Baby boomers and Generation Xers may recall the days of being screened for scoliosis in elementary or middle school. While this practice was common in states across the U.S. for a number of years, it has stopped in many communities.

Some may also remember when kids diagnosed with scoliosis -- the medical term for an abnormal curvature of the spine -- wore heavy-looking metal braces. This full-torso brace extended from the pelvis to the base of the skull. Designed by Milwaukee-area physicians and commonly referred to as "The Milwaukee Brace," it was the most popular bracing approach in past decades.

Today, screenings and treatment approaches are varied.

Wisconsin is one of more than 25 states where school screenings are not currently mandated. Yet many organizations recognize the benefits of screening programs including the American Academy of Orthopedic Surgeons (AAOS), Scoliosis Research Society, and American Academy of Pediatrics.

Most physicians perform screenings during annual check-ups. Yet, a challenge exists because many adolescents do not have routine wellness doctor visits.

Screenings take as little as 30 seconds and are commonly performed on children between 10 and 15. A trained health care professional views the spine in both standing and bending positions. Children with suspicious findings should see a physician who often orders an x-ray. Parents may also want to have a child examined by a physical therapist (PT) to discuss exercise-based approaches to treatment.

Most children with scoliosis have mild curves and won't need aggressive treatment. When a curve is suspected or confirmed, routine screenings are critically important. Some parents opt for screenings every three months rather than semi-annually or yearly, especially during times of rapid adolescent growth. Information about a curve's progression is important in determining the best treatment approach.

Medical organizations publish treatment guidelines. The decision to treat scoliosis is based on many factors, including age, maturity, sex, family history, curve size and how much the child is likely to grow.

Traditionally in the U.S., treatment involved a "wait and see" approach. Physicians have most commonly monitored curve progression and initiated treatment if the curve passed a certain threshold. Typically, physicians recommend bracing or surgery, or both. Scoliosis surgery involves techniques to fuse or join the vertebrae along the curve.

Bracing options have expanded. The most commonly used brace is a thoraco-lumbo-sacral orthosis (TLSO), or underarm brace. It is more easily concealed under clothing than the Milwaukee Brace. Additional bracing approaches have emerged in recent years with some options including (insert list).

In the U.S., PT has also recently emerged as a valuable treatment. In past decades, while PT has played a minor role in scoliosis treatment in America, it is now becoming more popular among a growing number of patients.

One PT-based approach has seen increased popularity in the U.S. within the past five years. The Schroth method is a conservative, non-surgical, exercise-based approach developed in Germany in the 1960s. In Europe, more than 3,000 patients are treated with Scroth annually. Today, fewer than 20 therapists in the US are Schroth-certified; three are on staff at our Milwaukee area clinic which draws patients from across the U.S.

Many physicians from the United States say research is inconclusive for bracing or physical therapy. With Schroth, most patients report a benefit of being empowered to take action in addressing scoliosis, and many report improved postural deformity.

Decision about screening for and treating scoliosis are always individual choices of families. Parents and children should be aware of the importance of screening and explore various treatment options if scoliosis is present.