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Mild Scoliosis

Symptoms, Treatment, and Surgery? EARLY STAGE INTERVENTION IS IMPORTANT

image assetPart of diagnosing a patient with scoliosis is further classifying the condition. This is based on various characteristics of the condition and the patient such as age, cause (if known), condition severity, and location of the curvature. Once a patient’s condition is classified as mild, moderate, or severe, we can move forward with designing a customized treatment plan.

When a person first receives a scoliosis diagnosis, that diagnosis includes a classification of the condition. Based on a measurement known as ‘Cobb angle’, the patient’s scoliosis is classified as mild, moderate, or severe. If a patient’s spine bends and rotates with a Cobb angle measuring between 10 and 25 degrees, this is considered ‘mild scoliosis’.

If you or a loved one has recently been diagnosed with mild scoliosis, chances are, the patient will be feeling anything but lucky; however, just by detecting the condition in its mildest form, they are already ahead of the game. This is because when it comes to the condition’s most common form, early detection can be as challenging as it is beneficial.

What is Mild Scoliosis, and How is it Classified?

The human spine has three main natural healthy curves. These curves give the spine its strength, flexibility, and allow us to maintain an upright posture.

If there is a loss of one or more of those healthy curves, the spine’s overall biomechanics are thrown off, and this can lead to a number of experienced symptoms and potential complications.

If a spine has an abnormal bend to the side, plus has rotation, these are good indicators that scoliosis is present.

The other marker that has to be met is what’s known as ‘Cobb angle’.

Cobb Angle

Cobb angle is a measurement, taken via X-ray, from the most-tilted vertebrae of the curvature; this measurement tells us how far from a natural and healthy alignment the patient’s spine twists and bends.

If the Cobb angle measures at more than 10 degrees, but less than 25, this is classified as ‘mild scoliosis’, and this is the first stop on the condition’s progressive line.

Cobb angle is a big part of classifying the condition, but other important factors include the patient’s age, condition cause (if known), and location of the curvature.

Patient’s Age

While scoliosis can develop at any age, its most common form develops between the ages of 10 and 18: adolescent idiopathic scoliosis (AIS).

This form of the condition makes up 80 percent of known diagnosed cases.

The patient’s age is an important aspect of the classification process for a couple of reasons.

First of all, a person’s age gives us a general idea as to their fitness level and ability to handle the rigors of treatment.

In terms of scoliosis, age is particularly important because once a person reaches skeletal maturity, the biggest trigger for the condition’s progression is removed: growth.

While there is a lot we don’t know about the condition, including what causes the onset of idiopathic forms, we do know that patients with growth and development yet to go through are at the highest risk of progression.

Age is also important because it helps indicate likely symptoms that might be part of the patient’s scoliosis experience, such as pain, and this leads us into why early detection of mild scoliosis can be difficult, which we will return to.

For now, let’s stick to the benchmarks for classifying a condition. We’ve talked about Cobb angle (condition severity), and patient age, so let’s move on to condition cause.

Condition Cause

As already mentioned, the condition’s most common form is AIS, and the condition’s ‘idiopathic’ designation tells us there is no single known cause that we can contribute the condition’s onset to.

AIS is, instead, thought to develop out of a number of variables that can vary from patient to patient: multifactorial.

As we mentioned how AIS makes up 80 percent of known diagnosed cases, you might be wondering what the other 20 percent is.

The other 20 percent of known diagnosed cases have known causes, and these are less typical forms of the condition such as neuromuscular, congenital, degenerative, and traumatic.

In the above types of cases, the scoliosis develops as a secondary complication to a more primary medical issue or disease.

This is important to know because treatment for these forms have to address the larger medical issue at play, first and foremost.

Location of the Curvature

There are three main sections to the spine: cervical (upper back and neck), thoracic (middle back), and lumbar (lower back).

Scoliosis can develop at any location along the spine, but it most commonly develops along the thoracic spine.

Knowing the precise location of the curvature is not only important for knowing where to concentrate components of treatment, such as targeted chiropractic adjustments, but also because certain curvature locations are related to certain symptoms, and this can help guide our treatment approach moving forward.

So now that we have touched on how a condition is classified, you can better understand how a condition such as mild adolescent idiopathic thoraco-lumbar scoliosis is named: ‘mild’ based on Cobb angle, ‘adolescent’ based on age, ‘idiopathic’ based on cause, and ‘thoraco-lumbar’ tells us the curvature location.

Now that we fully understand the characteristics that classify a condition as mild, let’s take a look at why early detection can be such a challenge.

Mild Scoliosis and Early Detection

Two important features of scoliosis to understand is that it is both progressive and incurable.

What this means is that it’s in the condition’s nature to worsen over time and that there is no known cure.

While this can be very frightening for someone recently diagnosed to hear, I remind patients and their families that while we might not be able to cure it, we have many resources at our disposal to help us treat and manage it effectively.

While a spinal disorder marked by an abnormal bend and twist seems like it would be easy to spot, this is not always the case, especially with mild forms of the condition.

As mild scoliosis is the first stop on the condition’s progressive line, this is also the stage that carries the fewest/mildest symptoms, and those that are present are often not noticeable to anyone other than a scoliosis specialist who is trained to recognize the condition’s subtle early signs.

Postural changes that develop during this stage are subtle, and very often, the person and their families will not notice them until progression occurs and the condition moves into the next stages: moderate and severe scoliosis.

So for those wondering what does mild scoliosis look like? The answer is, in many cases, patients with mild scoliosis don’t look much different on the outside, at least not to those with an untrained eye.
mild scoliosis correction
The before-and-after treatment X-ray images show what’s going on with the spine, but at this stage, these changes are rarely noticeable to the naked eye or to those with no scoliosis-specific experience.

If you suspect you have scoliosis, or suspect a loved one does, don’t hesitate to reach out to us here so we can help determine whether scoliosis is present or not.

This brings us to the next question you might be asking: what are the symptoms of mild scoliosis?

Symptoms of Mild Scoliosis

Scoliosis is a difficult condition to talk about in general terms; this is because it ranges so much in severity from mild to moderate and severe.

Even within one of those categories, such as mild scoliosis, there is a lot of variance, and no two patients will experience their condition in the exact same way, including symptoms.

That being said, especially in the context of early diagnosis, there are some common symptoms that can be watched out for.

When most people think of symptoms of scoliosis, they think of back pain, but remember, AIS cases are rarely painful.

Mild Scoliosis Pain

Even though most cases of adolescent idiopathic scoliosis aren’t painful, that does not mean a patient will never experience any scoliosis-related pain.

As a condition progresses, the curvature gets larger, and the more likely it is to produce adverse symptoms like pain.

In fact, approximately 20 percent of adolescents report feelings of muscle pain, and as progression continues, this is only likely to get worse.

A mention should also be given to adults and mild scoliosis pain. As previously stated, adults experience scoliosis-related pain very differently than adolescents.

Once growth stops, so too does the spine’s lengthening motion. Once a person with scoliosis stops growing, that lengthening motion is replaced by compression, which puts pressure on the spine and its surrounding muscles, nerves, and tissues.

For adults, even with mild forms, scoliosis can cause a lot of neck and back pain, in addition to radiating pain into the arms, legs, and feet due to pinched nerves.

Mild scoliosis hip pain can also be a very real complaint for adults, especially if the scoliosis has caused a change to the symmetry of the pelvis.

If the abnormal curvature has caused the pelvis to shift and one hip sits higher than the other, one side is taking on more weight, and this can lead to pain and discomfort.

Basically, the longer a person lives with scoliosis, the more likely it is that it will start causing pain at some point, especially if left untreated.

This leads us into the area of mild scoliosis that I most want people to understand: progression.

If you are experiencing scoliosis-related pain or other symptoms, there is no reason to suffer needlessly.

Help is only a click away and can be the first step towards active treatment and relief.

Uneven Posture

Uneven shoulders and hips can be indicators of mild scoliosis; basically, any sign that the body is asymmetrical is cause for further investigation.

Following are some additional postural changes associated with mild scoliosis:

  • Head appears uncentered over the torso
  • Arms can seem to hang at different lengths
  • Ribs can protrude more on one side than the other
  • When standing, the body can seem to lean more to one side
  • Legs can seem to hang at different lengths
  • One hip can sit higher than the other
  • One side of the waist can be flatter, or more rounded than the other
  • One shoulder blade can protrude more than the other
  • Space between the arms and torso can appear uneven

Clothing Fitting Unevenly

The way clothing hangs on a body can be a good indicator of any asymmetries present.

While hard to spot, some of the subtle postural changes associated with mild scoliosis can cause a change to how clothing fits.

Pay attention to the cuffs of sleeves and how they line up on each arm. Do the necklines of shirts always seem to pull more to one side?

Ill-fitting clothing isn’t a definitive sign of scoliosis, but if these types of changes seem to happen suddenly, it can be enough of a reason to investigate further.

Headaches

While having mild scoliosis doesn’t guarantee a person will struggle with headaches, it can be a common issue for scoliosis patients.

As mentioned earlier, sometimes curvature location can indicate likely symptoms, such as tension headaches that are commonly associated with curvatures of the cervical spine (upper back and neck).

When the cervical spine is abnormally curved, this can cause the neck muscles to tighten, placing tension on the head; these types of headaches have been known to reach migraine levels.

Scoliosis-related headaches and migraines are also connected to the flow of cerebrospinal fluid (CSF).

CSF fluid is not only important because it cushions the spinal cord and brain, protecting them from injury, it also helps deliver nutrients and remove waste.

If scoliosis has caused an interruption to the flow of CSF, this can lower its levels in the brain, and debilitating headaches can occur as a result.

Balance and Coordination Issues

Issues with balance and coordination can be a difficult symptom to spot early on, especially in adolescents.

Considering that classic adolescent slouch and constant reminders to teenagers to “stand up straight,” changes to balance and coordination can seem little more than klutzy teenage awkwardness.

A good way to further test this is to have the person close their eyes and try to balance on one leg for 30 seconds; most people should be able to do this.

For people with scoliosis, the ability to recognize the body’s positioning without visual cues can be an extra challenge, known as ‘proprioception’.

Changes in Gait

Connected to issues with balance and coordination are changes to gait.

I can tell a lot about my patients’ conditions by how they walk. It’s not uncommon for mild scoliosis to reveal itself in the way a person walks.

Arms can swing less, and the normal counter-rotating motion of the hips and shoulders can be lessened.

Also, asymmetrical motion during walking can be a sign that mild scoliosis is present.

While having one of the aforementioned issues might not mean scoliosis is present, if a few of these postural issues are sounding familiar, this is a good indication that some further testing should be done to rule out scoliosis.

Remember, there is no harm to being assessed needlessly, but there is harm done by not being proactive and leaving a condition to progress undiagnosed and unimpeded.

Mild Scoliosis Progression

As previously mentioned, scoliosis is progressive, and this means that it is virtually guaranteed to get worse over time, if left untreated.

Part of the challenge of treating mild scoliosis, in addition to early detection, is that while we know the biggest trigger for progression is growth, there is no way to tell precisely at what pace a patient’s spine is going to respond to that growth.

I believe that patients have the best chance for treatment success when their condition is caught during the mild stage.

As AIS is the condition’s most common form, it’s this age group that faces the biggest risk for rapid progression.

If an adolescent’s condition was left undiagnosed and untreated until its symptoms became severe enough to reach a diagnosis in adulthood, progression tends to slow, but it is still an issue.

In most cases of adult idiopathic scoliosis, these are continuations of AIS that were not diagnosed and treated during adolescence, most often because the person was simply unaware of their condition.

By the time these adults are diagnosed, obviously their condition has been left to progress unimpeded for quite some time, and it’s not until the condition started to produce noticeable symptoms that they sought a diagnosis and treatment.

So let’s say an adult comes in to see me because of back pain, and I diagnose them with mild scoliosis with a Cobb angle measurement of 24 degrees.

Even with the slower progression characteristic of adulthood, let’s say of one degree a year, over 10 years, that adult now has a Cobb angle of 34 degrees and is that much closer to reaching that surgical threshold.

You can see how, even slow progression, has a cumulative effect that can equal up to a large abnormal spinal curvature.

My point is progression is progression; whether it happens slowly or quickly, the end result of a more severe form of the condition is virtually inevitable, if left untreated.

This moves us into the topic of treatment options for mild scoliosis, which brings us to that fork in the road that every scoliosis patient has to face: choosing a treatment approach.

Mild Scoliosis Treatment Options

As is also the case with moderate and severe scoliosis, there are two main scoliosis-treatment approaches for mild scoliosis: traditional and functional.

While the traditional approach is still a choice for many, I want people to make that choice out of knowledge and power, and to me, this means being fully aware of all treatment options available, including known benefits and risks of each.

Traditional Approach to Treating Mild Scoliosis

When it comes to the traditional approach for treating mild scoliosis, there is not a whole lot to say because this approach does nothing proactive during this early stage; instead, patients are told to watch and wait to see if/how fast their condition will progress.

For mild and moderate cases, other than monitoring, and possibly bracing, there is typically nothing done in the form of active treatment, until the patient’s degree of curvature reaches the surgical threshold.

The issue is that there is no way to know what would have happened had treatment been started earlier.

In many cases, treatment started early in the condition’s progressive line means avoiding the hardships of reaching more severe stages, especially when severe scoliosis can come with the recommendation for spinal-fusion surgery.

In the traditional approach, people watch and wait while patients’ conditions progress, which they are bound to do, and to me, this is wasting valuable treatment time.

Once a patient crosses that surgical threshold at around 45 degrees, shows continued progression, and bracing has proved ineffectual (if attempted), they are funnelled towards surgery as the best way to stop the condition from progressing further.

So to be clear, if a patient with mild scoliosis is referred to a spinal surgeon for treatment options, no proactive treatment is done during this stage; in the traditional approach, the strategy is to monitor the condition to see how the spine responds to growth (AIS) and progresses.

If mild and moderate scoliosis is left untreated, or not treated proactively, it’s virtually guaranteed to progress, and if a patient with mild scoliosis progresses into the moderate and then severe stage, surgery can be presented as a positive treatment option, and that comes with a whole lot of potential risks and side effects, not to mention the cost.

This brings us to a question most people freshly diagnosed with mild scoliosis would ask: does mild scoliosis require surgery?

Does Mild Scoliosis Require Surgery?

The question of whether mild scoliosis requires surgery has a complex answer.

In simple terms: no, mild scoliosis does not require surgery. However, if mild scoliosis is left untreated and progresses into the severe stage, for those on the traditional-treatment path, they could end up being told surgery is necessary.

In order for a person’s scoliosis to be considered in the surgical threshold, in most cases, this involves curvatures of 40+ degrees, but again, every case is different.

Spinal fusion surgery will never be necessary for treating mild scoliosis because in this stage, curvatures are far below the surgical level, and even for supporters of spinal fusion for severe scoliosis, no surgeon would perform such an invasive procedure on a patient whose curvature is not even close to that surgical level.

Spinal fusion should only be used, in my opinion, as an absolute last resort, after all other options have been explored and failed.

This is because spinal fusion is permanent. If a patient is unhappy with the results, or the procedure fails for any number of reasons, the only possible recourse is more surgery.

If a patient is unhappy with the results of our functional approach, there is no harm done. As it is a natural and noninvasive approach, there are few, if any, side effects, and nothing is irreversible.

Scoliosis surgery also comes with some heavy side effects such as reduced flexibility, and it’s not uncommon for patients to report an increase in scoliosis-related pain post surgery.

In addition, there is also no guarantee that a patient’s scoliosis won’t continue to progress, despite having undergone the invasive surgery.

To answer the question clearly, no surgeon is going to perform spinal fusion on a person with mild scoliosis because not only would it be unnecessary, it would mean exposing that patient to all the potential risks, complications, and costs associated with the surgery.

Here at the Scoliosis Reduction Center, this is why our functional treatment approach is more proactive than reactive.

We want to reduce our patients’ abnormal curvatures while their conditions are in the mildest form possible; we strive for this to improve their overall quality of life, and a big part of that is avoiding the hardships of severe scoliosis and potentially facing spinal-fusion surgery down the road

Now, let’s explore our treatment approach for a typical case of AIS diagnosed in the mild stage.

Functional Approach to Treating Mild Scoliosis

If a patient came in to see me with scoliosis concerns, I would give them a physical exam and take their histories. If I saw some indicators, I would order a scoliosis X-ray to take actual measurements and confirm that structural scoliosis is present.

If the Cobb angle measured at more than 10 degrees, but less than 25, and included rotation, I would sit down with the patient, and their family, and give them their diagnosis of mild scoliosis.

From there, I would recommend starting treatment as soon as possible. I would explain the benefits of this in the context of progression and how if left alone, related symptoms and degree of curvature are virtually guaranteed to increase.

From the X-ray and exam, I would have all the condition information I need to design a treatment approach moving forward.

Our treatment approach would also involve a lot of monitoring to observe how growth affects the spine, but the difference between our monitoring and monitoring in the traditional approach is that we would actively respond.

From the following X-ray images taken before and after treatment, you can see the difference that active treatment can make.
mild scoliosis correction
Our integrative approach combines multiple treatment disciplines. This is highly beneficial for scoliosis patients not only because they can benefit from the different merits of each approach, but because it allows us to fully customize our treatment plans to address the individual patients and their conditions.

In the mild stage, our ultimate treatment goal is to impact the condition on a structural level by reducing the curvature, lessening related symptoms, and stopping the condition from ever reaching the moderate and severe stage of progression.

Different Facets of Functional Treatment for Mild Scoliosis

As mentioned, here at the Center, we combine multiple treatment disciplines.

These disciplines are scoliosis-specific and include targeted chiropractic adjustments, active and passive rehabilitation, exercises, and corrective bracing.

We combine these disciplines based on the needs of the patient and their condition, then we adjust and apportion them differently as we observe how they are working together and how the spine is responding.

The great thing about this approach, in addition to its efficacy, is how engaged the patient is throughout the process.

Obviously, it would be hard for an adolescent patient freshly diagnosed with mild scoliosis to see themselves as fortunate, but I do my best to accentuate the positives of early detection and how it increases treatment success.

You can see, by looking at the below X-ray images taken before and after treatment, just how effective our functional approach can be; here, the patient’s curvature has been  reduced and improved upon the postural asymmetries caused by the condition.
mild scoliosis correction
In addition, active treatment helps patients maintain feelings of power and control over their condition, bodies, and lives, and this translates into a better attitude, better treatment efficacy, and improved mental health.

Here, I would like to say a few words to clearly explain what each facet of treatment involves:

Scoliosis-specific chiropractic - for this treatment facet, we use scoliosis-specific chiropractic adjustments to try and manipulate the spine to move out of the unhealthy curvature and restore as much of the spine’s healthy curves as possible.

Traditionally, the place of chiropractic in scoliosis treatment has been questioned, but as general chiropractic will most certainly fall short when it comes to treating scoliosis, scoliosis-specific chiropractic is different and has the power to impact the condition in very positive ways.

Scoliosis-specific therapy - the goal of scoliosis-specific therapy is to passively mobilize the spine into a corrective position.

This facet of treatment would include traction, de-rotation, and vibration.

Here at the Center, we use multiple types of equipment that were designed specifically for reducing scoliosis.

Scoliosis-specific exercises (SSEs) - for a long time, it was questioned just where and if exercise fit into scoliosis treatment; we have since learned that scoliosis-specific exercises, when done correctly and customized to a patient’s condition, can be extremely effective.

These self-correction exercises are customized to each patient’s ability and curvature type/severity; they would include a combination of exercises that are movement-based, isometric, or reflexive.

SSEs are also a great tool for mild scoliosis pain management. Keeping the spine and its surrounding muscles and tendons as loose and strong as possible is a healthy and proactive way to manage and reduce scoliosis-related back and muscle pain.

Here at the Center, we have all the state-of-the-art exercise equipment needed to facilitate this component of treatment.

Corrective bracing - for those who have done their due diligence in researching scoliosis treatment, they have likely come across the reference to bracing as a component of treatment.

For those wondering why sometimes the term ‘corrective’ is applied to bracing, and sometimes not, this is because not all braces are created equal and have the same treatment goal in mind.

Corrective braces have a structural curvature reduction as its end goal, whereas common traditional braces, such as the Boston brace, have a different goal.

As mentioned earlier, bracing is the only form of active treatment that takes place in the traditional approach, prior to reaching that surgical threshold, and the most common brace used in the traditional approach is the Boston.

The Boston brace, like scoliosis surgery, doesn’t have correction as its ultimate goal, but rather slowing/stopping progression. It does this by squeezing the spine at certain points along the curvature and holding it in a corrective position, but doesn’t actually correct it.

With our functional treatment approach, we use a completely different type of brace: the 3D corrective ScoliBrace.

The big difference between the Boston brace and the ScoliBrace is in design and treatment goal. The ScoliBrace is designed to actually reduce the curvature while being worn.

In addition, it is custom manufactured based on each patient’s curvature type, body type, and level of spinal flexibility.

The difference in design is related to the contrasting end goals; instead of slowing/stopping progression as the Boston brace hopes to do, the ScoliBrace strives to actually correct the scoliosis by reducing the curvature and supporting the reduction.

So when it comes to the best mild scoliosis brace, a brace that is corrective and customized has the best shot of actually impacting the scoliosis on a structural level, which is precisely what successful treatment entails.

If you would like to learn more about our proactive functional treatment approach here at the Center, don’t hesitate to reach out.

Mild Idiopathic Scoliosis in Adults

As the condition’s most common form (AIS) accounts for 80 percent of known diagnosed cases, I have focused the article on this form of the condition.

While the majority of my patients are adolescents in the moderate stage, let’s not forget that adults can develop the condition as well. Scoliosis in adults has two main forms: idiopathic and degenerative.

When idiopathic scoliosis appears in adulthood, it is most commonly an extension of AIS.

As discussed, it’s not always easy to diagnose AIS, and it’s not uncommon for adolescents to grow and develop with their scoliosis in tow, until growth stops in adulthood, the condition becomes painful, and this is what brings them in to see me for a diagnosis.

In these cases, our treatment goal is to reduce the abnormal curvature back to where it was before it starting producing noticeable symptoms like back and muscle pain.

Mild Degenerative Scoliosis in Adults

Degenerative scoliosis most often appears after the age of 40. This develops due to the natural degenerative effects of aging on the spine, commonly affecting the intervertebral discs.

The intervertebral discs act as cushions between the individual vertebra and shock absorbers for evenly distributing the force of impact.

When the discs that sit between the vertebrae of the spine start to degrade, this can cause slippage to occur, and the spine can start to gradually bend out of alignment and develop scoliosis as a result.

In these types of cases, it’s pain and discomfort that brings adults in to see me, and once we do an X-ray, we can gauge the health of the spine, its intervertebral discs, and give the patient their diagnosis.

In women, changes to hormone levels and bone density due to menopause can also play a role.

Regardless of age or condition severity, there is a potential treatment plan for each and every patient we see.

Here at the Center, our goal is to help patients avoid reaching the higher stages of progression; the first step to reaching that end goal is connecting with patients in need.

Reach out to us here if you feel you, or a loved one, are one of these patients.

Conclusion

When it comes to mild scoliosis, this is the earliest stage of the condition.

Defined as a spinal disorder with a Cobb angle measurement between 10 and 25 degrees that coincides with rotation, mild scoliosis is the best time to start treatment.

While there are multiple benefits to starting active treatment while a patient’s scoliosis is still mild, this can be particularly challenging because early detection isn’t always possible, which is why the majority of my patients are in the moderate stage.

Mild scoliosis does have some telltale signs to look out for, but many of these are very subtle and difficult to spot.

Let’s also not forget that in AIS, there is the possibility that adolescents wouldn’t share the discovery of any bodily changes they don’t understand or feel sets them apart from their peers.

I’ve said it before, and I’ll say it again: there is no harm to reducing an already-mild curvature to even smaller, but there is most certainly harm done by simply watching while a patient’s condition progresses from mild to moderate and severe.

Here at the Scoliosis Reduction Center, we feel privileged to walk alongside patients on their scoliosis journey.

For those I diagnose with mild scoliosis, I enjoy sharing with them, and their families, the potential positive treatment outcomes ahead.

With some hard work and patience, we can help these mild-scoliosis patients avoid the hardships of the moderate and severe stages of progression altogether.

Additional Resources

Nalda, Dr. Tony - Scoliosis Hope

Scoliosisreductioncenter.com - Results

Scoliosisreductioncenter.com - Contact Us

Clear-institute.org - Understanding the Boston Brace: Benefits and Alternatives

Clear-institute.org - Surgery

Scolicare.com - ScoliBrace

Learn more at our resource here: What Is Mild Scoliosis?

About Scoliosis Reduction Center
Welcome to Scoliosis Reduction Center. Our team, under the leadership of Dr. Tony Nalda, is focused on treating your scoliosis in the most patient-centered, effective manner possible.

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