What is Scoliosis?
Scoliosis is a medical condition where your spine is curved from side to side. The spine shape with typical scoliosis may look more like an “S” than a straight line. Approximately 2% of the population will have a scoliotic curvature in their spine, and about 10% of these are severe.
Scoliosis terminology is according to where the apex of the curvature of the spine occurs. These curves commonly happen in the thoracic (mid-back) and thoracolumbar (junction between the thoracic and lumbar) areas of the spine. Scoliosis does not frequently occur in the neck.
Early adolescence, specifically between 11 and 14 years of age, is ideal for screening your spine for scoliosis. Scoliosis can progress during adulthood if not treated during youth. Therefore, being checked and treated at any stage can significantly improve your comfort, muscular strength and mobility.
What Causes Scoliosis?
Several types of scoliosis exist:
Structural (Idiopathic) scoliosis has genetic roots. A family history of scoliosis, particularly along the female side, can increase your likelihood of having it by up to 20%. Idiopathic scoliosis usually develops in early adolescence between 11-14, with a higher incidence in females than males (10:1). Progression of scoliosis is also more common in females than males. If left undiagnosed and untreated in adolescence, the curvature of the spine can progress.
Functional scoliosis can develop in adulthood, often in response to an injury or repetitive practice of asymmetrical activities (i.e. tennis, golf swing, etc.). It is a curvature of the spine formed from overuse of muscles on one side and underuse of muscles on the reciprocal side. Since it is muscular based, it can reverse with appropriate treatment and exercise.
Pathology-related scoliosis can arise in people with a neuromuscular disease. Examples include muscular dystrophy or response to a severe injury to the spinal cord such as quadriplegia.
What are the Symptoms of Scoliosis?
Physical signs in children after the age of 8 that parents should suspect is scoliosis:
- Uneven hips
- Uneven shoulders
- The one-shoulder blade being more prominent than the other.
- Listing (bending) to one side
- Pain around the areas above imbalanced areas.
Contrary to common belief, scoliosis does not result from poor posture. However, it can progress to a more severe curve due to an inferior position of weak spinal muscles.
How is Scoliosis Diagnosed?
Checking for scoliosis usually is undertaken during a routine clinical examination by your physiotherapist or doctor.
Your physiotherapist will examine your spine, shoulders, rib cage, pelvis, legs and feet for abnormalities and asymmetry. If they suspect significant scoliosis, they will arrange for X-rays to confirm your cobb angle – or severity of scoliosis.
Significant curvature in the spine detected in adolescence will require a review from an orthopaedic spine specialist. Would you please seek the advice of your doctor or back physiotherapist?
PHASE I – Pain Alleviation
While not all scoliosis sufferers experience pain or discomfort, a percentage do. In these patients, the provision of pain relief assists patient compliance with corrective or prevention exercises.
Pain relief can result from a variety of techniques:
- electrotherapy modalities (ultrasound, TENs),
- release of tight muscles, and
- supportive postural taping.
In this phase, your physiotherapist may also introduce gentle exercises to maintain mobility in your spine and enhance your posture while your pain settles.
PHASE II – Rectifying Imbalances (Strengthening and Stretching!)
As your pain and inflammation settle, your physiotherapist will turn their attention to optimising the strength and flexibility of your muscles on either side of scoliosis. They will also include adjacent areas like the hip and shoulder region that may impact your spinal alignment.
The main treatment aims will include restoring normal spine range of motion, muscle length and resting tension, muscle strength, endurance and core stability.
Taping techniques may assist until adequate strength and flexibility in the targeted muscles has been achieved.
PHASE III – Restoring Full Function
This scoliosis treatment phase gears towards ensuring that you resume most of your normal daily activities. Activities, including sports and recreational activities, without re-aggravation of your symptoms.
Depending on your chosen work, sport or activities of daily living, your physiotherapist will aim to restore your function to allow you to return to your desired activities safely.
Everyone has different demands for their body that will determine what specific treatment goals you need to achieve. For some, it may be only to walk around the block. Others may wish to run a marathon. Your physiotherapist will tailor your back rehabilitation to help you achieve your own functional goals.
PHASE IV – Preventing a Recurrence
Since scoliosis, in many cases, is a permanent structural change in the skeleton, ongoing self-management is paramount to preventing re-exacerbation of your symptoms. Self-management will include a routine of a few critical exercises to maintain optimal strength, flexibility, core stability and postural support. Your physiotherapist will assist you in identifying which are the best exercises to continue in the long term.
In addition to your muscle control, your physiotherapist will assess your hip biomechanics. Some scoliosis results from an unequal leg length, which your therapist may treat with a heel raise, shoe rise or a built-up foot orthotic. If you would benefit from any exercises for adjacent muscles or some foot orthotics to address to correct for biomechanical faults, you will be p[prescribed relevant activities.
Rectifying these deficits and learning self-management techniques is key to maintaining function and ongoing participation in your daily and sporting activities. Your physiotherapist will guide you.
What Results Can You Expect?
If you have mild to moderate scoliosis, you can expect a full return to regular daily, sporting and recreational activities. Your return to function is more promising when your diagnosis and treatment commences early.
Individuals with more moderate to severe scoliosis curvatures may need to wear an orthopaedic brace to halt curve progression. In some extreme cases during adolescence, surgery is indicated. Both of these latter two pathways are overseen by an orthopaedic specialist who may require monitoring the progress of the curve with routine X-rays.
Would you please seek the advice of your trusted scoliosis physiotherapist or spinal surgeon to determine your best scoliosis treatment?
Common Causes of Upper Back Pain & Injury
Thoracic Spine Conditions
- Scheuermann's Disease
- Spinal Stenosis
- Rib Stress Fracture
Nerve-Related / Referred Pain
Youth Spinal Pain
Teenager Neck & Back Pain
Teenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control.
The competitive athlete and most individuals who exercise regularly or maintain fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Your physiotherapist can assist in the resolution of any deficits in this area.
Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions.
Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these types of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
For specific advice regarding youth neck or back pain, please seek the professional advice of your trusted spinal physiotherapist or doctor.