Hui is a lively and adorable 10-year-old elementary school student who loves dancing.

Typically, children who practice dance are supposed to have particularly refined and graceful posture. However, recently, Hui’s mother noticed that her daughter’s sitting and standing postures were not correct, and her daughter’s walking seemed somewhat unsteady, leading her to initially suspect it was a leg issue.

It wasn’t until one day during a bath that she truly realized something was wrong. A sudden glance at Hui’s back revealed that Hui’s spinal alignment appeared unusual...

Jun is a 9-year-old boy who has less endurance in sports compared to his peers. He often finishes last in running at school and does not have a good shape.

His parents assumed he was just lazy and had poor posture. However, his grandmother believed that even minor issues should be addressed to ensure the child’s health. She insisted on taking Jun to see a doctor.

The Rehabilitation Medicine Department specialist’s assessment and examination results showed that Hui, who loves to dance, has scoliosis, accompanies by the loss of spinal curvature. Additionally, the inactive Jun has flat feet and functional leg length discrepancy in both lower limbs, leading to improper running posture and suboptimal sports performance, along with the aggravation of spinal curvature.

 

Both children received a “cruel” diagnosis from the doctor——“Scoliosis”

What is scoliosis? 

Adolescent Idiopathic Scoliosis (AIS) is a deformity characterized by a lateral deviation of the spine from the midline, resulting in a curved or “S” shape. It is a three-dimensional spinal deformity that includes abnormalities in the coronal, sagittal, and axial planes. According to the Scoliosis Research Society (SRS), scoliosis is defined as a spinal deformity with a curvature greater than 10° measured using the Cobb method on standing full-spine anteroposterior X-rays. AIS is one of the most common deformities in adolescents.

 

 

Layman’s term——

The spine is misaligned.

It may curve abnormally to the left, right, forward, or backward.

According to rough statistics, approximately three million children in China suffer from varying degrees of scoliosis and the majority of cases occur from age 12 to 15.

In early stages, the physical abnormalities caused by scoliosis may not be obvious and are often difficult to detect. However, if not detected and treated promptly, some patients may experience worsening curvature with age, potentially leading to severe deformities. This can result in abnormal physical appearance, impaired spinal mobility, and even affect walking ability and cardiopulmonary function, significantly impacting the patient’s daily activities.

When a child is diagnosed with scoliosis, many parents feel “overwhelmed”. They believe that if their child does not undergo surgery, the kid will be forever deprived of beauty and may even face life-threatening risks.

Actually, the vast majority of scoliosis cases involve only mild to moderate curvatures. With early screening and assessment, and by adhering to sports therapy under the guidance of rehabilitation medicine specialists and therapists, most cases can effectively control the progression of the curvature and minimize adverse impacts on daily life and learning.

Therefore, early diagnosis and early treatment are crucial.

 

So what’s the  symptoms？

A prominence or indentation on the back?

Crooked standing posture?

Uneven shoulders?

Asymmetrical rig cage?

Lack of gracefulness?

Yes! There is also a very simple posture that clearly indicates scoliosis.

—90 degree bow

How to observe?

Starting from the shoulders, observe step by step.

A total of six areas needs to be observed.

STEP ONE

Please have the child remove his top, stand with feet shoulder-width apart, eyes looking straight ahead, and stand upright:

Figure1

Shoulders: Are both shoulders level? (Red line in Figure 1)

Image Scapulae: Is one side more prominent than the other?

Image Inferior angle of the scapula: Are both sides level? (Green line in Figure 1)

STEP TWO

Please have the child bend forward at the waist to achieve a 90-degree bow position, ensuring that both knee joints remain straight and both lower limbs are extended. Have him touch the same-side knee joint with both hands and continue to observe the other three areas:

Image Back: Is there a prominence? (Observe for any tilt in the red line in Figure 2)

Image Lumbus: Is there a prominence? (Observe for any tilt in the red line in Figure 2)

Image Spinal alignment: Does it form a straight line? (Observe the yellow line in Figure 2)

 

As long as the back is flat and the midspinal line feels like a straight line, there is no problem.

If asymmetry is observed in the back, with one side higher than the other, it is important to seek medical treatment at medical facilities in time. If necessary, a full-spine X-ray may be required for assessment. The specialist can then evaluate the degree of curvature to determine further treatment.

If adolescents under the age of 20 do not receive early intervention, the severity of scoliosis may progressively worsen with age due to skeletal growth! The Cobb angle, which is a measure used to assess the degree of scoliosis, may increase progressively until growth is complete and skeletal maturity is reached, at which point the progression will gradually slow down.

 

But he child practiced dance, how could he/she still develop this condition?

The development of scoliosis is not only related to clinical medical factors but is also closely associated with daily postural habits. Furthermore, adolescents experience rapid skeletal growth and are in an age range for the acceleration of curvature progression. Many of the postures that children adopt during daily activities and learning are incorrect, which can contribute to and exacerbate the progression of scoliosis. Therefore, parents need to closely monitor and correct these postural habits.

1.Excessive weight and asymmetrical backpack carrying

On one occasion, while I was in an elevator, a child happened to enter as well. Perhaps due to the weight of his backpack, as soon as he stepped into the elevator, he unloaded the backpack from his shoulder and placed it on the floor—resulting in a loud “thud” that even made the elevator sway slightly, causing my heart to skip a beat.

Even the child in the elevator knew to take a moment to rest. An excessively heavy backpack places undue pressure on the spine, which can lead to spinal health issues and exacerbate existing problems, increasing the risk of scoliosis and alterations in spinal curvature.

Particularly concerning is the incorrect method of carrying a backpack, as uneven pressure distribution can lead to postural abnormalities, which pose significant risks.

2.Incorrect posture

It is commonly referred to as improper sitting and standing posture.

Sitting position

Learning and recreational activities occupy a large portion of a child’s life. Maintaining improper postures during these activities can adversely affect the child’s spine.

Crossed legs

Sitting crossed-legs can cause one side of the pelvis and the opposite scapula to elevate. This incorrect pressure distribution and posture can easily impact the proper growth of the spine.

The harms of sitting crossed-legs could warrant a dedicated article on the topic, which I will not elaborate on in this discussion.

Sleeping posture (lying posture)

A good sleeping posture can alleviate fatigue and even serve preventive and therapeutic purposes. In contrast, poor sleeping posture can lead to a variety of health problems.

 

Faulty biomechanics of lower limbs

Layman’s term——

Flat feet/pes cavus，issues with the structure and function of the feet arise.

A journey of a thousand miles begins with a single step. Problems with the feet can directly affect the structure and function of the entire spine.

Differences in the degree of arch on both sides, whether flat feet or pes cavus, can lead to overall faulty biomechanics and affect the curvature, creating a chain reaction that may result in additional functional and pain problems.

 

So,What is the correct posture?

1. The weight of the backpack should not be excessive. If this cannot be resolved, consider using a handcart, but it is essential to alternate between hands frequently to avoid overexertion on one side, which can lead to pressure on and structure of the spine and muscles, resulting in curvature and twisting.

2. Maintain an upright sitting posture. The shoulders should not be too forward or hang freely, and avoid shrugging the shoulders or protruding the neck.

3. The optimal sleeping posture is lying on the back. Avoid sleeping on overly soft mattresses that cause the spine to sag.

4. Avoid abnormal postures, such as crossing the legs.

 

If scoliosis has already developed, how should it be properly corrected and treated？

Currently, the internationally recognized effective therapeutic methods include:

Sports therapy

This should be conducted under the guidance of specialists and therapists to implement targeted correction training.

Electrical stimulation therapy

Orthosis therapy

Massage therapy

Operative treatment

If the Cobb angle is within 20 degrees,

functional training should be conducted under the guidance of rehabilitation medicine specialists and therapists, which involves three-dimensional correction through targeted sports therapy. Currently, the effectiveness of sports therapy in correcting mild to moderate scoliosis is widely recognized.

Given that the spine can undergo “three-dimensional twisting” in multiple directions, there are various types of scoliosis, and thus the corresponding sports therapies will also have multiple combinations. It is essential to implement a “1v1 VIP customized treatment plan” under the guidance of qualified rehabilitation medicine specialists and physical therapists at medical facilities.

Some children develop scoliosis at a very young age, which suggests that the progression of their curvature may be more severe. For these children, it is advisable to wear corrective braces “preventively” even when the curvature is within 20 degrees.

Children with flat feet can be fitted with appropriate orthotic insoles at specialized prosthetics and orthotics centers. This can help correct the faulty biomechanics and structure in the lower limbs, addressing the spinal misalignment.

If the Cobb angle is between 20 and 40 degrees,

it indicates that the curvature is likely to continue progressing. Children in this category should wear corrective braces in conjunction with sports training, applying force on the convex side to physically help the spine “realign”.

If the Cobb angle is greater than 40 degrees,

surgical treatment to correct the spinal deformity may be necessary, based on the recommendations of a spinal surgery specialist.

If you notice any of the following signs in your child—uneven collar, uneven shoulders, asymmetrical breast development in girls, a prominence on one side of the back, wrinkles on one side of the waist, one hip higher than the other, leg length discrepancy or the spine not being aligned with the midline—you should be vigilant for potential scoliosis.

Mild scoliosis, if detected and treated early, generally does not impact daily life. However, if scoliosis continues to worsen, it not only increases the difficulty of treatment and affects treatment outcomes but also leads to many secondary problems!

 

After a month of treatment, Huihui, who loves to dance, has improved a lot. To express her gratitude for the therapist’s help, Huihui hand-drew two adorable note papers to the therapist, making it easier for him to take notes on the go.

 

Department of Rehabilitation Medicine

The Department of Rehabilitation Medicine, the Seventh Affiliated Hospital, Sun Yat-sen University, draws its core strength from one of the best rehabilitation medicine departments in South China—the First Affiliated Hospital, Sun Yat-sen University. It has established a highly qualified medical team that adheres to the latest concepts in rehabilitation.

The department incorporates the latest rehabilitation concepts and utilizes techniques such as physical therapy, occupational therapy, speech therapy, and psychological and cognitive therapy, all of which have been scientifically validated in clinical practice, to provide professional rehabilitation assessment and treatment for patients with various functional disorders. The department offers comprehensive services that include neuro-rehabilitation, orthopedic rehabilitation, cancer rehabilitation, intensive care rehabilitation, gastrointestinal rehabilitation, cardiopulmonary rehabilitation, pelvic floor rehabilitation, and pediatric rehabilitation. Its goal is to shorten the disease progression and maximize the alleviation of pain, improve functionality, and facilitate the restoration of both physical and mental well-being, ultimately enhancing the life quality for patients, helping them return to their families, resume their jobs, continue their education, and rejoin society.

 

Some images are sourced from Baidu.