Scoliosis types can vary based on their underlying cause. Most cases of scoliosis involve idiopathic scoliosis: no known cause. In terms of progression and pain, scoliosis affects children and adults differently.
There are two main types of scoliosis to affect adults: idiopathic scoliosis and degenerative de novo scoliosis. Most cases of idiopathic scoliosi in adults are pre-existing from adolescence, and degenerative scoliosis is caused by degenerative instability.
Scoliosis is often thought of as a childhood condition, but it also affects adults, and the rate of scoliosis increases among the aging population.
Scoliosis in Adults
Scoliosis is a progressive spinal condition that causes the development of an unnatural lateral spinal curve that rotates.
Ranging widely in severity from mild to very severe, scoliosis symptoms can change over time as progression occurs.
Most cases of scoliosis have no known cause, but we know that in childhood scoliosis, it’s growth that triggers progression, and in adult scoliosis, progression usually occurs at a slower rate; in older adults, degenerative changes can increase curve progression.
There are two main types of scoliosis to affect adults: idiopathic scoliosis and degenerative scoliosis.
Idiopathic Scoliosis in Adulthood
Most cases of idiopathic scoliosis in adulthood are pre-existing from adolescence as adolescent idiopathic scoliosis; a common scenario is for adolescents to be unaware of their scoliosis until after growth stops and compression-related pain develops.
Symptoms of adolescent scoliosis can be mild, and childhood scoliosis isn’t closely associated with pain, so mild cases can go unnoticed for years.
Once growth stops and skeletal maturity is reached, scoliosis becomes compressive, and while children can also experience varying degrees of back and muscle pain, back, muscle, and radiating pain caused by nerve compression are the main signs of adult scoliosis.
Adult scoliosis patients need comprehensive assessment to determine if the scoliosis is pre-existing from adolescence (most common type of adult scoliosis) or if it develops later in life with no prior history as degenerative scoliosis.
The reality is had these patients been diagnosed and treated during adolescence, their spines would be far healthier, but it’s never too late to start treatment; all cases of scoliosis can benefit from treatment.
The main symptom of degenerative scoliosis is lower back pain, and early intervention can help prevent injury from a fall.
As a progressive condition, the nature of scoliosis is to get worse over time. While some scoliosis cases progress rapidly, particularly during periods of rapid growth, others can progress slowly over time, as in many cases of adult scoliosis, but even incremental increases can add up over time, and age-related degenerative changes can increase progression.
Degenerative Scoliosis
Degenerative scoliosis most often affects older adults over the age of 45. Degenerive de novo scoliosis isn’t pre-existing; it develops later in life due to increasing instability in the spine caused by degenerative changes.
Because the spine is facing degenerative instability, most cases of degenerative scoliosis are progressive and painful.
Most degeneration starts in the spine’s discs that suffer from asymmetrical loading due to the spine’s unnatural curve and twist.
The longer a patient continues with daily activity while the uneven forces are compressing one side of an affected disc, the more likely disc damage is; the discs don’t have their own vascular supply so can be slow to heal.
While adults are no longer growing, progression still occurs. Degenerative scoliosis progresses approximately 4 degrees a year once the cycle of degeneration is initiated, and the postural changes of leaning too far forward, or too far back, is a main cause of disability in aging adults.
The spine’s increasing instability can affect posture, and vice versa.
Adult Scoliosis Treatment
Early detection is an advantage with scoliosis patients of all ages, and when it comes to adult scoliosis, a focus of treatment is improving the spine’s alignment and stability for fall prevention (older adults).
Adult scoliosis can be painful, so pain management is also a focus of scoliosis treatment.
When it comes to diagnosing adult scoliosis, a key factor is determining whether the scoliosis is pre-existing, most often from adolescence, or has developed later in life as degenerative scoliosis.
Adolescent Scoliosis in Adults
For adolescent scoliosis in adulthood (ASA), restoring healthy posture is important as asymmetrical posture contributes to uneven wear and tear on the spine and its surroundings. A scoliosis-specific exercise rehabilitation program works towards increasing core strength for more stability and support for the spine.
Targeted scoliosis-specific exercise can also address any muscular imbalance: lengthening and relieving strained muscles and tightening and activating muscles that have become weak from lack of use.
The use of Mirror Image exercise helps educate patients on recognizing poor posture and its effects. Patients are taught how to maintain the spine’s optimal alignment to counteract the scoliosis during activity, and these exercises can also be performed from home for long-term sustainable treatment results.
Scoliosis bracing can also help with pain management, holding the torso and spine in a straight and upright posture, and providing stability.
Scoliosis-specific Chiropractic BioPhysics® can complement scoliosis-specific exercise and bracing, as an adjunctive treatment working towards the same goal: improving the spine’s position.
Degenerative Scoliosis
For cases of degenerative scoliosis, a treatment focus is on increasing core stability and balance for fall prevention. Improving posture is key to reducing the uneven forces contributing to increasing degenerative changes, and early intervention is key to preventing vertebral and postural collapse that leads to injury.
Scoliosis-specific physical therapy can help improve pain, posture, core strength, and stability, while bracing supports healthy posture, the spine’s straight alignment, and helps re-train the brain-body connection to maintain its healthier position.
Conclusion
The main type of scoliosis in adults is idiopathic and pre-existing from adolescence: highlighting the importance of awareness and early detection. Adolescent scoliosis in adults is more complex to treat than adolescent idiopathic scoliosis diagnosed while mild.
Mild curves are smaller and more flexible, and once scoliosis becomes compressive in adulthood, progression makes the spine increasingly rigid and less responsive to treatment; flexibility of the curve is a determining factor when it comes to treatment plans.
Starting treatment while curves are small and flexible has greater potential for correction, and once a significant amount of progression has occurred, the condition’s effects are more well established and difficult to improve and/or reverse.
Degenerative scoliosis develops later in life and is caused by increasing instability in the spine due to degenerative changes. When the spine is unnaturally curved and rotates, it applies uneven forces to its structures and surroundings, and uneven pressure on the spinal discs can initiate the degenerative cycle.
With early intervention, however, the spine’s stability and balance can be improved for fall prevention, pain relief, and improvements to quality of life.
When it comes to progressive conditions like scoliosis, the sooner treatment is started, the better, and idiopathic scoliosis in adults and adult degenerative scoliosis can benefit from proactive nonsurgical scoliosis treatment that works towards improving the spine’s position and support for better overall balance and stability.
