Scoliosis: Causes, Symptoms, and Treatment
Scoliosis is the most common spine disorder among school-aged children, affecting anywhere from 2-5% of teens and pre-teens. Shockingly, this number increases to almost 66% in women age 60 and over! Despite the fact that so many people have this condition, this is a lot of factually incorrect information out there. Since no two patients with scoliosis are alike (including identical twins!), making treatment plans tailored to each individual is critical. This is one of the reasons scoliosis is such a difficult condition to treat.
Scoliosis is a spinal disorder characterized by the loss of normal curves in the spine, and the development of abnormal curves. Scoliosis comes in a variety of forms, each with its own cause and treatment requirements. Postural changes are the most prevalent symptoms of adolescent scoliosis and back pain is most common in adults with scoliosis. A diagnosis of scoliosis is made based on several types of criteria.
Diagnosing Scoliosis
The development of an abnormal sideways spinal curve with a rotating component is referred to as scoliosis, a structural spinal disorder. Since the spine does not just bend abnormally to one side, but also twists from front to back and back to front, scoliosis is a three-dimensional affliction.
The curve must have a Cobb angle of 10 degrees in order to be classified as scoliosis. As a method of standardizing the diagnostic procedure, 10 degrees was set as the minimum threshold, due to inherent measurement error associated with a Cobb angle. The Cobb angle of a patient is an X-ray measurement that indicates how far misaligned a scoliotic spine is and assigns severity levels:
- Mild scoliosis: Cobb angle between 10 and 25 degrees
- Moderate scoliosis: Cobb angle between 25 and 40 degrees
- Severe scoliosis: Cobb angle measurement of 40+ degrees
It’s crucial to recognize that scoliosis is a progressive illness, and that where it is at the moment of diagnosis isn’t always indicative of where it will ultimately reach. If left untreated or not treated proactively, a patient with mild scoliosis may progress to moderate, or severe.
Causes of Scoliosis
Idiopathic
Scoliosis is a complicated disorder because of its prevalence, as well as the wide range of severity that exists among different patients and curve types.
The most prevalent form of scoliosis is idiopathic scoliosis (IS), which accounts for roughly 80% of all cases, and the remaining 20% are associated with known causes: neuromuscular, congenital, or traumatic. The term idiopathic means not clearly associated with a single-known cause. Females tend to be diagnosed far more frequently than males, with a ratio as high as 8:1 female-to-male. In fact, many scoliosis physicians will immediately refer for magnetic resonance imaging (MRI) in newly diagnosed males, to rule out the possibility of an identifiable pathology that directly contributes to the curve (such as a spinal cord cyst or tumor).
Idiopathic scoliosis is multifactorial: caused by the combination of different variables that can differ from patient to patient. As a result, scoliosis is a complex condition to treat because there is no singular cause in the majority of cases (hence, idiopathic). Despite having multiple potential causes for idiopathic scoliosis in each and every person diagnosed with it, one thing is clear: proper treatment should include robust strategies to also address these multiple underlying causes from person to person.
Idiopathic scoliosis can occur at any time throughout the lifespan, and is classified by age of diagnosis:
Infantile idiopathic scoliosis occurs from birth to age 3.
Juvenile idiopathic scoliosis occurs from ages 3-10
Adolescent idiopathic scoliosis occurs from ages 10-18
Adult (de Novo) scoliosis occurs as an adult, often during peri-menopause in females, or during very late growth spurts in males.
Neuromuscular
Pre-existing neuromuscular disorders, such as cerebral palsy, muscular dystrophy, or spina bifida, affect the link between the brain and the muscles and connective tissues that support the spine. This results in neuromuscular scoliosis (NMS). As a consequence, muscular fatigue or spasticity might lead to severe aggressive curves. Cerebral palsy is the most common cause for neuromuscular scoliosis, and requires a comprehensive treatment strategy. In fact, we offer a one-of-a-kind specialized ScoliSMART BootCamp for children with neuromuscular scoliosis.
Congenital
In cases of congenital scoliosis, infants are born with the condition due to a malformation within the spine that develops during pregnancy; this is a rare form that affects only 1 in 10,000 people. Examples of this would be drug-induced adverse effects, kidney, bladder, or pelvic floor deformities, or changes in the shape of the spinal column before birth.
Adult (de Novo)
This type of scoliosis is caused by age-related spinal degeneration and metabolic changes, which affects the spine’s intervertebral discs first. Adult scoliosis is also sometimes referred to as degenerative scoliosis when arthritis-type changes are the main trigger for the curve. Other reasons the adult scoliosis can develop are hormone changes during pregnancy or peri-menopause, bone density loss, and prolonged abnormal postural loading from other degenerative conditions such as Parkinson’s disease or Alzheimer’s disease.
Traumatic
Traumatic scoliosis is directly caused by trauma or injury. Examples of such injuries might include car accident trauma, trauma from birthing, trauma from a severe slip and fall accident, or from osteoporosis fractures. Successfully treating and managing this type of scoliosis requires us to treat the underlying injury sustained from the traumatic event.
Scoliosis Symptoms
There are many variables that shape a person’s life experiences with this condition, such as patient age and overall health, scoliosis type, curvature location and severity, and how the curve has evolved over time since initial diagnosis. These factors are what drive the scoliosis treatment decision making process.
Scoliosis introduces a lot of uneven forces to the body, which is why the main symptoms of scoliosis in children and teens are postural changes:
- Uneven shoulders
- Uneven shoulder blades with one protruding more on one side than the other
- Rib hump behind the shoulder blade
- Uneven hips
- An uneven waistline
- Arms and legs that appear to hang at different lengths
Scoliosis symptoms may also include alterations to posture, clothing that is ill-fitting, and modifications to gait, balance, and coordination. Scoliosis can be indicated by one or two physical asymmetries, but it does not always mean that further testing is required.
Pain isn’t mentioned in the above list because the condition isn’t typically painful in children and teens. Once skeletal maturity is attained, however, scoliosis becomes compressive, and can create chronic pain episodes in adulthood.
During our growing years, the spine experiences a constant lengthening with brief periods of rapid growth, such as during puberty, which counteracts the compressive forces of the scoliosis curve. Once a person reaches skeletal maturity and stops growing, the spine and its surrounding muscles and nerves are vulnerable to compression: the main cause of condition-related pain.
The primary scoliosis symptom in adults is back or hip pain caused by compressed nerves, in addition to the aforementioned postural deviations and a prominent lean to one side. Adults with pain in the arms, hands, or feet are actually the majority of those who seek treatment.
Scoliosis Treatment and Management
There are two main scoliosis treatment approaches for patients to choose from: conventional and comprehensive
Each treatment option has its own clinical roadmap, and offers patients a different potential outcome.
The most critical choice after a scoliosis diagnosis is how to treat it going forward.
Conventional Treatment
Patients with mild scoliosis are advised to monitor and wait for indications of future progression. Conventional treatment does not have a good method for dealing with mild scoliosis, curves must get worse to a certain degree before commencing conventional treatment. The problem with monitoring and waiting is that it wastes precious treatment time while leaving the condition to progress freely; as a progressive condition, we know that practically every instance of scoliosis progresses at some point across the lifespan.
Early detection has a number of advantages when it is used in conjunction with proactive treatment. Scoliosis is easier to treat in the early stages before significant development occurs, before the curve becomes larger, stiffer, less responsive to therapy, and before the body has had enough time to adapt to create secondary musculoskeletal adaptations.
The only type of treatment applied during traditional scoliosis treatment is traditional bracing, like the Boston brace, often prescribed for full-time wear during the moderate stage of progression, but traditional bracing is associated with a number of shortfalls.
Traditional treatment has to stop progression as its end goal, not correcting scoliosis, and if bracing is unsuccessful at stopping progression and a patient progresses into the severe classification at 40+ degrees, they are commonly funneled toward spinal fusion surgery.
While all surgical procedures come with their share of risks, spinal fusion is a costly, lengthy, and invasive procedure that can cost the spine in terms of its overall strength, function, and health.
Comprehensive Scoliosis Treatment and Management
Here at the Natural Wellness & Pain Relief Center, we treat patients with a comprehensive patient-centered treatment approach that strives to preserve as much of the spine’s natural strength and function as possible..
By starting treatment as soon as possible after diagnosis, we can work toward preventing curve progression, chronic symptoms, and the necessity for invasive therapy in the future, such as spinal fusion surgery. The integrative approach used here, which incorporates various types of body systems-specific treatment for the greatest possible outcomes, is beneficial to patients in a variety of ways.
To treat the problem on every level, we combine manual therapy, in-office care, corrective bracing, the ScoliSMART Activity Suit, specialized diagnostics and labs, and scoliosis-specific home exercises. Scoliosis must be altered on a structural level, in a manner that body can adapt to quickly and efficiently. Since the curvature is controlled by it’s surrounding muscles, which are collectively controlled by the brain, we must teach those muscle how to work differently and better, so they can begin holding the spine in a more vertical, optimal position.
We working with children high risk categories for curve progression, we combine our scoliosis rehabilitation methods with aggressive 3-D rigid bracing. This bracing is different from conventional bracing in that it is designed to be corrective instead of just trying to keep the curve from getting worse. We typically use the SCT Cheneau brace, which allows us to create a mirror-imaged model of the patient’s torso, thus creating a brace that holds the corrected position of the patient’s spine, not the current scoliosis position.
Finally, we are very interested in idetnifying the underlying causes of scoliosis for each patient we see. Our approach uses highly specialized diagnostic testing to see what underlying factors are contributing to each person’s curve. Evidence has shown that non-surgical treatment options simply don’t work as well if the underlying causes are not addressed.
In Summary
Scoliosis is the development of an abnormal sideways spinal twist, measuring 10 degrees by Cobb angle. This 3-dimensional disorder requires a comprehensive treatment strategy due to the variety of types and severity. In pre-teens and teens, postural deviations are the most common scoliosis symptom, whereas in adults, it’s pain. Uneven shoulders and hips are commonly the first indicators of scoliosis, which affects the body’s overall symmetry. Scoliosis causes discomfort in adults, with localized back, hip, and/or shoulder blade discomfort caused by nerve compression.
Patients and their families deserve to have a full understanding of all types of scoliosis treatment so they can choose the best option for them. In most cases, scoliosis may be treated non-surgically with a comprehensive patient-centered approach that emphasizes being proactive while preserving as much of the spine’s natural function as possible, even though there is still a place for surgery in the treatment of scoliosis.