Scoliosis Awareness Month

Jun 22, 2023

While physical therapy can be very effective to improve range of motion and strength as well as addressing pain associated with scoliosis, considering the implications for gait is also crucial for this population.

People with scoliosis are less able to take advantage of the typical energy conversions during gait that naturally increase efficiency, so not surprisingly they demonstrate a higher energy cost to walk the same distance as people with typical spines. People with scoliosis also demonstrate reduced pelvic range of motion during gait. In many other aspects of gait, different studies arrive at different results in terms of whether or not people with scoliosis are unique – which highlights how crucial it is to perform thorough evaluations of each individual presenting with a gait disorder. Additionally, scoliosis has a fascinating relationship with leg length discrepancy (LLD), and the two have a strong correlation. LLD comes up a lot in the clinic and again requires careful evaluation as research shows this is also a highly individual issue with no one-size-fits-all solution. As you can see from this video of a gentleman with a shorter left leg, the changes in a gait pattern affect the whole body.

Some quick tips for a few common considerations in LLD:

  • check the foot posture – some individuals will end up supinating the shorter leg and pronating the longer leg as their bodies seek symmetry. Therefore, quickly prescribing them bilateral in-shoe orthotics without much consideration could potentially make their symptoms worse!
  • check the hip strength – some individuals report feeling as if one leg is shorter during gait, but further testing shows symmetrical leg lengths but weakness on the perceived shorter side. This person needs to understand how to control their hip and pelvis during gait to prevent the pelvis from dropping and making them feel shorter during the stance phase on that side. Gait training cues like “elongate your standing leg into the floor” may be helpful for some.

In our virtual course, we discuss in depth how the spine and pelvis drive the gait pattern, and how to design effective treatment programs for anyone with a gait disorder.

Sources:

Daryabor A, Arazpour M, Sharifi G, Bani MA, Aboutorabi A, Golchin N. Gait and energy consumption in adolescent idiopathic scoliosis: A literature review. Ann Phys Rehabil Med. 2017;60(2):107-116. doi:10.1016/j.rehab.2016.10.008

Hamada T, Matsubara H, Kato S, et al. Correlation Analysis between Leg-length Discrepancy and Lumbar Scoliosis Using Full-length Standing Radiographs. Strategies Trauma Limb Reconstr. 2022;17(3):144-147. doi:10.5005/jp-journals-10080-1566

Vogt B, Gosheger G, Wirth T, Horn J, Rödl R. Leg Length Discrepancy- Treatment Indications and Strategies. Dtsch Arztebl Int. 2020;117(24):405-411. doi:10.3238/arztebl.2020.0405″