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Article written and designed by Cosimo Simeone, Msc, PgdDip, Bsc, Physiotherapist

Scoliosis is a medical condition characterized by a different curvature of the spine. In fact, the physiological spine is straight from the head to the bottom. But in the case of scoliosis, the spine usually takes an “S” or “C” shape, which can be seen from behind. This shape could be present in the cervical, thoracic, or lumbar spine area.

It affects around 6-9 millions of people in the Unites States and 2/3% of the worldwide population. It usually affects more women then men. Usually due to the facts that women have a rapid growth of the spine before puberty.

There are 4 main types: congenital, idiopathic, neuromuscular, and degenerative. I will describe them more deeply in the following paragraph. Generally the age average of scoliosis affection is between 10-15 years old, in both genders.

In this article I will describe not only the different types but also symptoms and pain related. Also I will describe the different causes, diagnosis and the most effective treatments in cases of mild, moderate or severe Scoliosis.

4 Main Types of Scoliosis:

We have two categories of scoliosis: structural and functional. The structural on is the most common. It’s characterized by curvature and rotation of the spine and could involve different areas of the spine. If not treated the structural one can be permanent.

Conversely, the functional scoliosis is a temporary problem that only causes curvature of the spine, not twisting. We have 4 main types of structural scoliosis: congenital, idiopathic, neuromuscular, and degenerative.

Idiopathic scoliosis is the most common type, in fact it involves 80% of the all cases of scoliosis. It usually appear during the adolescence but it can also develop during the childhood.

It’s called idiopathic because there is no a specific cause but some research shows a genetic component. It has a sideways curve in the spine and can progress slowly or quickly with different levels of severity.

The congenital scoliosis is present at birth and is a rare condition. It is due to a congenital problem in the formation of the vertebrae. Also in this case the severity can vary from mild to life threatening.

The spine is not the only thing that forms in the first weeks of pregnancy, but also some visceral organs do. In fact, children with congenital scoliosis can also have bladder, kidney, or nervous system problems.

The neuromuscular scoliosis is due to a neuromuscular condition that affects the nerve and muscle function. This type of scoliosis progress rapidly and it could be caused by neuromuscular conditions such as cerebral palsy. Usually the treatment is focus on addressing the neuromuscular condition (1).

In the case of degenerative scoliosis, adults are more affected, especially after 50 years old. The curvature of the spine in this case is due to a degenerative process such as osteoarthritis.

What are the most common symptoms?

Knowing early the symptoms of scoliosis can help to prevent that it aggravates. In this way you can take the first steps for treatment and management of it. I advice you to see a physiotherapist either remotely or face to face to have the best treatments options, to reduce your scoliosis.

Here you can book an appointment with me. I’m also specialized in postural therapy. The following are some of the most common symptoms:

  1. Uneven Shoulders: This one of the most common sign of scoliosis. When someone with scoliosis stands up straight, one shoulder may appear higher than the other.
  2. Uneven Hips: Scoliosis can also cause uneven hips. One hip may appear to be more prominent or higher than the other, creating an imbalance in the lower part of the body.
  3. Difference in Leg Length: It’s also called Functional Leg Length Discrepancy. As I said before the scoliosis can cause uneven hips. For this reason one leg may appear longer than the other. But might be possible that in the end they have the same length.
  4. Rib Hump: In some cases, scoliosis can lead to the formation of a rib bump. This occurs when the ribs on one side of the body protrude more prominently than on the other side, creating a noticeable bump in the back.
  5. Clothing Fit Issues: Scoliosis can affect the way clothing fits. For example, pants may appear uneven in length because of the uneven hips.
  6. Back Pain: This is not common for everyone with Scoliosis but if you have scoliosis you might experience a dull ache pain of different severity.

What are the main causes of idiopathic scoliosis?

As mentioned before, the term “idiopathic” means that there is no specific cause. It is probably due to a combination of genetic and environmental factors. The spinal curvature of scoliosis may be connected to hormonal problems too. However, abnormal bone or muscle growth, nervous system abnormalities, and other unidentified factors could also play a role.

The genetic component could also be another factor that can cause it. The genetic could cause this type of scoliosis, but also could affect the severity and the progression of the curvature. Despite many genes have been studied, there is no a clear and consistent association between scoliosis and genetic.

Nutrition could also be a determining factor. In fact, research has shown that gene-diet interactions can impact various aspects of growth and development. For example, in Jamaica, scientists observed these dietary influences when they added endocrine additives to livestock in 1965. After a 10-year delay, scoliosis rates increased significantly (2).

Diagnosis:

Early detection of scoliosis is essential because it allows doctors to provide the right treatment and prevent the curve from getting worse (3).

  1. Physical Examination: When you visit the doctor, they will ask you to undress to your underwear. They will then look at your back, shoulders, and hips to see if anything looks unusual.
  1. Adam’s Forward Bend Test: You’ll be asked to bend forward with your arms hanging down. The doctor will check if one side of your ribcage is higher than the other.
  2. Measurement: Sometimes, doctors use a scoliometer to measure the curve. It’s a small tool that helps them see how much the spine curves.
  3. X-rays: If the doctor suspects scoliosis, they will take an X-ray of your spine. X-rays provide a clear picture of how severe the curve is.
  4. Cobb Angle: Doctors use the Cobb angle to measure the curve’s size. It’s determined by drawing lines on the X-ray.
  5. MRI or CT Scan: In some cases, doctors might order an MRI or CT scan to get a better look at the spine.
  6. Monitoring: If you have a small curve, the doctor might monitor it with regular check-ups. They will measure it to see if it gets worse.
  7. Referral to a Specialist: If the curve is severe, the doctor may refer you to a specialist for further evaluation and treatment.
  8. Family History: Doctors will also ask if anyone in your family has scoliosis because it can run in families.
  9. Growth Assessment: Children and teenagers are more likely to develop scoliosis during growth spurts. So, doctors will often monitor their growth.

What are the treatment options?

Scoliosis treatments can vary depending on the size and progression of the curve. For example, people with mild curvature don’t need special treatments. But with some exercises prescribed by a physiotherapist could be enough to improve the posture and reduce the curvature.

These exercises will have the goal of strengthening the weaker muscles and stretching the tight ones, restoring muscles balance. The muscle imbalance will depend on the direction of the curvature. Furthermore, regular checkups may be necessary to monitor the progression of scoliosis.

Treatment options depend on the curve’s size. Mild curves in children often don’t need treatment but require regular checkups to track any changes as they grow.

Moderate to large curves might require bracing or surgery. Several factors come into play:

  1. Maturity: If a child’s bones have stopped growing, the risk of curve progression is low. Braces are most effective during growth. Bone maturity can be assessed with hand X-rays.
  2. Curve Size: Larger curves are more likely to worsen over time.
  3. Gender: Girls face a higher risk of progression compared to boys.

Braces:

If your child has moderate scoliosis and their bones are still growing, their healthcare provider may recommend a brace. While it won’t cure or reverse scoliosis, it effectively stop the progression of the curve.

These braces, typically made of plastic, conform to your child’s body shape. They almost vanish under clothing, as they snugly embrace the rib cage, lower back, hips, and underarms.

Generally, kids wear these braces for 13 to 16 hours daily. The longer they wear them, the more effective they are. Children who wear braces can usually engage in most activities with few restrictions. If necessary, they can remove the brace for sports or other physical activities.

Braces continue to be used until there is no further growth in height. Typically, girls complete their growth around age 14, and boys around age 16, although this timeline can vary significantly from person to person.

Scoliosis surgery options may include:

  1. Spinal Fusion: Connects spine bones, using bone material and metal supports to straighten the spine.
  2. Expandable Rods: Adjustable rods along the spine for growing kids, lengthened every few months.
  3. Vertebral Body Tethering: Minimal incisions, screws, and a cord to straighten the spine gradually.

Surgery can have some complications like bleeding, infection, or nerve issues, but these usually are manageable with medical care.

1 Comment

  1. Antonio

    Very nice article!
    Full of details, with all the necessary information about scoliosis in which a person could require… from A to Z…
    Very accurate, well done and flowing.

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