Adolescent idiopathic scoliosis (AIS) is the most common form of the condition. The largest age group diagnosed with scoliosis is between the ages of 10 and 18, and among that group, approximately 80 percent of those cases are classed as ‘idiopathic’. Idiopathic means there is no known single cause and that it’s thought to have multiple causes. If a person in this age group has an abnormal spinal curvature that measures more than 10 degrees, coincides with rotation, and has no known single cause, it’s classed as adolescent idiopathic scoliosis.
While AIS is the condition’s most common form, it can also be the hardest to diagnose; this makes screening all the more important. Early detection leads to treatment, and treatment is how we monitor and manage the condition. Before we start discussing signs of scoliosis to look for in adolescents, let’s first discuss some of the basics of AIS.
With 80 percent of adolescents diagnosed with scoliosis having no known single cause, this is a large group; the remaining 20 percent are caused by either a congenital malformation, tumors, or a neuromuscular disease.
To be clear, AIS cases can’t be tied to a known ‘single’ cause and are thought, instead, to be the result of ‘multifactorial causation’.
I believe there are close to 70 theories out there currently that have found correlations between different factors and the condition’s development. These theories range from vitamin deficiencies, melatonin production, neurotransmitter issues, hormones, familial connections, rapid growth, and even too much time spent in chlorinated swimming pools or getting braces too early.
You can see there are numerous theories around that attempt to explain the development of such a prevalent condition, and what’s fascinating is that most of them seem to have found correlations, but they are currently little more than that.
The general consensus of experts is that it could be a number of factors that culminate in the development of AIS, and that the answer could vary from patient to patient.
This would explain the vast variance within the condition itself as it ranges from mild, moderate, to severe, and how each treatment plan has to be customized to the individual patient’s condition to be effective.
Here at the Scoliosis Reduction Center, I can honestly say I’ve never treated two patients with the same treatment plan, and that should tell you something about just how complex a condition AIS can be.
Not only is AIS not fully understood in terms of causation, a lot of people don’t realize that it’s progressive in nature.
All forms of the condition, AIS included, are classed as progressive. What this means is that it’s in the very nature of scoliosis to worsen over time. The tricky part about this is that we have no way of knowing exactly which cases will progress quickly and others slowly.
That being said, there are known triggers of progression, and these are what we structure our treatment approach around.
The reason scoliosis is thought to be so prevalent amongst adolescents is the intense phase of growth and development this age group is entering into. The condition is even more common in adolescent girls, and this is thought to be due to the early development of female vs. male adolescents.
We know that growth causes scoliosis to progress, and while we suspect it has something to do with tension on the spinal cord during growth, we can only speculate.
The challenge to treating cases of AIS is staying ahead of its progression, which of course is different in every patient. This is why monitoring is such a large part of our treatment approach.
If I see an adolescent patient grow as little as an inch, I want to order an X-ray to see how that growth is affecting progression. If we see a rapid growth spurt starting that is speeding up progression, we have to intensify our treatment to stay ahead of the curve.
Action vs. Inaction
The single worst approach to take with AIS, and I’ve seen it numerous times with the traditional approach, is to watch and wait. Even in the time between ordering, getting, and reading a scoliosis X-ray, a patient can have a huge growth spurt with the potential to cause a big progressive jump, meaning their spinal curvature gets more severe.
As progression occurs and the spine loses more of its healthy curves, it also loses its flexibility. As a spine gets more rigid, it becomes harder to manipulate, and manipulating the spine to achieve a reduction is the foundation of our chiropractic treatment approach.
Following the traditional approach to treatment involves observing to see how a condition progresses, and when it reaches a certain severity level, spinal-fusion surgery is often recommended as the best option.
Here at the Center, we take the opposite stance. Our conservative approach is based on starting active treatment as early as possible. While there’s no harm in reducing a small curve early on, there most certainly is harm in letting a small curve progress to a larger one.
Of course, before any form of treatment can start, the condition first has to be diagnosed. I mentioned earlier how challenging it can be to diagnose AIS, so let’s take a look at why.
You might think it would seem easy to spot a spinal deformity in yourself, or the body of an adolescent, but I can assure you that’s not always the case.
Firstly, conditions can range from mild, with very few signs and postural changes, to severe with overt deformities and an overall asymmetrical appearance to the body.
You might also think that AIS would be painful, but that’s also not the case. While commonly a part of the adult’s experience of living with scoliosis, pain is simply not a noted part of the adolescent experience.
This is understood because of the compressive forces of gravity and the scoliosis. As adolescents are constantly growing, their spine and its surrounding muscles and nerves aren't vulnerable to the compressive forces of the curvature.
In adults who have reached skeletal maturity, this is the opposite. As the spine is no longer experiencing a lengthening motion during growth, the compressive forces of the scoliosis can cause pain in the back, neck, shoulders, legs and feet.
In fact, most cases of adult scoliosis that walk through our center are adolescents who had the condition for years but didn’t know; it’s often not until the body stops growing that scoliosis starts to become painful, and this makes it easier to notice that something wrong is happening within the body.
The body is also an amazingly resilient and adaptable system, and even with a severe spinal deformity, the body can adjust so it doesn’t necessarily cause any functional deficits or interfere with daily life; this is another reason it can be hard to spot initially.
Let’s discuss some other reasons AIS can be difficult to spot.
The Adolescent Slouch
We’ve all been there, and we’ve all seen it: the classic adolescent slouch. Teenagers are known for their bad posture.
You add to that the prevalence of time spent hunched over screens in this digital age, and you have a lot of teenagers walking around with hunched shoulders and heads bent forward.
Often, the subtle postural changes that can indicate the onset of scoliosis look like little more than the typical teenage appearance.
Of course, not all teenagers are secretive and non-communicative, but the teenage years tend to be the time that many adolescents seek independence, enjoy having their own life, and stop sharing as much with their families.
The need for privacy is big, as can be the desire to fit in. It’s not uncommon for an adolescent to notice some unexplained changes to their bodies and not share their findings.
For someone who doesn’t want to be different, doesn’t want to stand out, doesn’t want to draw attention to themselves, sometimes noticing a postural change, a change to how they walk, or a strange body asymmetry is something they might want to conceal, rather than point out and draw attention to.
Teenagers who seem to live in baggy clothes and hoodies can make it difficult to spot the range of changes that scoliosis can cause in the adolescent body; this is why it’s so important for parents and caregivers to know the signs to look for that indicate the need for further testing.
Often, the signs of AIS can be difficult for anyone other than a scoliosis specialist to spot.
As it’s so important to start treatment as soon as possible with progressive conditions like scoliosis, knowing the signs to look for can be very beneficial, especially for parents and caregivers of adolescents who might keep to themselves, or be confused by the changes.
As mentioned earlier, scoliosis can range from mild, moderate, to severe. If an abnormal sideways curvature of the spine measures at more than 10 degrees and includes rotation, this is considered scoliosis. Depending where on the severity scale a patient falls, the signs to look for can range from subtle to overt.
As scoliosis develops, the spine loses its natural healthy curves and are replaced by bad curves. These bad curves throw off the body’s symmetrical appearance, and following are a range of signs to look for, both subtle and overt.
If you or an adolescent in your life has noticed some of these symptoms of AIS, it’s a good idea to seek out further testing to either confirm, or rule out, a scoliosis diagnosis.
Here at the Scoliosis Reduction Center, we can help determine if scoliosis is a factor, and how to best treat it moving forward.
As the most common form of scoliosis, adolescent idiopathic scoliosis poses some challenges. Early detection can be difficult, but the best treatment outcomes are those whose conditions were diagnosed and treated while in its milder stage.
That’s not to say we can’t treat and reduce severe scoliosis, but when it comes to treating adolescents, as growth is such a big factor, it’s easier to reduce a small curve than one that has been left to progress unimpeded.
Here at the Scoliosis Reduction Center, our proactive conservative treatment approach combines multiple forms of treatment, and we customize each and every treatment plan to address the individual characteristics of the patient’s condition.
For an adolescent, getting a scoliosis diagnosis can feel like some kind of life sentence, but we are here to help change the narrative around these stories and help these young people thrive with their condition.