Scoliosis is a structural spinal condition that ranges widely in severity, in addition to having multiple condition types, based on causation. Idiopathic scoliosis, with no known cause, is the most prevalent type to affect both children and adults, with adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18, being the most prevalent condition type overall.
Different types of scoliosis have different causes, but the reality is that we don’t always know what causes scoliosis to develop. Idiopathic scoliosis, the condition’s most prevalent form, is not clearly associated with a single-known cause, and is a progressive condition triggered by growth.
Let’s start our exploration of idiopathic scoliosis by exploring how a diagnosis is reached, and then move on to the main condition forms, while answering some common condition-related questions.
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With so many different spinal conditions in existence, in order to reach a diagnosis of scoliosis, certain parameters have to be met.
Scoliosis is a structural spinal condition that involves the development of an unnatural sideways spinal curve, and the curve also twists, with the rotational component making scoliosis a 3-dimensional condition.
The size of the unnatural spinal curve has to be of a minimum size to be diagnosed as a scoliotic curve: Cobb angle measurement of at least 10 degrees.
A patient’s Cobb angle is a key piece of information when it comes to shaping the design of customized treatment plans, and this is where the condtion’s progressive nature comes in.
Scoliosis has it in its very nature to get worse over time, making it a progressive condition, so where a scoliosis is at the time of diagnosis doesn’t mean that’s where it will stay.
The best way to counteract the condition’s progressive nature is through proactive treatment.
A patient’s Cobb angle classifies conditions in terms of severity, and the severity scale is also the condition’s progressive line:
Scoliosis progressing means the unnatural spinal curve is increasing in size, which means the condition’s uneven forces are also increasing, as will their effects.
In addition to severity, another key classification point is condition type, and this is determined by causation.
Many people have heard the term idiopathic, which is a medical term for cause unknown.
Idiopathic means not clearly associated with a single-known cause, and this isn’t exactly the same as a complete absence of cause; for example, idiopathic scoliosis is generally thought to be multifactorial, meaning caused by a combination of factors that can vary from person to person.
For those wondering, how did idiopathic scoliosis get discovered, the condition has been around since ancient times and was first described by Hippocrates and Galen.
Hippocrates also coined the term scoliosis from skolios, which is Greek for bent; in these early days, the condition was thought to be caused by poor posture.
Approximately 80 percent of known diagnosed scoliosis cases are classified as idiopathic, with the remaining 20 percent associated with known causes: neuromuscular scoliosis, degenerative scoliosis, and congenital scoliosis.
Idiopathic scoliosis can affect infants, juveniles, adolescents, and adults, but is most commonly diagnosed in adolescents.
As mentioned, idiopathic scoliosis is the condition’s most prevalent type, both in adults and children, and adolescent idiopathic scoliosis is the most common form of scoliosis overall.
AIS is highly-prevalent with current literature showing a rate of scoliosis in teenagers of between 0.47 and 5.2 percent, and scoliosis is the leading spinal condition amongst school-aged children.
Adolescents are most often diagnosed with AIS between the ages of 10 and 18, and growth and development is known as the condition’s main trigger, which puts adolescents at risk for rapid-phase progression due to the rapid and unpredictable growth spurts that characterize the stage of puberty.
Because adolescents are always growing, their conditions are constantly being triggered to progress, which is why observing how the spine is responding both to treatment, and growth, is an important facet of treatment.
While each case is unique, scoliosis needs to be measured frequently in young patients who are still growing; in general, with every inch of growth, I will re-measure an adolescent’s scoliosis as a key focus of treatment is reducing curves and holding them there despite the constant trigger of growth.
The most common symptom of scoliosis in adolescents is postural deviation, and this is due to the condition’s uneven forces disrupting the body’s overall symmetry.
Oftentimes, the earliest signs of scoliosis in adolescents are uneven shoulders and hips, and other types of postural changes can include:
Due to the aforementioned postural changes associated with AIS, disruptions to gait, balance, and coordination are additional condition indicators, along with clothing that suddenly seems ill-fitting.
While scoliosis is more common in children and adolescents, idiopathic scoliosis does also affect adults.
Idiopathic scoliosis in adults is the most common type of adult scoliosis, and these cases are cases of AIS that went undiagnosed and untreated throughout adolescence.
It can seem difficult to imagine that an unnatural spinal curve could go unnoticed, undiagnosed, and untreated for so many years, but it is actually quite common.
Scoliosis doesn’t become a compressive condition until adulthood, so for children and adolescents, the condition isn’t generally known as painful; the lengthening motion of a growing spine counteracts the compressive force of the unnatural spinal curve, and it’s compression of the spine and its surrounding muscles and nerves that causes the majority of condition-related pain.
When scoliosis becomes compressive, its main symptom is pain, which is why so many adolescents remain undiagnosed and untreated while the condition’s symptoms are mild and subtle, and don’t receive a diagnosis and treatment until it becomes painful in adulthood.
Pain can include localized back pain and pain that radiates throughout the body, due to nerve compression, but is particularly common in the hands and feet.
The unfortunate reality is that had these patients been diagnosed and treated during adolescence, their spines would likely be in far better shape than by the time I see them, but nevertheless, it’s never too late to start treatment.
When it comes to treating scoliosis, the type of treatment committed to is the most important decision to be made, following a diagnosis.
There are two main scoliosis treatment approaches for patients, and their families, to choose between: traditional and conservative.
It’s important to understand the differences between the two as each offers patients a different potential outcome, and patients need to ensure their treatment expectations are aligned with the realities of their potential outcomes.
Traditional scoliosis treatment is described as more reactive than proactive, and this is because it doesn’t have a strategy for treating scoliosis while mild, so merely watches and waits for progression, despite the fact that as a progressive condition, every case is virtually guaranteed to progress.
Once a condition progresses into the severe classification and shows signs of continued progression, patients become surgical candidates and are commonly funneled towards spinal fusion surgery.
Spinal fusion surgery is a costly, invasive, and lengthy procedure that strives to prevent progression by fusing the curve’s most-tilted vertebrae together into one solid bone as this eliminates movement in the area.
While this can work in terms of straightening a scoliotic spine, it does so by artificial means and can come at a high cost: the spine’s overall health, strength, function, and flexibility.
Now, there are many variables that factor into how a patient responds to spinal fusion surgery such as patient age, condition severity, fusion location, and the number of vertebrae fused, with some not experiencing noticeable adverse effects, but the risk is there so should be considered carefully.
Modern conservative treatment is also referred to as functional and/or chiropractic-centered, and this is because the approach strives to preserve as much of the spine’s natural strength and function as possible, and it does so by working to reduce the unnatural spinal curve.
Because scoliosis is a structural condition, it has to, first and foremost, be impacted on a structural level, and conservative treatment values being proactive by starting treatment as close to the time of diagnosis as possible.
While there are never treatment guarantees, scoliosis is simplest to treat while mild, and this is because with progression, the spine gets increasingly rigid, making it less responsive to treatment, and the body has more time to adjust to the unnatural spinal curve’s presence.
When adolescent idiopathic scoliosis is detected early and responded to with proactive treatment, there are few limits to what can be achieved.
By integrating multiple condition-specific treatment disciplines into treatment plans, they can be fully customized for the most specific results.
Here at the Scoliosis Reduction Center, I combine chiropractic care, in-office therapy, corrective bracing, and rehabilitation to work towards impacting conditions on every level.
Through chiropractic care that includes manual adjustments and a variety of techniques, I work towards adjusting the most-tilted vertebrae of the curve back into alignment with the rest of the spine, thus restoring as much of its natural curves as possible.
Once I start to see structural results in the form of a curvature reduction, with physical therapy and a series of scoliosis-specific exercises (SSEs), I shift the focus of treatment onto increasing core strength so the spine is optimally supported by its surrounding muscles.
Corrective bracing is also known to be particularly effective on growing spines, and the ScoliBrace can help augment corrective treatment results by pushing the spine into a corrective position.
The final phase of treatment is an ongoing one. As a progressive and incurable condition, scoliosis is with a person for life, but it is highly treatable, and with continued rehabilitation efforts, treatment results can be sustainable and long-term; a series of custom-prescribed exercises can help patients establish a home-rehabilitation program for continued stabilization of the spine.
There is no invasiveness about a conservative chiropractic-centered treatment approach, so it doesn’t come with the potential risks, side effects, and complications that spinal fusion does.
As such a complex progressive spinal condition, the very nature of scoliosis necessitates a customized treatment approach and the experience of a scoliosis specialist.
While most traditional scoliosis treatment involves invasive spinal surgery, the reality is that many cases of scoliosis can be treated with non-operative treatment, and through a proactive conservative treatment approach, curves can be reduced and core strength can be increased so progression, escalating symptoms, and surgical recommendations can be avoided.
When it comes to idiopathic scoliosis, we’re talking about the most common type to affect both children and adults, and as idiopathic means not clearly associated with a single-known cause, we don’t fully understand the etiology of adolescent idiopathic scoliosis (the most-prevalent condition type), but we do know how to treat it.
The prevalence of idiopathic scoliosis in adults attests to the challenge of early detection, as these cases were adolescents whose conditions went unnoticed, not being diagnosed until becoming compressive, and painful, once skeletal maturity was reached in adulthood.
When it comes to idiopathic scoliosis, like all condition-types, the best time to start treatment is always now; the sooner a curvature reduction is worked towards, the more likely it is to be successful.
