Scoliosis
By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
As the school year progresses there will come a point where most schools will perform scoliosis screenings on your children. Here is what you need to know about scoliosis when that exam form comes home. Scoliosis is a term that describes any abnormal, sideways curvature of the spine. When viewed from the back, the spine should be straight. When scoliosis occurs, the spine is curved side to side. If the spine curves as a single curve to the left or shaped like the letter C, it is referred to as levoscoliosis. If the spine curves as a single curve to the right or shaped like a reverse letter C, it is referred to as dextroscoliosis. If the spine has two curves it is shaped like the letter S.
The most common form of scoliosis is idiopathic scoliosis, which occurs in approximately 2% the population. It is accepted that scoliosis affects about 2% of females and 0.5% of males. Idiopathic means there is no known cause. Idiopathic scoliosis is the most common cause of scoliosis in children. It is rarely symptomatic, and, in most cases, the curve is so minor that it requires minimal treatment. However, once scoliosis is detected, it should be monitored by a licensed healthcare professional and the patient should be educated about maintenance exercise.
The skeletons of children and young adults are still growing; there is a reasonable chance that the spinal curve may worsen during growth periods. In those cases, scoliosis treatment may become advisable. Idiopathic scoliosis is not caused by exercise, sports, heavy lifting or sleeping position.
If the person is less than 3 years old, it is called infantile idiopathic scoliosis. Scoliosis that develops between 3-10 years of age is called juvenile idiopathic scoliosis, and people who are over 10 years old have adolescent idiopathic scoliosis.
Scoliosis typically occurs in individuals 10 to 18 years old and is usually picked up during school screenings or well child physician visits. Healthcare providers look for clues such as: curvature of the spine, uneven shoulders, a prominent shoulder blade, or one hip being higher than the other.
Once scoliosis is detected, it will be important to have a full spine x-ray or scoliosis series so that degree of the scoliosis can be determined and monitored. A curvature that is at 20 degrees or less will most likely require monitoring, observation, and a conservative treatment program of home exercises. A curvature between 20 and 40 degrees requires non-surgical treatment in the form of physical therapy for mobility and strengthening, both of which will help to prevent further progression of the curve. Curves greater than 40 degrees may require bracing and/or surgical intervention because of the risk for cardiopulmonary compromise as the curve in the spine rotates the chest and closes down the space available for the lungs and heart.
While adolescent scoliosis is the most common, there are other types of scoliosis.
Functional scoliosis is when the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscular asymmetries in the back. A broken leg early in life can result in a functional scoliosis.
Neuromuscular scoliosis occurs when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of scoliosis develops in people with other disorders, including birth defects, muscular dystrophy, cerebral palsy, or Marfan’s syndrome (an inherited connective tissue disease). People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.
Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures, and disc degeneration. Spinal discs can degenerate asymmetrically with age and this can result in a degenerative scoliosis.
Generally speaking, idiopathic, functional, and degenerative scoliosis will respond well to aggressive physical therapy. The physical therapist that is familiar with various forms of scoliosis can use many tools at their disposal to help the patient with scoliosis form a plan of treatment and develop a home exercise program to keep the curvature from progressing. If your child is told they have scoliosis, bring them to a medical provider of your choice for evaluation.
