By definition, scoliosis is the abnormal lateral (sideways or away from the midline) deviation of the spine. In Greek, the word ‘skolios’ is translated to ‘crooked’, ‘curved’, or ‘twisted.
When we look at the spine from the side, it has curves that are not only normal but very important. In the middle of the spine (thoracic spine) and at the very base of the spine (sacrum), we have a kyphotic curve where the spine bends forward. In the lower back (lumbar spine) and neck (cervical spine), we have a lordotic curve where it bends backward. As babies, the only curve we are born with is kyphosis where the entire spine has a ‘C’ shape. As we start doing tummy time and start lifting our heads, lordosis starts to form in the neck and the lower back – this develops further as we start sitting up and walking – having gravity on our side. Suddenly, we have all these interesting curves of the spine to serve us in our daily lives in many wonderful ways. The main ones are flexibility and greater range of motion as well as optimal shock absorption.
But, when we look at the spine from the back, it should appear straight. It’s when this deviates, visibly creating either a ‘C’ or an ‘S’ shape, that we start to see abnormal movement and mechanics of the spine, upsetting all the structures around it.
So, what is the big deal?
3 months ago, we had a patient, Emma (13 years old), and her mom, come into Chirolink. Her mom was concerned about Emma and didn’t know where to go. Emma had been diagnosed with scoliosis one year prior where she went through the system and some x-rays were performed, a brace was given, and was told to come back in a year. They were told it was serious, but Emma and her mom were given no other information. Why does Emma have this? What does this mean for her life and her future health? Does she need an operation? How long does she have to wear the brace and why is it necessary to use it? And what else can she do for her scoliosis?
At Chirolink we believe that it is incredibly important for our patients to know what is going on in their bodies and what can be done about it.
Scoliosis affects 2 – 3% of the population and there are several causes that we will discuss.
Unfortunately, the most common type of scoliosis is ‘idiopathic’ with a staggering 80% of cases. What does this mean? The term idiopathic is used in medicine when the cause of something is unknown.
There are several other known causes, but they are less common. These being:
- Myopathic – where the ‘misfiring’ muscles pull in abnormal directions – forcing the curve into place (conditions such as muscular dystrophy).
- Neuropathic – where the neurological supply to the bone is inhibited (Charcot-Marie-Tooth disease).
- Congenital (born with) – where an actual vertebra is half-formed (specific genetic anomalies).
- Trauma – such as a fracture, changing the shape of the vertebra.
- Bone softening conditions – such as rickets or infection of the bone.
These are all causes of ‘structural’ scoliosis. Functional scoliosis also exists. This is when the scoliotic curve in the spine straightens when the person bends to the side. The cause is postural where the body uncontrollably accommodates to remove pressure off a problem area such as nerve root irritation, tumors, or disc herniations.
The curve in the spine is classified in a specific manner. This is important as each aspect has specific risks associated with the progression of the curve.
- Location – thoracic spine, lumber spine, thoracolumbar junction, cervical spine, etc.
- The number of curves – either creating an ‘S’ or ‘C’ shape.
- The primary curve and which curve is due to compensation is also determined.
- Age of the patient – adolescent, juvenile, infantile, or adult (after skeletal maturity).
What are the symptoms?
- Initially, there may be no symptoms.
- Depending on the severity, as it progresses there may be a visible curve of the spine, crooked ribcage (rib hump), off-center head position, and uneven hips and shoulders.
- Back pain.
- Chest pressure and pain.
- Low self-esteem (cosmetically different back)
Why is scoliosis a problem?
The reality is that many people don’t even know they have scoliosis until later in life when they are experiencing a lot of pain. They seek help and it is diagnosed. Unfortunately, due to the unpreferable and abnormal biomechanics of the spine over many years, these structures suffer more than average wear and tear. This can lead to degenerative spinal arthritis (and quite a lot of pain).
The other complications that can be present may involve the heart and the lungs. This is more pronounced in cases where the curve is situated within the thoracic spine and particularly to the left side. The mechanical pressure, with less movement of the ribcage, can put unnecessary pressure on vital systems.
There are the more noticeable cases, as with idiopathic adolescent scoliosis, where a parent can physically see that their child’s back doesn’t look straight, and they seek assistance sometimes there are cases where a parent takes their child for a general checkup with their Chiropractor and it is found. With each of these, the risk here is their adolescence. Adolescence and significant progression of scoliosis associated with that. Between the ages of 10 and 16 are the critical years for every young spine to be screened! If any sign of scoliosis is present, it warrants further investigation. Why? These are the critical years when the young spine is not fully grown or formed. The bones are more ‘pliable’ and immature. During the years of a growth spurt, the spine is highly vulnerable and curve progression needs to be prevented where possible.
How is scoliosis diagnosed?
X-rays are performed after the initial assessment done by your Chiropractor or GP. These are incredibly important. The X-rays will help determine the degree of curvature (the site, magnitude, and flexibility), assess bone maturity (and therefore the risk of progression), and are used as a tool to aid in the appropriate treatment plan. X-rays are performed at regular intervals throughout life to determine the progression of the curve and the risks associated.
What next?
You have scoliosis. Once the degree and risk or progression are assessed, an appropriate treatment plan is put in place.
In cases where progression is not likely (skeletally mature) and cases where the curve is less than 20 degrees, it is managed conservatively. What does this mean? Chiropractic treatment is important. This ensures that all the joints that are under too much mechanical stress are moving properly. Even when the patient doesn’t experience pain. Optimal movement is vitally important. The other key part of treatment and most people dislike hearing it, is exercise! Very specific exercises can be given to help reduce the curve and prevent progression. These are so important, and we strongly suggest to our patients not to neglect them. They work!
If there is a high risk of progression (as with an adolescent patient who has a large curve (generally over 20 degrees)), bracing will be done. A hard brace is specifically molded to the patient’s body and is worn for approximately 23 hours a day. In even more severe cases (curves over 40 degrees), surgery may be required, but should it really come to that point?
Every scoliosis patient needs to go for checkups at regular intervals to ensure that the curve is not progressing.
The take-home message:
Get checked by your Chiropractor! That simple screening can make all the difference. And to all the moms and dads, please bring in your children for regular checkups from the age of 10 years old. This can undoubtedly change a life.
If you have scoliosis, come for regular treatment, and do your exercises. At Chirolink, we have seen the results over and over. Your body will be so grateful.