Fig. 2

Image on the left: The Vicious cycle. Dr. Stokes and Burwell hypothesized that the vicious cycle of scoliosis curve progression begins with a triggering event which leads to the formation of wedged vertebrae. Wedged vertebrae cause the spine to curve which results in continuous asymmetric loading on the spine. This in turn, can potentially promote asymmetric growth of the spine and progression of scoliosis curves as asymmetric growth increases the wedging of the vertebrae and perpetuates the cycle to continue. The image on the right shows a scoliosis patient sitting with increased asymmetric loading of the spine as described in Stokes’ ‘Vicious Cycle”. The large red “X” on the image indicates that this is not the desired posture. The image on the right shows the same scoliosis patient sitting with improved asymmetric loading of the spine as she performs scoliosis specific physiotherapy exercises in accordance with the Lyon approach