Scoliosis has been around since ancient times, and as our understanding of the condition has evolved over the years, so too has our knowledge of how it responds to different forms of treatment. Part of the diagnostic process involves comprehensive assessment to further classify conditions based on important variables, and these variables inform the crafting of customized treatment plans moving forward.
Scoliosis is a complex structural spinal condition, with a progressive nature that necessitates a customized treatment approach. The 4 types of scoliosis are idiopathic, degenerative, neuromuscular, and congenital, each with its own unique causation and treatment needs.
As we’ll be discussing the four types of scoliosis in-depth, let’s start with some basic spinal anatomy to better understand how scoliosis affects the spine’s overall health and function.
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A healthy spine’s natural curvatures give it a soft ‘S’ shape when viewed from the sides and will appear straight when viewed from the front and/or back.
The spine’s healthy curves make it stronger, more flexible, and better able to absorb/distribute mechanical stress incurred during movement.
When the spine loses one or more of its healthy curves, its overall biomechanics are disrupted, impacting its health and function in different ways.
In addition, the spine and brain work in tandem to form the body’s central nervous system (CNS), which facilitates brain-body communication, which is why spinal conditions, like scoliosis, can produce a myriad of symptoms felt throughout the body.
The spine has three main sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back).
In a healthy spine, the vertebrae (bones) are stacked on top of one another in a straight and neutral alignment, and are separated by intervertebral discs.
The discs sit between adjacent vertebrae and provide the spine with structure (adjacent vertebrae attach to the disc in between). In addition, they facilitate spinal flexibility and act as the spine’s shock absorber.
The discs consist of a soft inner gel-like interior known as the nucleus and a tough and durable outer layer known as the annulus.
Disc health is important when it comes to the spine’s ability to maintain its natural curves and alignment, which we’ll return to in more detail later.
As we’re discussing treatment options in-depth, I’d like to take a minute to explain the differences between the two main scoliosis treatment approaches because the choice to commit to one or the other is the most important decision made following a scoliosis diagnosis.
There are two main scoliosis treatment approaches for patients, and their families, to choose between, and it’s important that patients understand the differences because different treatment approaches offer different potential outcomes.
I encourage patients to ensure their treatment expectations are aligned with the realities of their chosen treatment approach’s potential outcome as the choice can have life-long consequences.
Traditional Scoliosis Treatment Approach
The traditional approach to scoliosis treatment has been the dominant choice for many years, but despite our growing understanding of the condition and treatment efficacy, it has changed little over those years, and tends to funnel patients towards invasive surgery.
The traditional approach to scoliosis treatment involves watching and waiting for signs of continued progression in patients. Still, this response is more reactive than proactive and has consequences, especially if, during a period of watching and waiting, a young patient has a significant growth spurt and progresses significantly because of it.
At that point, the scoliotic curve has been allowed to progress unimpeded, and valuable treatment time has been wasted.
Once a condition progresses into the severe classification and crosses that surgical-level threshold of 40+ degrees, patients are commonly presented with invasive and costly spinal fusion as the best remaining option, but like all surgeries, scoliosis surgery comes with its share of risks and potential side effects.
Conservative Chiropractic-Centered Scoliosis Treatment Approach
Fortunately, there is another dynamic and modern treatment approach that has emerged, with proven results, that addresses many of the shortcomings of traditional treatment: a conservative chiropractic-centered approach.
It’s far simpler to treat a scoliotic curve while it’s at its smallest before significant progression has occurred, spinal rigidity has increased, and prior to the body has had time to adjust to its presence.
Under a conservative chiropractic-centered treatment approach, proactive treatment is applied as close to the time of diagnosis as possible, and as this is the approach I favor here at the Scoliosis Reduction Center, the treatment options presented here are aligned with this approach.
As a structural spinal condition, first and foremost, I want to impact scoliosis on a structural level to address the underlying cause of any related symptoms.
As we move through each of the main types of scoliosis, we’ll address how I approach treatment for each condition form.
So now that we have a better understanding of the main spinal sections, the basic structures and function of the spine itself, and the two main scoliosis treatment approaches, let’s talk about the four main types of scoliosis: idiopathic, degenerative, neuromuscular, and congenital.
Idiopathic scoliosis is the condition’s most-prevalent form, and the idiopathic designation means it’s not clearly associated with a single causative source; instead, idiopathic scoliosis is considered to be multifactorial, meaning caused by multiple factors that can vary from person to person.
The most prevalent form of idiopathic scoliosis is adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18.
Idiopathic scoliosis accounts for 80 percent of known diagnosed scoliosis cases, and the remaining 20 percent are associated with known causes: degenerative, neuromuscular, and congenital.
One of the most important things to understand about scoliosis is that it’s a progressive condition, meaning it’s in its very nature to worsen over time, particularly if left untreated or not treated proactively.
Scoliosis can range greatly in severity from mild to moderate and severe to very severe, and due to its progressive nature, where a person’s scoliosis is at the time of diagnosis is not indicative of where it will stay.
Condition severity is determined by a measurement known as Cobb angle, and this is taken during X-ray and involves drawing lines from the tops and bottoms of the most-tilted vertebrae at the apex of the curve; the resulting angle is measured in degrees and classifies conditions as mild, moderate, severe, or very severe:
While we might not fully understand the etiology of idiopathic scoliosis, we most certainly know how to treat it effectively.
Part of effective scoliosis treatment, particularly in children and adolescents, is managing progression. As growth and development is the condition’s main trigger for progression, children and adolescents are at risk for rapid-phase progression due to the amount of growth and development they have yet to go through, particularly during the stage of puberty.
So what are the treatment options for idiopathic scoliosis in adolescents and adults?
As a progressive condition, the time to start scoliosis treatment is always now.
As the most prevalent form of idiopathic scoliosis is adolescent idiopathic scoliosis, diagnosed between the ages of 10 and 18, we’ll focus on treatment options for this age group, but also include idiopathic scoliosis treatment options for adults.
Here at the Center, I offer patients a conservative treatment approach that works towards impacting a condition on multiple levels for the best potential results.
When it comes to AIS, as mentioned, because of the stage of growth and development, this age group is in or entering into, managing progression is an important part of treatment.
Rapid and unpredictable growth spurts characterize puberty, and as we know, growth/development is the condition’s main trigger for progression. A primary goal of treatment for this age group is staying ahead of that progressive line by applying different forms of treatment in an attempt to counteract the trigger of growth.
While there are no treatment guarantees, the likelihood of treatment success is higher if a condition is detected early, but only if proactive treatment is applied in response.
When it comes to AIS, early detection isn’t always easy to achieve, and while it might seem difficult to imagine that an unnatural sideways spinal curve, with rotation, would be difficult to miss, it’s easier than you might think.
Following are the main reasons so many cases of AIS go undetected during adolescence:
In children and adolescents, the lengthening motion of a growing spine counteracts the compressive force of the unnatural spinal curve; it’s compression (uneven pressure/forces) of the spine and its surrounding muscles and nerves that causes the majority of condition-related pain.
Remember, scoliosis is a highly-variable condition, ranging from mild to very severe, and particularly in mild cases, postural deviation (the main symptom of AIS) can be subtle and difficult to notice, functional deficits are rare, and again, the condition isn’t commonly painful.
So when it comes to treating AIS patients, treatment goals include:
Here at the Center, I customize treatment plans to address key patient/condition variables such as patient age, curvature location, condition severity, and causation.
By combining condition-specific chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing, I can work towards adjusting the most-tilted vertebrae at the apex of the curve back into alignment with the rest of the spine. Using scoliosis-specific exercises (SSEs) and stretches to increase spinal flexibility and strength, not to mention keeping the spine’s surrounding muscles as strong and loose as possible for optimal support.
In addition, the use of ultra-corrective bracing, like the ScoliBrace, can help complement the other forms of treatment and augment corrective results.
When it comes to adult idiopathic scoliosis, this is the most prevalent form of scoliosis to affect adults, and these cases are extensions of AIS that progressed into maturity undiagnosed and untreated.
Given the aforementioned reasons of why early detection of AIS can be a challenge, it’s understandable that so many adolescents mature with the condition unaware, until reaching skeletal maturity makes the condition compressive, causing noticeable symptoms like pain, that lead to a diagnosis.
Pain that brings adults in to see me for an idiopathic scoliosis diagnosis, and the unfortunate reality is that had these adults received treatment during adolescence, their spines would be in far better shape than by the time they see me.
At this time, adult patients have likely experienced significant progression, and spines get increasingly rigid as a scoliotic curve increases in size, so often, prep work has to be done to work towards increasing spinal flexibility, to make it more responsive to treatment, before starting the typical treatment path.
Just like my AIS patients, I customize treatment plans for my adult patients, and while curvature reductions are always a goal of treatment, with adults, as the big trigger of growth is removed, the threat of rapid-phase progression is not as strong so we have more time to work on pain management through increasing spinal support and stabilization.
This may be achieved through the use of a variety of therapies done in-office and at home to increase core strength, so the spine has help with maintaining its natural curves and alignment.
Scoliosis-specific exercises can help with building muscle strength and flexibility, as well as activating certain areas of the brain for postural remodeling and better body positioning.
In many cases, my goal is to reduce an adult’s curve back to where it was prior to causing noticeable symptoms like pain.
Through gentle and precise chiropractic care, I can also work towards addressing areas of spinal subluxation to improve spinal alignment and restore as much of the spine’s healthy curves as possible: addressing the underlying cause of pain for sustainable and long-term pain management.
When it comes to my adult patients and bracing, I favor the use of the modern ultra-corrective ScoliBrace because, unlike traditional scoliosis braces, it addresses the condition’s true 3-dimensional nature and has corrective potential.
For adults who have reached skeletal maturity, the ScoliBrace can help augment corrective results achieved through integrating multiple treatment disciplines and can also help with spinal stabilization and providing short-term pain relief while being worn.
Now that we have addressed the most prevalent form of scoliosis in both adolescents and adults, let’s move on to the next most-common form to affect adults: degenerative scoliosis.
Also known as de novo scoliosis, meaning no prior history with the condition (unlike cases of adult idiopathic scoliosis), degenerative scoliosis commonly develops after the age of 40.
As mentioned earlier, once skeletal maturity has been reached, rates of progression tend to slow down because the big trigger of growth is removed; however, it’s important to understand that once the spine starts to experience degenerative changes, over time, the cumulative effect of even incremental progression can add up to a significant curve increase.
If an aging adult is experiencing as little as one degree of progression a year, for example, over 10 years, added to an existing Cobb angle measurement of 25 degrees (moderate scoliosis), that still adds up to a 35-degree curve and is approaching the severe classification at 40+ degrees.
While scoliosis is often considered mainly a child and adolescent condition, in actuality, the percentage of aging adults with the condition is higher, with the rate of scoliosis in adolescents estimated at between 2 to 4 percent, while the rates of adults with scoliosis is between 12 and 20 percent.
With studies showing 68 percent of healthy adults being diagnosed with scoliosis after the age of 60, scoliosis rates increase with age.
Degenerative scoliosis is also more common in aging women, and this is understood as the result of changing bone density and hormones related to menopause.
Natural age-related spinal degeneration is the cause of degenerative scoliosis, and in most cases, it’s the spine’s intervertebral discs that are the first spinal structures to show the effects of wear and tear on the spine.
Over time, the spinal discs can become desiccated, bulging, and/or herniated, and as the discs play so many important roles in spinal health and function, any change to disc health/shape/function impacts the spine’s ability to maintain its natural curves and alignment.
The goals of treating scoliosis in adults are subtly different than in younger patients because counteracting progression is not so pressing, and instead, the focus tends to be on:
Treatment options for degenerative scoliosis include gentle chiropractic adjustments to take pressure off affected discs and restore their function, a variety of physical therapy programs to improve core strength and circulation surrounding the discs (discs use osmosis to absorb nutrients needed for cellular repair and rejuvenation), and corrective bracing for pain relief/spinal stabilization/augmenting corrective results.
I want to help my adult patients experiencing spinal degeneration preserve as much of their natural function as possible; regardless of age, improvements can always be worked towards in terms of pain management and improving quality of life.
Now that we have discussed the most typical forms of scoliosis let’s move on to the next two that are considered atypical: neuromuscular and congenital scoliosis.
As mentioned earlier, there are types of scoliosis that are considered typical, and those that are considered atypical.
In addition to there being multiple condition types and severity levels, there are also different curvature types and patterns that further classify a condition.
In most cases, a scoliotic curve bends to the right, away from the heart, and this is considered a typical curvature pattern, but in atypical cases, a curve can bend to the left, towards the heart, known as levoscoliosis: a red flag that there is an underlying pathology at play, making the scoliosis atypical.
In cases of neuromuscular scoliosis (NMS), the scoliosis is caused by the presence of a larger neuromuscular condition such as muscular dystrophy, cerebral palsy, and spina bifida, to name a few.
Unfortunately, I can’t give my neuromuscular scoliosis patients as positive a prognosis as I can with many of my more typical scoliosis patients because in order to impact the scoliosis, the underlying neuromuscular condition has to be the focus of treatment, making the process and potential for scoliosis treatment success far more complex and challenging.
Neuromuscular conditions can affect the body’s neurological system, the muscular system, or both, and severity is largely determined by the degree of nerve involvement.
NMS curves generally progress quickly and don’t necessarily slow down once skeletal maturity has been reached, so treatment focuses on managing the condition for improved quality of life.
Here at the Center, I can help my NMS patients work towards subtle improvements by integrating condition-specific exercises, rehabilitation, and bracing for less-severe cases.
Another atypical condition type, and our last for discussion, is congenital scoliosis.
Congenital scoliosis is considered another atypical form as it’s caused by a malformation within the spine itself that develops in utero.
Infants are born with congenital scoliosis, which is rare, affecting approximately 1 in 10,000.
Infants born with congenital scoliosis are known to have additional health issues, so are in need of comprehensive assessment.
In some cases, even though an infant is born with the condition, scoliosis doesn’t become evident until adolescence, when growth and development make it more noticeable.
In a healthy spine, the vertebrae are rectangular in shape and stacked on top of one another in a straight and neutral alignment, but sometimes, as the spine is forming in utero, a vertebrae can be malformed and more triangular in shape, creating a sharp angle within the spine that disrupts its alignment; this can involve one vertebrae or multiple throughout the spine.
Another common spinal malformation involves multiple vertebrae fusing together into one solid bone, rather than distinct and separate vertebral bodies as in a healthy spine; this prevents the infant’s spine from growing normally on one side, and results in an unnatural scoliotic curve that progresses with growth.
When it comes to treatment options for congenital scoliosis, clearly, there are unique treatment challenges associated with this age group.
In general, nonsurgical treatment will involve close monitoring and assessment and the modification of treatment plans used in more typical cases of child and adolescent scoliosis.
Depending on condition severity, in most cases of congenital scoliosis, treatment options include a combination of scoliosis-specific therapy and/or corrective bracing.
When it comes to the 4 types of scoliosis & your scoliosis treatment options, we are talking about idiopathic, degenerative, neuromuscular, and congenital.
In order for any potential treatment plan to be effective, it needs to be fully customized to address a condition’s underlying cause, when known, and additional important patient/condition variables such as age, curvature location, and condition severity.
Each case of scoliosis is unique, and treatment options/needs will be case-specific, but it’s important for patients to understand that there is more than just one treatment approach available to choose between: each offering patients different potential results.
Here at the Scoliosis Reduction Center, I treat patients with a conservative chiropractic-centered treatment approach as I feel this is the least-invasive and
most-effective means of helping patients avoid the hardships associated with increasing condition severity.
While there are no treatment guarantees, I work towards impacting patients’ conditions on every level by integrating multiple condition-specific treatment modalities such as chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing.
