Scoliosis in adults is often more complex than in adolescents, due to the interplay of spinal deformity with age-related changes in bone density, muscle strength, and overall balance. One concerning issue for older patients with adult scoliosis is the increased risk of falls, which can have serious consequences for health and quality of life (1). Below, we delve into why adult scoliosis contributes to fall risk and how to address it without the need for surgery.
Why Adult Scoliosis Increases Fall Risk
Several factors associated with scoliosis and aging combine to elevate the likelihood of falls:
- Sagittal Imbalance (2):
- Forward-leaning posture (positive sagittal balance) shifts the center of gravity, making it harder to maintain stability.
- Difficulty compensating for this imbalance increases the likelihood of tripping or falling.
- Reduced Proprioception:
- Spinal deformity can impair the body’s ability to sense joint position, reducing balance and coordination.
Neurological Impairments (3):
- Nerve compression from spinal stenosis or degenerative changes can cause numbness, weakness, or loss of motor control in the lower extremities.
- Pain and Mobility Issues (4):
- Chronic back pain and stiffness can limit mobility, making it harder to recover from a stumble or avoid obstacles.
- Comorbidities (5):
- Conditions like osteoporosis or arthritis, often coexisting with scoliosis, can weaken bones and joints, increasing fracture risk in falls.
Identifying High-Risk Patients
Certain factors may indicate a heightened fall risk in older adults with scoliosis (2,3,4,5):
- severe sagittal or coronal plane deformities
- symptoms of leg numbness, tingling, or weakness
- history of previous falls or balance issues
- use of walking aids due to instability
- coexisting conditions like osteoporosis or vestibular disorders.
Strategies to Mitigate Fall Risk
Preventing falls in older patients with scoliosis involves a multidisciplinary approach targeting both the spinal deformity and overall physical function:
1. ScoliBalance and Exercise
- ScoliBalance is a physiotherapeutic scoliosis specific exercise program that provides patients individualised scoliosis specific exercises based on their curve type and postural characteristics that also addresses any relevant functional weaknesses.
- Keeping up any sort of balance training, such as Tai Chi or targeted exercises, to enhance coordination and proprioception can be useful but not a replacement for scoliosis specific exercise programs.
Not all exercises are ‘scoliosis specific’. Exercises such as Pilates and Yoga can be helpful at keeping patients strong but the exercises are not specifically addressing the 3D nature of the scoliosis, which is more accurately addressed in scoliosis specific programs, such as ScoliBalance.
2. Pain and Symptom Management
- Customised scoliosis bracing for postural support in cases of significant instability.
- Pain and other symptoms can be managed through a combination of ScoliBalance and, when necessary, a combination of ScoliBalance and ScoliBrace.
Addressing the alignment and posture of the spine can assist with pain management (6).
3. Addressing Neurological Impairments
- Sometimes the non-surgical options may address the nerve compression of the spine alignment and posture can be improved through ScoliBalance and/or ScoliBrace.
- In more severe cases surgical decompression or other interventions may be required.
Regular neurological assessments to monitor progression are vital to improve patient outcomes.
4. Environmental Modifications
- Fall-proofing the home by removing tripping hazards, adding grab bars, and improving lighting.
- Ensuring footwear is supportive and non-slip.
Recognising that scoliosis can alter posture and increase falls risk is an important consideration in the home. Keep the home fall proof!
5. Bone Health Optimization
- Managing osteoporosis in patients with scoliosis is important because if they fall they have a higher risk of fractures, which further impacts their posture, and the risk of falls increases. Management in some cases may also require supplementation and the patient should be under the care of someone appropriately trained in osteoporosis to work alongside the scoliosis professional.
- Weight-bearing exercises to strengthen bones.
Older scoliosis patients may be at risk of falls if their coronal and sagittal balance has been altered (2). Strong bones will help with posture and minimise risk of fractures if they do fall.
6. Comprehensive Fall-Risk Assessments
- Regular evaluations by healthcare providers, including gait analysis and balance testing.
ScoliBalance staff are well trained in falls risk assessment. The programs are designed to help minimise falls risk.
Conclusion
While scoliosis is a complex condition, understanding its contribution to falls risk in older adults is crucial for effective management. By adopting a comprehensive approach that addresses spinal alignment, physical function, and environmental safety, healthcare providers can significantly reduce the risk of falls and improve the quality of life for older patients.
References
- Godzik, J., Frames, C. W., Smith Hussain, V., Olson, M. C., Kakarla, U. K., Uribe, J. S., Lockhart, T. E., & Turner, J. D. (2020). Postural Stability and Dynamic Balance in Adult Spinal Deformity: Prospective Pilot Study. World Neurosurgery, 141, e783-e791. https://doi.org/https://doi.org/10.1016/j.wneu.2020.06.010
- Kim, J., Hwang, J. Y., Oh, J. K., Park, M. S., Kim, S. W., Chang, H., & Kim, T. H. (2017). The association between whole body sagittal balance and risk of falls among elderly patients seeking treatment for back pain. Bone Joint Res, 6(5), 337-344. https://doi.org/10.1302/2046-3758.65.Bjr-2016-0271.R2
- Smith, J. S., Fu, K. M., Urban, P., & Shaffrey, C. I. (2008). Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine, 9(4), 326-331. https://doi.org/10.3171/spi.2008.9.10.326
- Aebi, M. (2005). The adult scoliosis. Eur Spine J, 14(10), 925-948. https://doi.org/10.1007/s00586-005-1053-9
- Kelly, A., Younus, A., & Lekgwara, P. (2020). Adult degenerative scoliosis – A literature review. Interdisciplinary Neurosurgery, 20, 100661. https://doi.org/https://doi.org/10.1016/j.inat.2019.100661
- Weiss, H. R., Moramarco, K., & Moramarco, M. (2016). Scoliosis bracing and exercise for pain management in adults-a case report. J Phys Ther Sci, 28(8), 2404-2407. https://doi.org/10.1589/jpts.28.2404
