Scoliosis can be a mystifying condition. While some forms have known causes, the majority of diagnosed cases are classed as ‘idiopathic’, meaning there is no known single cause. As a progressive condition, there is no known cure for scoliosis, but that doesn’t mean we can’t effectively treat and control it.
To answer this question fully, this article will ask some important questions related to scoliosis in an effort to define and understand the nature and progression in children, adolescents and adults.
Scoliosis is defined as an abnormal sideways curvature of the spine that coincides with spinal rotation. This means the condition is 3-D and occurs on the spine’s three planes: frontal, sagittal, and transverse.
The condition causes structural changes to the spine, and its progressive nature means that it will get worse over time. It’s the progressive aspect of the condition that’s the hardest to predict as every patient progresses at their own rate. Despite what anyone says, there’s no way to definitely gauge exactly how much a person’s scoliosis will progress and at what rate.
It’s also the leading cause of spinal deformity in school-aged children, and let’s keep in mind that these estimates are in the States alone and only include known cases of the condition. There are, undoubtedly, many people living with the condition unaware in the States and throughout the world.
When I have to give a patient, and their families, a scoliosis diagnosis, it’s not always the easiest news to give. In my book Scoliosis Hope, I spend a lot of time demystifying the condition, and also trying to change the narrative around it from negative to positive. While I do think, and have seen, that people can live amazing lives with the condition, I also recognize that it’s most certainly a challenge.
There are some common questions and concerns I am met with when a patient first finds out they have scoliosis, and I don’t always have the answers patients want to hear. Most often, the questions surround the most mystifying parts of the condition: causation and progression.
One of the aspects of the condition that the medical community has spent the most time researching and studying is causation. It’s a natural human drive to want to understand what initially causes a condition to develop, and understanding causation increases awareness of potential preventative measures. This is what’s difficult with scoliosis.
Only 20 percent of diagnosed scoliosis cases have known causes, and in many of these cases, scoliosis develops as a secondary complication of a larger medical issue. Congenital, neuromuscular, traumatic, and degenerative scoliosis make up this category.
Congenital Scoliosis: scoliosis that develops due to a bone malformation that occurs during gestation. If you think of the individual vertebra of the spine as rectangular bricks stacked on top of one another, if one of those rectangles was, instead, a triangle, that would shift the whole spine out of alignment; that shift in alignment causes the scoliosis to develop.
Neuromuscular Scoliosis: scoliosis that develops as a secondary complication of neuromuscular diseases such as cerebral palsy and muscular dystrophy. In these conditions, there is a disconnect between muscles and how they are directly controlled by the central nervous system.
Traumatic Scoliosis: as the name indicates, scoliosis can develop as a result of a trauma experienced by the spine. Accidents such as falls or car crashes can damage the spine and cause scoliosis to develop as a symptom of the trauma.
Degenerative Scoliosis: scoliosis that is most common in adults over the age of 50, and this often develops due to wear and tear on the spinal discs that separate the vertebrae of the spine. The discs act as the spine’s shock absorbers, hold the vertebra of the spine together, and help facilitate the spine’s mobility. Degenerative changes to the discs can easily cause the spine to slip out of alignment, causing scoliosis to develop.
Treating one of the above forms of scoliosis, that accounts for 20 percent of known cases, involves addressing its underlying cause; the remaining 80 percent have no known cause and are classed as ‘idiopathic’. In these cases, we might not fully understand the condition’s causation, but we do have a thorough understanding of groups most commonly affected, and triggers for/patterns of progression.
Most patients who’ve recently received a scoliosis diagnosis want to fully understand the condition’s progressive nature. This is not an easy explanation to give as, at some point, it’s likely that everyone’s scoliosis will get worse. Some people’s condition progresses rapidly, while others move at a glacial pace.
While I can learn everything I need to about a patient’s condition from reading their scoliosis X-ray, progression is still something we can’t fully predict. That being said, we do know which groups are more likely to face rapid progression and adjust our treatment plans accordingly to monitor and control that progression.
When it comes to children with scoliosis, they are at a high risk of for rapid progression because they have the most growth to go through. One thing we know for certain about scoliosis progression is that growth is its number-one trigger.
With children, the sooner the condition is diagnosed, the better. If the condition is caught before the age of the first major growth spurt, the potential to heal and reduce the spinal curvature is at its greatest.
The age group most commonly diagnosed with scoliosis is adolescents between 10 and 18 years of age. Adolescents diagnosed with scoliosis are also at a high risk for rapid progression because the puberty stage is characterized by rapid and unpredictable growth spurts.
With my adolescent patients, we know that they need to be monitored closely to see how growth impacts their scoliosis. If a patient grows an inch, I’ll want a new X-ray taken to monitor if progression is occurring alongside the growth spurt; if it is, we adjust their treatment plan in order to stay ahead of the curve.
When it comes to adults with scoliosis, progression can be slower because they have already reached skeletal maturity, so that big progression-trigger has been removed. That being said, many adults with scoliosis are former adolescents with the condition who didn’t get diagnosed until adulthood. This is because adolescent scoliosis is often a painless condition, and depending on the condition’s severity level, symptoms and changes can be very subtle and difficult to spot.
If an adult comes to me with a large spinal curvature, they are still at a high risk for progression because the larger a curvature is, the more likely it is to progress, even though they’ve already reached skeletal maturity.
In these cases, our treatment goal is to reduce the adult patient’s curvature to where it was when they weren’t experiencing any pain and discomfort.
As mentioned earlier, there is no known cure for scoliosis, and this is why the more relevant issue then becomes how to manage the condition’s progression through a functional and proactive treatment approach.
Here at the Scoliosis Reduction Center, our scoliosis-specific chiropractic approach is all about proactively and effectively managing our patients’ condition.
The first step to developing a customized treatment plan for a patient is to assess the information provided by their scoliosis X-ray. I can find out everything I need to know about a patient’s condition through comprehensively reading their X-ray results. I can see how severe their curvature is and where along the spine it’s located.
While this information can’t tell us exactly how fast the curvature will progress, combined with other classifications such as age, gender, and causation, we can gauge its most likely rate of progression and how best to monitor it and respond.
First, I address the structural issue of the curvature through a series of chiropractic adjustments that help the spine move in the direction we want it to. Once we’ve achieved a reduction and know our approach is working, we widen that treatment plan to include a customized exercise regime that patients can do from home to augment the structural results we’ve achieved.
Through scoliosis-specific exercise and stretches, our patients work towards strengthening the muscles that support the spine and increase their overall strength and flexibility. If additional forms of treatment such as therapy or custom 3-D bracing are deemed necessary, our patients benefit from being able to access these multiple treatment forms in one accessible location.
Despite the efforts made over the years to find a cure for scoliosis, it still evades us, which is why the focus has shifted to managing its progression. Fortunately, there are many triggers for and patterns of progression that make monitoring and treating the condition highly effective.
Our approach here at the Scoliosis Reduction Center is to treat the condition functionally through scoliosis-specific chiropractic, and a variety of other facets of treatment, so the curvature is reduced by natural means. With our alternative approach to treatment, we manipulate the spine to move in the direction we want it to; this results in the spine holding itself in a corrective position, rather than being artificially held as it is in the more traditional approach to treating scoliosis. The difference is that our approach is a functional one, meaning the spine can still maintain its natural strength and flexibility throughout treatment and beyond.
Nalda, Tony - Scoliosis Hope