What is scoliosis? In medical terms, it describes lateral (side to side) curvatures of the spine (aka: the mid and/or lower back).
Occurring at any age, scoliosis most commonly develops between the ages of 10 and 15. Girls are more commonly affected than boys. The condition may be inherited or the cause may be unknown. In any case, scoliosis can be puzzling and should be evaluated and monitored properly to ensure the best outcome at any age.
Our bodies have specific spinal curvatures from front to back, as well as a straight line appearance from top to bottom. Because we stand and walk on two feet, we constantly use muscle control to keep us upright, while fighting external forces such as gravity. In most cases, "normal" spinal curves allow us to move and function correctly, and allow the body to be more resistant to injury.
On the other hand, abnormal curvatures can cause problems. In some individuals, lateral (or sideways) spinal curvatures can develop, which change the "normal" straight line appearance of the spine. If the curvature is measured larger than 10 degrees (side to side), it can be called a scoliosis. Curves less than 10 degrees are not classified as a scoliosis and may just be postural compensations. Some curvatures may be accompanied by increased front to back curves (kyphosis), may involve rotation of the spinal bones (vertebrae), or even contain more than one curve. Whether from daily activities, poor posture, specific injury, or even due to genetics, any change in "normal" curvature will affect spinal movement, position and function.
In most cases, the cause is unknown. In other cases, trauma, postural problems, developmental issues, neurological diseases, or other conditions may be causally related. Some scoliosis may be related to muscle spasm, biomechanical compensation, or leg-length inequality, which can often be addressed conservatively. Other scoliosis may be more complicated and may require more invasive treatments.
How is scoliosis evaluated? A thorough history and physical examination, including a postural analysis and spinal screening, is usually the first step in evaluating a spinal curvature or diagnosing scoliosis. Only if clinically appropriate and necessary, X-ray evaluation can determine the location and degree of the curvature, as well as monitor other associated factors. Depending on each case, additional diagnostic testing and/or repeat X-rays may be necessary as often as every 3 months to as little as once every few years to monitor abnormal findings.
Symptoms differ in each person. Fortunately, 4 out of 5 people with a scoliosis have curves less than 20 degrees, which are usually not detected by the untrained eye and have no symptoms. In most small curves, pain is not an issue and progression of the curve does not occur. In severe cases, pain and limited physical activity may be evident, in addition to possible harm to internal structures.
Will the scoliosis progress? In most cases, scoliosis remains mild, does not progress, and requires little treatment, if any. In other cases, growing children may have rapidly progressive curves which require more frequent check-ups and more aggressive treatment. One group of concern will be young females who have a scoliosis greater than 25 degrees and who have not had their first menstrual period. This concern is due to rapid growth during this developmental period. In addition, adults with pain and progressive curvatures must be monitored more closely.
Successful treatment doesn’t mean reversing the curve, but it means managing it and stopping it from getting worse. Curves under 20 degrees are usually "treated" with careful observation and conservative options, since most mild scolioses don’t progress or cause physical problems. Specific therapeutic exercises and stretching, electrical stimulation and spinal manipulation have been successfully utilized in the management of scoliosis. For curves between 25 and 45 degrees, in addition to those who are not at skeletal maturity, conservative care to include bracing may also be recommended. Bracing depends on the type and site of curvature. Surgery may be an option for curves greater than 45 degrees and progressive, and/or when internal organ function is affected.
Most people with scoliosis lead normal lives without complications. Physical activity is usually well-tolerated and encouraged. Since none of these therapies alone have been shown to consistently reduce scoliosis or to make the curves worse, an integrated approach to the treatment of scoliosis using your medical doctor as well as a chiropractic physician is a proven and effective treatment option.
Dr. Todd Joachim, a chiropractic physician, practices in Marion. He specializes in the conservative treatment, rehabilitation and management of musculoskeletal injuries and conditions including scoliosis, while using non-surgical chiropractic treatment options. Questions regarding chiropractic care or health concerns can be addressed to [email protected]