It is still unclear whether breathing difficulties are more due to the bend in the spine or its rigidity. It can also help doctors determine the stiffness of the chest wall and whether a patient needs surgery. Testing is performed in a pulmonary function lab. Here are scoliosis-specific breathing exercises to help improve the dysfunctional breathing patterns associated with scoliosis.
Schroth Method. Corrective rotational breathing or rotational angular breathing RAB is an important component of the Schroth method. It teaches patients to change their breathing patterns to decrease the risk of curve progression. Pilates Method. Air misdistribution is more often found in older patients [ 36 ]. Mild hypoxemia with normocapnia has been commonly encountered in patients with idiopathic scoliosis presumptively due to ventilation-perfusion mismatch.
It was speculated that this was due to sleep-related hypoventilation and improved after surgical correction [ 37 ]. During exercise testing, the ventilatory response is lower in scoliotic patients than in normal subjects.
Exercise capacity is usually decreased, even in patients with mild scoliosis and dyspnea on exertion may be one of the first clinical manifestations of scoliosis, or the first manifestation of respiratory impairment in the already diagnosed ones. In moderate and more severe scoliotic patients Cobb angle more than 40 degrees work capacity is reduced, heart rate is higher per work load and ventilatory reserve is reduced in some but not all patients [ 32 , 39 ].
The strategy of breathing adopted by scoliotic patients during exercise combines a reduced rather than increased V T with an increased breathing frequency in order to minimize the increase in work of breathing. Reduced respiratory system compliance, increased work of breathing, perhaps a blunted respiratory drive and decreased muscle strength, account for their lower respiratory performances.
It was found that reduced muscle strength, involving both the respiratory muscles and also the quadriceps muscles correlated with reduced work capacity. Exercise was terminated due to leg discomfort rather than dyspnea. The results showed generalized muscle dysfunction which contributed to the reduction in their exercise capacity, even in the absence of severe ventilatory impairment.
The limitations in exercise are ascribed to cardiopulmonary limitations, muscle weakness, and also physical and cardiovascular deconditioning [ 32 , 39 , 40 ].
In one small study, the Apnea-Hypopnea Index AHI was abnormal in 14 of 15 patients but could not be explained by apneic events. Instead, hypopneic episodes associated with oxy-hemoglobin desaturation and arousals were common and occurred more frequently in REM sleep [ 41 ]. The authors postulated that low lung volumes typical of thoracic cage deformities predisposed children to oxy-hemoglobin desaturation when hypopnea occurs.
Currently there is no consensus as to when polysomnograms PSGs should be ordered in this group of patients. Pulmonary complications are the principal cause of morbidity and mortality in the immediate period following surgery for scoliosis.
Although there is no direct correlation between the preoperative pulmonary function of a patient and the incidence and severity of postoperative complications, preoperative assessment of pulmonary function including TLC and an overnight oximetry should be performed as a guide to prevent postoperative complications. From a practical standpoint the most useful parameters are the vital capacity and the respiratory muscle strength.
Depending on the surgical approach, studies have demonstrated improvement, decline, or no effect on pulmonary function [ 43 — 45 ]. Surgical intervention corrects the spinal curvature, but its effect on lung volume and arterial oxygenation only becomes apparent later after surgery and improvement may not be measurable for 2 years or more [ 46 , 47 ].
Spinal fusion in young children may result in a short trunk and stunted growth of the thorax and lungs [ 22 , 48 ]. Controversy still exists over whether Harrington instrumentation improves lung function. An expansion thoracoplasty on the concave side of the scoliosis by means of a vertical, expandable prosthetic titanium rib VEPTR was originally designed to treat thoracic insufficiency secondary to congenital anomalies with fused ribs, hypoplastic chest wall deformities, and early-onset scoliosis.
Several reports suggest the device may increase thorax and lung volume, as well as hemoglobin levels [ 21 , 37 , 50 , 51 ]. In one study with data from 7 different centers, although there was a clinically and radiographically apparent expansion of the thorax after VEPTR insertion, no similar improvement in lung volume was found, and instead a decrease in forced vital capacity and increase in residual volume was documented [ 52 ].
In a recent study, serial VPTR expansion thoracoplasty resulted in significant increases in lung volume in most patients as evidenced by increases in FVC over time. The effect appeared to be far better when the initial surgical intervention was performed before the age of 6 years.
A decreasing respiratory system compliance was noticed over time which is a major concern for the long term effect of this intervention [ 48 ]. In summary, idiopathic scoliosis is a common debilitating deformity of the thoracic cage with potentially severe and irreversible effects on lung function. Because the pulmonary manifestations may not become clinically evident until significant or irreversible changes in lung function have already occurred, early recognition of the problem and regular evaluation with pulmonary function testing are advisable.
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J Clin Invest. Spine J. Scoliosis care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Scoliosis Open pop-up dialog box Close. Scoliosis Viewed from the side, the normal spine takes the form of an elongated S, the upper back bowing outward and the lower back curving slightly inward.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Scoliosis in children and teens: In depth. Accessed April 7, Introduction to scoliosis. American Academy of Orthopaedic Surgeons. Kliegman RM, et al. The spine. In: Nelson Textbook of Pediatrics. Elsevier; Scherl SA. Adolescent idiopathic scoliosis: Clinical features, evaluation and diagnosis. Ferri FF. In: Ferri's Clinical Advisor Adolescent idiopathic scoliosis: Management and prognosis.
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