICO, we are increasingly committed to exploring how AI can support daily clinical work and contribute to highly personalised therapeutic decisions.

We discussed this with Francesco Negrini, a specialist physiatrist at ISICO and the author of a groundbreaking 2023 study on AI and rehabilitation. This study, “Developing a new tool for scoliosis screening in a tertiary specialist setting using artificial intelligence: a retrospective study on 10,813 patients,” won the prestigious SOSORT Award in 2023.

Dr Negrini recently presented another paper exploring the use of AI in rehabilitation projects, particularly in stroke recovery.

What Are the Key Areas Where AI Can Be Used in Rehabilitation?
Artificial Intelligence (AI) is incredibly versatile and can be applied at various stages of the medical process. It can range from diagnosis, using automated analysis of X-ray or MRI images to identify pathologies with greater precision, to prognosis, with predictions on treatment outcomes, and on to the personalisation of treatments, determining the most effective therapeutic pathway based on patient data. AI also enables continuous monitoring, allowing real-time patient progress evaluation to adapt the treatment accordingly.
At ISICO, we are exploring, for example, how AI can support personalised treatment approaches. This technology could analyse a patient’s natural history and the likelihood of success when using one type of brace over another, providing physicians with more accurate decision-making tools.

Can you give a concrete example of how ISICO is using AI?
A significant example is the research that won the SOSORT Award 2023, recently published (link). The study demonstrated how analysing clinical data using advanced techniques can enhance our understanding of scoliosis and its treatments.

Another potential application involves the diagnosis of low back pain, where AI can analyse radiographic images to identify aetiologies that the human eye might otherwise miss. This approach takes advantage of today’s enhanced computational power, enabling the rapid and accurate processing of large volumes of data.

How Could AI Transform the Management of Spinal Disorders in the Future?
There are three key areas where we see tremendous potential. The first is screening and early diagnosis, which involves early detection of scoliosis or other conditions to improve treatment outcomes. The second area is the customisation of braces, using data collected from clinical centres to predict which type of brace will be most effective for a specific patient. Lastly, monitoring outcomes plays a crucial role, as it allows for tracking the progress of therapy and adapting it based on observed improvements, thereby enhancing the overall effectiveness of treatment.

What Makes AI Such a Valuable Ally for Clinicians?
AI amplifies a clinician’s capabilities, providing more detailed information and helping them make data-driven decisions. However, as we always emphasise at ISICO, the doctor-patient relationship remains central. AI does not replace a clinician’s experience and empathy; instead, it offers tools that enhance human expertise.

What is the Future of AI in Rehabilitation Medicine?
I believe we will see an increasingly close integration of AI in clinical practice. At ISICO, we are moving in this direction, exploring how AI can improve therapeutic outcomes and make rehabilitation more targeted. We are just at the beginning, but the possibilities are immense, especially if we can combine the best of technology with the invaluable expertise of healthcare professionals.

SEAS Therapy: 20 Minutes of Daily Exercises at Home – Too Much or Too Little?

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The International Society for Conservative Scoliosis Treatment (SOSORT) recommends exercises based on self-correction, which involves movement aimed at counteracting spinal curves, stabilising this position, and integrating it into daily life【1.

At ISICO, we have developed and use the SEAS approach. These exercises involve actively achieving the self-corrected position and working to maintain it despite various challenges. The exercises are designed to test the stability of the correction, requiring the patient to stabilise their spine and recover the correction if control is lost【2.
Gradually, as therapy progresses and through continuous practice, patients become more adept at incorporating self-correction into their daily lives—for example, while eating, walking, or doing homework.

How much time should be dedicated to practising the exercises each day?
Typically, 20 minutes daily is a significant commitment, especially as this therapy can last for a long time—sometimes several years. Patients are given one rest day per week, making the total weekly commitment about two hours.

Some parents, particularly at the beginning, ask whether more than the prescribed amount can be done. We usually respond that it is important to train without overwhelming the patient. For example, consider marathon training: a young person should not exhaust all their energy at the start and then abandon therapy, but instead maintain endurance and continue until skeletal maturity. At this point, we can say that the risk of scoliosis progression has decreased.
Conversely, reducing the duration would result in an insufficient period of practice. When we think about how much time young people spend on their phones daily, 20 minutes is not much.

How much time is needed for exercises in other scoliosis treatment approaches?
According to current data, the other most widely used approach globally is the Schroth therapy, developed in Germany.
This method involves hospitalisation in a specialised clinic for 3–4 weeks, during which patients undergo daily two-hour sessions to learn the exercises properly. After the training period, patients are instructed to continue the exercises at home and visit the clinic one to four times a month to ensure proper execution【3.
Alternatively, patients can learn the exercises through closely spaced individual sessions with a therapist, lasting 60–90 minutes, followed by weekly group sessions of 60 minutes, combined with a daily home exercise programme lasting 30–45 minutes【4.
This represents a significantly greater commitment than the 20 minutes required for SEAS therapy.

1. Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3. doi: 10.1186/s13013-017-0145-8. PMID: 29435499; PMCID: PMC5795289.

2. Romano M, Negrini A, Parzini S, Tavernaro M, Zaina F, Donzelli S, Negrini S. SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis. 2015 Feb 5;10:3. doi: 10.1186/s13013-014-0027-2. PMID: 25729406; PMCID: PMC4344739.

3. Rigo M, Reiter C, Weiss H-R. Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil. 2003;6(3–4):209–14.

4. Burger M, Coetzee W, du Plessis LZ, Geldenhuys L, Joubert F, Myburgh E, van Rooyen C, Vermeulen N. The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. S Afr J Physiother. 2019 Jun 3;75(1):904. doi: 10.4102/sajp.v75i1.904. PMID: 31206094; PMCID: PMC6556933.

How to Write a Winning Abstract: 10 Key Tips for SOSORT 2025

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The deadline for SOSORT abstract submissions is fast approaching! December 7th is just around the corner, and with the conference scheduled for April 23-26, 2025, in Dubrovnik, it’s time to refine your submissions.
To assist those still working on their abstracts, ISICO has prepared a practical pocket guide with tips. These are based on SOSORT’s guidelines, provided by the Scientific Committee. For more detailed insights, a SOSORT webinar on the topic is also available. Additionally, we’ve included a special tip from our researchers, offering a glimpse into the unique approach we follow at our institute.
ISICO’s approach emphasises the direct link between research and clinical applications, reinforcing the idea that addressing existing clinical challenges can lead to advancements in understanding and rehabilitation therapies.

SOSORT Guidelines for Presenting an Effective Abstract

  1. Craft a Clear and Specific Title
    • Keep the title concise but informative. Focus on the essence of the work, using terms that reflect your main objectives and findings. The title word count is not included in the abstract text but should be condensed and not exceed 300 characters.
  2. Highlight Key Objectives and Results
    • Define the primary goal of the study and the hypothesis tested. Summarize your findings briefly, emphasising data that strongly support your conclusions.
  3. Follow the Required Structure
    • Organize your abstract according to the conference’s format: introduction, methods, results, and conclusions. This makes your abstract easier to read and aligns with reviewers’ expectations.
  4. Be Compact and Precise
    • Avoid unnecessary details and focus on delivering the most essential information. Each sentence should add value to the abstract and enhance overall clarity. The body of the abstract text must NOT exceed 450 words and must include the following sections: title, authors, background, objectives, study design, method, result, clinical significance, and level of evidence. 
  5. Avoid Brand Names and Commercial References
    • Maintain a neutral tone by using generic terms instead of brand names, enhancing scientific objectivity.
  6. Use Tables or Graphs Strategically
    • If allowed to include one table or figure, choose the data that best summarizes a key aspect of your work. Make sure it’s clear and enhances understanding.
  7. Check Ethical Compliance
    • For studies involving human subjects, ensure you have the necessary approvals, as you’ll be required to confirm this during submission.
  8. Request Feedback and Mentorship
    • If pre-submission mentorship is available, use it to get feedback on impact, clarity, and quality.
  9. Review Additional Writing Resources

ISICO’s Insightful Tip

  1. Identify Clinical Needs or New Insights in the Field
  • Stefano Negrini, ISICO Scientific Director: “When it comes to research, start from a clinical need. Focus on something that has already been explored to some degree or choose a topic highlighted by recent articles in the field. This approach adds value, ensures relevance to clinical practice, and drives improvements in the therapies themselves.”
  • Fabio Zaina, physiatrist: “By following these guidelines, you can ensure your abstract aligns with SOSORT’s standards, effectively communicates your research, and contributes to advancing evidence-based scoliosis care and conservative treatment practices. Additionally, ensure the title is clear, focused, and engaging, as this will help attract attention to the research.”

Scoliosis X-rays: Why We No Longer Use Old Protections

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The use of protective devices intended to shield the foetus and gonads of the patient during X-ray imaging should be discontinued as a routine practice since it can compromise its benefits. This recommendation, published in April 2019 by the American Association of Physicists in Medicine AAPM represents a historic change.

Why, after more than 70 years of gonadal protection, have we reached this conclusion?
Let’s take a closer look. At ISICO, this topic is particularly important to us because we need to visualise the spine to offer the best therapies for scoliosis and assess its progress properly. Thus, while we reduce requests as much as possible, it’s almost always necessary to prescribe complete spine X-rays in one projection (either frontal or lateral) at least once a year.

Why This Change? There Are Two Reasons:

  1. Minimal or No Benefits from Protections
    Current scientific evidence shows that these protections provide minimal or no health benefits to patients. In the past, it was believed that radiation could damage reproductive cells, potentially harming future offspring. However, it has been discovered that reproductive cells are much less sensitive to radiation than previously thought, and there is no evidence that the very low doses currently used in diagnostic imaging can harm reproductive cells or the foetus. Radiation is not harmful to the foetus, even when a radiographic exam on a pregnant patient is necessary and indispensable.
  2. Negative Impact on Exam Effectiveness
    The protective equipment can obscure anatomy or significant pathologies or produce artefacts that require repeating the exam, thereby substantially increasing the dose. Additionally, most modern X-ray equipment can automatically adjust the amount of radiation used based on the body region being examined. Lead-equivalent individual protection in the field of view could lead to a significant and unjustified increase in the patient’s dose. These technological advancements have made patient shielding a practice that introduces more risks than benefits.

In line with this evidence, at ISICO, we discourage using these protections as they could potentially be harmful.

Gym workouts and scoliosis: can the two go hand in hand?

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In recent years, fitness has become a booming industry, driven by a growing interest among young people and on social media. This trend has resulted in the emergence of better-qualified fitness professionals, triggering a virtuous circle in terms of improving the quality and safety of training.

From our perspective, it is worth remembering that physical activity, if performed correctly, can have a protective role in the management of scoliosis.
We are often asked whether patients with scoliosis, particularly those undergoing bracing treatment, can work out in the gym.
Before answering this question, let’s make two things clear:

● the literature contains nothing specific on this topic;

● “working out in the gym” means more than one thing (i.e., not all training is the same).

The importance of goals
Before embarking on a training programme, it is crucial to establish your personal goals. Among adolescents, the main reasons for working out are often the desire to build muscle (boys) or tone up (girls). However, in adolescence, learning the correct training techniques and improving your physical abilities, such as coordination, balance, strength, and resistance, are more important than immediately seeking to bulk up your muscles.
Young people will find that efforts to gain muscle mass give more gratifying results once they have finished growing (i.e. after reaching 16-18 years of age).
The best approach, then, is to try to focus on what you actually do in the gym, striving to do it better and more effectively and thinking less about what you see in the mirror.

The benefits of training in the gym

Training in the gym offers you the chance to monitor your body and safely regulate training stimuli, unlike when practising many competitive sports, during which you are more likely to sustain an injury. Several studies show that the gym is associated with a lower injury rate than other sports.

Advice for those with scoliosis

We should first point out that young people with scoliosis (boys and girls) are, in most cases, no different from their peers who do not have scoliosis. Having said this, we do have some advice.

  1. Find a professional. A properly qualified trainer can help you do the exercises correctly and adapt the training programme to your individual requirements. It might also be a good idea to put your doctor/physiotherapist and trainer in contact with each other, so that the training programme can be refined and any doubts addressed.
  2. Don’t be in a hurry. Targeted warm-up exercises can improve flexibility and reduce stiffness in the spine.
  3. Choose your exercises. It is important to start with simple and controlled exercises, then gradually increase the difficulty level.
  4. Take care with axial loads. Axial loading exercises must be performed carefully to avoid sudden or compensatory movements. When it comes to the squat, for example, the goblet squat may be the best option as it is performed with the weight (dumbbell/plate/kettlebell) held in your hands, at chest height, in front of you. By facilitating load management, this version guarantees greater stability and makes it easier to control the movement.
  5. Learn to “dose” self-correction. When you are working out in the gym, the amount of self-correction you apply (i.e., the extent to which you adopt the position designed to counteract the scoliotic curves and therefore keep your spine more aligned) will depend on the type of exercise you are doing and the level of fatigue you are experiencing. The objective of exercises done in the gym differs from that of the specific exercises taught you by your physiotherapist, where self-correction is the key element, and determines how the exercises are performed. When you are using weights, the priority is to focus on the specific training stimulus, while at the same time trying to keep your spine properly supported.

Should a brace be worn in the gym?

Individuals who are being treated with a brace can consider doing their physical activity during their brace-on hours, so as to take full advantage of the support provided by the brace itself. However, if they prefer to train during their brace-off window, they should make sure they do a longer warm up, so as to prepare their back for the training session.

So, finally

Working out in the gym is possible for those with scoliosis and can indeed be beneficial if the necessary precautions are taken. Be sure to find a professional trainer, keep your doctor in the loop, and listen to your body because these are the keys to safe and effective training.