In a career spanning twenty-two years of practice and fifteen years typing away at the keyboard, I am shocked to realize that I have never written a piece on scoliosis. I know, I know…scoliosis and chiropractic go together like bee stings and EpiPens; but alas, I have not found until now to write about it, so here goes:
Scoliosis is sideways (lateral) curvature of the spine. There may be a C-curve or an S-curve, with the spine having both convexities (like the exterior of a circle) and concavities (like the interior of a circle). Two to three percent of the population is found to have scoliosis – that’s 6-9 million people in the U.S. Most cases of scoliosis are idiopathic – that is, the cause is unknown. And this type is most commonly found in adolescents (80%), affecting both genders equally, and is typically discovered during puberty (10-15 years old). The degree of curvature varies among individuals and although it is primarily measured in the coronal plane (side to side), scoliosis is truly a complex three-dimensional curvature with associated rotations in the sagittal plane (front-back) and increased curves in the axial plane (top-bottom). As a result, the normal lordotic (concave posteriorly) and kyphotic (convex posteriorly) curves of the back can become excessive.
Scoliosis is most definitively assessed through x-ray, as children with mild scoliosis can develop a more severe curve. Severe scoliosis can diminish lung function by reducing space in the thoracic cavity, and thus can be disabling. As a result, if determined that a child’s scoliosis is becoming severe, he or she may need surgery or a brace. Females are eight times more likely to progress and require treatment for severe scoliosis.
Some physical signs that occur as a result of scoliosis are:
- Uneven shoulders
- One or both shoulder blades may stick out
- Head not centered above the pelvis
- Uneven waist
- One hip higher than the other
- One side of the rib cage jutting forward
- A prominence on one side of the back when bending forward (which is used as a quick scan test for scoliosis)
For most people with scoliosis, it is a rather benign condition. Those with the severe version notwithstanding, the worst consequence of scoliosis is back pain. One meta-analysis looking at long-term studies of idiopathic scoliosis found that 61% of scoliotics had chronic back pain when compared to age- and sex-matched controls. Pain usually emanates from the apices, where the muscles must compensate for the associated vertebral rotation. Often the pain arises from muscle spasm – one major reason scoliotic patients should seek help from a chiropractor. Pain from scoliosis is most common in adults. When an adolescent has pain associated with a scoliosis, an orthopedist might need to be consulted to rule out any other medical causes (e.g. brain stem or spinal cord abnormalities).
The primary management goals with adolescent idiopathic scoliosis are to prevent progression and perhaps an attempt at reversal. Most adolescents with scoliosis have no associated pain and thus live with sole complication of appearance. This is not to minimize this concern; on the contrary, cosmetic concerns are valid and should be taken seriously. This may be another reason for these people to see a chiropractor.
If you or a loved one has scoliosis, the first thing to do is be checked by a doctor – a chiropractor if you have pain. Chiropractic adjustments and muscle work to relieve spasms should help and might even reduce some of the curvature if the tight muscles are contributing. True structural scoliosis, independent of muscle spasm, is unlikely to change, but it often is not painful for young people. Of course, as you get older, the excessive curves can cause heightened subluxation (joint fixation) and muscle imbalances, both which can cause pain. Either way, scoliosis should not be difficult from which to find pain relief if you get the proper treatment. If you are in Beverly Hills, Los Angeles, or West Hollywood and have pain related to scoliosis, please contact my office for an assessment and care.