Every case of scoliosis is as unique as the patient themselves. Scoliosis can develop at any age, in different forms, and can range in severity from mild to moderate, severe and very severe. Generally speaking, the more severe a patient’s condition is, the more likely it is to cause related pain, especially in adults.
No two cases of scoliosis are the same, including related back pain. While back pain can be a common part of the adult experience of living with scoliosis, for children and adolescents, it is not. Pain is largely dependent on patient/condition characteristics such as condition severity, patient age, and condition type.
Scoliosis can cause varying levels of back pain. As the condition introduces a lot of uneven forces to the body, related postural changes and other symptoms can cause pain as well. Let’s start our discussion of scoliosis and back pain by exploring how scoliosis generally affects the body.
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When a person first receives a scoliosis diagnosis, they understandably have a lot of questions. Among the most common questions I’m asked are, “How much worse will the condition get?” and “Will it be painful?”
These are difficult questions to answer because scoliosis is a complex condition that varies greatly from one patient to the next. I can never know, with 100-percent certainty, just how much, or how fast, a patient’s condition will progress, although certain condition factors, such as condition severity and patient age, can help me predict these variables.
When a person develops scoliosis, it means their spine has an abnormal sideways curvature, with rotation. In order to receive an official structural scoliosis diagnosis, the abnormal curvature has to not just bend from side to side, but also twist from back to front, front to back, (rotational element), and in addition, the abnormal curvature has to have a Cobb angle measurement of at least 10 degrees.
While the spine has natural curvatures that give it added strength, flexibility, and facilitate its even distribution of mechanical stress, when a spinal condition causes a loss of one or more of its healthy curves, adverse spinal tension is introduced, and its effects can be felt throughout the body, and not just in the back.
As mentioned, no two cases of scoliosis are the same, which is why I have never used the same treatment plan twice. The very nature of scoliosis necessitates an integrative and customized treatment approach, and one of the main factors that guides the crafting of a treatment plan is condition severity.
Condition severity plays a large role in determining whether or not a person’s scoliosis will produce noticeable symptoms such as postural changes and pain.
The parameters that have to be met to fulfill the definition of scoliosis reflect key elements of the condition, such as a patient’s Cobb angle that places the condition on its severity scale of mild, moderate, severe, or very severe.
A patient’s Cobb angle is obtained via X-ray as it involves a measurement of the spine taken from the tops and bottoms of the curvature’s most-tilted vertebrae (bones of the spine). The resulting angle is measured in degrees, and that tells us how far out of alignment a scoliotic spine is:
While there are other important factors that feed into the design of a treatment plan such as patient age, condition type, and curvature location, condition severity plays a dominant role in determining pain levels and crafting effective treatment plans.
As you can see by the range of Cobb angle degrees, scoliosis develops across a wide severity spectrum, which is why it’s so important for effective treatment plans to be fully customized to address the specifics of each patient and their condition.
While there are no guarantees, generally speaking, the higher a patient’s Cobb angle, the more severe their condition is, and the more likely it is to produce related postural changes and pain.
When it comes to pain, the likelihood of scoliosis becoming painful increases substantially once skeletal maturity has been reached, meaning a person is no longer growing; this is where patient age comes into play with when and when not to expect scoliosis-related back pain.
While scoliosis can develop at any age and in a variety of forms, the most prevalent type of scoliosis is adolescent idiopathic scoliosis (AIS) diagnosed between the ages of 10 and 18.
The ‘idiopathic’ designation means it is not associated with any single-known cause, and idiopathic scoliosis accounts for 80 percent of known diagnosed scoliosis cases; the remaining 20 percent, however, are associated with known causes such as congenital, neuromuscular, degenerative, and traumatic.
As mentioned, age is a huge related factor when it comes to predicting how painful a patient’s condition is likely to be, and this is related to having reached, or not reached, skeletal maturity.
For children and adolescents who are still growing, scoliosis is not commonly painful; this is because a growing spine is constantly experiencing a lengthening motion, which counteracts the compressive force of an abnormal spinal curvature.
The tendency for scoliosis to not be painful in children and adolescents is part of the reason early detection is not always easy to achieve. If pain isn’t present as a signifier that something is amiss within the body, and in mild cases where postural changes can be subtle, it can be difficult for anyone, other than a scoliosis expert, to recognize the condition’s early signs.
In adults who have reached skeletal maturity and are no longer growing, it’s the curvature-related compression felt by the spine and its surrounding muscles, vessels, and nerves that causes pain, which can range from mild to debilitating.
In fact, in adult scoliosis, it’s often pain that brings adults in for a diagnosis, whether their condition is idiopathic or degenerative (the two main forms affecting adults).
So when it comes to what to expect in terms of scoliosis-related back pain, while there are no guarantees as every case is unique and dependant upon a number of variables, in general, back pain is not a common complaint of children and adolescents living with the condition; however, when it comes to adults living with scoliosis, back pain is a common symptom.
Now, as I’ve mentioned, there are different types of scoliosis that can develop, such as idiopathic, or those associated with known causes; let’s expand on back pain in some of these different condition types.
In addition to condition severity and patient age, condition type can play a role in determining whether or not a patient is going to experience back pain.
As the majority of idiopathic scoliosis patients are children and adolescents who have not yet reached skeletal maturity, back pain is not a common aspect of living with the condition; however, once again, the adult experience of living with scoliosis is very different, and idiopathic scoliosis in adults is the most common form of adult scoliosis.
Idiopathic Scoliosis in Adults
The two main types of scoliosis affecting adults are idiopathic and degenerative, so let’s take a moment and address the topic of pain in these two condition forms.
As AIS is not always easily detectable, this means many adolescents mature with their condition unaware, without a diagnosis, and without treatment. What tends to happen in these cases is that once skeletal maturity is reached, noticeable symptoms start to appear; these include more overt postural changes, because progression has occurred over time, and as the spine and its surroundings are more vulnerable to the curvature’s progressive force, the condition can become painful, signifying something is wrong and leading to a diagnosis.
While back pain is common in adults living with scoliosis, pain that radiates into the legs and feet is also common, and this is caused by compression of the spinal nerves.
Nerves are like branches on a tree, fanning off in multiple directions, so even if a compressed spinal nerve is the source of pain, that’s not always where its effects are felt, and this is common among my adult scoliosis patients.
Compressed nerves can also lead to unpleasant feelings of tingling and numbness in related areas. Nerve-related back pain is often described as one of the worst types of back pain as its effects are not just limited to its site of origin, but can be felt throughout the body.
As adults have reached skeletal maturity and can be subject to compression-related pain in the back and other areas, some level of pain should be expected, especially if left untreated.
The other most-common form of scoliosis in adults is degenerative.
Degenerative scoliosis most commonly affects adults over the age of 40. As the body ages, it faces degenerative changes, including the spine. The spine can also face age-related degeneration due to the cumulative effect of certain lifestyle choices such as not maintaining a healthy weight, leading a sedentary lifestyle, chronic bad posture, and repeatedly lifting heavy objects incorrectly and straining the back.
The spine is made up of individual bones (vertebrae), and these are separated by intervertebral discs. These discs have two main components: a durable and hard outer casing and a soft gel-like interior.
The discs sit between adjacent vertebrae cushioning them so they don’t rub up against one another, generating friction during movement. They also give the spine more flexibility and act as ligaments providing the spine with structure.
In addition, the intervertebral discs function as the spine’s shock absorbers so mechanical stress is evenly distributed throughout, ensuring no one area of the spine is taking on more stress/weight than others.
As you can see, the intervertebral discs are important to the spine’s overall strength, function, and health, and when it comes to spinal degeneration, this is most commonly felt in the discs.
Degenerative Disc Disease
As the discs start to degenerate, the spine’s ability to maintain its natural and healthy curvatures is compromised, potentially leading to the development of scoliosis. As this form of scoliosis is caused by the spine’s already weakening health, it can be particularly painful, especially if discs are affected to the point of developing degenerative disc disease (DDD).
In severe cases of DDD, the discs can lose height, which narrows the nerve pathways, potentially causing nerve impingement, inflammation in the affected area, and varying levels of pain.
Mechanical pain can also be an issue if the shock-absorbing role of the discs is adversely affected, causing adjacent vertebrae to rub up against one another.
In addition, other spinal conditions that compromise the overall health of the spine such as osteoarthritis and osteoporosis can lead to the development of degenerative scoliosis, and when this type of scoliosis is caused by another spinal condition, progressive rates can increase, along with condition severity, and pain as a related symptom.
So for those recently diagnosed with degenerative scoliosis, it’s likely that pain is part of what led to their diagnosis, and varying levels of back pain is likely going to continue, especially without proactive treatment.
In addition to idiopathic and degenerative scoliosis in adults, there are other condition types associated with known causes that can cause pain, particularly in adults.
In cases of neuromuscular scoliosis, the scoliosis develops as a secondary complication of a larger neurological condition/disease such as spina bifida, muscular dystrophy, or cerebral palsy.
This form can be particularly aggressive in terms of progression, and can result in patients being wheelchair-bound.
As these conditions tend to progress faster, increasing in severity, their potential to cause pain is higher than in more typical forms of the condition; this is because there is an underlying condition causing its development and complicating the treatment process.
Both in children and adults, neuromuscular scoliosis can cause severe postural asymmetries, such as pelvic obliquity, and while not commonly painful in young patients who are still growing, adults can experience varying levels of related back pain, in addition to pain felt in other areas such as the hips.
So for adults who develop neuromuscular scoliosis, it’s realistic to expect some level of back pain as part of the experience of life with the condition, but in children, back pain is not commonly experienced.
Traumatic scoliosis is not a particularly common form of the condition; this is caused by traumatic events experienced by the spine such as surgery, accidents, or other body traumas affecting the spine adversely, such as the presence of tumors pressing on the spine.
In this condition form, back pain is a realistic expectation as the condition has developed as a result of some form of trauma.
In the instance of tumors pressing on the spine, treatments such as chemotherapy and radiation are also known to weaken the bones, making them more prone to injury, degeneration, and a number of related issues capable of causing back pain.
So we’ve talked about condition characteristics that play a large role in determining how painful scoliosis can be such as condition severity, patient age, and condition type, and we have also addressed how everyone has their own unique experience of life with the condition, making it impossible to fully predict just how painful a patient’s scoliosis is going to be.
We’ve also addressed how different types of scoliosis have different pain levels associated with them, and now, you might be wondering just how people living with scoliosis-related back pain would describe it.
As mentioned, every patient has their own unique experience of day-to-day life with scoliosis, including pain levels.
For those living with varying levels of scoliosis-related back pain, a common description is that the back feels stiff on one side; this is the result of scoliosis introducing uneven forces to the spine and body.
Spinal rigidity also accompanies progression, making the spine stiff and inflexible. Progression can also stiffen the muscles surrounding the spine as they are worked unevenly and strained in an effort to provide the scoliotic spine with support and stabilization.
Patients also describe the sensation of their bodies feeling weighed down, stretched, and pulled. This discomfort can be felt in the back, and throughout the body, as the adverse spinal tension that scoliosis introduces causes compression.
The feeling of being pulled down is also understood as a result of the shift in the body’s center of gravity that occurs as scoliosis develops and progresses, and the overall asymmetrical affect it has on the body.
I understand why people ask questions about what to expect when they are diagnosed with scoliosis. Knowing what to expect can not only help patients prepare, but also regain some of the feelings of powerlessness that can accompany such a diagnosis.
However, these questions are not always easy to answer because scoliosis is so highly variable from one person to the next. There are multiple factors that play into how a person’s life will look and feel with their condition, particularly in terms of pain: condition severity, patient age, and condition type.
One thing I can address with certainty is that the most effective and sustainable way to reduce a patient’s scoliosis-related pain, long-term, is to respond to the condition’s presence proactively, with a treatment approach that prioritizes correction, curvature reduction, and spinal function.
So in common forms of scoliosis, such as idiopathic, children and adolescents should not expect to experience significant amounts of back pain because they have not yet reached skeletal maturity; adults, however, experience scoliosis-related back pain very differently, and it is likely to be part of life with the condition to some degree, especially if left untreated.
Here at the Scoliosis Reduction Center, our treatment approach is chiropractic-centered and functional, prioritizing the spine’s overall health and function by addressing the condition’s underlying structural nature.