Although scoliosis is more prevalent in children and adolescents, adults can also develop various forms of the condition. While the experience of living with scoliosis can differ between young and older patients, if adult scoliosis is treated proactively, there is still a lot of potential for improvement.
There are two main forms of scoliosis that affect adults: idiopathic and degenerative. Idiopathic cases involve adolescents who progressed into maturity unaware of their scoliosis, and degenerative scoliosis develops in older individuals facing age-related spinal degeneration.
Most often, when I talk or write about scoliosis, the focus is on adolescents; this is because adolescent idiopathic scoliosis (AIS) is the condition’s most prevalent form, accounting for 80 percent of known diagnosed cases. However, scoliosis doesn’t just affect teenagers, so let’s spend some time exploring the subject of scoliosis in adults.
While the majority of my scoliosis patients are navigating their teenage years, the condition also affects adults.
In many cases, individuals with AIS don’t realize they have scoliosis until later in life, after going through puberty and reaching skeletal maturity; when this happens, this is known as ‘adult scoliosis’.
While scoliosis can develop anew in adulthood, it’s more common that adults with the condition developed it during adolescence but were unaware, progressing with it into maturity.
In these types of cases, my patients didn’t receive a diagnosis or treatment for their condition because they were simply unaware of its presence; it's not until adulthood that symptoms tend to become more noticeable, leading them to a diagnosis of ‘adult idiopathic scoliosis’.
While the above example represents the bulk of my adult scoliosis patients, adults can also develop scoliosis fresh in adulthood with no prior history, and this form is known as ‘degenerative scoliosis’.
Regardless of whether a patient’s condition is diagnosed as idiopathic or degenerative, adults with scoliosis, especially older ones, need to seek out a treatment approach that accounts for the different needs of older patients and the different characteristics of adult scoliosis.
Let’s talk some more about the causes of adult scoliosis.
Regardless of age, when a patient receives a scoliosis diagnosis, part of that process is learning everything needed to further classify the condition. I learn what I need from discussing a patient’s medical history, conducting a physical exam, and scoliosis X-ray results.
Classification is based on a number of important patient and condition characteristics: age, condition severity, curvature location, and cause. The cause is important because the reason behind a condition developing, if it’s known, can provide guidance on how to best manage and treat the condition.
Let’s start our discussion with adolescent idiopathic scoliosis, the most common form of scoliosis, that can remain undiagnosed until adulthood.
Idiopathic Scoliosis in Adults
As mentioned, idiopathic scoliosis is the most common type of scoliosis, and the ‘idiopathic’ designation means there is no single known cause. As idiopathic scoliosis accounts for such a large percentage of known cases, it makes sense that this form would also be the most prevalent in adults, even though it’s more commonly diagnosed in adolescents between the ages of 10 and 18.
By its very nature, there is no simple cause to explain its development. Its onset could be the result of multiple factors that can vary from one person to the next. The truth is, as is the case with adolescent idiopathic scoliosis, it’s impossible to determine the cause behind most cases of adult scoliosis.
This can sound disheartening, especially when it falls on the ears of someone who has just been diagnosed, but what I’m always very clear on is that even if the cause were known and obvious, it’s unlikely that it would change much moving forward.
The truth of the matter is, and this is especially the case with adult idiopathic scoliosis, by the time adults receive a scoliosis diagnosis, their abnormal spinal curvature has been left to progress unimpeded. By the time these patients are alerted that something is wrong, their spines can be in rough shape, and sadly, had they received a diagnosis and treatment in adolescence, there would have been far fewer limits to treatment efficacy.
Right about now, you’re likely wondering just how a person can live with a progressive spinal condition for so many years, but be completely unaware; this is largely due to the fact that many adolescents with scoliosis don’t experience pain until reaching adulthood, and condition severity also plays a role.
‘Cobb angle’ is a measurement obtained via X-ray that expresses, in degrees, how far out of alignment a scoliotic spine is. The higher the Cobb angle, the larger the abnormal spinal curvature is, and the more severe a condition is.
Just from the range of numbers, you can see how much the condition can vary in severity, and mild forms aren’t commonly known to produce a lot of noticeable symptoms or functional deficits.
In addition, in individuals whose spines are still growing, the condition is not often painful. This is due to the gradual lengthening motion the spine is experiencing during growth; this motion counteracts the compressive force that the curvature exposes the spine and its surrounding vessels, muscles, and nerves to.
Once skeletal maturity has been reached, as in adulthood, the spine is no longer growing, making it vulnerable to compression and the pain it causes. Pain is the number-one reason adults come to me for a diagnosis, usually involving the back and/or radiating pain into the legs and feet.
This is why it’s so common for adolescents to be unaware of their condition and progress with it into maturity, and this is also why adulthood tends to bring more noticeable symptoms: progression and compression.
After idiopathic scoliosis, another prevalent type of scoliosis that affects adults is degenerative scoliosis.
When scoliosis develops in adulthood and is not a pre-existing condition from adolescence, this is ‘degenerative scoliosis’. This form of scoliosis most commonly affects people over the age of 40.
As the body ages, its parts and systems face natural degenerative changes, including the spine, but not every aging person has back problems. There are a lot of factors that can slow or speed up spinal degeneration, some controllable and some not.
Genetics can play a role, as can gender, with women being more likely to experience conditions related to bone health and function because of menopause-related hormone changes that affect bone density.
In addition, the presence of secondary conditions, such as osteoarthritis or osteoporosis, known to cause changes in bone density can impact spine health and lead to compression fractures. These types of conditions can predispose adults to developing scoliosis as the overall biomechanics of the spine can be adversely affected: speeding up spinal degeneration and leading to the development of degenerative scoliosis.
Most commonly, it’s the intervertebral discs of the spine that face degeneration and are related to the development of a scoliotic curve. The bones of the spine (vertebrae) are stacked on top of one another and separated by intervertebral discs.
These discs serve many functions. They cushion adjacent vertebrae so they are not rubbing up against each other and causing friction during movement. Their tough exterior/soft gel-like interior helps provide the spine with flexibility and structure. The discs also facilitate the even distribution of mechanical stress throughout the spine and help maintain its healthy curvatures.
While idiopathic scoliosis is, again, the most common form to affect adults, followed by degenerative scoliosis, there are rarer cases where an adult develops scoliosis due to the presence of a paralytic curve or a myopathic deformity.
When adult scoliosis is caused by a paralytic curve, this means the muscles located closely to the spine don’t work properly. The impairment of the muscles surrounding the spine means they can’t provide the spine with the support it needs to maintain its alignment and natural curvatures.
As the spine is thrown off balance and out of alignment, over time, this can lead to the development of an abnormal paralytic curvature. Paralytic curvatures can be the result of spinal cord injuries that preceded paralysis, but this is rare.
One of the forms of scoliosis with a known cause is neuromuscular scoliosis. In these types of cases, the presence of an underlying neuromuscular disease such as cerebral palsy, polio, or muscular dystrophy can lead to the development of abnormal spinal curvatures in what’s referred to as a ‘myopathic deformity’.
In these types of cases, ‘myopathic’ refers to muscles that don’t work properly. Cases of neuromuscular scoliosis are more challenging to treat because there is a serious medical condition that is causing the abnormal spinal curvature, and the underlying condition has to be the guiding force of treatment.
Adults can also develop what’s known as ‘traumatic scoliosis’.
Traumatic scoliosis can also affect adults who have experienced a significant trauma that has adversely affected the spine.
Examples of causes would include an imbalance in the spine caused by surgery, a trauma such as a car accident or fall, or the presence of tumors pressing on the spine that can force it out of alignment and cause the development of a scoliotic curve.
As we have addressed the different types of scoliosis that can affect adults, and the specific symptoms known to accompany the different forms, let’s now address the general symptoms of adult scoliosis.
Adults who receive a scoliosis diagnosis have generally been led to the doctor because of experiencing one or more of the following symptoms.
In terms of postural changes, scoliosis in adults is known to cause a prominent lean to one side, an uneven shoulder height, or the presence of a rib arch. Of course, as mentioned earlier, scoliosis can range greatly in severity, but most often, the more severe a condition is, the more likely it is that it will produce noticeable symptoms, such as postural changes and pain. Related postural changes in adults are often more pronounced when in a forward-bend position.
In adults with scoliosis, it’s most commonly back pain that is the most noticeable symptom, as well as the motivation behind seeking out a diagnosis for what is causing the pain. If back pain develops, it can range from mild nagging pain to chronic and severe.
Pain is the big difference between how adolescents and adults experience scoliosis. As explained earlier, pain is not commonly a part of the scoliosis experience in younger patients, but as adults have stopped growing, their spines have settled due to gravity, compressing parts of the spine, and this is what leads to pain.
As a scoliotic curve develops and progresses, this puts greater pressure on surrounding nerves and the entire spinal cord, generally leading to increasing back discomfort and radiating pain in other parts of the body.
In many cases of severe scoliosis in adults, the pressure exerted on the spinal cord can lead to impairment in balance, coordination, and the ability to use the limbs. If a patient reaches this point, it can become difficult for them to walk normally and take part in different forms of physical activity.
Luckily, these extreme symptoms are uncommon, but should be noted as a divider between the typical adolescent and adult experience of life with scoliosis.
Now that we have touched on the different forms of scoliosis adults can develop, plus causes and symptoms, let’s take a moment to address some positive ways to approach living with adult scoliosis, including treatment.
Adults with scoliosis have different condition characteristics, such as progressive rates, than adolescents and younger patients do. Even though adults have reached skeletal maturity, meaning they have stopped growing, they are still at risk for continual progression.
While adults have the big trigger for rapid-phase progression removed (growth), they also have the degenerative effects of aging on the spine to contend with, and even if adults tend to progress at slower rates than adolescents, these rates can increase as a person ages, especially after the age of 50.
In addition, while progressive rates can vary from half a degree to 2 degrees a year, the cumulative effect over time is still a larger curvature, especially if left untreated.
At one time, when we knew less about scoliosis, it was taught that progression was limited to younger patients who had not yet reached skeletal maturity. Now that we understand the progressive nature of the condition more comprehensively, we know that adults need to be just as proactive with their condition as younger patients; treatment just needs to be adjusted to address a person’s age and likeliest progressive rate.
Following are some tips for handling life with adult scoliosis: being proactive, practicing a healthy lifestyle, positivity, and choosing treatment wisely.
As mentioned, adults have different condition characteristics than in younger patients, and this has to be factored into the treatment approach. As scoliosis is progressive in nature, it won’t get better on its own, and especially not through inaction.
Any effective treatment plan has to involve commitment and dedication from the patient and engage them in the process. The first step is to get a diagnosis; don’t assume the source of your pain will simply remedy itself. Then adult patients need to consult with an expert on the next steps to take towards proactive treatment.
Practicing a Healthy Lifestyle
When the mind and body are healthy, life with scoliosis, not to mention treatment, is easier. A scoliosis diagnosis at any age doesn’t equate to having to lead a sedentary lifestyle.
Losing weight, increasing core strength and flexibility, and moving away from bad habits like smoking can create positive changes in the body that make it better equipped to handle life with the condition and the rigors of active treatment.
While it’s essential to consult with the provider of your scoliosis treatment before attempting any new fitness or exercise regime, there are many ways that adults living with scoliosis can make positive lifestyle improvements safely and effectively.
In addition, the mental health benefits of making healthy lifestyle changes are also significant, and as the mind and body get healthier, this can lead to a better response to treatment and better results.
Some adults recently diagnosed with scoliosis make the mistake of assuming surgery is their only recourse, or looking at life with the condition in a negative light; these assumptions aren’t always true, and they can be downright destructive.
While those following a traditional path of scoliosis treatment often find themselves funneled towards spinal-fusion surgery, there are other positive options to consider, and I encourage all adults with scoliosis to do their own due diligence in researching the merits of a proactive and functional approach to treatment.
In my years of experience here at the Scoliosis Reduction Center, I have treated patients of all ages and severity levels.
I have seen impressive improvements in both young and older patients in terms of curvature reductions, function, and symptom-relief. The treatment I offer here at the Center is a functional chiropractic-centered approach dedicated to helping patients avoid costly and invasive surgery.
I believe in a scoliosis-specific integrative approach that involves combining multiple treatment disciplines to offer patients a fully customized treatment plan that addresses the unique characteristics of the patient and their condition: chiropractic care, in-office therapy, and custom-prescribed home exercises.
Often, with my adult patients, the goal of treatment is to stabilize the spine, and pain management can be equally important, depending on the patient. While curvature reduction can happen in adults, it’s not often the primary treatment goal.
When it comes to discussing and treating scoliosis, the focus remains on children and adolescents as they are most commonly diagnosed with the condition, but that doesn’t mean adults can’t also experience improvement and relief from related symptoms.
While it can pose some additional challenges, living with scoliosis in the later stages of life can still be productive, enjoyable, and carry few limitations, especially if proactive treatment is sought out.
While the traditional scoliosis treatment approach has been around for many years, that doesn’t mean it shouldn’t be questioned or improved upon. My chiropractic-centered approach represents the culmination of what we have learned over the years regarding how to increase treatment efficacy in patients of all ages.
Here at the Scoliosis Reduction Center, with hard work and dedication, our patients can experience the power and potential for change themselves, and this is something I feel privileged to witness and be a part of.