Do I have scoliosis and is it bad?
Scoliosis derives from the ancient Greek word ‘skolios’ meaning curved or crooked. It is defined as the abnormal, three-dimensional deformity of the spine associated with spinal curves in different types of spatial planes (e.g., frontal and rotational). These abnormalities put a great deal of load on the spine and ribcage, producing a spine with convexities and concavities. Scoliosis is a very common spinal disorder in children and adolescents. But, how do you know if you have it and how much can it negatively impact on health? In this Balmain Chiropractic Centre blog, Martin, our resident chiropractor, discusses the different types of scoliosis.
Scoliosis is the most common spinal disorder in children and adolescents. Scoliosis with no cause (i.e., idiopathic scoliosis) in adolescents affects approximately 5% of the population. Females appear to be affected 3:1 compared to males, which increases with age.
Causes of scoliosis
Scoliosis is classified according to age of when signs and symptoms began, cause, severity and type of curve. Here below are the major groups and subgroups:
1. Non-idiopathic scoliosis (i.e., with a known cause):
• Congenital. This is caused by malformation of the vertebrae (e.g., hemivertebra or block vertebra) due to abnormal activation of genes associated with vertebral malformation. This may or may not be present at birth and gets worse in adolescence.
• Neuromuscular. This is caused by a lack of activation of muscles and tendons of the spine and occurs in conditions like cerebral palsy, spinal cord injuries and muscular dystrophies.
• Mesenchymal. This is caused by a lack of strength in inert tissues like ligaments and joint capsules of the spine and occurs in conditions like Marfan’s syndrome and inflammatory diseases.
2. Idiopathic scoliosis (i.e., due to an unknown cause)
• Infantile. This develops at 0-3 years old at affects >1% of the population. Interestingly, this type of scoliosis appears to regress 50% of the time.
• Juvenile. This develops at 4-10 years old and affects 10-15% of all idiopathic scoliosis in children. If left untreated, it can potentially lead to serious complications of the heart and lungs. If spinal curves are 30 degrees or more, the conditions tends to get wore and 95% of patients require surgery.
• Adolescent. This develops at 11-18 years old and makes up 90% of all cases in children, and affects about 8% of the population over 25 years old, and 68% in >60 year olds due to spinal degeneration.
Scoliosis is characterised by a side-to-side curvature of the spine >10 degrees. It is usually combined with a rotation of the vertebrae and usually the mid back curve (i.e., kyphosis) is reduced. It is diagnosed using a combination of physical examinations and scans (e.g., x-rays, CT etc.).
During the physical examination, your clinician will look for things such as chest, chest bone and ribcage angulation, rib and spine asymmetry, heart and lung function and static and dynamic postural observation. If clinician’s suspect the cause of scoliosis to be due to serious pathology, they will order blood, heart, lungs, genetic or skin tests.
On scans, your clinician will look for the degree of spinal curve. The Cobb Angle is a standardised measurement to determine the degree of scoliosis. It is also used to track the progression of scoliosis in adolescents.
Structural vs. nonstructural scoliosis
Structural scoliosis is different than nonstructural (i.e., functional) scoliosis in which the spine has temporary side-to-side (i.e., lateral) curves, but is structurally normal (e.g. no rotation or pathology). Functional scoliosis is very common in the adult population.
Functional scoliosis is caused by underlying conditions such as a true leg-length discrepancy (i.e., >30mm), low back muscle spasms or injuries, and inflammatory conditions (e.g., appendicitis), which may also produce muscle spasms. Moreover, the very nature of handedness (i.e., dominance of one hand over the other) also causes slight curvatures of the spine. This is because handedness causes an unequal distribution of fine motor skills and a tendency to use one side of the body more frequently than the other. This subjects those particular tissues (e.g., muscles, joint capsules, ligaments etc.) to additional load. This additional load, coupled with poor and prolonged sitting postures or repetitive heavy lifting puts a great deal of strain on those tissues. The body often then compensates to deal with this unequal distribution of forces and scoliosis can slowly develop as the spine begins to curve under the force, leading to chronic back pain.
This is perhaps the most common ‘condition’ that presents to allied health professionals. Patients often describe a sensation that their “hips are out” or feel “rotated” and “bent in the back”. In actual fact, they most likely have a low-grade functional scoliosis due to one, or some, of the causes listed above. Good news is that this is very common and responds well to conservative management. Spinal mobility exercises, core and hip strengthening exercises, ancillary care (soft tissue massage, dry needling, stretching etc.) and reducing the mechanism of injury or risks (e.g., poor lifting or sitting etc.) are multimodal strategies allied health professionals, like chiropractors, use to conservative manage pain and disability associated with functional scoliosis.
At Balmain Chiropractic Centre, our chiropractors are highly skilled and trained to identify factors leading to a wide range of musculoskeletal conditions, including structural and nonstructural scoliosis, and provide evidence-based, individualised treatment plans for patients. We identify lifestyle factors that may lead to back pain and provide strategies to minimise their effects. Visit us at our Inner West clinic today.
Please visit our website and blog pages for more information on what causes back pain:
- Do Genetic Factors Cause Back Pain?
- Does Back Pain Require Surgery?
- Top 3 Things To Do When You Injure Your Back
- 9 Lifestyle Factors Causing Back Pain
- Back Pain Facts
- Low Back Pain Overview