Scoliosis is most often diagnosed during adolescence, but it also affects adults. There are two main types of adult scoliosis, and a patient’s assessment considers if the scoliosis is pre-existing or develops in later adulthood, commonly over the age of 50, before making treatment recommendations.
Adults are primarily affected by idiopathic scoliosis and degenerative scoliosis. Most cases of idiopathic scoliosis in adults are pre-existing from adolescence, and degenerative scoliosis affects older adults and is caused by declining spinal/bone health. Adult scoliosis treatment focuses on pain relief, improving posture, and managing curve progression.
Like all patients, adults need a thorough assessment to determine the best course of action, and the first step is understanding the type of scoliosis that’s occurring.
Types of Adult Scoliosis
The two main types of scoliosis to affect adults are idiopathic scoliosis and degenerative de novo scoliosis, and the type of scoliosis shapes treatment planning.
When an adult comes in for an assessment and doesn’t have a previous diagnosis, the first step is determining whether the scoliosis is pre-existing or new. This is important for treatment planning and understanding a patient’s risk of curve progression.
There are a lot of factors that can contribute to the onset of scoliosis and/or scoliosis progression in adults including the cumulative effect of certain lifestyle choices and age-related changes to posture, muscle strength, bone and spinal health.
While some scoliosis is assessed as stable because it’s not increasing in size, the nature of scoliosis is progressive, and if growth and/or changing spinal health are occurring, progression risk increases significantly.
The most common type of scoliosis overall is adolescent idiopathic scoliosis that commonly occurs around puberty. In some cases, particularly in patients with mild curves, an adolescent’s scoliosis can go undetected and untreated in adolescence.
If an adolescent’s scoliosis goes undiagnosed while mild or because it’s not noticed, it may be diagnosed after growth has stopped.
Idiopathic Scoliosis in Adults
Idiopathic scoliosis is the most common type of adult scoliosis. In most cases, it’s pre-existing from adolescence and is diagnosed as adolescent scoliosis in adults (ASA).
It’s not uncommon for childhood scoliosis to go undetected because mild curves can cause subtle effects, and when growth is occurring, scoliosis is less likely to be painful because the lengthening motion of growth counteracts the compressive force of the spine’s unnatural curve and twist.
So when scoliosis is mild, curves are small, effects can be subtle, and while growth increases a patient’s risk of progression, it can also make it harder to detect early if the scoliosis isn’t causing pain or noticeable deficits.
If a young or middle-aged adult comes in with no previous diagnosis and is complaining of back pain and increasing postural changes, this may indicate a pre-existing scoliosis. In cases of an adult’s assessment with a previous diagnosis, past X-rays are looked at to compare how much the scoliosis has changed over the years.
An idiopathic scoliosis curve in adults can be assessed as stable or progressive. In many cases, once skeletal maturity is reached, the scoliosis can start causing back and/or nerve pain, which leads to an assessment and diagnosis.
Symptoms of Adolescent Scoliosis in Adults
All types of scoliosis can benefit from early detection, and early signs of idiopathic scoliosis in adults to watch for include back pain, leg pain, muscle weakness and fatigue, and postural changes.
Back pain can be localized around the main spinal section affected, and muscle pain is also common as the spine’s surrounding muscles may become unbalanced and weak due to the conditions’ asymmetrical effects. Leg pain is a sign that nerve compression may be occurring and is common if the scoliosis develops in the lumbar spine and is compressing the sciatic nerve that projects down the back of the leg and into the foot.
Postural changes can include a noticeable lean forward that causes a slouching posture, and uneven shoulders and hips are also common. When posture is disrupted, over time, it can introduce uneven wear and tear on the spine, its individual structures, and surroundings. Detecting postural changes early may help interrupt the cycle.
Treatment Options for Adolescent Scoliosis in Adults
Treatment options for ASA are based on the specifics of a patient’s assessment, and customizing treatment plans supports specific results.
A patient’s risk of curve progression is a treatment planning factor, along with symptoms and a patient’s treatment goals.
While working towards a significant curvature reduction is a focus of most childhood scoliosis cases, in some cases of adult scoliosis, reducing a curve back to an asymptomatic size is the focus. Pain is a main symptom in adults, so pain relief involves restoring the spine’s balance because studies support that a lot of adult scoliosis pain isn’t related to the size of the curve, as much as the degree of imbalance and instability.
Treatment options for adolescent scoliosis in adults can include scoliosis-specific physical therapy that works towards strengthening the spine’s surrounding muscles for more support and stability and postural improvement. Corrective bracing can increase the potential of scoliosis-specific exercise by further supporting the spine and body’s straighter position and alignment. Scoliosis-specific chiropractic care, known as Chiropractic BioPhysics®, may also be recommended and can involve a series of techniques and manual adjustments that work towards improving the position of the vertebrae that are the most misaligned.
If an older adult comes in for an assessment with no previous diagnosis, this often involves cases of degenerative scoliosis.
Degenerative De Novo Scoliosis
Degenerative de novo scoliosis develops later in life, affecting older adults over the age of 50, and is caused by the spine’s increasing degenerative instability.
There are a number of factors that can contribute to age-related changes to spinal health including lifestyle factors that, over time, affect a patient’s posture and muscle health.
Key lifestyle factors that can negatively affect a person’s long-term spinal health include carrying excess weight, not enough movement, chronic poor posture, excessive drinking or smoking, and poor diet. In older adults, changes to bone health can also trigger the onset/progression of adult degenerative scoliosis.
Degenerative scoliosis is more prevalent in females due, in part, to changing bone health that is linked with menopause, osteoporosis, and osteopenia. Low bone density can weaken vertebrae and contribute to curve development/progression.
Postural decline is also common as we age, and this can be due to many factors including a loss of muscle strength. It takes a strong core to support healthy posture, and it takes healthy posture to support the spine’s straight alignment.
Degenerative disc disease and facet joint degeneration are primary contributors to degenerative scoliosis. If the discs that sit between adjacent vertebrae are degenerating, they can dehydrate, lose height, and shift the position of attached vertebrae. This can cause vertebrae and facet joints connecting the vertebrae to wear unevenly.
Symptoms of Degenerative Scoliosis
Signs of degenerative scoliosis that should be assessed include lower back pain, declining posture, and disruptions to balance and mobility. Back pain is common and can increase with activity, standing, or sitting for long periods of time.
The longer postural decline is left unaddressed, the more potential damage it can do, particularly for older adults struggling to maintain balance and stability.
A degenerative scoliosis patient’s assessment will focus on areas of the spine with too much movement and instability.
Older adults with degenerative scoliosis experiencing an increase in back pain or postural collapse should be closely monitored for changes that may indicate treatment needs to be adjusted.
Treatment Options for Degenerative Scoliosis
Treatment options for degenerative scoliosis patients are also based on the results of a thorough assessment.
In older patients, a treatment focus is pain relief, improving the spine’s stability for fall prevention and mobility improvement, and restoring posture to support balance and even wear.
A lot of uneven forces are happening with scoliosis, and because degenerative scoliosis may involve individual spinal structures degenerating, most cases are progressive and cause lower back pain.
Treatment recommendations for degenerative scoliosis usually focus on pain relief and fall prevention, and targeted scoliosis-specific exercise can work towards improving the spine’s surrounding muscle strength and balance for better posture, support, and stability. Bracing may be recommended to be worn for a few hours a day for pain relief and stability, and gentle chiropractic adjustments may further support pain relief and improvements to the spine’s position and function.
When it comes to treating adult scoliosis, progression, pain, and curve flexibility are treatment-shaping factors. Adults are no longer growing, so their spines are naturally not as flexible as a child’s, which can limit the corrective potential of treatment, and progression also causes increasing spinal rigidity, so adult scoliosis patients, in general, undergo treatment to restore healthy posture, improve stability, and to improve pain for a better quality of life.
Conclusion
Scoliosis treatment for adults starts with a comprehensive assessment that provides the information needed to make suitable treatment recommendations.
Here at the Scoliosis Reduction Center®, the treatment approach is nonsurgical, proactive, and integrative, so it prioritizes spinal function, early detection, and a multidisciplinary approach to impact a patient’s curve on all levels.
While many consider scoliosis to be a childhood condition, it also affects adults, and older adults may be experiencing a number of changes that can contribute to the onset or progression of adult scoliosis.
The two main types of scoliosis to affect adults are idiopathic scoliosis and degenerative scoliosis, and a timely assessment supports early detection and intervention for improvements to an adult patient’s pain, posture, spinal health, function, and quality of life.
