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30 Seconds Of Therapy: Are Heel Lifts Making Scoliosis Worse?
Jun 3
9 min read
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Diagnosing Correctly: AIS (Adolescent Idiopathic Scoliosis)
AIS is a 3D spinal and trunk deformity in children over age 10, with no known cause. (Includes lateral curvature with rotation, Structural (fixed) vs. Postural (flexible) asymmetries, Vertebral deformity occurs first, then spinal curve develops)
Verify Objective Findings: (Don’t Rely on Posture Alone)
Adams Forward Bend Test: rib hump ≥ 5–7°
Cobb Angle ≥ 10° on X-ray (required)
Look for vertebral rotation & wedging.
Visual curve patterns: (Thoracic, Lumbar, Double Curves)
Understand Underlying Mechanisms
AIS is not just muscular—bone, growth, and nervous system timing are involved.
Causes are multifactorial: (Growth plate Asymmetry, CNS/ANS mismatch “Bi-NOTOM Theory”, Genetics and Hormonal "Leptin"
Test Results: Low bone density, abnormal bone cell activity.
Progression is 3D: Growth + asymmetrical loading = spinal torsion and instability.
STOP
Ignoring Early Screening
Delaying referral increases curve progression.Screen girls at 10 & 12, boys at 13–14: Early detection = better outcomes, fewer surgeries.
Adams Forward Bend Test + Scoliometer: (Refer if ATR ≥ 5° (SOSORT) or ≥ 7° (SRS)
Relying Only on Observation
Clinical signs aren’t enough—confirm with imaging: Order standing PA & lateral full-spine X-rays.
Must report: Cobb angle (≥ 10° confirms scoliosis), sagittal balance, Risser score.
Using Heel Lifts Without Imaging:
Leg length discrepancy (LLD) is often functional, not structural.
Do not use heel lifts based only on clinical observation: Clinical tools (tape measure, blocks) are not accurate enough.
Use CT scanogram or full-length standing X-ray for confirmation Improper use of heel lifts can disrupt mechanics and worsen postural asymmetry.
WHY
Early Screening and Imaging Matter
Detecting scoliosis during growth spurts allows PTs to initiate timely, effective conservative treatments like bracing and PSSE—before the curve progresses to surgical range.
Conservative Management Is Not Passive Care
Evidence-based programs like PSSE combined with bracing don’t just slow curve progression—they can reduce pain, improve posture, and enhance breathing and body image and empower adolescents to intervene in their condition.
References: 1. MedBridge Adolescent Idiopathic Scoliosis Part 1: Definition & Diagnosis Cindy Marti, PT 2. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomized controlled trial M. Monticone, E. Ambrosini, D. Cazzaniga, B. Rocca, and S. Ferrante, “European Spine Journal, vol. 23, no. 6, pp. 1204–1214, 2014. View at Publisher · View at Google Scholar 3. Adolescent idiopathic scoliosis: current concepts on neurological and muscular etiologies. Wajchenberg M, et al. Scoliosis Spinal Disord. 2016; 11: 4.Published online 2016 Jun 27. doi: 10.1186/s13013-016-0066-y 4. Association between components of body components and scoliosis – a prospective cohort study reporting differences identifiable before the onset of scoliosis. Clare EM, Taylor HJ, Harding I, Hutchinson J, Nelson l, Deinfield JE J Bone Miner Res. 2014;29(8):1729-36 5. Ceballos-Laita, L., Carrasco-Uribarren, A., Cabanillas-Barea, S., Pérez-Guillén, S., PardosAguilella, P., & Jiménez Del Barrio, S. (2023). The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis. European journal of physical and rehabilitation medicine, 59(2), 228–236. https://doi.org/10.23736/S1973-9087.23.07654-2 6. Effects of Bracing in Adolescents with Idiopathic Scoliosis. Weinstein S, Dolan L, Wright J N Engl J Med 2013; 369:1512-1521October 17, 2013DOI: 10.1056/NEJMoa1307337 Effects of Exercise on Spinal Deformities and Quality of Life in pateints with Adolescent Idiopathic Scoliosis , Anwer S et al. BioMed Research International Volume 2015 (2015), Article ID 123848, http://dx.doi.org/10.1155/2015/1238487 7. Menger, R. P., & Sin, A. H. (2023). Adolescent and Idiopathic Scoliosis. In StatPearls. StatPearls Publishing. 8. Prognostic Value of Bone Mineral Density on Curve Progression: A Longitudinal Cohort Study of 513 Girls with Adolescent Idiopathic Scoliosis Benjamin Hon Kei YIP , Fiona Wai Ping YU, Zhiwei WANG, Vivian Wing Yin HUNG, Tsz Ping LAM, Bobby Kin Wah NG, Feng ZHU & Jack Chun Yiu CHENGScientific Reports 6, Article number: 39220 (2016)doi:10.1038/srep39220. 9. Three-Dimensional Vertebral Wedging in Mild and Moderate Adolescent Idiopathic Scoliosis Sophie-Anne Scherrer ,Mickaël Begon,Alberto Leardini,Christine Coillard,Charles-Hilaire Rivard,Paul Allard Published: August 15, 2013 https://doi.org/10.1371/journal.pone.0071504 10. Vendeuvre, T., Tabard-Fougère, A., Armand, S., & Dayer, R. (2023). Test characteristics of rasterstereography for the early diagnosis of adolescent idiopathic scoliosis. The bone & joint journal, 105-B(4), 431–438. https://doi.org/10.1302/0301- 620X.105B4.BJJ-2021-1440.R3 11. Wang, W., Chen, T., Liu, Y., Wang, S., Yang, N., & Luo, M. (2022). Predictive value of single-nucleotide polymorphisms in curve progression of adolescent idiopathic scoliosis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 31(9), 2311–2325. https://doi.org/10.1007/s00586-022-07213-y 12. Xu, W., Zang, J., & Wu, F. (2023). Association between lean mass and adolescent idiopathic scoliosis: a meta-analysis. BMC musculoskeletal disorders, 24(1), 671. https://doi.org/10.1186/s12891-023-06622-4 13. Zale, C. L., & McIntosh, A. L. (2022). Adolescent Idiopathic Scoliosis for Pediatric Providers. Pediatric annals, 51(9), e364–e369. https://doi.org/10.3928/19382359-20220724-01 14. MedBridge Adolescent Idiopathic Scoliosis Part 2: Clinical & Radiological Evaluation Cindy Marti, PT 15. Karam, M., Ghanem, I., Vergari, C., Khalil, N., Saadé, M., Chaaya, C., Rteil, A., Ayoub, E., Saad, E., Kharrat, K., Skalli, W., & Assi, A. (2022). Global malalignment in adolescent idiopathic scoliosis: the axial deformity is the main driver. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 31(9), 2326–2338. https://doi.org/10.1007/s00586-021-07101- x 16. Lee, J. S., Shin, K., Ryu, S. M., Jegal, S. G., Lee, W., Yoon, M. A., Hong, G. S., Paik, S., & Kim, N. (2023). Screening of adolescent idiopathic scoliosis using generative adversarial network (GAN) inversion method in chest radiographs. PloS one, 18(5), e0285489. https://doi.org/10.1371/journal.pone.0285489 17. Lee, J. S., Shin, K., Ryu, S. M., Jegal, S. G., Lee, W., Yoon, M. A., Hong, G. S., Paik, S., & Kim, N. (2023). Screening of adolescent idiopathic scoliosis using generative adversarial network (GAN) inversion method in chest radiographs. PloS one, 18(5), e0285489. https://doi.org/10.1371/journal.pone.0285489 18. Mariscal, G., Morales, J., Pérez, S., Rubio-Belmar, P. A., Bovea-Marco, M., Bas, J. L., Bas, P., & Bas, T. (2023). Meta-analysis on the efficacy and safety of anterior vertebral body tethering in adolescent idiopathic scoliosis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 32(1), 140–148. https://doi.org/10.1007/s00586-022-07448-9 19. Methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities - 6th SOSORT consensus paper. Kotwicki T et al. Scoliosis 20094:26 DOI: 10.1186/1748-7161-4-26. 20. Methods for Assessing Leg Length Discrepancy Clin Orthop Relat Res. 2008 Dec; 466(12): 2910–2922. Published online 2008 Oct 4. doi: 10.1007/s11999-008- 0524-9 21. Reliability and concurrent validity of postural asymmetry measurement in adolescent idiopathic scoliosis Ashleigh Prowse, Berit Aslaksen, Marie Kierkegaard, James Furness, Paul Gerdhem, and Allan Abbott World J Orthop. 2017 Jan 18; 8(1): 68–76. Published online 2017 Jan 18. doi: 10.5312/wjo.v8.i1.68 22. Screening for adolescent idiopathic scoliosis: an information statement by the scoliosis research society international task force, Labelle H, et al Scoliosis20138:17 DOI: 10.1186/1748-7161-8- 17 23. SOSORT 2012 consensus paper: reducing x-ray exposure in pediatric patients with scoliosis - Knott et al Scoliosis20149:4 24. State of the art of current 3-D scoliosis classifications: a systematic review from a clinical perspective Sabrina Donzelli, Salvatore Poma, Luca Balzarini, Alberto Borboni, Stefano Respizzi, Jorge Hugo Villafane, Fabio Zaina, and Stefano NegriniJ Neuroeng Rehabil. 2015; 12: 91. Published online 2015 Oct 16. doi: 10.1186/s12984-015-0083-8 25. Supine to standing Cobb angle change in idiopathic scoliosis: the effect of endplate preselection Bethany E Keenan Maree T Izatt, Geoffrey N Askin, Robert D Labrom, Mark J Pearcy and Clayton J Adam Scoliosis20149:16 DOI: 10.1186/1748-7161- 9-16 26. Wen, J. X., Yang, H. H., Han, S. M., Cao, L., Wu, H. Z., Yang, C., Li, H., Chen, L. L., Li, N. N., Yu, B. H., Gao, B. L., & Wu, W. J. (2022). Trunk balance, head posture and plantar pressure in adolescent idiopathic scoliosis. Frontiers in pediatrics, 10, 979816. https://doi.org/10.3389/fped.2022.979816 27. Wu, C., Meng, G., Lian, J., Xu, J., Gao, M., Huang, C., Zhang, S., Zhang, Y., Yu, Y., Wang, H., He, Y., Li, X., & Li, Z. (2022). A multi-stage ensemble network system to diagnose adolescent idiopathic scoliosis. European radiology, 32(9), 5880– 5889. https://doi.org/10.1007/s00330-022-08692-9 28. MedBridge Adolescent Idiopathic Scoliosis Part 3: Indications, Guidelines & Goals of Treatment Cindy Marti, PT 29. 2011 Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth Negrini et al Scoliosis 2012 7:3coliosis20127:3 DOI: 10.1186/1748-7161-7-3 30. Adolescent idiopathic scoliosis and back pain , Federico Balagué and Ferran Pellisé Scoliosis and Spinal Disorders201611:27 DOI: 10.1186/s13013-016-0086-7 31. Akyurek, E., Zengin Alpozgen, A., & Akgul, T. (2022). The preliminary results of physiotherapy scoliosisspecific exercises on spine joint position sense in adolescent idiopathic scoliosis: A randomized controlled trial. Prosthetics and orthotics international, 46(5), 510–517. https://doi.org/10.1097/PXR.0000000000000136 32. Effects of Bracing in Adolescents with Idiopathic Scoliosis. Weinstein S, Dolan L, Wright J, Dobbs M, N Engl J Med 2013; 368:1512-1521 October 17, 2013 DOI: 10.1056/NEJMoa1307337 33. Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis. Anwar S, Ahmad A, Shaphe A, Anwar D BioMed Research International Volume 2015 (2015), Article ID 123848, 15 pages http://dx.doi.org/10.1155/2015/123848 34. Fahim, T., Virsanikar, S., Mangharamani, D., Khan, S. N., Mhase, S., & Umate, L. (2022). Physiotherapy Interventions for Preventing Spinal Curve Progression in Adolescent Idiopathic Scoliosis: A Systematic Review. Cureus, 14(10), e30314. https://doi.org/10.7759/cureus.30314 35. Hariharan, A. R., Shah, S. A., Petfield, J., Baldwin, M., Yaszay, B., Newton, P. O., Lenke, L. G., Lonner, B. S., Miyanji, F., Sponseller, P. D., Samdani, A. F., & Harms Study Group (2022). Complications following surgical treatment of adolescent idiopathic scoliosis: a 10-year prospective follow-up study. Spine deformity, 10(5), 1097–1105. https://doi.org/10.1007/s43390-022-00508-6 36. Joarder, I., Taniguchi, S., Mendoza, A., & Snow, M. E. (2023). Defining "successful" treatment outcomes in adolescent idiopathic scoliosis: a scoping review. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 32(4), 1204–1244. https://doi.org/10.1007/s00586-023- 07592-w 37. Landauer, F., & Trieb, K., Prof (2022). Scoliosis: Brace treatment - from the past 50 years to the future. Medicine, 101(37), e30556. https://doi.org/10.1097/MD.0000000000030556 Recommendations for research studies on treatment of idiopathic scoliosis: Consensus 2014 between SOSORT and SRS non–operative management committee, Negrini et al, SOSORT Board, SRS Non-Operative Committee Scoliosis2015 10:08 doi:10.1186/s13013-014-0025-4 The efficacy of three dimensional Schroth exercises in adolescent idiopathic scoliosis: A randomized controlled clinical trial. Kuru T, et al. Clinical Rehabilitation 1-10 2015. DOI: 10.117/o269215515575745 38. Traversari, M., Ruffilli, A., Barile, F., Viroli, G., Manzetti, M., Vita, F., & Faldini, C. (2022). Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach: A systematic review and meta-analysis. Journal of craniovertebral junction & spine, 13(4), 390–400. https://doi.org/10.4103/jcvjs.jcvjs_80_22 39. Zale, C. L., & McIntosh, A. L. (2022). Adolescent Idiopathic Scoliosis for Pediatric Providers. Pediatric annals, 51(9), e364–e369. https://doi.org/10.3928/19382359-20220724-01 40. MedBridge Adolescent Idiopathic Scoliosis Part 4: Specific Exercises to the Condition Cindy Marti, PT 41. Attitudes Towards Scoliosis Specific Exercises Among Scoliosis Research Society Surgeons: an online survey – Scoliosis Journal, May 2015 Authors: C. Marti, S. Glassman, P. Knott, L. Carreon, M. Hresko Scoliosis201510:16 DOI: 10.1186/s13013-015-0041-z 42. Baik, S. M., Kim, S. H., & Lee, J. H. (2023). A scoping review of the different types of exercise programs proposed for the improvement of postural balance in adolescents with idiopathic scoliosis. Journal of back and musculoskeletal rehabilitation, 10.3233/BMR-220391. Advance online publication. https://doi.org/10.3233/BMR-220391 43. Lau, R. W., Kwan, R. L., Cheng, J. C., Hui, S. S., & Lam, T. P. (2023). Patients with Adolescent Idiopathic Scoliosis Have Higher Metabolic Cost during HighIntensity Interval Training. International journal of environmental research and public health, 20(3), 2155. https://doi.org/10.3390/ijerph20032155 44. Maharathi, S., Iyengar, R., & Chandrasekhar, P. (2023). Biomechanically designed Curve Specific Corrective Exercise for Adolescent Idiopathic Scoliosis gives significant outcomes in an Adult: A case report. Frontiers in rehabilitation sciences, 4, 1127222. https://doi.org/10.3389/fresc.2023.1127222 45. Physiotherapeautic Scoliosis Specfiic Exercises – a comprehensive review of seven major schools. Berdishevsky H, Lebel A, et al. Scoliosis Spinal Disorders. 2016 Aug 4;11:20. doi: 10.1186/s13013-016-0076-9 46. Physiotherapeautic Scoliosis Specific Exercises for Adolescent Idiopathic Scoliosis . Betany-Saltikov J, Parent E, Romano M, Villagrasa M, Negrini S et al – European Journal of Physical Rehabilitation and Medicine, 2014 50:111-21 47. Rezaeian, Z., Andalib, A., Bokaee, F., Poorpooneh Najafabadi, M., Yeowell, G., & SadeghiDemneh, E. (2023). The Efficacy of Trunk Bracing With an Instrumented Corrective Exercise on Spinal Deformity, Pulmonary Function, Trunk Muscle Endurance, and Quality of Life in Adolescent Idiopathic Scoliosis: Protocol for a Parallel Groups Clinical Study. JMIR research protocols, 12, e43265. https://doi.org/10.2196/43265 48. Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis – an Assessor and Statistician Blinded Randomized Controlled Trial. Schreiber S, Parent E, et al. Published: December 29, 2016 https://doi.org/10.1371/journal.pone.0168746 49. SEAS (Scientific Exercises Approach to Scoliosis): A modern and effective evidence based approach to physiotherapeutic specific scoliosis exercises. Scoliosis 10(1) December 2015 . DOI: 10.1186/s13013-014-0027-2 50. Weng, H., & Li, Q. (2022). Effect of Core Stability Training on Correction and Surface Electronic Signals of Paravertebral in Adolescent Idiopathic Scoliosis. BioMed research international, 2022, 1819606. https://doi.org/10.1155/2022/1819606 51. Wnuk, B., Stepanik, M., Milewska-Mączka, E., Huta, M., Wolicka, J., Karcz, A., Szołtysek, J., & Durmała, J. (2023). Assessment of the Reliability of the DoboMed Exercise Method Mastery Evaluation Scale in People with Adolescent Idiopathic Scoliosis. Ortopedia, traumatologia, rehabilitacja, 25(2), 73–81. https://doi.org/10.5604/01.3001.0053.6160 |
