Your spine (or backbone) is your body’s central support structure. It connects different parts of your musculoskeletal system. Your spine helps you sit, stand, walk, twist, and bend. A healthy spine has three natural curves that make an S-shape. These curves absorb shocks to your body and protect your spine from injury. Several different parts make up your spine, such as the vertebrae, facet joints, intervertebral disks, spinal cord and nerves, and soft tissues. The 33 vertebrae make up five distinct spine segments – starting at the neck and going down toward your buttocks, these segments include the cervical, thoracic, lumbar, sacrum, and coccyx.
Scoliosis is a three-dimensional abnormality that occurs when the spine becomes rotated and curved sideways. A scoliosis curve normally looks a bit like a backward C-shape and involves the spine bending sideways to the right, which is also called dextroscoliosis. Sideways spinal curvature on the left side of the back is more like a regular C-shape and is called levoscoliosis. The following four common types of scoliosis curves include:
- Right thoracolumbar curve – This type of curve bends to the right side (starting in the thoracic and ending in the lumbar).
- Right thoracic curve – If a straight line were drawn down the center of the back, this curve bends to the right side of the thoracic region.
- Right lumbar curve – This type of curve bends to the right side (beginning and ending in the lower back).
- Double major curve – Usually, a double curve involves a right thoracic curve on top and a left lumbar curve on the bottom. Patients who have a double major curve may initially have a less obvious deformity due to the two curves balancing each other out more.
Many other types of curves are possible, such as a left thoracic curve. In rare cases, there have also been scoliosis cases involving triple curves.
Causes & Symptoms
Generally, there are a total of four types of scoliosis, which are idiopathic, congenital, neuromuscular, and degenerative, as described below:
- Congenital scoliosis – This condition begins as a baby’s back develops right before birth. Certain problems with the tiny bones in the back, called vertebrae, can cause the spine to curve. The vertebrae may be incomplete or fail to divide properly. Doctors may discover this condition when the child is born, or they may not find it until the teen years.
- Idiopathic scoliosis – Idiopathic scoliosis is a type of scoliosis that does not include any cause. Doctors cannot find the exact reason for a curved spine due to idiopathic scoliosis.
- Neuromuscular scoliosis – This is caused by a disorder like spina bifida, spinal cord injury, or cerebral palsy. These conditions can oftentimes damage your muscles, so they do not support your spine correctly, thus leading to neuromuscular scoliosis.
- Degenerative scoliosis – This condition commonly affects adults. It usually develops in the lower back as the disks and joints of the spine begin to wear out as you age.
Some of the common symptoms present in moderate or severe scoliosis, include:
- Trouble breathing – If the spine rotates enough, the rib cage can twist and tighten the space available for the lungs. The bone might push against the lungs and make breathing much more difficult.
- Reduced range of motion – The deformity from spinal twisting can increase rigidity, which reduces the spine’s flexibility for bending.
- Cardiovascular problems – Similarly, if the rib cage twists enough, reduced spacing for the heart can hamper its ability to pump blood.
- Changes with walking – When the spine abnormally twists and bends sideways enough, it can cause the hips to be out of alignment, which changes a person’s gait or how they walk. The extra compensating that an individual does to maintain balance for the uneven hips and legs can cause the muscles to tire sooner. A person might even notice that one hand brushes against a hip while walking but the other does not.
- A sudden feeling of pain – If curvature becomes severe enough, back muscles could become more prone to painful spasms. Local inflammation may develop around the strained muscles, which can also lead to pain. It is possible for the intervertebral discs and facet joints to begin to degenerate due to higher loads.
- Lower self-esteem – This specific symptom is often overlooked or minimized by outside observers, although it can be a significant factor for people who have a noticeably spinal deformity.
It can be possible, albeit very rarely, for scoliosis to progress to the point of causing death. Typically, a person would have access to a surgical solution before that type of deformity could set in.
In some cases, there is controversy regarding scoliosis as a cause of back pain…scoliosis by itself is typically not thought to cause pain; if a child or adolescent with scoliosis presents wit
Who gets Scoliosis?
Certain risk factors that are associated with all scoliosis types include the following below:
- Gender – Although males and females can develop mild scoliosis at about the same rate, younger female patients have a much higher risk of the curve worsening and requiring further treatment.
- Age – Signs and symptoms usually begin in adolescence.
Family history – Scoliosis can run in families, however, most children with scoliosis do not have a family history of the disease.
How Does it Affect You? How Serious is it?
While most people with scoliosis have a mild form of the condition, scoliosis may sometimes cause serious complications, including:
Severe scoliosis can also impact organs, such as the lungs. Rib cage deformities are common at this stage, especially when a patient’s scoliosis is in the thoracic spine. When scoliosis causes a rib cage deformity, lung impairment becomes a risk factor. This is because the deformity is pressing on the lungs, affecting lung volume and making it harder to take deep breaths.
Severe scoliosis is also associated with digestive issues such as constipation, stomach pains, and irritable bowel syndrome. This can lead to nutritional deficiencies, as the body cannot absorb the nutrients it needs. This can be the result of a blockage or related issues with the nervous system or blood vessels.
Motor and sensory control impairment
When there is instability in the spinal joints due to an abnormal curvature, the spinal cord is being stretched. As the spine works in tandem with the brain to form the body’s central nervous system, this can affect motor and sensory control. Neurological disorders are commonly associated with scoliosis, and hormones can also be affected, as they are associated with the brain and central nervous system.
Mobility and muscle impairment
With severe scoliosis, mobility issues can also develop. Due to uneven pressure on the spine and its joints, motion can be limited as muscles are affected, causing intense pain and trigger points. When a person is experiencing problems with muscles that support the spine, this impacts mobility both in terms of discomfort and function.
Recommended Treatment & Rehabilitation
Before any treatment plan can be suggested, if scoliosis is suspected, your doctor will need to take a medical history. This may include questions about your family history, curve progression, any bowel, bladder, or motor dysfunction. In a physical exam, your doctor will examine your back to check the shape of your spine and see how you move around. Your nerves may also be tested through reflex, sensation, and muscle-strength checks. If required, your doctor may order X-rays. X-rays taken from the front and side will show a full picture of your spine. Your doctor can then determine if you have scoliosis and if so, to what degree.
During a physiotherapy session, a physiotherapist will work with you / your child to develop and tailor a treatment plan specific to the type and severity of scoliosis. They will work with you to help you reach your goals. They and your doctor will check progress throughout treatment. The following physiotherapy treatments may include:
- Patient education – Your physiotherapist will provide information about how scoliosis affects the body and movement. He or she will teach you strategies to help manage the condition.
- Range of motion exercises – Your physiotherapist will design a treatment program to improve or maintain movement. They will select specific exercises to help keep and improve your range of motion if it is limited.
- Strength training – Your physiotherapist will design a treatment program to strengthen the muscles around the spine. He or she will also help strengthen other parts of the body weakened by scoliosis.
- Manual therapy – Your physiotherapist can help restore motion to joints and muscles restricted by scoliosis. Your physiotherapist may use hands-on therapy to help guide and retrain movement patterns.
For patients who are experiencing mild scoliosis, you may not need treatment. However, if it is needed, your doctor might suggest the following:
- Braces – In children who are still growing, wearing a brace around your torso can stop the curve from getting worse. They’re usually made of plastic. Many kids wear them 24 hours a day. You can’t see them under clothes, and they won’t stop you from doing everyday activities. Sometimes, a scoliosis curve continues to progress despite bracing. If this occurs and the curve progresses past 40 or 50 degrees, spinal fusion surgery may be considered.
- Spinal fusion surgery – In this operation, your doctor inserts pieces of bone or similar material between bones in your spine. They use hardware to hold the bones in place until they grow together, or fuse. The surgery can lessen the curve in your spine as well as keep it from ever getting worse.
- Spine growing operation – This is done to correct more serious scoliosis in children who are still growing. The doctor attaches rods to your spine or ribs with hardware. As you grow, the doctor adjusts the length of the rods.
The most recommended scoliosis exercises depend on the location of the scoliosis curve. Patients with lumbar scoliosis should focus on exercising the lumbar area, while those with thoracic scoliosis need to exercise the shoulders. Some of these exercises may help you improve symptoms linked to scoliosis:
Lie on your back with your feet flat on the floor and knees bent. Next, tighten your stomach muscles while flattening your back toward the floor. Hold for 5 seconds, then release, repeating 2-3 times a day.
Begin on the hands and knees with your back straight. Then, place your hands directly under your shoulders, with the knees directly under the hips. Extend one arm straight out and forward while extending the opposite leg straight back. Breathe normally and hold for 5 seconds. Repeat this method 2-3 times a day.
Lie on your back with your feet flat on the ground and knees bent. Keep the back in a neutral, tension-free position. Raise both with lower legs off the floor until they reach a 90-degree angle. Hold for 5 seconds, then repeat 2-3 times a day.
Alternative & Homeopathic Treatment
Choices of scoliosis treatments depend on what is causing your symptoms, the location of the problem, and the severity of your symptoms. If your symptoms are mild, here are some homeopathic treatments you can try:
- Heat application – Heat typically is the better choice for pain due to spinal injuries in general. Heat increases blood flow, which relaxes muscles and relieves aching joints.
- Ice application – If heat is not relieving your symptoms, try an ice pack or frozen gel pack. Usually, ice is applied 20 minutes on and 20 minutes off. Ice reduces swelling, tenderness, and inflammation.
- Pain relievers – Pain medications such as ibuprofen, naproxen, and acetaminophen may be used to temporarily ease the discomfort of scoliosis.