A spine curves naturally for strength, flexibility, and shock absorption, but an unnatural spinal curve may cause a number of issues. People diagnosed with scoliosis deal with an unnatural curvature of the spine that also rotates, meaning it bends and twists.
As a 3-dimensional spinal condition, rotation matters because as the vertebrae (bones of the spine) twist, they can pull on the spine’s surrounding muscles and the rib cage, causing more imbalance. The size of a patient’s curve and level of rotation indicate the severity, and higher rotation can mean more rigidity, pain, and a higher risk of curve progression.
When it comes to assessing and diagnosing scoliosis, key factors such as patient age, risk of curve progression, symptoms, type, severity, and angle of trunk rotation need to be considered.
Why Rotation Matters
When the spine is aligned, its vertebrae are held in a straight and neutral position and the spine’s healthy curves are in place, but if the spine curves and rotates unnaturally, the rotational component alone can cause biomechanical changes, excessive spinal rigidity, and asymmetrical vertebral growth.
Scoliosis disrupts the spine’s healthy position by causing it to curve unnaturally to the side, but in order to be considered a true scoliosis, there has to be a rotational component, meaning the spine also twists unnaturally.
To be diagnosed as scoliosis, an unnatural curvature of the spine has to have a minimum Cobb angle measurement of at least 10 degrees, with rotation.
The diagnostic process requires an X-ray to confirm the presence of scoliosis, the size and pattern of the spinal curve, the amount of axial rotation, skeletal maturity, and risk of curve progression.
There are a number of factors that influence progression such as patient age, scoliosis type, severity, and the amount of rotation; the more rotation there is, the higher the risk of curve progression because the spine is structurally off balance.
Rotation matters because it can contribute to rapid progression, changes to spinal biomechanics, and uneven vertebral growth.
Rotation and Progression
The larger the size of a spine’s unnatural curve, the more severe it is and the more likely curve progression is, and higher angles of trunk rotation mean the spine is also severely twisted.
While some cases of scoliosis are stable, many progress with growth spurts in children, and degenerative changes to spinal health in older adults can contribute to the onset/progression of adult scoliosis.
Rotation matters because it increases the risk of curve progression because the spine is even more off balance, and a larger Cobb angle and a higher degree of rotation makes the spine more rigid, and this is important for treatment because the more flexible the spine is at the onset of treatment, the more responsive it may be to changes in position.
Rotation and Biomechanics
Spinal biomechanics is a complex term but can be broken down simply by saying it’s how the spine’s individual structures (vertebrae, discs, facet joints, ligaments, and surrounding muscles) work together. The spine’s balance, shock absorption, flexibility, and ability to protect the spinal cord (central nervous system) are shaped by its biomechanics.
If a section of the spine has severe vertebral rotation, the twisting of the vertebrae expose the structures in the area to uneven pressure, and if left unaddressed, can cause uneven wear and trigger degenerative changes to spinal health.
Discs between vertebrae can become desiccated and lose height because they’re not able to stay centered between the vertebrae, and the small hinge-like joints that connect vertebrae (facet joints) can lose cartilage due to friction during movement.
Degenerative disc disease and facet joint arthritis can cause increasing instability in the spine.
Rotation and Vertebral Growth
Curve progression in children is triggered by growth, and when there are vertebral abnormalities, such as twisting, the constant uneven pressure on one side of the growth plates may slow bone development and cause vertebral wedging.
Vertebral wedging further contributes to the spine’s inability to stay balanced and aligned.
When vertebral rotation is occurring, the twisting bones are not carrying weight evenly, leading to asymmetric growth and wear.
What Does Rotation Mean for Symptoms?
If you have recently been diagnosed with scoliosis, there can be a lot of confusing medical words and terms that classify a condition, but what most patients really want to know is if the scoliosis will increase, how fast, and what daily life will be like.
When it comes to quality of life with scoliosis, patients can lead normal and healthy lives, particularly those undergoing proactive treatment; in fact, there are a number of famous athletes and celebrities who are thriving in their careers, despite an earlier diagnosis of scoliosis.
Scoliosis varies in severity, type, cause, curve pattern and location, and the spine’s rotational component.
There are different levels of rotation that may make a patient’s scoliosis more symptomatic and/or difficult to correct than a lower angle of trunk rotation.
Rotoscoliosis and Postural Changes
A diagnosis of rotoscoliosis means the spine curves to the side and rotates severely. Rotoscoliosis means the spine is severely twisted, so it’s more likely to cause noticeable postural changes and pain.
It’s important to recognize the early signs of scoliosis so a scoliosis-specific assessment can be performed and the next steps can be determined.
In children, the earliest signs are often uneven shoulders and uneven hips, and because most cases of rotoscoliosis occur in the thoracic spine, because the thoracic spine is the only section attached to the rib cage, it’s also associated with noticeable rib flaring; this occurs when the spine’s unnatural curve and twist is pulling excessively on one side of the rib cage, causing a visible rib hump with one side of the rib cage protruding noticeably.
Because thoracic scoliosis is the most prone to rapid advancement, symptoms may change quickly, becoming more noticeable and disruptive. Additional postural changes to watch for include the head appearing uncentered over the torso, one shoulder blade protruding more, an uneven waist line, and arms and legs that don’t hang evenly. Clothing not hanging properly is another sign the body is becoming less symmetrical.
Rotoscoliosis and Pain
Scoliosis isn’t always painful, particularly when mild, and in most cases, childhood scoliosis isn’t as painful as adult scoliosis because when growth stops, the spine is less resistant to the compressive force of the unnatural curve and rotation in the spine.
Scoliosis pain can involve the back, pain that radiates into the extremities due to nerve compression, and supportive muscles. Pain is a primary symptom of adult scoliosis; in fact, it’s often pain felt in the arms and hands, legs and feet that lead to a number of diagnoses.
When the spine twists more, the uneven forces are more extreme and more likely to cause severe back pain.
A potential complication of severe scoliosis rotation is breathing problems. The rib cage attaches to the thoracic spine, forming the thoracic cage that protects important organs such as the lungs, and if the lungs are being compressed and/or have lost space within the thoracic cage because of the structural changes to the rib cage’s position, the lungs may be affected.
Children with severe rotation are less likely to experience severe pain than adults due to compression, but severe curves with rotation in children may cause pain involving the back and the spine’s surrounding muscles.
Rotation and Treatment Planning
The most common type of scoliosis overall is idiopathic scoliosis, and idiopathic thoracic scoliosis curves are the most prone to rapid progression, rotation, and pain.
When scoliosis symptoms are noticed and assessment is performed, this will involve a comprehensive evaluation of body posture and an Adams forward bend test where the spine is examined in a forward bend position; the spine and any related trunk asymmetries are highly visible in this position.
A Scoliometer can be placed over the spine to assess a patient’s angle of trunk rotation. If an assessment finds indicators of scoliosis, the next step is a scoliosis X-ray: the only way to confirm the presence of the spine’s unnatural curve and rotation.
A shortcoming of some traditional forms of scoliosis treatment is that it doesn’t address the spine’s rotation, and as a 3-dimensional structural spinal condition, for long-term improvement, the spine’s unnatural curve and rotation need to be improved.
Treatment options are varied and need to be customized around the specifics of a patient’s scoliosis: size of the unnatural curve, the amount of rotation, where it’s located in the spine, risk of curve progression, and symptoms.
If the spine’s rotation isn’t addressed, the spine and body’s alignment can’t be fully improved.
Why rotation matters is because it makes the scoliosis a 3-dimensional condition, and treatment will be limited if it only addresses the spine’s unnatural curve, but not its rotation.
Treatment plans are customized, but here at the Scoliosis Reduction Center®, scoliosis-specific chiropractic care, physical therapy, with a focus on postural restoration, and 3D corrective bracing work together towards the goal of improving the spine and body’s alignment.
Conclusion
Scoliosis causes the spine to curve unnaturally to the side, and to be considered a true scoliosis, the vertebrae also twist, and rotoscoliosis refers to cases that involve severe rotation.
The more rotation there is in the spine, the more severe the scoliosis, and idiopathic thoracic scoliosis curves are the most prone to progression and rotation.
If severe scoliosis is left unaddressed, it’s likely to continue progressing, and the longer it’s left unaddressed, the more potential there is for complications such as lung impairment.
A focus of scoliosis treatment is restoring the spine’s alignment and symmetrical body posture, and because curve progression is likely in most cases, early detection and early intervention can be outcome-shaping factors.
