Scoliosis is a term used to describe an abnormally curved spine. Most textbooks describe a normal spine as having gentle sagittal curves that balance the head above the pelvis such that a line dropped from the ceiling would fall through the ear lobe, the tip of the shoulder, center of the hip and knee, and anterior to the ankle joint. From behind, ideal posture is when the spine is straight. If the structure of your spine is bent or crooked you will not be able to achieve this position despite your efforts to “stand up straight!”. Compensations will occur above and below the bend as your body strives to stay upright.
Scoliosis is not caused by poor postural habits but develops because of a misshapen vertebrae within the spine itself. The deformed vertebra will cause the spine to rotate and bend eventually reshaping the back to appear scoliotic. According to the National Scoliosis Foundation, over 4 million people in the United States have scoliosis and 30,000 surgeries are performed each year to correct scoliosis deformity.
Types of scoliosis
There are different types of scoliosis. Idiopathic scoliosis is a diagnosis given when one or more vertebrae become deformed, for reasons we don’t know, causing the spine to become disfigured. The term idiopathic scoliosis was coined almost 100 years ago but we still do not know for certain what causes the deformity. A few plausible theories have been published and these articles can be found through The Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT). These theories point to a series of events that disrupt the process of vertebral growth and symmetry. A cure has yet to be developed.
Some other causes of scoliosis include degenerative changes, trauma, fractures, disease and tumors which may all result in a crooked spine. These causes are known and are not considered idiopathic. Functional scoliosis is another cause of a crooked spine. A curve may develop due to leg length differences or significant musculoskeletal imbalance. This is not the same as idiopathic scoliosis which does not resolve with external lifts or stretching.
Once a child or a young adult is diagnosed with idiopathic scoliosis, the disorder will not go away. In most cases the degree of scoliosis stays minor and remains stable into adulthood. In other cases, the severity of the curve can progress. Early diagnosis can make a world of difference in treating scoliosis. The Adams Forward Bend Test is one test physicians use to assess spinal changes in a child.
If the disorder is discovered in a child, the severity of the curve and the risk of progression will dictate the course of care. Conservative options for children are offered based on the severity of the curve and the age of the child. Age coupled with degree of curve (Cobb angle) helps determine the risk of progression. In general, the younger the child and the larger the curve, the more aggressive the treatment. In some cases, a child will simply be monitored. For others, an intense regimen includes full time bracing and exercise. For a few, surgery is necessary.
If you are an adult with scoliosis, you may have had it during adolescence, or you developed a crooked spine due to other reasons. Treatment for you may be more conservative. The shape of the spine will not change much with maturity, but it can change some. Goals for you as an adult would be to learn lifestyle habits to slow progression, manage pain and to reduce the curve through appropriate exercise. Learning to modify positions that may worsen your curve and managing your condition through appropriate exercise have been shown to reduce both the pain and the deformity,.
Scoliosis specific exercises
Regardless of your age, scoliosis specific exercises can be of great benefit. If the forces through your spine are uneven, the exercises you do should address your asymmetries to improve balance, not worsen the uneven forces. If you imagine an S curve (there are many variations of curves according to the Rigo Classification System) the muscles in the concave part of the S will be shortened and weak, and the muscles in the convex portion of the S will be over stretched and weak. Learning how to open the collapsed areas and then to strengthen the muscles of your inner rib cage from this optimal posture is one emphasis of physiotherapeutic scoliosis specific exercises (PSSEs). Finding a practitioner in your area knowledgeable in PSSE will help you to better manage your condition. Simply treating the symptoms has shown to be ineffective.
A few suggestions to help maintain a healthy spine
1) Continue to exercise! Just be smart about the sport you choose. Twisting, bending forwards, or bending backwards may irritate your back and worsen the scoliosis. Choose exercise that makes you feel good afterwards and promotes balance in body such as recreational swimming, pilates, and tai chi to name a few.
2) Notice if you tend to slump to one side when you sit, if you carry your bag on the same shoulder, or if you always lean on the same hip. Do your best to stay centered in all your daily activities.
3) Practice good body mechanics. If you do housework requiring you to bend to the floor, do so with a straight spine. Bend your knees!
4) Love your body. If you don’t have a straight spine, you can still take care of the one you have. If you are unsure how to care for your spine, seek guidance. Special spines deserve special care!
5) Finally, please contact us if you have questions about whether physical therapy is right for you or your child.