Close to seven million people live with scoliosis in the United States alone. While there are different condition types, idiopathic scoliosis accounts for 80 percent of known diagnosed cases, and this type is the most common to be found in adults. Keep reading to find out more about scoliosis in adults.
Many consider scoliosis to be a condition that affects young people, and while it’s more commonly diagnosed in children and adolescents, it also affects adults. The two main forms of adult scoliosis are idiopathic and degenerative, each with its own causation and unique condition characteristics.
Before moving on to the specifics of adult scoliosis, let’s start with a general introduction to the condition for a more comprehensive understanding of the differences in how adults and adolescents experience it.
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When a person of any age is diagnosed with scoliosis, this means they have an abnormal sideways spinal curvature, with rotation, making it a 3-dimensional condition, and a minimum Cobb angle measurement of 10 degrees.
Healthy spines have natural curvatures that make them stronger, more flexible, and better able to absorb and distribute mechanical stress incurred during movement.
The spine has three main sections, each with its own range of curvature degree: the cervical spine (neck), the thoracic spine (middle/upper back), and the lumbar spine (lower back).
Each healthy curvature is reliant upon the others as each affects the spinal section above and/or below. When a section’s curvature degree falls beyond a normal and healthy range, it can disrupt the biomechanics of the entire spine.
The spine consists of bones (vertebrae) stacked on top of one another in a neutral and natural alignment and separated by intervertebral discs: essential spinal structures that we’ll revisit later.
Another parameter that has to be met to reach a scoliosis diagnosis is a measurement known as the orthopedic gold standard in the diagnosis and assessment of scoliosis: Cobb angle.
A patient’s Cobb angle is measured during X-ray by drawing intersecting lines from the tops and bottoms of the curvature’s most-tilted vertebrae at the apex of the curve, and this tells me how far out of alignment a scoliotic spine is and places conditions on a severity scale of mild, moderate, severe, and very severe.
From the wide range of Cobb angle measurements, you can see that a defining characteristic of scoliosis is its highly-variable nature, making no two cases the same and necessitating the design of fully-customized treatment plans.
So if you are diagnosed with scoliosis, your spine has an unnatural spinal curve that compromises its ability to remain optimally aligned, which impacts the spine’s overall health and function.
An important factor to understand is that where the condition is at the time of diagnosis is not indicative of where it will stay. Scoliosis is not a static condition, and this is because it’s progressive: meaning it’s in the condition’s nature to worsen over time, especially if left untreated or not treated proactively.
Now that we have a basic understanding of what a scoliosis diagnosis means let’s address the specifics of adult scoliosis and how it differs from the condition’s most prevalent form: adolescent idiopathic scoliosis (AIS).
Although there are multiple forms of scoliosis an adult can develop when scoliosis is diagnosed in adults, the two most common types are idiopathic and degenerative.
Idiopathic means not clearly associated with a single causative source. In the context of scoliosis, this does not mean an absolute lack of causation. Instead, the condition is considered multifactorial, meaning caused by a combination of many factors that can vary from one person to the next.
A large percentage of known diagnosed cases (80 percent) are classified as idiopathic, and the remaining 20 percent fall into one of the following classifications: neuromuscular, congenital, degenerative, and traumatic.
So now that we know the different classifications of scoliosis, let's focus on the types that affect adults: idiopathic, degenerative, neuromuscular, and traumatic.
Idiopathic Scoliosis
Adults who had scoliosis as adolescents are the adults diagnosed with idiopathic scoliosis later in life.
Idiopathic scoliosis is the most common condition type to affect adults. While it might seem surprising that a person could have scoliosis throughout adolescence and not be aware of its presence until adulthood, this is quite common.
Adolescent idiopathic scoliosis, diagnosed between the ages of 10 and 18, is the most prevalent form, and as mentioned, scoliosis develops across a wide severity spectrum from mild to moderate and severe to very severe.
So let’s talk about the two main scoliosis symptoms: postural changes and pain.
In terms of postural changes, we’re talking about how the body responds to the uneven forces introduced by the development of an unnatural spinal curve. While every case is different, the earliest signs of scoliosis are often the development of uneven shoulders and hips.
However, in mild cases, postural changes can be subtle and only noticeable to medical professionals trained in the telltale signs of scoliosis and know what to look for.
For the average parent and adolescent, condition-related postural changes can be confused with natural responses to adolescence: the classic adolescent slouch, for example.
When it comes to pain, scoliosis isn’t known to be painful in adolescents because they have not yet reached skeletal maturity, meaning they are still growing.
Growing spines are constantly being lengthened, and this lengthening motion counteracts the compressive force of a scoliotic curve and its compression of the spine and its surrounding ligaments, muscles, and nerves that are the main source of condition-related pain.
Scoliosis pain in adults is experienced very differently, which we’ll explore in more detail later.
In terms of functional deficits, again, scoliosis isn’t known to produce noticeable ones at the mild level, which is why even the majority of adolescents, when diagnosed, aren’t diagnosed until having progressed from mild to moderate.
Now that you have a better understanding of why and how adolescent idiopathic scoliosis can progress into adulthood unnoticed, let’s move on to the next most prevalent form of scoliosis in adults: degenerative.
Degenerative Scoliosis
Degenerative scoliosis is most commonly diagnosed in adults after the age of 40 and involves spinal degeneration related to aging.
While the spine is subject to degenerative changes as we age, there are certain preventative measures a person can take to minimize these effects.
In terms of preserving spinal health and function, certain lifestyle choices can speed up natural age-related spinal degeneration: carrying excess weight, low activity levels, chronic poor posture, and repeatedly lifting heavy objects incorrectly.
These choices can mean a spine has excess weight to carry, and this also affects the spine’s surrounding muscles that play a part in providing support and stabilization.
Leading a sedentary life is contrary to the spine’s very design, which is based on movement.
Chronic poor posture, over time, can impact the spine’s ability to maintain its natural curvatures and alignment, and not understanding the ergonomics of proper lifting can expose the spine to uneven wear and lead to injury.
So now that we’ve addressed lifestyle and spinal degeneration, let’s talk about natural age-related changes to the spine.
Once a certain age is reached, the body naturally starts to degenerate, and the spine is no exception.
The spine has a lot of work to do. It gives the body structure, allows us to stand upright and practice good posture, engage in flexible movement, supports the weight of the trunk, absorbs and distributes mechanical stress that’s incurred during movement, and facilitates brain-body communication by working in tandem with the brain to form the central nervous system (CNS).
As such a complex and integral part of human anatomy, it has equally-complex and important moving parts and structures.
In most cases of spinal degeneration, it’s the spine’s intervertebral discs that show the first signs of deterioration.
In fact, degenerative disc disease is a common feature of degenerative scoliosis as the discs provide the spine with structure, enable flexibility, and act as its shock absorbers.
When the health of an intervertebral disc is compromised, this can affect its surroundings, including adjacent vertebrae that are attached. When a disc deteriorates and/or faces disc desiccation, bulges, or herniates, the disc’s change in shape affects adjacent vertebrae and can change their position.
So when a disc changes shape, adjacent vertebrae often face a shift in position that can lead to the further development of an unnatural sideways spinal curve: scoliosis.
As growth is the condition’s number one trigger for progression, it can seem as though adults wouldn’t experience this. While progression can slow once adulthood is reached, the cumulative effect, over time, of even incremental Cobb-angle increases can lead to a significant increase in condition severity.
When natural age-related spinal degeneration comes into play, this can speed up progression as the spine’s overall health and function decline.
Now let's move on to another type of scoliosis known to affect adults: neuromuscular scoliosis.
Neuromuscular Scoliosis
My neuromuscular scoliosis patients are among the most complex to treat, and this is because scoliosis develops as a secondary complication of a serious neuromuscular condition/disease like cerebral palsy, muscular dystrophy, and/or spina bifida.
Neuromuscular conditions involve a disconnect in brain-body communication, particularly in terms of how the brain talks to the muscles and connective tissues that support and stabilize the spine.
As mentioned earlier, the brain and spine work in tandem to form the central nervous system, which facilitates brain-body communication through the transmission of signals sent and received throughout the body. When a neuromuscular condition affects this system of communication, it can impact the muscles and nerves that surround the spine, compromising their ability to properly balance the spine and trunk: uneven forces.
These uneven forces can lead to the development of neuromuscular scoliosis as the spine’s ability to maintain its natural curvatures and alignment is compromised.
When neuromuscular scoliosis develops as a secondary complication, the underlying condition causing its development has to be the guiding force of the treatment, which complicates the treatment process, meaning I can’t offer my neuromuscular scoliosis patients the same type of prognosis as I can with more typical forms.
There are always improvements that can be worked towards that can greatly impact a person’s quality of life moving forward.
While not as common as the aforementioned types of adult scoliosis, traumatic scoliosis is another form that affects adults.
Traumatic Scoliosis
Traumatic scoliosis can occur at any age, including adulthood, because it involves the spine experiencing an extreme trauma and/or sustained injury; common causes are car accidents and falls.
In addition, the presence of tumors pressing on the spine can also be the driving force behind the development of an unnatural spinal curve because their uneven pressure on the spine can push it out of alignment and disrupt its natural and healthy curves.
Now that we have discussed and explored the types of scoliosis that affect adults, let’s explore the types of symptoms associated with the different severity levels of adult scoliosis.
Scoliosis is a highly-prevalent spinal condition; the Scoliosis Research Society has current estimates at close to seven million people currently living with scoliosis in the United States alone, and that number only includes known diagnosed cases.
If it was possible to estimate the number of people living with the condition unknown, which is a common scenario, that number would increase exponentially.
Scoliosis is the leading spinal condition amongst school-aged children, and while the condition is more commonly diagnosed in children, it also affects adults of all ages.
Scoliosis is thought to develop irrespective of race, geography, and socioeconomic factors, and the multifactorial nature of idiopathic scoliosis can explain its high prevalence around the world and across different age groups.
The most prevalent type of scoliosis overall is adolescent idiopathic scoliosis, and the two most common types to affect adults are idiopathic scoliosis and degenerative scoliosis.
The estimated rate of scoliosis in adolescents is 0.47 to 5.2 percent, and as growth is the main trigger for progression, adolescents are the most at risk for rapid-phase progression, and prevalence and curve severity is higher in females than in males.
When it comes to adults, while children are more frequently diagnosed with the progressive spinal condition, the actual rate of scoliosis increases with age.
Some studies show a rate of between 12 and 20 percent, with one study focusing on the prevalence of scoliosis in adults over the age of 60 showing rates as high as 68 percent; this is attributed to the development of degenerative scoliosis that develops in older adults due to natural age-related spinal degeneration and the cumulative effect of negative lifestyle factors.
As mentioned earlier, the lack of pain in adolescent idiopathic scoliosis is attributed to it not being a compressive condition, but as skeletal maturity is reached, the spine settles due to gravity and maturity, and compression becomes an issue.
Scoliosis pain in adults is the number-one reason bringing them in to see me for a diagnosis and treatment, and often, it isn’t back pain but radicular pain felt in the legs, hands, and feet.
For adults diagnosed with idiopathic scoliosis, I have to explain that it’s not a new development, and the unfortunate reality is that, as a progressive condition, had these patients received a diagnosis and proactive treatment during adolescence, their spines would be in far better shape than they are by the time I see them.
That doesn’t mean, however, that idiopathic scoliosis in adults is untreatable, and while there are no treatment guarantees, early detection does carry a lot of benefits in terms of potential treatment success, and this is because treating a mild curvature is less complex: curvature reductions are more easily achieved prior to significant progression.
As scoliosis progresses, this means the abnormal spinal curve is increasing in size, and with progression comes increasing spinal rigidity.
A rigid spine is less responsive to treatment, which is why with many of my adult patients, we have to do some preliminary work to restore a degree of spinal flexibility before moving on to the next stage of treatment.
In addition, treating scoliosis in the milder stage means the body has not had as much time to adjust to its presence.
Scoliosis pain in adults can range from mild and intermittent to chronic and debilitating. This can be caused by spinal rigidity and stiff and sore muscles surrounding the spine that are struggling to provide it with support and stabilization.
Once scoliosis becomes a compressive condition, it’s not just the spine that’s exposed to compression but also its surrounding ligaments, muscles, and nerves.
Often, compression-related pain is determined by the degree of nerve involvement, and this and other important factors such as patient age and overall health, causation, curvature location, and severity will factor into just how painful a condition is.
When spinal nerves are exposed to compression, they can become irritated and/or inflamed, and as nerves are like branches on a tree, fanning off in multiple directions, this means the effects of nerve compression can be felt anywhere along a nerve’s pathway, which can be extensive.
Take sciatica, for example: the sciatic nerve is the largest nerve in the body and extends from the lower back, down the buttocks, thigh, leg, and foot, and all of these areas can experience pain as a result of sciatic-nerve compression.
Nerve-related pain is often considered the most debilitating form of back pain and can feel like tingling, numbness, weakness, and/or like electric shocks.
There are so many variables that factor into how painful scoliosis is for adult patients, and this is why there is no clear-cut answer as to precisely how painful scoliosis will be, and this is also why it’s essential that treatment plans are fully customized to address important patient/condition characteristics.
In addition to pain, adults can also experience postural changes related to their condition.
Again, while every case is different, condition-related postural changes in adults can involve a pronounced lean to one side, as the uneven forces of scoliosis affect the body’s overall symmetry.
Uneven shoulder height and/or one shoulder blade protruding more on one side than the other is another common postural change in adults, as well as the development of a rib arch.
Often, these changes are more noticeable when in a forward-bend position.
As is the case with all forms of scoliosis, adult scoliosis also ranges in severity from mild to moderate and severe.
When scoliosis is mild in adults, its symptoms tend to be too, although as adults are no longer growing, the compression of elements in the spine can still cause pain, and the reality is that in cases of idiopathic scoliosis in adults, they are rarely mild as they have progressed throughout adolescence and into adulthood.
An important thing to remember is that even if an adult is diagnosed with mild scoliosis, as a progressive condition, it’s unlikely to stay that way, and this is particularly true as age-related spinal deterioration is a factor that makes the spine even more vulnerable to loss of health and function.
When I see a case of mild scoliosis, I see it as a chance to keep it that way through proactive treatment.
Once a condition has progressed from mild to moderate, its symptoms become increasingly noticeable, which is why the majority of my patients, both young and old, are diagnosed and treated in the moderate stage.
In moderate scoliosis, even subtle postural changes become more overt as the condition affects the body’s overall symmetry.
At this severity level, there is likely to be a certain degree of nerve compression, and as mentioned, this can cause a variety of symptoms such as localized and radicular pain felt throughout the body, but most commonly in the hands, legs, and feet.
Scoliosis is also associated with headaches as an unnatural spinal curve can disrupt the flow of cerebrospinal fluid that protects the spinal cord and brain.
When CSF fluid pressure changes in and around the brain, it can cause painful headaches that can reach migraine status.
Severe scoliosis in adults will produce overt symptoms as the uneven forces introduced to the body are severe.
At this stage, adults have experienced significant progression, meaning their spines will be rigid and surrounding spinal muscles are likely to be tight and sore as they struggle to support the spine’s increasingly unnatural spinal curve.
There is bound to be a lot of nerve involvement at this severity level, meaning debilitating radicular pain is likely, not to mention significant levels of back and muscle pain.
In many cases of severe scoliosis in adults, pressure on the entire spinal cord can cause deficiencies in coordination and limb impairment.
Disruptions to coordination affect balance and gait and can make it challenging to participate in a number of activities, disrupting daily life.
Fortunately, with proactive treatment, many adults can avoid ever reaching this stage and degree of complications, but it should be noted as a typical difference between adult and adolescent scoliosis.
So now that we’ve explored the characteristics of scoliosis in adults such as causation, symptoms, and severity levels, let’s address what can be done about it in terms of treatment.
While a lot of the literature around scoliosis focuses on the adolescent form, the topic of scoliosis in adults is also worthy of attention.
Many people assume the only treatment option for adult scoliosis is surgery, but that’s not always the case.
In fact, while it might be surprising, here at the Scoliosis Reduction Center, I’ve seen treatment results in my adult patients that are similar to those achieved in my younger patients.
As a scoliosis chiropractor, I can help adults develop healthy scoliosis-friendly lifestyle habits that, when coupled with proactive customized treatment, can lead to huge improvements in quality of life, and in many cases, avoid the need for more invasive forms of treatment, like spinal fusion that comes with heavy risks and side effects.
Another important distinction to understand between adult and adolescent scoliosis is that adults don’t have the same luxury of time that younger patients have, and this is because as their bodies have grown fully, they are at risk for continuous progression over time.
As scoliosis never improves through inaction, effective treatment is essential for those wanting to avoid increasing condition severity, related symptoms, and the need for costly and invasive treatment.
Here at the Center, my patients benefit from a conservative chiropractic-centered treatment approach that combines multiple treatment disciplines for the best, and most customized, results.
I combine condition-specific chiropractic care to, first and foremost, impact conditions on a structural level, and in-office therapy and custom-prescribed home exercises work towards increasing core strength so the spine is optimally supported by its surrounding muscles.
When appropriate, I recommend the use of corrective bracing for pain management and increased spinal stabilization.
While treating adult scoliosis can be more complex than in younger patients, due to the fact that natural age-related spinal degeneration can be a factor, there is always hope for my adult scoliosis patients.
With some hard work and commitment, results might not happen quickly, but here at the Scoliosis Reduction Center, my adult patients can experience similar benefits to what my younger patients experience: curvature reductions, increased core strength, and effective pain management through addressing its underlying cause.
While progression isn’t generally as fast as with younger patients, as the progressive trigger of growth is removed, adults still experience progression over time, and in order to avoid increasing condition severity and all that comes with it, proactive treatment offers adult patients hope for a better quality of life throughout treatment and beyond.
