While scoliosis is far more commonly diagnosed in adolescence, adults can also develop the condition and come to me for treatment. Once skeletal maturity has been reached, the treatment focus shifts to reducing a curvature back to where it was before it started to produce noticeable symptoms, such as pain. Read on to find out how we accomplish this.
While adult scoliosis can be managed through active treatment, no form of the condition can be fully ‘corrected’, meaning ‘cured’. This is because as a progressive and incurable condition, scoliosis is virtually guaranteed to get worse over time. While adult scoliosis can progress slowly, there is still a cumulative effect, and this is why engaging in active treatment is so important.
Before we move on to exploring the specifics of adult scoliosis in terms of treatment and symptoms, let’s take a look at where adult scoliosis fits in terms of condition form and prevalence.
One of the reasons scoliosis is so often described as a complex condition is because it can develop at any age, and there are many different forms of the condition.
It’s also complex to treat because there is no one treatment plan that can be applied to multiple patients; every case is unique, which is why I have never used the same treatment plan twice.
Scoliosis can develop at any age; however, the condition is most commonly diagnosed between the ages of 10 and 18.
This form of the condition is known as ‘adolescent idiopathic scoliosis’ and accounts for approximately 80 percent of known diagnosed cases.
The ‘idiopathic’ designation refers to the condition’s cause, which is unknown.
As this form has no known single cause, it’s considered, instead, to be multifactorial, meaning it’s onset is understood as a result of multiple factors that can differ from one person to the next.
One of the condition’s classification points is cause, and the remaining 20 percent of diagnosed cases have known specific causes: congenital, neuromuscular, traumatic, and degenerative.
Congenital scoliosis - congenital scoliosis develops due to a failure of the bones of the spine (vertebrae) to form properly.
Often, the spine’s abnormal development occurs between week eight and week 12 of gestation.
If you picture the vertebrae of the spine as rectangular-shaped bricks stacked on top of one another, imagine what would happen if one of those bones was triangular in shape instead.
That malformed vertebrae can cause the spine to slip out of alignment, throwing off the spine’s biomechanics and leading to the development of scoliosis.
Neuromuscular scoliosis develops as a secondary complication of a more primary medical disease such as muscular dystrophy or cerebral palsy; these are diseases of the spine, muscular system, and brain.
Neuromuscular scoliosis is the second most common form of the condition.
These diseases impair the body’s ability to control movement via the muscles that support the spine, and this can lead to the development of scoliosis.
These cases are among the most difficult to treat because there are two factors governing the condition: the neuromuscular disease and the progressive nature of scoliosis itself.
When it comes to treatment, it’s the primary neuromuscular disorder that has to be addressed first and foremost and will dictate the treatment approach.
I can’t give these patients as positive prognoses as I can with more typical and treatable forms of the condition, but there is still a lot we can do in terms of alleviating discomfort and helping these patients live their best lives.
Traumatic scoliosis can develop after the spine has sustained a trauma that has affected it adversely.
Potential sources can be tumors, accidents, or other body traumas that impact the spine.
Degenerative scoliosis is a common form of adult scoliosis.
It develops out of the natural degenerative effects of aging that impact the spine, most notably the intervertebral discs.
We will expand on this form more in a later section when we move onto the specifics of adult scoliosis.
For now, we have discussed the condition’s most common form (AIS) and the difference between a condition classified as idiopathic, one considered as multifactorial, or having a known cause.
Now that we have a decent understanding of different condition forms and their prevalence, let’s move on to early detection and diagnosis.
If you have done your due diligence in researching scoliosis, it’s likely you would have come across the important benefits of early detection.
This is because as a progressive condition, you want to start active treatment as soon as possible in the hopes of staying ahead of its natural progressive line.
This is particularly important in the condition’s most common form, AIS, as early detection has a strong correlation to treatment success, but how does that factor into adults with the condition?
This leads us directly into one of the condition’s most complex characteristics: progression.
One of the condition characteristics that factors into treatment approach most significantly is progression.
In the condition’s most common form, AIS, progression guides the treatment approach because this age group is at the biggest risk of rapid progression.
While we might not know the cause for this form, we do understand its progressive nature and how closely it’s tied to growth and development.
As adolescents, this age group is entering into the stage of puberty, marked by rapid and unpredictable growth spurts, so a large component of treatment is monitoring for growth and how the spine responds to that growth.
When it comes to adult scoliosis, progression carries a different significance as having reached skeletal maturity, the risk factor of growth is removed.
That being said, and this is important to understand, progression is progression. Whether a condition progresses 10 degrees in two years, or over 12 years, if left untreated, the abnormal spinal curvature will still reach the same severity level; it just might take more time to get there.
While scoliosis is often thought of as an adolescent disorder, there has been a shift to exploring the prevalence of the condition in adults as well.
In fact, adolescent scoliosis rates sit at approximately 2 to 4 percent, while the rate of scoliosis in adults sits at between 12 and 20 percent.
While it’s far more common to diagnose scoliosis in adolescents, it’s clear that as the population ages, scoliosis rates increase.
While progression becomes less of an immediate concern in the treatment of adult scoliosis, the actual number of scoliosis cases does increase with age.
Now that we’ve determined that the prevalence of scoliosis increases with age, let’s take an in-depth look at the two main forms of adult scoliosis: adult idiopathic scoliosis, and adult degenerative scoliosis.
Discussing adult idiopathic scoliosis brings us back to something we’ve already touched on: early detection.
This is because cases of adult idiopathic scoliosis are childhood cases that were undiagnosed.
As touched on earlier, early detection of scoliosis in adolescents is highly beneficial, but not always easy to achieve.
This is because having not yet reached skeletal maturity, adolescents don’t generally find their condition painful, and especially in milder forms of the condition, even some of the postural changes it can produce are too subtle for an average person to notice.
In many of these types of cases, patients went through adolescence unaware of their scoliosis, and it’s not until reaching adulthood that they became aware something was wrong.
When it comes to adult idiopathic scoliosis, it’s pain that most often brings adults in to see me. This is because a spine that is no longer growing is vulnerable to the compressive force of the curvature, and this affects the spine and its surrounding nerves, muscles, and tendons.
This can present as back and/or neck pain, but is often expressed as radiating pain in the arms, legs, and feet due to pinched nerves.
As scoliosis ranges in severity from mild to moderate and severe, related symptoms can also change to reflect the variance within these classifications.
Before we explore adult scoliosis treatment options, let’s move on to the other common form of adult scoliosis which we touched on earlier: degenerative scoliosis.
Most common in adults over the age of 40, degenerative scoliosis occurs when the spine and its individual parts start to feel the effects of years of wear and tear.
This is most commonly experienced by the intervertebral discs. Once the intervertebral discs start to degenerate, the spine can easily slip out of alignment.
This is because the vertebrae of the spine are separated by the discs that act as cushions so the bones don’t grind up against each other.
If the discs start to deteriorate and are no longer giving support to the spine, this can speed up degenerative changes and lead to the spine slipping out of alignment and scoliosis developing.
While the discs of the spine don’t automatically degenerate with age, the cumulative effect of lifestyle choices contribute to the health of the spine and its intervertebral discs.
For example, choices such as sitting for long periods of time without good posture, not consuming enough water, leading an inactive life, or regularly lifting heavy objects improperly can lead to the cumulative effect of spinal-disc degeneration.
Other factors such as genetics can also play a role as some people’s discs are better at holding water, meaning they are less likely to deteriorate.
Lack of motion is a huge contributing factor to an unhealthy spine. The very design of the spine is to facilitate movement, and it is through movement that the spinal discs can replenish their water level and stay healthy.
Activity also increases blood flow, meaning nutrients and moisture are more readily available to the discs; if activity levels are low or nonexistent, the longevity of the discs is compromised, as is the overall health of the spine.
In addition, people with degenerative scoliosis also often have osteoporosis; this commonly affects aging women facing changes to bone density associated with fluctuating hormone levels and menopause.
When it comes to treating adult scoliosis, having reached skeletal maturity, there are not as many treatment options available as there are for children and adolescents.
However, an adult with scoliosis still has options, and still has to make the important choice of how to manage and treat their condition moving forward.
When an adult comes in to see me here at the Scoliosis Reduction Center, whether they already have a scoliosis diagnosis or not, part of my assessment is to discuss potential treatment options moving forward.
Here at the Center, we want to treat the whole patient; this means taking into account any and all areas of a patient’s life affected by their condition, and treatment approach can greatly impact daily life.
As already mentioned, there are less treatment options available to adults than adolescents, and this is because of a few factors.
If you think of idiopathic scoliosis in adults, remember that these people have already been living with their condition for years, prior to even finding out they have scoliosis.
Chances are, adults with idiopathic scoliosis who have just learned they have scoliosis, are not in the early stages of progression.
Treating scoliosis only becomes more challenging as a condition progresses. Not only is this because the condition is naturally moving into its more severe stage of progression over time, but also because the body has had years to adjust to the abnormal spinal curvature.
The body can be remarkably effective at adjusting to structural changes and compensating for these changes to preserve function.
After a person has been living with scoliosis for years, their spinal discs, muscles, and tendons gradually adjust to the spine’s unnatural position.
Also, keep in mind that as part of the central nervous system, the health of the spine impacts the brain. Just as the spine and closely-surrounding muscles and tendons can grow accustomed to the abnormal spinal curvature, so too does the brain as it becomes comfortable with the patterns reinforcing the curvature.
In addition, a spine that is no longer growing is less malleable and more rigid.
Sometimes, in cases where the spine is particularly rigid, we first have to work towards restoring some spinal flexibility before we concentrate our efforts on an actual curvature reduction.
Now that we’ve covered adult scoliosis in general terms, let’s move on to treatment approach.
As mentioned earlier, even though we are often dealing with adult patients who have already been progressing for years, or those dealing with degenerative scoliosis, deciding between the two main treatment approaches is still important.
While there are obvious benefits to catching a condition early on in its progressive line, it’s never too late to start treatment.
When it comes to scoliosis treatment options, there are two main approaches patients have to decide between: traditional and functional.
As the name suggests, ‘traditional’ has been around the longest, and the dominance of this approach is one of the factors that led to my becoming a scoliosis specialist.
I wanted to spread awareness of, in my opinion, a better option. I wanted patients and their families to be aware that there are alternative treatment options available: options that are more natural, less invasive, carry few, if any, side effects, and don’t lead to irreversible spinal-fusion surgery.
The traditional scoliosis treatment approach is marked by watching and waiting.
Even with adolescent forms, these patients are often told that if their condition is mild at the time of diagnosis, the best recourse is to wait and observe to see if the condition actually gets worse.
The problem with this is, as we have already discussed, as a progressive condition, scoliosis is virtually guaranteed to get worse, and whether it happens rapidly or glacially, progression is, again, progression.
In adolescent idiopathic scoliosis, the only likely active treatment effort made, prior to recommending surgery when a condition progresses into that surgical threshold (40+ degrees), is bracing.
While bracing can be an effective form of treatment, for adults, this is less so as their spine is no longer growing.
In adults, if a brace is used as part of treatment, it’s most often used to stabilize the spine and/or alleviate related pain and discomfort.
So, if an adult with scoliosis is walking the traditional treatment path, they might be told to wear a brace, but more likely, and especially if their curvature has already progressed past 40 degrees, they will be told that spinal-fusion surgery is their best option.
This is where I want patients to really do their due diligence in researching the potential cost, side effects, and complications associated with spinal fusion.
Once a spine is fused, there is no un-fusing it; however, if an adult was to come into the Center and choose our functional approach, if unhappy with treatment results, there is no harm done. Our approach carries few, if any, side effects.
Here at the Center, we offer our patients an active and alternative functional treatment approach.
Our approach is integrative as patients benefit from the accessibility of multiple treatment disciplines all available under one roof.
We want to address the underlying structural nature of the condition, which is why, first and foremost, we want to produce a structural change in the form of a curvature reduction.
We do this by combining the merits of scoliosis-specific treatment disciplines such as targeted chiropractic adjustments, exercise, therapy, and corrective bracing.
While bracing doesn’t have as strong a place in our treatment of adult scoliosis, our other disciplines work together to produce the best possible results.
Often, the treatment goal for adult scoliosis is to return the curvature to where it was before it started producing noticeable symptoms such as pain and postural changes; this helps to lessen/alleviate adverse symptoms by actively treating the underlying condition.
In this way, we are working towards reducing the spine’s abnormal curvature, plus related symptoms, by restoring as much of the spine’s healthy curves as possible.
To clearly answer the question of if scoliosis can be corrected in adults and if there is still reason to hope: yes, active treatment can provide my adult patients with amazing results.
That being said, there is no ‘correcting’ scoliosis; I say this because, most often, people associate the term ‘correction’ with ‘cure’.
As explained earlier in the article, there is no cure for a progressive and incurable condition like scoliosis.
The treatment goal is not to cure the condition, in the usual sense, but to instead control and manage its progression and related symptoms.
Even once treatment has been deemed successful and a patient’s degree of curvature has decreased, active efforts have to be made to maintain that reduction.
Scoliosis-specific exercise and stretches done from home, plus in-office rehabilitation, therapy, and chiropractic care all work together to sustain those results once the intense treatment phase is over.
There is always hope for people with scoliosis of any age, and this is one of the main points I work towards getting across in Scoliosis Hope.
While adults may not have the treatment benefit of early detection while the spine is still growing and flexible, there are still active forms of treatment that can lead to symptom-relief, a curvature reduction, and a significant improvement to every-day life.