The complex nature of scoliosis necessitates the customization of effective treatment plans, and this is because no two cases are the same. Each patient’s scoliosis will cause its own unique set of symptoms; the main scoliosis symptom in adolescents is postural deviation, while the main symptom in adults is pain.
Scoliosis ranges widely in severity from mild to moderate and severe to very severe. How scoliosis affects a person, in terms of its symptoms, will depend on a number of key patient/condition variables; patient age, for example, shapes whether or not a condition is likely to be painful.
When I give a scoliosis diagnosis, I’m asked what types of symptoms a person can expect, and this depends on a number of variables.
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Being diagnosed with scoliosis means an unnatural sideways spinal curve has developed, with rotation, making it a 3-dimensional condition.
In addition, scoliosis has to be of a minimum size to reach the parameters of a diagnosis, but we’ll return to that later.
The spine’s natural and healthy curves make it stronger, more flexible, and better able to absorb/distribute mechanical stress incurred during movement.
There are a number of spinal conditions a person can develop that involve a loss of the spine’s healthy curves, and when that happens, the spine’s overall health, function, and biomechanics are disrupted.
When the spine develops an unnatural curve, a lot of uneven forces are introduced to the body, and this can cause a number of symptoms.
In addition, remember the spine and brain work in tandem to form the body’s central nervous system (CNS), so spinal conditions have the potential to cause a wide range of symptoms felt throughout the body, especially when there is a degree of nerve involvement.
An important condition characteristic is its progressive nature, meaning it will get worse over time, so where a scoliosis is at the time of diagnosis is not indicative of where it will stay.
As a condition progresses, the unnatural spinal curve is increasing in size, symptoms will likely become more noticeable, and the condition becomes more complex to treat.
Scoliosis treated while mild means the curve is at its smallest, its most flexible, and treatment is started before the body has had ample time to adjust to the unnatural spinal curve’s presence.
Spinal rigidity increases with progression, making the spine less responsive to treatment, and the potential of chiropractic care to impact scoliosis on a structural level is key to a conservative treatment approach.
As mentioned earlier, a scoliotic curve has to be of a minimum size in order to be diagnosed as scoliosis, and this variable shapes a condition’s symptoms, so let’s return to a patient’s Cobb angle.
A scoliotic curve has to have a minimum Cobb angle of 10 degrees to be diagnosed as scoliosis, and a patient’s Cobb angle is taken during X-ray.
Measuring a patient’s Cobb angle involves drawing lines from the tops and bottoms of the curve’s most-tilted vertebrae, at its apex; the intersecting angle is expressed in degrees.
Cobb angle tells me how far out of alignment a scoliotic spine is, and classifies conditions in terms of severity:
Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
Severe scoliosis: Cobb angle measurement of 40+ degrees
Very-severe scoliosis: Cobb angle measurement of 80+ degrees
Two factors that help shape a patient’s condition symptoms are condition severity and the angle of trunk rotation (ATR); the more bent and twisted the spine is, the more likely it is that its effects are going to be noticeable.
A key patient factor when it comes to scoliosis symptoms is also patient age, as this shapes how painful a condition is likely to be.
So now that we’ve defined the condition and some of its important characteristics, let’s talk about scoliosis symptoms in the condition’s most-prevalent form: adolescent idiopathic scoliosis (AIS).
Scoliosis affects everyone from infants to the elderly and every age in between, but it’s most commonly diagnosed in adolescents between the ages of 10 and 18.
Adolescent idiopathic scoliosis is the condition’s most-prevalent type, and this age group is at risk for rapid-phase progression.
While the idiopathic designation means not clearly associated with a single-known cause, we do know how to respond to it with treatment, and fully understanding the condition’s etiology doesn’t necessarily mean the course of treatment, or its outcome, would change.
In cases of adolescent idiopathic scoliosis, the most common symptom, and noticeable way that it affects the body, is postural deviation.
As mentioned, scoliosis introduces a lot of uneven forces to the body, and this can disrupt the body’s natural symmetry.
Common signs of scoliosis in adolescents can include:
Additional symptoms of AIS can include clothing becoming ill-fitting (due to changes in the body’s overall symmetry), and changes to balance, coordination, and gait (due to postural deviation caused by the condition’s uneven forces).
Although there is usually a degree of related muscle pain, scoliosis in children and adolescents isn’t commonly described as painful, at least not when it comes to back and radicular pain, and this is largely determined by patient age, so let’s move onto common symptoms of adult scoliosis.
When it comes to scoliosis in adults, the most common type is idiopathic, and these cases are patients that had AIS but didn’t receive a diagnosis and/or treatment during adolescence, so their condition progressed with maturity and time.
This is a common scenario as adolescents don’t generally find the condition painful, and particularly in mild forms, the condition isn’t known to cause noticeable functional deficits, and postural changes can be subtle, making early detection a challenge.
In these types of cases, it’s not until the condition becomes compressive, when skeletal maturity has been reached, that the condition starts causing noticeable symptoms that lead to a diagnosis and treatment.
The most common symptom that brings adults in to see me is localized back and/or radicular pain felt in the hands and feet, and this is due to compression.
In younger patients who are still growing, their spines are experiencing a constant lengthening motion, and this counteracts the compressive force of the unnatural spinal curve.
It’s compression of the spine and its surrounding muscles and nerves that causes the majority of scoliosis-related pain.
So while the condition does also cause postural changes in adults, similar to those mentioned in adolescents, the most noticeable way it affects the body is in how painful it is, and for adults, pain is the condition’s number-one symptom.
Now that we’re on the topic of adult scoliosis, let’s address how the condition can affect people throughout their lives.
Just as the condition’s severity and symptoms will differ from one patient to the next, so too will its effects throughout life.
There is no way to predict how a condition will affect a person as they age because there are multiple factors that play a role: overall health and fitness, condition severity, type, and how it’s treated.
A condition that’s left untreated is going to progress faster, become more severe, and cause more-noticeable effects than one that is diagnosed and treated early in its progressive line.
The two main ways that the condition’s effects change over time is in terms of pain and progression.
Pain
As already touched on, one of the main ways in which the condition’s effects change throughout life is in how painful it is; once skeletal maturity is reached, the condition becomes compressive.
As mentioned, idiopathic scoliosis is the most common type to affect adults, followed by degenerative scoliosis, and this type is caused by natural age-related spinal degeneration.
The body degenerates with age, and the spine is no exception; in most cases of degenerative scoliosis, it’s the spine’s intervertebral discs that are the first spinal structures to feel the effects of deterioration.
Symptoms of degenerative scoliosis in adults can include:
So as we age, scoliosis is likely to become more painful, and this is because the condition has become compressive, and also, natural age-related spinal degeneration can exacerbate its effects and increase progressive rates.
Progression
Another way that scoliosis affects change with age is in the condition’s progressive rate.
As mentioned, while we don’t fully understand the condition’s etiology, we do understand how to treat it, and what triggers its progression: growth and development.
Growth and development is the condition’s main progressive trigger, which is why children and adolescents are at risk for rapid-phase progression, because of the stage of puberty characterized by rapid and unpredictable growth spurts.
Once skeletal maturity is reached, the trigger of growth is removed, so as the condition tends to become more painful, its progressive rate tends to slow; however, once the effects of spinal degeneration, due to aging, come into play, this can increase an adult’s progressive rate.
It’s also important to understand that althoug monitoring for progression is more of a focus when treating children and adolescents, even seemingly-glacial rates of progression in adults can add up over time.
Most adults with idiopathic scoliosis tend to progress at a rate of one degree a year, while adults with degenerative scoliosis tend to progress at a rate of 0.5 to 3 degrees a year.
At even either of those minor rates, over 10 years, the cumulative effect of incremental progression adds up to significant progression over time.
“What can scoliosis do to you?” This is a question I’m commonly asked when giving a scoliosis diagnosis, and the answer will vary from patient to patient and will depend on a number of factors such as patient age, condition severity, and how the condition is treated.
If a diagnosis of mild scolosis is responded to with proactive treatment, there are fewer limits to what we can achieve, and its effects can be minimized, but if left untreated, or not treated proactively, the condition will likely progress, symptoms will become more severe and noticeable, and the condition will become more complex to treat.
The main symptom of scoliosis in children and adolescents is postural deviation caused by how the condition’s uneven forces disrupts the body’s overall symmetry; when it comes to adults, the main symptom is pain, and this is due to the condition becoming compressive in adulthood.
Regardless of patient age or severity, the best time to start scoliosis treatment, with the potential of minimizing the condition’s effects, is always now.
Here at the Scoliosis Reduction Center, I start treatment as close to the time of diagnosis as possible with the goal of preventing progression, increasing symptoms, and the need for more invasive forms of treatment in the future.
