(646) 355-8777

Herman & Wallace Blog

Adolescent Idiopathic Scoliosis

In some families, puberty is not only a time to have to deal with all the physical, hormonal, and emotional changes that are occurring, but it is a time to have to worry about and check for spinal abnormalities that can run in families. Adolescent idiopathic scoliosis is an abnormal curvature of the spine that appears in late childhood or adolescence. The spine will rotate, and a curvature will develop in an “S” shape or “C” shape. Scoliosis is the most common spinal disorder in children and adolescents. It is present in 2 to 4 percent of children between the ages of 10 and 16 years of age. There is a genetic link to developing scoliosis and scientists are working to identify the gene that leads to adolescent idiopathic scoliosis. Adolescent girls are more likely to develop more severe scoliosis. The ratio of girls to boys with small curves of 10 degrees or less is equal, however the ratio of girls to boys with a curvature of 30 degrees or greater is 10:1. Additionally, the risk of curve progression is 10 times higher in girls compared to boys. Scoliosis can cause quite a bit of pain, morbidity, and if severe enough can warrant spinal surgery.

A recent article in Pediatric Physical Therapy by Zapata et al. assessed if there were asymmetries in paraspinal muscle thickness in adolescents with and without adolescent idiopathic scoliosis. They utilized ultrasound imaging to compare muscle thickness of the deep paraspinals at T8 and the multifidus at L1 and L4. They found significant differences in muscle thickness on the concave side compared to the convex side at T8 and L1 in subjects with scoliosis. They also found significantly greater muscle thickness on the concave side at T8, L1, and L4 in patients with adolescent idiopathic scoliosis compared to controls. This is very interesting to me, and exciting to think about the possibilities of how we therapists might can use this information! My first question is, is the difference in muscle thickness a cause or result of the curvature of the spine? My next question is if we trained the multifidus on the convex side, the side that is thinner, would it make a difference in supporting the spine and therefore help prevent some of the curvature? Would strengthening the multifidus in a very segmental manner comparing right versus left and targeting segments and sides that are weaker than others help prevent rotation and curvature in individuals who have a familial predisposition to developing idiopathic scoliosis? I hope so! I hope this group continues to study scoliosis and provides some evidence-based treatment that can help decrease the severity of curvature.

Assessing the multifidus thickness and strength, and differentiating it from the paraspinal muscles can be tricky. The best way to do this is the same way the authors of this article did, using ultrasound imaging. Ultrasound imaging gives unparalleled information on muscle shape, size, and activation of the muscle. Learning to use ultrasound imaging will change your practice! You will see dramatic differences in how you treat patients as well as the results you get when training the local core musculature. It also may open doors to treating different patient types than you are treating now, like adolescents with scoliosis. Join me in Spokane, WA on October 20-22 to further discuss how ultrasound can change your practice and perhaps help you reach out to a new population that you may not be treating now!


Miller NH. Cause and natural history of adolescent idiopathic scoliosis. Orthop Clin North Am. 1999;30:343–52.
Roach JW. Adolescent idiopathic scoliosis. Orthop Clin North Am. 1999;30:353–65.
Zapata KA, Wang-Price SS, Sucato DJ, Dempsey-Robertson M. Ultrasonographic measurements of parspinal muscle thickness in adolescent idiopathic scoliosis: a comparison and reliability study. Pediatr Phys Ther. 2015; 27(2): 119-25.

Female Athletes: Fit to be Dry
Post-Traumatic Stress Disorder

Upcoming Continuing Education Courses

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Jan 23, 2021 - Jan 24, 2021
Location: Replacement Remote Course

Yoga for Pelvic Pain - Remote Course

Jan 23, 2021 - Jan 24, 2021
Location: Replacement Remote Course

Mindfulness for Rehabilitation Professionals - Remote Course

Jan 23, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Self-Hosted\ (SOLD OUT)

Jan 23, 2021 - Jan 24, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2A - Portland, OR Satellite Location

Jan 23, 2021 - Jan 24, 2021
Location: Benchmark Physical Therapy

Pelvic Floor Level 2A - Truckee, CA Satellite Location- RESCHEDULED

Jan 23, 2021 - Jan 24, 2021
Location: Tahoe Forest Center for Health and Sports Performance / Alliance Therapy Partners

Pelvic Floor Level 2A - Freehold, NJ Satellite Location

Jan 23, 2021 - Jan 24, 2021
Location: Atlantic PT Center

Pelvic Floor Level 2A - Somerset, NJ Satellite Location

Jan 23, 2021 - Jan 24, 2021
Location: Sports Medicine Institute

Pelvic Floor Level 2A - New York, NY Satellite Location

Jan 23, 2021 - Jan 24, 2021
Location: 5 Point Physical Therapy

Pelvic Floor Level 2A - Phoenix, AZ Satellite Location

Jan 23, 2021 - Jan 24, 2021
Location: Spooner Physical Therapy

Pelvic Floor Level 2A - Richmond, VA Satellite Location

Jan 23, 2021 - Jan 24, 2021
Location: Pivot Physical Therapy

Pelvic Floor Level 2A - St George, UT Satellite Location

Jan 23, 2021 - Jan 24, 2021
Location: Unity Health & Wellness Llc

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course

Jan 29, 2021 - Jan 30, 2021
Location: Replacement Remote Course

Postpartum Rehabilitation - Remote Course (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Satellite Lab Course

Jan 30, 2021 - Jan 31, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Oklahoma City, OK Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Oklahoma Physical Therapy

Pelvic Floor Level 1 - Greenville, SC Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Restore Pelvic Health and Wellness

Pelvic Floor Level 1 - Doylestown, PA Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Central Bucks Physical Therapy LLC

Pelvic Floor Level 1 - Annapolis, MD Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Encompass PT

Oncology of the Pelvic Floor Level 1 - Remote Course

Jan 30, 2021 - Jan 31, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Marietta, GA Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 1 - Torrance, CA Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Women's Advantage Inc

Lumbar Nerve Manual Assessment and Treatment - Remote Course

Jan 30, 2021 - Jan 31, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Brooklyn, NY Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: PT of the City

Pelvic Floor Level 1 - Self-Hosted

Jan 30, 2021 - Jan 31, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - New Orleans, LA Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Ochsner Therapy and Wellness/Ochsner Health System

Pelvic Floor Level 1 - Metairie, LA Satellite Location

Jan 30, 2021 - Jan 31, 2021
Location: East Jefferson General Hospital

Sexual Medicine in Pelvic Rehab - Remote Course

Feb 6, 2021 - Feb 7, 2021
Location: Replacement Remote Course

Osteoporosis Management - Remote Course

Feb 6, 2021 - Feb 7, 2021
Location: Replacement Remote Course

Manual Therapy for the Abdominal Wall - Remote Course

Feb 7, 2021
Location: Short Form Remote Course