Scoliosis is a lateral deviation from the longitudinal axis of the spinal column with rotation (twisting) of the vertebrae around the longitudinal axis and torsion of the vertebral bodies – accompanied by structural deformation of the vertebral bodies. This can no longer be straightened by the muscular system. The spinal column usually forms several, opposing curvatures that compensate each other in order to keep the body in balance (S-shape). Scoliosis can occur in all vertebrates including fish. In humans, scoliosis was first described and treated by the Greek physician Hippocrates.
The Cobb angle serves as a measurement for the assessment of scoliosis.

Classification

1. Following Lenke, the main curvatures (the most pronounced curvatures that are structurally fixed; also called primary curvatures) are named according to the height of their apex (centre of the curve):

• Upper thoracic: Apex of the curve between the vertebrae Th2 and Th6
• Thoracic: Apex of the curve between Th6 and intervertebral discs Th11/12
• Thoracolumbar: Apex of the curve between Th12 and L1
• Lumbar: Apex of the curve between intervertebral disk L1/2 and L4

2. Scoliosis is differentiated according to the curvature as follows:

• C-shaped scoliosis: Lenke type I and V
• S-shaped scoliosis: Lenke type II and III
• Double-S scoliosis (triplescoliosis): Lenke type IV and VI

Idiopathic scoliosis

The cause of scoliosis is not known in around 90 per cent of all cases. Three forms of idiopathic scoliosis are differentiated based on the age of onset:

1. Infantile idiopathic scoliosis (IIS): Onset up to the age of three years
2. Juvenile idiopathic scoliosis (JIS): Onset between the ages of four and ten years
3. Adolescent idiopathic scoliosis (AIS): Onset after the age of eleven years

Idiopathic scoliosis has nothing to do with what is known as ‘infantile scoliosis’, which is usually only a short-term posture deviation in the first year of life.

Symptomatic scoliosis (secondary scoliosis)

The remaining 10 per cent of scoliosis cases are caused by the following:

• Malformation scoliosis due to congenital malformations of the vertebra, Klippel-Feil syndrome, spina bifida and others.
• Neuropathic scoliosis due to nerve and muscle diseases, for example cerebral palsy, spinal muscular atrophy or poliomyelitis.
• Myopathic scoliosis due to muscular dystrophy or arthrogryposis.
• Scoliosis due to systemic diseases such as neurofibromatosis, skeletal dysplasia, osteogenesis imperfecta.
• Iatrogenic scoliosis, that is scoliosis caused by medical treatment (for example irradiation or because of scar formation after operations).
• Post-traumatic scoliosis caused by external force, amputations or tumour operations in the area of the spinal column.
• Static scoliosis due to leg length discrepancies

The progression of the curvature is directly proportional to the growth of the spine. Accordingly, the curvatures progress rapidly during the first five years of life and during growth spurts around puberty (between the ages of 11 and 15). Juvenile scoliosis occurring between the ages of five and 10, on the other hand, can remain stable for a long time until the onset of puberty.

Unexpected and rapid progression frequently occurs during growth spurts around puberty. Then, within a few months, scoliosis often reaches an extent that requires surgery. With scoliosis that occurred before puberty and that had barely deteriorated for a long time, many parents and therapists make an error in judgement so that the scoliosis is no longer monitored by a physician at the onset of puberty or therapeutic care is insufficient for the progression that can be expected.

With the most severe scoliosis, there is a risk that the vital capacity may be significantly restricted. This can overload the cardio-pulmonary circulation and cause pulmonary heart disease with a restriction in quality of life and reduced life expectancy. Limitations of this kind only occur with curvature angles greater than 80-90° Cobb.

The development of a rib hump and lumbar bulge are particularly common cosmetic problems. Back pain mainly occurs in patients with lumbar and thoracolumbar scoliosis as well as decompensated scoliosis. In patients with thoracic scoliosis, there are usually no or only minor pain symptoms. The occurrence of paralysis is not expected with idiopathic scoliosis. As a rule, this only develops with congenital or other secondary scoliosis.

Since scoliosis worsens in the majority of cases if it is not treated, early diagnosis is very important.
The onset of scoliosis is gradual and rarely causes the kind of pain that would make the affected individual consult a doctor. That is why a precautionary examination performed annually between the ages of 11 and 13 for girls or 12 and 14 years for boys, when idiopathic adolescent scoliosis typically develops, is required for early detection.

Depending on the severity of scoliosis, it is treated with physiotherapy (physiotherapeutic exercises), corsets and operations to stiffen the spine. Here one normally transitions from one treatment method to the next. 90 per cent of all scoliosis cases can be treated conservatively (with physiotherapy and corsets where appropriate) and do not require an operation.

Scoliotic malpositions up to 10° Cobb do not require treatment. Emerging scoliosis from 10–20° Cobb is treated with physiotherapy (physiotherapeutic exercises) to prevent further progression.
The objective of physiotherapy exercises in the treatment of scoliosis is to actively straighten the spinal column with subsequent muscular stabilisation.

Progressive scoliosis during adolescence in excess of 20° Cobb should be treated with scoliosis-specific physiotherapy and a corset that guides growth. The treatment goal is to prevent further worsening until growth stops, correct existing curvatures and maintain the corrections that have been achieved.

• It is especially important with scoliosis that tension in the core and superficial back musculature is relieved because this continuously increases pressure on the spine which causes even more severe lateral ‘buckling’.
  The kybun shoe can relieve muscle tension through walking on the soft, elastic sole. This effect is felt after just a few minutes of walking in the kybun shoe. Over the long term, the muscular tissue will tense up far less thanks to active walking in the kybun shoe, especially the superficial musculature which is prone to tension.
• Thanks to the natural rollover of the feet on the soft, elastic kybun shoe sole, the body is automatically straightened, which means the spinal column becomes more extended, relieving strain.
• Once the back musculature is more relaxed and the spine more upright, a good basis has been established for the effective training of the stabilising back musculature (with kybun and physiotherapy), which in turn counteracts scoliosis. Symptoms such as pain are alleviated and, as a result, scoliosis therapy can be performed independently every day without expending additional time.

Long-term, positive effects on the back and the entire body:

Muscle strengthening and stretching in the kybun shoe
The kybun shoe has a soft, elastic sole that does not limit foot mobility but provides full freedom for unrestricted movement in all directions. Standing on the soft, elastic surface with the associated instability in the kybun shoe trains the muscular system and straightens the body. A one-sided relieving posture is prevented. The load on both sides of the body is even, which counteracts tension. The foot can move freely while walking the way nature intended. By eliminating the heel, the foot sinks deep into the sole even on hard, flat surfaces. This stretches and relaxes the musculature.

Upright posture on the kybun mat
Sitting for long periods of time, especially with poor posture, puts one-sided strain on the muscles and spinal column. Underused muscles get weaker and shorten over time. On the other hand, muscles under excessive one-sided strain respond by tensing up. This leads to neck, hip and back pain, and subsequently to further malpositions.

The muscles are stretched, relaxed and trained on the soft, elastic mat of the kybun mat, which brings the body into a natural, upright posture. This releases tension and imbalances. The standing and posture muscles are strengthened in a targeted manner. Back pain can be relieved by switching between tensing and relaxing the muscles.

• Please wear the kybun shoe at the retail outlet for at least 5–10 minutes to give your body some time. You will feel how your body responds to the kybun Shoe and you can get advice to help you find an appropriate shoe.
• Walk as much as possible in the kybun shoe and do not spend too much time standing.
• We advise you to perform the kybun exercises regularly every now and again. They loosen your musculature and you are less likely to assume a passive posture, which puts strain on the back.
• Choose a kybun shoe with a lower rebound effect. It provides you with greater midfoot stability. Ask your kybun dealer to show you the various models.
• If you experience severe fatigue even with the kybun exercises, feel pain or in case of lateral/medial rolling on the kybun sole, we advise taking a short kybun shoe/kybun mat break until the symptoms go away.
• Be sure to maintain an upright posture, avoid taking excessively long steps and keep your gaze forward (do not look at the floor). You should walk straight on the kybun shoe sole and correct any lateral/medial rolling of the ankle joint!
• Should your back pain continue even though you are following the application tips, please seek advice from your kybun dealer.