When it comes to living with the condition’s most common form, adolescent idiopathic scoliosis (AIS), pain isn’t generally a big part of the experience; adults, however, experience scoliosis-related pain very differently. This difference is largely based on condition severity, compression, and the degenerative effects of aging.
Before we get into the more specific types of scoliosis-related pain and how it affects multiple areas of the body, let’s first take a general look at scoliosis and why the typical AIS experience does not include pain.
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According to the National Scoliosis Foundation, there are currently close to seven million people living with scoliosis in the United States alone. Amongst school-aged children, it is the most common spinal deformity.
Given the prevalence of the condition, many people have heard of scoliosis or know someone who has been diagnosed. What many people don’t realize is just how much of an affect the condition can have throughout the body.
Any disorder that affects the brain or spine can come with a myriad of symptoms and related complications. In light of how the spine works in tandem with the brain to control virtually all working systems within the body, you can see how the effects of scoliosis can be felt in multiple areas.
When scoliosis develops, the spine has an abnormal lateral (sideways) curvature with rotation (twisting); this is why true scoliosis is considered a 3-dimensional condition. This leads us into discussing the various severity levels of scoliosis as this is a big factor in determining how painful a condition is.
Regardless of age or condition form, a scoliosis diagnosis would involve comprehensively assessing and classifying the condition on its severity spectrum. This is important not only because it guides the treatment approach moving forward, but also because it indicates likely symptoms and potential related complications a patient might experience.
If a patient’s Cobb angle (measurement, in degrees, of how far out of alignment the spine is) is more than 10 degrees, but less than 25, this is diagnosed as ‘mild scoliosis’.
Common mild scoliosis symptoms are subtle postural changes such as:
In addition, clothing suddenly seeming to hang unevenly or changes to a person’s walk or balance can also be a sign. The main indicators for mild scoliosis are subtle enough that unless you or a loved one are already on the lookout for signs, it’s likely that only an expert knowing exactly what to look for would spot the early days of the condition.
If a patient’s Cobb angle is between 25 and 40 degrees, this is classified as ‘moderate scoliosis’. At this stage, the aforementioned symptoms associated with mild scoliosis are more pronounced and easier to notice:
Even in moderate forms of the condition, pain isn’t always guaranteed to play a role, especially in younger patients who are still growing.
With a Cobb angle measurement of 40+ degrees, this is classified as ‘severe scoliosis’. At this stage, the aforementioned symptoms are more severe.
The more severe a patient’s condition is, adolescent or adult, the more likely that patient is to experience severe symptoms or potential related complications:
There are two common myths regarding scoliosis pain: the first is that it is always horrendously painful, and the next is that it is not painful at all. The converse nature of this is due, in part, to the wide variance that exists within the condition, such as severity, and the different age groups experiencing it.
Adolescent idiopathic scoliosis (AIS) is the condition’s most common form; it makes up approximately 80 percent of known diagnosed cases. ‘Idiopathic’ means no known single cause. The remaining 20 percent have known causes such as neuromuscular, congenital, degenerative, and traumatic.
It’s not easy to be clear when answering questions about whether or not scoliosis is painful because even within one form of the condition, such as AIS, severity levels and related symptoms can range so substantially.
So before I move on to the common adolescent experience of scoliosis pain, the caveat is that there are always exceptions and each individual’s experience of scoliosis will be uniquely their own; this is why treating scoliosis effectively demands such a customized approach.
Early Diagnosis and Pain in AIS
An indicator of the absence of pain in AIS is how challenging early detection can be. We know that treatment started early on in the condition’s progressive line has better results, so why doesn’t everyone start treatment early: because scoliosis, especially milder forms, often doesn’t produce noticeable symptoms, such as pain.
If you really think about what prompts the majority of your doctor, clinic, or hospital visits, it’s likely pain. While different medical conditions/diseases produce different related symptoms, a common signifier that something wrong is happening in the body is pain.
If a person developed a condition with mild symptoms and pain wasn’t one of them, think of how long that person could continue on with their life completely unaware that a condition was developing. If that condition was progressive, as is scoliosis, that could cause complications in terms of treatment timing and efficacy.
The lack of pain characteristic of AIS is understood in terms of growth and development. For adolescents who have not yet reached skeletal maturity, their spine is constantly experiencing a lengthening motion associated with growth; this means that the spine of an adolescent is less vulnerable to the compressive force of an abnormal curvature.
In addition, the younger a person is and the milder their scoliosis is, the more flexible their spine will be. As a person ages and a condition progresses, spinal rigidity can set in and cause a lot of pain in the spine and the areas around it, such as the muscles that support it.
So, while every patient’s experience is different, in the majority of cases involving AIS, pain is not a defining feature.
As mentioned earlier, adults experience pain very differently as part of their life with scoliosis. In fact, it’s most often pain that brings adults in to see me for an official diagnosis, or treatment to reduce their pain.
Now that we are focusing on adults and scoliosis-related pain, let’s discuss the two main forms of adult scoliosis: idiopathic and degenerative.
Idiopathic Scoliosis in Adults
In the majority of cases where an adult develops scoliosis fresh in adulthood with no prior history (known as ‘de novo’), this is a continuation of AIS cases that went undetected through adolescence.
As AIS is not known to be painful and doesn’t always produce a lot of noticeable symptoms until later stages of progression, it’s understandable how this can happen.
Most common in adults over the age of 40, degenerative scoliosis develops as a result of the degenerative effects of aging on the spine. Often, this involves the erosion of the intervertebral discs and the development of degenerative disc disease.
Diagnosis and Pain in Adult Scoliosis
While an absence of scoliosis pain makes early detection challenging in adolescents, the prevalence of pain in adults makes it far easier to reach a diagnosis.
When it comes to scoliosis in adults, back pain can be severe and felt throughout the body in the form of radiating pain affecting the neck, back, arms, legs and feet.
As adults have reached skeletal maturity, their spine is no longer experiencing that lengthening motion characteristic of growth and development; the abnormal curvature causes compression of the spine and the nerves, vessels, and muscles that surround it.
Now that we have explored the different severity levels of scoliosis, common symptoms, and the main differences in scoliosis-related pain in adolescents and adults, let’s address some individual parts of the body and look at how scoliosis can affect them and cause pain.
As discussed, one of the signs of scoliosis is one hip sitting higher than the other, or one appearing more rounded than the other. This can lead to pain when standing or walking for lengthy periods of time.
Pain is often felt at the apex of the curvature, where the vertebrae are the most tilted. As scoliosis develops and progresses, the ligaments that support the spine are stretched, and the muscles that run alongside the spine to support it are subjected to uneven strain as the body tries to compensate for the abnormally-curved spine.
If pelvic obliquity develops (commonly associated with neuromuscular scoliosis), one hip is worked more heavily than the other, and this can lead to severe pain due to overuse and tendon/musculature strain.
Scoliosis can, indeed, be the culprit of neck pain. Especially in cases of abnormal cervical spine (upper back-neck) positioning, neck pain can be a scoliosis symptom.
When the cervical spine has lost its healthy lordosis (inward curve), it alters the positioning of the cervical spine, neck, and head. When there is a loss of the cervical spine’s healthy forward curve, what’s known as ‘forward head posture’ can be introduced; with this, the neck can become straighter in an attempt to support the increasing weight of the head.
As a result, the neck muscles can become sore and strained, causing neck pain and discomfort.
Sometimes connected to lung impairment, scoliosis can affect the rib cage and cause varying levels of related pain and discomfort.
One of the signs of scoliosis is what’s known as a ‘rib arch’, and this is most commonly associated with scoliosis that develops along the thoracic spine (middle-upper back).
When the spine bends and twists abnormally, its function can be disrupted. As the rib cage is attached to the spine, the abnormal positioning of the spine can also affect the rib cage, resulting in what’s known as ‘biomechanical rib cage dysfunction’.
While this isn’t guaranteed to produce rib pain, the more severe a rib deformity is, the more likely it is to be painful. Related rib pain can be caused by muscle spasms, strained muscles, ligaments, or stiff joints.
If you take a second and pause from reading to deeply inhale, pay attention to how it’s not just your lungs being engaged, but also the rib cage as it expands upwards and outwards to decrease pressure in the lungs and pass air into the chest cavity.
If a rib cage deformity is preventing the rib cage from fully expanding during inhalation, this can also impair overall lung function.
Mainly in cases of adult scoliosis who are vulnerable to compression, the tilted vertebrae of the curvature can compress nearby nerves and muscles.
This nerve compression can be felt throughout the body but is commonly experienced in the back and legs, often in the form of numbness, weakness, and/or tingling.
In cases of degenerative scoliosis, when paired with disc degeneration or spinal stenosis (narrowing of the spaces within the spine), scoliosis can cause a number of unpleasant sensations, such as shooting pain down the legs caused by adverse pressure placed on the nerves that pass through the spine.
Sciatica is defined as leg pain that starts in the lower back and radiates down the sciatic nerve along the back of the leg.
While there does seem to be a connection between scoliosis and sciatica, whether that relationship is direct or indirect is somewhat unclear. When sciatica pain and scoliosis are both present, it can be difficult to separate them.
As scoliosis can affect the nerves that travel through the spinal cord and we know that nerve pain can radiate throughout the body, it’s not a huge leap to assume that sciatica pain could be related to nerve compression caused by the scoliosis.
However, a large percentage of people who struggle with sciatica find out it’s due to a herniated disc causing nerve compression, but we also know that scoliosis can adversely affect the intervertebral discs.
There is also a school of thought that acknowledges the possibility of scoliosis causing pain in the sciatic nerve, but also suggests that sciatica could be more directly related to the postural imbalance that scoliosis is known to cause.
In addition, adults who have lived with scoliosis for longer periods of time also tend to develop arthritis faster, and this can also contribute to sciatica issues.
Basically, whether sciatica is caused by scoliosis itself, or a related complication of scoliosis such as disc problems, postural imbalance, or arthritis, I think it’s fair to say that scoliosis can cause sciatica.
One of the early warning signs that scoliosis is present is an asymmetry of the shoulders: one can appear to sit higher than the other. Especially when bending forward, it becomes more noticeable if one shoulder blade is protruding more on one side than the other.
So does the postural effect that the shoulders experience produce pain, or does scoliosis just make them look different, but not necessarily feel different?
There are a lot of uneven forces at work with scoliosis, so when a patient is struggling with shoulder pain, it’s most likely going to be the shoulder that isn’t subject to the postural shift. For example, if a patient’s curvature bends to the left, it’s going to be the right shoulder that’s most likely to feel the affects, and vice versa.
This is because the ‘normal’ shoulder is trying to compensate for the uneven force of the tendons and muscles working to move the spine back into a healthy alignment.
If left untreated and to progress, scoliosis can start to affect both shoulders as the body tries harder to adjust to the unhealthy spinal curvature.
Anyone who has experienced migraines knows they are more than average headaches. In fact, it’s my early history with migraines that introduced me to the power of chiropractic and led me to where I am today.
Migraines can be accompanied by visual disturbances (often referred to as ‘migraine aura’), nausea, numbness in the hands and face, even loss of memory and speech.
The connection between headaches, migraines, and scoliosis can be related to muscle fatigue and strain in the neck, but also the flow of cerebrospinal fluid that is controlled by the spine.
Cerebrospinal fluid (CSF) is an important fluid housed in the dura mater that surrounds and supports the brain and spinal cord.
Particularly with curvatures of the upper back, scoliosis can cause frequent tension headaches. These are related to tight/strained neck muscles that introduce adverse tension to the head, and this pain can reach migraine-status.
When the brain’s CSF levels are low, this can also lead to debilitating headaches and migraines.
Particularly for scoliosis that occurs in the thoracic section of the spine (middle-upper back), this can affect the chest. Again, the more severe a person’s condition is, or if it has been left untreated for long periods of time and allowed to progress, the more likely it is that extreme symptoms such as chest pain or lung impairment will become an issue.
As an abnormal spinal curvature becomes more and more pronounced, the more the biomechanics of the entire spine is affected, and this can produce a number of seemingly-unrelated complications.
For example, as the thoracic spine bends and twists, it pulls at the rib cage more and more, contorting it and producing that ‘rib arch’ commonly associated with scoliosis.
The more the ribs become affected, the more the chest can feel it in a number of ways such as pain and muscle spasms.
In extreme cases, this can also impact the lungs and the heart’s pulmonary artery flow.
As the rib cage twists and contorts, the space available for the lungs is limited, and this can affect the ability to inhale/exhale deeply. This can result in a feeling of restricted pressure on the chest.
If lung function is impaired, the heart has to work harder to pump blood through the lungs, potentially causing cardiac issues.
While lung impairment and related cardiac issues aren’t a common symptom of scoliosis, in extreme cases, or cases that have been left untreated, chest pain caused by impairments felt by the lungs and heart can become a factor.
Anyone who has done their due diligence in researching scoliosis and pain management will have come across scoliosis surgery as a form of treatment.
During scoliosis surgery, also known as ‘spinal fusion’, the most-tilted vertebrae of the curvature are fused together into solid bone. Rods and screws are attached to the spine in order to hold it in place while the vertebrae fuse into one solid bone.
It’s important to remember that the end goal of scoliosis surgery is not to ‘correct’ the abnormal curvature, but to stop it from progressing further. While surgery can be successful at stopping progression, there is no guarantee that it will do so.
One of the primary reasons people opt for scoliosis surgery is pain relief. Many patients end up disappointed with the pain-reduction results of surgery, and some find they are in more pain.
In the portion of the spine that’s fused, movement is eliminated, which is why, in theory, it stops progression; however, the stiffness and loss of flexibility in that area can lead to an increase in scoliosis-related pain post surgery.
For the above reasons, and the fact that spinal-fusion is irreversible and lacks data on long-term effects, I feel that regardless of the motivation, scoliosis surgery should only be considered as a last resort.
So can scoliosis cause pain? Scoliosis can most certainly cause a number of painful symptoms and complications, but in the most typical scenarios, this is more common in adults, severe cases with a high Cobb angle, or in conditions left untreated.
In most cases, with a proactive functional treatment approach, many of these symptoms can be avoided, mitigated, or eliminated. Our approach here at the Scoliosis Reduction Center is to treat every patient proactively in the hopes of avoiding significant progression by correcting the curvature and supporting/stabilizing the spine.
It’s important, I feel, to take a minute here and put peoples’ minds somewhat at ease. Obviously, we’ve covered the gamut of scoliosis-related symptoms known to cause pain, but do remember that in most cases, especially those that involve children and adolescents, scoliosis is rarely described as painful.
If a patient comes in to see me because of pain, whether they have received a previous scoliosis diagnosis or not, the best way to respond is with active treatment. By actively treating a patient’s scoliosis, we are not just addressing their pain, but the underlying cause of it. If I was to simply prescribe some exercises and/or pain medications, this would only be addressing one symptom of the scoliosis (the pain), and not the condition itself.
In addition, these traditional ways of addressing pain are only successful in the short-term. In order for long-term sustainable pain-reduction results to be achieved, the condition itself needs to be addressed and effectively treated on a structural level; we do this by combining scoliosis-specific chiropractic, therapy, rehabilitation, and corrective bracing.
By combining multiple treatment disciplines, we can fully customize our treatment plan and address the individual needs of the patient and their condition.
Once we successfully achieve a curvature reduction, any pain and related symptoms are naturally decreased as the spine’s healthy curves and overall biomechanics are restored.
Regardless of the stage your scoliosis is in, or the pain and symptoms you might be experiencing, it is never too late to make improvements; committing to a functional and proactive treatment approach can be the first step along the path to treatment success.