Scoliosis is an abnormal sideways curvature of the mid back and/or the lower back.  Most cases of scoliosis arise due to an unknown origin, called idiopathic scoliosis.  Scoliosis impacts females more than males and is most often detected during the growth spurt from ages 10 to 18. 

The incidence of scoliosis varies in different countries and among different references between 2% and 13.6% (Weinstein et al., 2008).  Scoliosis is considered one of the main musculoskeletal changes of adolescence and is the most common spinal disorder in childhood (de Assis et al., 2021).   

Scoliosis is a progressive and deforming musculoskeletal dysfunction of the spine.  If an abnormal curve of the spine is detected, it should be monitored to prevent curve progression.

Adolescent idiopathic scoliosis is found predominantly in adolescent females, with a 10:1 ratio of female to male (Adhoot, Fan, & Aminian, 2021).  Adolescent idiopathic scoliosis is the most common form of scoliosis and is distinguished from other types of scoliosis by the absence of underlying congenital or neuromuscular abnormalities (Kuznia, Hernandez, & Lee, 2020).

Adolescents with scoliosis have the highest risk of curve progression during the period of rapid growth prior to skeletal maturity.  Females should be checked for scoliosis from ages 10 to 12 and males should be checked from ages 13 to 14 (Zapata, Sucato, & Jo, 2019). 

Types of Scoliosis:

• Idiopathic scoliosis = scoliosis that arises due to an unknown cause
• Congenital scoliosis = scoliosis that develops before birth
• Neuromuscular scoliosis = scoliosis caused by a disorder such as cerebral palsy, spina bifida, or muscular dystrophy
• Degenerative scoliosis = scoliosis that develops in the lumbar spine due to “wear and tear” 

Signs of Scoliosis:

• Sideways curvature of the middle or lower back
• One shoulder is higher than the other
• One hip is higher than the other
• One scapula is more prominent than the other

How Scoliosis Can Impact Your Health:

• Aesthetic changes
• Musculoskeletal restrictions
• Back pain
• Severe scoliosis may be associated with respiration dysfunction or heart damage

Risk Factors for Scoliosis

The causes of scoliosis vary and are classified broadly as congenital, neuromuscular, idiopathic, and spinal curvature due to secondary reasons such as degeneration (Janicki & Alman, 2007).  80% of cases of scoliosis in childhood are idiopathic, meaning they arise from an unknown origin (Negrini et al., 2012).

Schoolchildren are more susceptible to scoliosis because they go through a rapid growth phase in adolescence, are sedentary at school, and have a low daily level of physical activity.  Schoolchildren being classified as irregularly active is considered a risk factor for the development of scoliosis (de Assis et al., 2021). 

Contributing factors to Scoliosis: (Karimi & Rabczuk, 2018)

• Genetic predisposition
• Hormonal dysfunction
• Change in bone mineral density
• Abnormal platelet calmodulin levels
• Biomechanical factors
• Central nervous system abnormalities
• Lack of physical exercise
• Poor posture
• Neuromuscular conditions
• Birth defects
• Spinal infection

Potential Complications of Scoliosis:

Not all patients with scoliosis will experience symptoms.  While some people may experience back pain, others may not.

Complications may occur due to severe scoliosis.  With a severe scoliosis it is possible to have rib deformities, pulmonary dysfunction, and even heart problems.  These complications are rare, but they may occur in severe cases.   

Scoliosis Screening

If you think that you or a family member may have scoliosis, you should get it checked sooner rather than later to prevent curve progression.  An initial screen will be performed including a posture analysis and a forward bend test.  The posture analysis and forward bend test will provide initial information to the practitioner that there may be a scoliosis curvature. 

If there is suspicion of scoliosis, your healthcare provider may recommend having an X-ray analysis performed to confirm the diagnosis.  On the radiograph your practitioner will evaluate the Cobb Angle of the curvature.  A Cobb Angle of more than 10 degrees is considered scoliosis.    

A complete analysis will include a case history, physical examination, and radiographs.  Your practitioner will evaluate your spine and check for musculoskeletal restrictions such as decreased range of motion, neurologic symptoms such as poor balance, and functional deficits such as gait abnormalities. 

Treatment Options for Scoliosis

Treatment of scoliosis will vary based upon the severity of the curve.  Curves with a Cobb Angle of 10-39 degrees are considered mild to moderate.  Mild to moderate scoliosis can be managed with conservative care options.   

Conservative care for mild and moderate scoliosis includes physical therapy, manual therapy, posture rehabilitation, physical activity, and posture correction habits for your activities of daily living.   

• Physical Therapy – may include exercises, mobilization and distraction of the spine and joints, whole body vibration, and soft tissue work to improve alignment and manage pain.

• Manual Therapy – spinal manipulation and mobilization to improve alignment and spinal flexibility.

• Posture Rehabilitation – posture exercises to reduce the lateral curvature and to correct other postural distortion patterns associated with the scoliosis.

• Physical Activity – aerobic activity and frequent movement breaks for sedentary occupations and schoolchildren. 

• Posture Correction Habits – auto correction habits to correct your posture and flatten the scoliosis curve during daily activities. 

A brace may be recommended for scoliotic curves greater than 30 degrees. 

Severe scoliosis is a Cobb Angle of 40 degrees of more.  Severe cases of scoliosis should be referred for a surgical consultation.

How Can We Help?

We can help you if you are considering conservative treatment options.  To determine if you are a good candidate for conservative care, we recommend a consultation and a complete posture analysis for specialized patient centered care options. 

After ruling out complications with your physician we can discuss best options based on objective measures.  All new patients are valued, will felt heard, and will have an objective analysis performed prior to discussing treatment options. 

References:

Ahdoot, E. S., Fan, J., & Aminian, A. (2021). Rapid Recovery Pathway for Postoperative Treatment of Adolescent Idiopathic Scoliosis. JAAOS Global Research & Reviews, 5(3).

Burns, K. (2021) Scoliosis, American Posture Institute Blog

de Assis, S. J. C., Sanchis, G. J. B., de Souza, C. G., & Roncalli, A. G. (2021). Influence of physical activity and postural habits in schoolchildren with scoliosis. Archives of Public Health, 79(1), 1-7.

Janicki, J. A., & Alman, B. (2007). Scoliosis: Review of diagnosis and treatment. Paediatrics & child health, 12(9), 771-776.

Karimi, M. T., & Rabczuk, T. (2018). Scoliosis conservative treatment: A review of literature. Journal of craniovertebral junction & spine, 9(1), 3.

Kuznia, A. L., Hernandez, A. K., & Lee, L. U. (2020). Adolescent idiopathic scoliosis: common questions and answers. American family physician, 101(1), 19-23.

Negrini S, Aulisa AG, Aulisa L, et al. (2012) 2011 SOSORT guidelines: orthopedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 7 (1):3.

Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. (2008) Adolescent idiopathic scoliosis. Lancet. 371(9623), p. 1527–1537.

Zapata, K. A., Sucato, D. J., & Jo, C. H. (2019). Physical therapy scoliosis-specific exercises may reduce curve progression in mild adolescent idiopathic scoliosis curves. Pediatric Physical Therapy, 31(3), 280-285.