Scoliosis is often described as a complex and mysterious spinal condition. This is partially because, despite being around for hundreds of years, the etiology of its most common form is still not fully understood. In addition, there are numerous different types of scoliosis a person can develop, and while the condition is most commonly diagnosed between the ages of 10 and 18, it can develop at any age.
Scoliosis is a progressive spinal condition characterized by the development of an abnormal sideways spinal curvature. For a person to be diagnosed with scoliosis, their abnormal spinal curvature has to have a Cobb angle measurement of 10+ degrees and include rotation.
To start our discussion of scoliosis, let’s first take a look at how prevalent the condition is. Then we’ll explore the condition itself, early detection and diagnosis, progression, different causes, symptoms, and treatment options.
It’s important to know just how prevalent scoliosis is, meaning how many people have it. By extension, it’s also helpful to know certain factors that increase its occurrence and rate of development, known as ‘incidence’.
Current estimates from the National Scoliosis Foundation put between 7 to 9 million people currently living with scoliosis in the United States alone, approximately 2 to 3 percent of the population; remember, this number only includes ‘known’ diagnosed cases.
Scoliosis is also the most common spinal condition amongst school-aged children.
When it comes to incidence, the condition is most-commonly diagnosed between the ages of 10 and 18, and while the condition develops equally in both males and females, females are eight times more likely to experience significant progression to the point of needing treatment.
Yearly, more than 600,000 scoliosis-related visits to doctors are made, with approximately 30,000 children being fitted with a brace, and an estimated 38,000 patients undergo spinal-fusion surgery.
Now that you have a better idea of how many people are currently living with scoliosis in the States alone, let’s answer the question, what is scoliosis?
Essentially, scoliosis is defined as an abnormal sideways curvature of the spine that includes rotation, meaning a ‘twisting’ component.
I describe scoliosis as a 3-dimensional condition because the spine doesn’t just bend forward or backwards, left or right; it bends, twists, and rotates in multiple directions.
It’s important to understand the 3-dimensional nature of scoliosis because, traditionally, it’s been considered and treated as a 2-dimensional condition. This designation doesn’t account for its true nature, and if it’s treated as a 2-dimensional condition, it can limit treatment efficacy and cause further harm to the spine.
It’s also important to understand that the spine is naturally curved for a reason; its curves give it added strength, flexibility, and allow it to evenly distribute mechanical stress that’s incurred during movement.
When there is a loss of one or more of these healthy curvatures due to scoliosis, the spine’s overall biomechanics are impaired, and the effects of this can be felt throughout the body.
Before we get further into the effects that scoliosis can have on the body, let’s discuss why early detection is so beneficial for people with scoliosis.
Of course, it’s always better to find out that something is amiss within the body sooner than later, but this is especially true of progressive conditions whose nature is to worsen over time; scoliosis is one such condition.
Early detection of scoliosis leads to better treatment outcomes because it means being able to start treatment earlier on in the condition’s progressive line.
When scoliosis is diagnosed early, it gives me the best possible chance of designing an effective treatment plan, and when the condition is diagnosed in children before the first major growth spurt, there are very few limits to what I can do in terms of healing and reducing curvatures.
While early detection doesn’t guarantee a positive outcome every time, it certainly increases the chances, and in a condition that’s virtually guaranteed to get worse over time, I see no point in wasting valuable treatment time.
Early detection increases the chances of being able to manage a patient’s condition so they don’t have to face the hardships of later stages of progression.
Let’s move on to explore another key component of the condition’s nature: progression.
One of the condition’s defining features is its progressive nature. Progression helps guide treatment, especially in children and adolescents who are facing a high risk of rapid-phase progression.
While scoliosis is progressive at any age, individuals who have not yet reached skeletal maturity are at a much higher risk of progression, and this is because growth is its number-one trigger.
Children and adolescents entering into the stage of puberty, marked by rapid and unpredictable growth spurts, are particularly susceptible to rapid-phase progression, which is why every effort needs to be made to stay ahead of the condition’s progressive line.
While “How much worse will my condition get?” is one of the most common questions I’m asked at the time of diagnosis, it also requires the most clarification.
This topic is important for patients and their families to understand because knowing the risk factors associated with scoliosis progression can help people make the right treatment choices.
When answering the above question, I often explain that, yes, it is likely to get worse, but by how much is impossible to tell.
This is where the somewhat ‘mysterious’ nature of scoliosis comes in because although we understand the trigger points of progression, we still can’t fully gauge how fast, or slow, a patient’s condition is going to progress.
This uncertainty is part of why I feel it’s so beneficial to start treatment as early as possible; when it comes to progression in children and adolescents, parents often come to me in shock over how their child’s condition seemed to worsen overnight.
When it comes to adult scoliosis and progression, the risk factor is not as high; however, as a person ages and the spine becomes more vulnerable to the degenerative effects of aging, adults can also experience rapid progression.
In addition, even if an adult is progressing at a seemingly-slow rate of a degree a year, over 10, 20 years, the cumulative effect can equal a large curvature increase.
Also, and this is true in both children and adults, the bigger the curve, the higher the risk of rapid-phase progression.
Let’s summarize the topic of scoliosis progression with some key points:
So as scoliosis progression has fluctuating periods of progression, some fast and some slow, the current consensus of experts is that, at some point, at some level, scoliosis progression is to be expected, but that rate is different for everyone.
As mentioned, one of the factors that feeds into a patient’s rate of progression is curvature size, which is akin to condition severity. Let’s take a look at the factors that place scoliosis on its severity scale of mild, moderate, or severe at the time of diagnosis.
When it comes to diagnosing scoliosis, most often, either some type of early screening such as an Adam’s forward bend test has been done, showing indicators for the condition, or an individual has noticed some postural changes associated with scoliosis.
When it comes to diagnosing scoliosis in adults, this is not as challenging as in children and adolescents, because adult scoliosis can be painful, whereas scoliosis in children rarely is.
As children and adolescents have not yet reached skeletal maturity, their spines are constantly growing and lengthening, and this counteracts the compressive force of a scoliotic curve, known to cause pain in adults who are no longer growing.
In adults, it’s most often pain in the back, or radiating pain into the arms, legs, and feet that leads to a diagnosis.
When a patient comes in to see me with concerns they have scoliosis, I would conduct a physical exam and take the patient’s medical history. I can also tell a lot about a patient’s condition by how they walk.
If I find enough indicators to warrant further testing, I would order a scoliosis X-ray, and from these results, I would have everything I need in order to diagnose and treat a patient’s scoliosis.
The scoliosis X-ray is the go-to method for diagnosing and assessing scoliosis because it tells us precisely what is happening in the spine.
As I treat scoliosis as a 3-dimensional condition, I make sure I have multiple images from multiple angles so every plane of the spine is explored for a full 3-dimensional picture of what is happening and why.
From an examination and X-ray results, I can fully classify a condition based on crucial patient/condition characteristics: age, condition cause (if known), condition severity, and curvature location.
From the patient’s age, the scoliosis is classified as infantile, juvenile, adolescent, or adult and elderly.
Condition cause has the potential to be the guiding force of treatment. Based on cause, scoliosis is classified as either idiopathic, congenital, neuromuscular, degenerative, or traumatic.
When a condition is classified as idiopathic, this means it has no single known cause. This form affects adolescents between the ages of 10 and 18 diagnosed with AIS, and it also affects adults who went through their adolescence unaware of their condition and didn’t get it diagnosed until it started producing noticeable symptoms in adulthood.
Idiopathic scoliosis is considered to be multifatorial, meaning caused by multiple factors that can vary from person to person.
AIS cases make up a staggering 80 percent of known diagnosed cases; the other 20 percent consists of cases with known causes:
Congenital scoliosis is the result of a bone malformation that occurred in utero.
If you think of the individual bones of the spine (vertebrae) as rectangular in shape and stacked on top of one another, in congenital scoliosis, one of those vertebrae is triangular in shape.
You can imagine how much that malformed bone could throw off the alignment of the entire spine.
Cases of neuromuscular scoliosis are among the hardest to treat with less potential for positive outcomes. This is because a neuromuscular disease, such as cerebral palsy or muscular dystrophy, is impairing the ability to control muscles located closely to the spine, responsible for stabilizing and supporting it.
In cases like these, the underlying condition causing the scoliosis has to be the primary focus of treatment and will guide the treatment approach.
Degenerative scoliosis is one of the two main forms that affect adults. The first, idiopathic, is an extension of AIS cases that were left undiagnosed until adulthood.
Degenerative scoliosis is most common in adults over the age of 40. When the degenerative effects of aging are felt by the spine, commonly affecting the intervertebral discs, the spine can become misaligned and develop scoliosis.
Traumatic scoliosis occurs as a result of surgeries, accidents, or other forms of body trauma that adversely affect the spine.
When it comes to classifying the condition on its severity scale, a patient’s X-ray will tell me how far out of a healthy alignment my patient’s spine is. This is determined by what’s known as the ‘gold standard’ in the diagnosis and assessment of scoliosis: Cobb angle.
Cobb angle is measured by drawing intersecting lines from the tops and bottoms of the curvature’s most-tilted vertebrae; the resultant angle is measured in degrees.
The higher a patient’s Cobb angle, the more severe their condition is, and this factors greatly into how easy, or difficult, it is to detect the condition’s presence early on.
Once a condition is classified as mild, moderate, or severe, it helps us move forward with our treatment plan and account for likely symptoms a patient could experience.
We’ll explore the signs and symptoms associated with each level of scoliosis in detail later, but what’s important to understand is that the milder the condition, the more difficult it can be for an average person to detect its presence.
Another piece of information provided by the scoliosis X-ray is where along the spine the abnormal curvature has developed.
The spine has three main sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back). Curvatures most commonly develop along the thoracic spine, accounting for the characteristic rib arch that can develop.
Knowing where along the spine the curvature has developed not only tells me where our scoliosis-specific chiropractic adjustments need to be focused, but also indicates likely symptoms that are associated with certain areas of the spine.
In addition, I also want to see in which direction the curvature is bending. In most cases, the curvature will bend to the right, away from the heart.
In atypical cases, a curvature can bend to the left, towards the heart; when I see this, a red flag goes up that there could be another issue involved such as a neuromuscular disease, or a tumor pressing on the spine.
We’ve discussed how beneficial early detection can be and touched on some of the reasons this can be challenging to achieve; now, let’s focus on signs and symptoms associated with the condition, and how much these symptoms can range from subtle to overt.
I’m going to focus on AIS, as this is the condition’s most common form, and when it comes to early detection, it’s children and adolescents who benefit the most.
Following are three general signs of scoliosis for parents and/or caregivers to look out for. Then we will look at the signs and symptoms associated with each severity level.
Unfortunately, the signs of scoliosis aren’t always obvious, but those who are educated on what to look out for have far better chances of noticing indicators of the condition.
If you suspect that you, or a loved one, has scoliosis, don’t hesitate to reach out to us here at the Scoliosis Reduction Center.
The most telltale signs of scoliosis in adolescents are connected to their physical appearance and posture. Most commonly affected is the body’s overall symmetry, the appearance of the back, hips, and shoulder blades.
Often, changes to the body’s symmetry are evident in how clothing hangs, or in the distance between the arms and torso; the distance on one side of the body can be greater than the other.
Additional scoliosis signs related to posture/appearance include:
These signs aren’t the only associated with scoliosis, but they are the most obvious, and they represent symptoms of the underlying structural condition.
Following are some additional signs that are less obvious, but also good to be aware of.
The presence of scoliosis in young people can affect balance due to the asymmetrical effects it can have on the body.
Often, people with scoliosis have difficulty recognizing their body’s position without visual cues; this is known as ‘proprioception’. A good test for this is to stand on one leg with eyes closed for 30 seconds. If there is difficulty remaining stable, this could indicate a balance issue related to scoliosis.
If an individual starts to feel excessively tired, it could be scoliosis-related. This is because as an abnormal spinal curvature progresses, the muscles surrounding the spine have to work harder to keep the spine aligned, supported, stabilized, and the body balanced.
As scoliosis becomes more severe, it can also exert extra pressure on the chest cavity, making it harder to inhale/exhale fully, and this can also lead to increased feelings of fatigue.
If this tiredness is uncharacteristic and still present when exerting very little energy, this can be another potential sign of scoliosis.
Now that we have looked at some of the general signs of scoliosis for individuals, parents and/or caregivers to watch out for, let’s focus on the different severity levels of the condition and explore some signs and symptoms associated with each stage, starting with mild scoliosis.
Patients diagnosed with mild scoliosis cases have a Cobb angle measurement of between 10 and 25 degrees.
The best time to treat scoliosis using my conservative chiropractic-centered approach is while the condition is still in its mild stage. Obviously, curvatures are at their smallest during the condition’s early days, and also, the body has not yet had a chance to adjust to the abnormal curvature.
However, before any progress can be made in terms of a diagnosis and treatment, it’s important that people know what the subtle signs of mild scoliosis are.
It’s during this stage that a lot can be done for patients to help control their condition and avoid reaching the higher stages of progression.
Initially, mild scoliosis is unlikely to produce any major deficits or impact a person’s life to a noticeable level in terms of function. The danger, however, is even cases that start as mild can become increasingly severe over time, unless they are caught and treated early on.
The best proactive measure is awareness. Being aware that the following issues could warrant further testing is the first step on the road to a potential diagnosis and early treatment.
As mentioned earlier, when scoliosis is present and causing postural changes, these changes affect the body’s overall symmetry.
Clothing that suddenly seems to be hanging unevenly and doesn’t fit the way it used to can be the result of the body becoming less symmetrical.
If shirt sleeves and cuffs appear uneven, or if shirt necklines seem to lean more to one side than the other, this could be indicative of asymmetrical changes to the body.
While ill-fitting clothing isn’t proof positive that scoliosis is present, it does suggest that further testing is necessary to fully rule out, or confirm, the presence of the condition.
If a person suddenly develops uncharacteristic issues with balance and/or coordination to a noticeable degree, this could be an indicator of mild scoliosis. Issues with proprioception are also another indicator to watch out for.
I can tell a lot about a patient’s condition by how they walk. In fact, quite often, mild scoliosis reveals itself in how an adolescent walks. Arms can swing less as they are held more tightly to the sides, and the normal counter-rotating motion made by the body in the hips and shoulders can be markedly different.
If an individual’s walk seems asymmetrical in some way, but you can’t quite determine why, it’s time to get a professional to take a look as we are trained in the subtle scoliosis signs to look for and what they mean.
While every case is different, it’s generally uneven shoulders and hips that are the earliest postural changes caused by scoliosis. In addition, the following are additional clues that mild scoliosis could be present:
Generally speaking, any indication that the body is asymmetrical could indicate the presence of mild scoliosis.
As mentioned earlier, scoliosis in children and adolescents is rarely painful, which is partially why early detection can be such a challenge.
While scoliosis is not characteristically painful in individuals who are still growing, headaches, neck pain, back pain, hip pain, and muscle pain are still possible indicators of the condition as every case is different.
In addition, scoliosis-related pain can increase dramatically with progression: another reason to try and catch the condition early on.
While having one of the aforementioned signs shouldn’t send a person into a panic that they have scoliosis, the more signs that are present, the more likely it is.
It’s never too early to start thinking proactively in terms of scoliosis. Now, let’s move on to common signs and symptoms of the next severity stage: moderate scoliosis.
When an individual’s Cobb angle measurement falls between 10 and 25 degrees, this is considered moderate scoliosis.
People with moderate scoliosis make up the majority of my patients because signs and symptoms become more noticeable in this stage as the condition has progressed beyond milder levels.
The reality of reaching the moderate stage is that the condition is virtually guaranteed to continue its progression. We don’t know how fast it will happen, but we know it will happen eventually.
The signs of moderate scoliosis are those associated with mild scoliosis, but on a more extreme level:
The postural changes associated with scoliosis are most noticeable when in a forward-bend position, which is why the Adam’s forward bend test is such an effective screening method.
I believe being proactive with treatment during the moderate stage is critical as it can help patients and their families avoid the known hardships of reaching the severe stage.
Patient’s with a Cobb angle measurement of 40+ degrees are diagnosed with severe scoliosis.
As scoliosis progresses, its symptoms get more extreme. When a person reaches the severe-scoliosis stage, the aforementioned signs and symptoms associated with mild and moderate scoliosis become more overt.
While part of classifying the condition is designating it as mild, moderate, or severe, even within one of those severity levels, there can be a significant range in how people experience the condition; this is why the condition’s very nature necessitates a customized treatment approach.
When a person enters into the severe stage of scoliosis, there is a high likelihood that their condition will continue progressing. In fact, severe-scoliosis cases carry a 90-percent risk of progression.
Living with severe scoliosis makes life more challenging. It can contribute to chronic daily pain, especially once skeletal maturity has been reached, and it can cause functional deficits that can place limits on a patient’s lifestyle.
As the postural changes mentioned for the mild and moderate stage become more pronounced and extreme in the severe stage, these patients are the most likely to suffer from negative self-image, depression, and suicidal thoughts.
When it comes to the common signs and symptoms of severe scoliosis, this is what to expect:
The postural changes associated with the severe stage of scoliosis progression can be extreme. At this stage, the spine’s abnormal curvature can be seen with the naked eye. The asymmetrical affect on the body is overt, as are the related symptoms:
In addition to the postural changes that start in the mild stage and increase into the moderate and severe stage, the severe stage has the potential to cause additional symptoms and potential complications:
Pulmonary function can be impacted by severe scoliosis. The larger a patient’s abnormal spinal curvature is, the more likely it is to cause lung impairment; the spine’s bend and twist places excess pressure on the chest cavity, giving the lungs less room to expand.
This impact is most likely to be noticed by those who place higher-than-average demands on their respiratory system (professional athletes and long-distance runners) during times of extreme exercise.
As the spine works in tandem with the brain to form the body’s central nervous system (CNS), scoliosis has the potential to negatively affect this system, leading to pain and discomfort.
Chronic and persistent pain in the back, neck, and legs are associated with severe scoliosis.
As the muscles of the spine struggle to support its misaligned form, they can become tight and stiff, leading to intense muscle and back pain.
In addition, large curvatures and the compression they cause often impacts near-by nerves, which can result in pain that radiates into the legs, arms and feet.
Tension headaches can be a common symptom of severe scoliosis, especially if the curvature is located in the cervical spine, as the neck muscles are worked unevenly and struggle to support the weight of the head.
Spinal conditions also have the potential to impact the flow of cerebrospinal fluid (CSF) as it passes through the spinal canal. Low levels of CSF in the brain can lead to debilitating headaches and/or migraines.
People living with severe scoliosis often struggle with sleep problems, which are typically due to an inability to get comfortable, the presence of pain, and/or lung impairment affecting breathing.
It might seem strange to think that an abnormal spinal curvature could affect a person’s digestive system, but as the spine is connected to virtually every working system within the body; it can impact the digestive tract as much as it can affect the muscles located closely to the spine.
This can be due to the severity of the abnormal curvature causing excess pressure on internal organs, or due to a disruption in the communication between the brain and the body’s organs and systems via the CNS.
The nerves running through the spine, as mentioned, are an integral part of the CNS performing optimally. They connect the brain with the body’s organs, which is why sleep, digestion, and even a person’s menstrual cycle can become disrupted by the presence of severe scoliosis.
While balance, equilibrium, and proprioception can all be impacted in the earlier stages of progression, this is more amplified in patients who have progressed to severe scoliosis.
As the body’s asymmetry increases with progression, its center of gravity is thrown off, causing balance to suffer, along with the ability to recognize the body’s position when the eyes are closed.
Now that we have touched on the common scoliosis signs and symptoms to look out for generally, and the specific signs and symptoms associated with each stage of severity, we can move on to the all-important topic of treatment.
While we don’t fully understand the etiology of the condition’s most common form, AIS, that doesn’t mean we don’t know how to manage and treat it effectively.
For people who have been recently diagnosed, or for those who are caring for a loved one recently diagnosed, deciding on a treatment approach to follow is a crucial choice, with potential life-long consequences.
Different treatment approaches offer different results, so before you commit to one over the other, make sure you fully understand the differences and which provides a better option for you and your family.
The two main treatment approaches are known as ‘traditional’ and ‘conservative’.
The traditional approach to treating scoliosis has been the dominant approach for many years and is characterized by passivity, watching and waiting, and eventual surgery.
The typical experience of an adolescent on the traditional treatment path would include a diagnosis, being told that the condition should be observed to see if it will progress, bracing with the outdated Boston or Milwaukee brace, and surgery once their degree of curvature progresses into the surgical level threshold of 40+ degrees.
The issue I have with this is that during all the watching and waiting in-between follow-up X-rays, typically taken every 3 to 6 months, adolescents can have huge growth spurts that trigger rapid progression.
Meanwhile, the curvature has been allowed to progress unimpeded, valuable treatment time has been lost, and the patient has moved that much further down the progressive line, and closer to a spinal-fusion recommendation.
While scoliosis surgery has evolved over the years, its general principal remains the same: fusing the most-tilted vertebrae of the curvature into one solid bone to eliminate movement and progression. Hardware is also attached to the spine to hold the bones in place during the fusion process.
Now, a person can come out of spinal-fusion surgery with a straighter spine, but at what cost? As the end-goal of surgery is to stop progression, not to actually correct the abnormal spinal curvature, movement in the fused area is no longer possible, and this loss of spinal flexibility is something many patients struggle with post-surgery.
In addition, there are no guarantees that progression will be permanently stopped, and there is also a large gap in the research on what happens to a person who has had spinal fusion 10, 20, and 30 years down the road. That hardware will only perform optimally for a certain amount of time, and the only recourse for people who have had spinal fusion with a negative outcome is more surgery.
A fused spine is a fused spine - there is no going back. This procedure is costly, invasive, and comes with serious side effects and numerous potential complications.
Everything I do here at the Scoliosis Reduction Center is to help my patients avoid getting to the point where surgery is presented as their best option.
Let’s take a look at how a conservative chiropractic-centered approach differs in process and outcome.
Here at the Scoliosis Reduction Center, our approach is patient and chiropractic-centered, integrative, and functional.
I opened the Center because I felt there was a lack of positive scoliosis-treatment options. I saw patients repeatedly funneled towards spinal-fusion surgery without even being aware of safer and less-invasive options.
What’s unique about the Center is that patients have access to multiple scoliosis-specific treatment options under one roof: fully accessible and convenient.
Each and every patient who walks through our door gets a 100-percent fully customized treatment plan that addresses the whole patient and the specifics of their condition.
We combine chiropractic, corrective bracing, in-office therapy, and home exercises. Through combining these disciplines, we are better able to customize our treatment plans, apportioning these disciplines as needed throughout the course of treatment, and our patients can reap the benefits of different treatment modalities.
While monitoring will always be part of my approach, after all, we have to closely observe the spine to see how it’s responding to treatment, that observation is a component of proactive treatment, not merely watching and waiting.
Through scoliosis-specific chiropractic adjustments, corrective bracing with the modern custom-designed ScoliBrace, in-office therapy, and rehabilitation, our goal is correction.
First and foremost, we want to impact the condition on a structural level, as that is the underlying cause, and then we want to focus on how to sustain those results; a component of which is scoliosis-specific exercise and in-office therapy with the goal of increasing core strength so the muscles located closely to the spine can better support and stabilize it.
We also provide guidance on scoliosis-specific stretches and exercises that can be done from home to help augment and sustain the treatment results we have achieved in-office.
In addition, should a patient choose to try the other traditional treatment route, our approach carries few, if any, side effects and risk of complications, so there are no permanent irreversible effects; the same can’t be said for those who chose a different path ending in spinal-fusion surgery.
Those recently diagnosed with scoliosis have a challenge ahead of them: not just in terms of living with their condition, but also in knowing the steps to take next.
While there are many benefits to early detection in terms of treatment efficacy, it’s never too late to start treatment.
When it comes to committing to a certain treatment approach, I caution patients and their families to make sure they fully understand the defining features of each approach, particularly the different outcomes they offer.
Here at the Scoliosis Reduction Center, our conservative chiropractic-centered approach is both proactive and preventative; we start treatment as early as possible in an effort to prevent our patients from reaching the higher stages of progression and the hardships they are associated with.
If after reading this, you still have unanswered questions about scoliosis, don’t hesitate to reach out to us here at the Center for further guidance and support.