Guía de prevención y control de la escoliosis en jóvenes

Title: Guide to Scoliosis Prevention and Control in Youth Profile: With the start of the semester, spinal health in adolescents is concerning. Scoliosis is becoming increasingly common. Early detection and intervention are key. Parents should conduct check-ups and encourage good posture and exercise. Keywords: ['Youth Health', 'Physical Health.']

With the beginning of the new semester, students return to campus filled with hopes. While focusing on their studies, spinal health is a fundamental aspect that should not be overlooked. According to statistics, there are currently more than 5 million primary and secondary school students in China with kyphosis, and this number increases annually by approximately 300,000, making it the third condition that most compromises the health of children and adolescents, after obesity and myopia. Kyphosis is diagnosed when the curvature angle of the spine in the standing position (Cobb angle) exceeds 10 degrees, characterized as a three-dimensional structural deformity, accompanied by rotation of the vertebral bodies and thoracic deformation. Since there are no specific discomforts in the early stages, this issue can easily be overlooked.

I. Risk Factors: Why is it common for adolescents to develop scoliosis?

Adolescence is a stage with high incidence of scoliosis, especially between ages 10 and 16. During this period, adolescents undergo rapid physical growth, and bone development is still immature. The muscles and ligaments around the spine are relatively weak, making them susceptible to various factors that can cause spinal curvature.

Genetic factors play an important role in idiopathic scoliosis. The incidence rate in our country's population is approximately 4%, with around 10% of patients experiencing a progression of the deformity requiring clinical intervention. Girls in adolescence are more prone to develop spinal curvatures than boys, although reasons for this gender difference have not yet been identified. Poor lifestyle habits are also a significant triggering factor. Behaviors such as studying for extended periods, maintaining incorrect sitting posture, lack of physical exercise, and carrying objects on one side increase the load on the spine, potentially leading to an imbalanced development.

II. Early Detection: Family Self-Evaluation Methods and Professional Screening.

Scoliosis in its early stages often shows no obvious symptoms and may merely present as a difference in shoulder height, a protrusion on one side of the scapula, or asymmetry in the back when leaning, which can easily be overlooked. Parents can perform a self-examination at home using the following methods:

(1) Six-Step Evaluation Method: Have the child wear a tight single-layer shirt or remove it, standing barefoot in a natural position. Parents should stand behind the child and observe: first, if the shoulders are at the same height; second, if one side of the scapula projects backward; third, compare if the lower ends of the scapulae are at the same height; fourth, touch and compare if there are protrusions on both sides of the back and if they are symmetrical; fifth, touch and compare if there are protrusions on both sides of the waist and if they are symmetrical; sixth, use the middle and index fingers to slide along the spine and check if a normal straight line can be traced.

(2) Adam's Forward Bend Test: Have the child stand with straight knees, feet together, and arms extended forward with palms together. Then, let them slowly lean the torso forward, lowering the head to approximately 90 degrees. The examiner should observe from behind for any asymmetry in the elevation of the back, which is an important method for detecting scoliosis.

Schools should regularly organize scoliosis screening tests for students, typically once a semester or annually, to identify issues early and make timely interventions. It is recommended that adolescents undergo a complete spinal X-ray once a year.

III. Preventive Measures: Cultivating Good Habits to Protect Spinal Health.

To prevent scoliosis in children and adolescents, it is necessary to approach the issue from multiple fronts and encourage good habits.

(1) Maintain Correct Posture: Maintaining proper posture when sitting, standing, and walking is essential to prevent scoliosis. In terms of sitting position, the torso should be kept straight, the back relaxed naturally, and the feet should be flat on the floor. The height of the desk and chair should be appropriate. It is important to adjust the height of school furniture according to the child's growth to avoid inducing scoliosis due to prolonged poor posture.

(2) Scientific Physical Exercise: Proper exercise practice helps strengthen the muscles around the spine and maintain its stability. Young people are encouraged to participate in activities such as swimming, basketball, badminton, yoga, and pull-ups. It is advised that adolescents engage in at least 3 to 5 exercise sessions per week, each lasting over 30 minutes.

(3) Reasonable Backpack Carrying Method: A backpack that is too heavy or incorrect carrying methods are potential contributors to lordosis. It is recommended to opt for double-shoulder backpacks, and the weight of the backpack should not exceed 10% of the body weight. Double-shoulder backpacks allow weight to be evenly distributed across both shoulders and the back, thereby reducing unilateral strain.

IV. Gradual Intervention: Selecting a Specific Treatment Plan.

Depending on the curvature angle and severity of scoliosis, treatments also vary. Below is the classified diagnostic and treatment strategy according to the Cobb angle:

The severity of Cobb angle, main treatment range, and follow-up frequency are as follows: mild 10°-20°, with periodic observation, functional exercises, and physical therapy, review every 6 months; severe >40°, surgical treatment, postoperative rehabilitation, and periodic follow-ups as indicated.

(1) Brace Treatment: For mild scoliosis (with a curvature angle between 20° and 40°), brace treatment is generally used. When using the brace, it is crucial to strictly follow the doctor's instructions, wearing it for at least 18 to 23 hours a day. As the condition improves and bones mature, the wearing time may gradually be reduced.

(2) Sports Rehabilitation: Carrying out specific exercises to strengthen muscles and improve posture, such as spinal stretching exercises. In the case of mild scoliosis, exercises to strengthen the lumbar and dorsal muscles should be performed, such as swimming, and some movements like "air cycling," "cat walking," and "little heron flight" under the guidance of a physician.

(3) Surgical Treatment: If the lateral curvature angle of the child's spine exceeds 40 degrees or more than 45 degrees, surgical treatment is recommended based on the physician's scientific assessment. The risks of surgery are high, and various perioperative complications exist; moreover, mobility is greatly diminished after spinal fusion, thus it should be considered as a last resort.

V. Comprehensive Management: Long-term Strategies for Maintaining Spinal Health.

(1) Periodic Reviews and Follow-up: During treatment, patients must undergo periodic reviews as indicated by the physician. This includes taking X-rays and assessing the progression of the spinal curvature. Based on the results of these reviews, the doctor will timely adjust the treatment plan. Even after treatment is discontinued, it is important to conduct regular follow-ups until bone development is mature.

(2) Nutritional Support and Balanced Diet: Adolescents are at a critical stage of growth and development, so they require adequate nutritional support. Parents should pay attention to their children’s balanced diet, ensuring they consume sufficient protein-rich foods, vitamins, calcium, and other nutrients, such as meats, eggs, dairy products, soy products, as well as fresh vegetables and fruits.

(3) Psychological Support and Social Encouragement: Scoliosis can create some psychological pressure on patients, so parents and teachers should provide understanding and support, helping them strengthen their confidence and actively cooperate in treatment. It is important to encourage children to participate in social activities and make new friends to relieve psychological pressure.

(4) Lifestyle Adjustments: Avoid prolonged use of electronic devices, reduce the time spent bending the head to use mobile phones, play video games, or look at computers, to prevent excessive neck and spinal flexion. Ensure adequate sleep, choosing a suitable mattress and pillow; the mattress should not be too soft to maintain the natural physiological curvature of the spine.