Fitness · Health

Detecting and Treating Scoliosis, Part I

 defects_of_formation

Defects of Formation
A: Misshapen vertebra causing scoliosis B: Misshapen vertebra fused to normal vertebra
C: Three misshapen vertebrae without scoliosis
D: Three fused vertebrae without scoliosis
E: Trapezoidal shaped vertebrae with scoliosis

When the normal block shape of the vertebra is disrupted into a wedge shape.
(Source: Scoliosis Research Society)

Less common forms of childhood scoliosis include congenital and neuromuscular scoliosis. Congenital scoliosis is often the result of an abnormally formed vertebra. Each vertebra is normally block-shaped, but at times a wedge-shaped vertebra forms, and this may be the direct cause of scoliosis. Early recognition by a pediatrician is very important, since surgical correction should be considered, and the timing of the surgery and planning for it is crucial. Neuromuscular scoliosis previously was commonly seen in those suffering from polio. In conditions such as polio, impaired nerve function leads to weak and/or tight muscles that are worse on one side of the body and can lead to the development of scoliosis. Today, neuromuscular scoliosis is commonly seen in the most common cause of childhood disability, cerebral palsy. Physical therapy and proper positioning are commonly utilized to prevent the development or progression of scoliosis when there is a neuromuscular cause.

During childhood and teenage years, patients are usually brought into a physician’s office due to changes in posture or alignment. In adulthood, patients with scoliosis usually come to a doctor’s office due to the onset of back pain, although at times the reason is due to worsening posture. The first question adults usually as is, “Why have I developed scoliosis or how long it has been present?”

Why would adults be diagnosed with scoliosis? Some childhood spinal curves are very mild and go undetected until an X-ray later in life, usually performed for the evaluation of back pain, reveals the curve. Certain spinal curvatures, such as those in the lumbar spine (lower back), are more difficult to detect than thoracic spine curvatures. The lumbar spine doesn’t support the ribs or shoulder blades, so there will not be a rib hump or asymmetric shoulder. There are other reasons that adults may receive a diagnosis of scoliosis, and these include, but are not limited to, degenerative changes of the spine, spinal trauma, fracture, or even a tumor. In my practice, excluding AIS that was previously unrecognized, degenerative scoliosis is the most common type in adults.

If you have a known history of scoliosis or are concerned that you may have scoliosis, your physician will take a detailed history, then perform a physical and radiographic (X-ray) examination of your spine. If the diagnosis of scoliosis is made, then the type and severity of scoliosis will be determined. Your care can then be planned based on this information, as well as your overall functional status, pain, and coexisting medical conditions. Your physician will also assess for any concomitant spinal deformities, such as exaggerated kyphosis (roundback posture) and/or lordosis (“swayback”)—see “The Hazards of a Misaligned Spine”). At times, these concomitant spinal deformities may cause as much, or even more, pain and dysfunction than your scoliosis. Long-term management of scoliosis will be directed by your physician and may involve a team of health care practictioners, such as a physical therapist, and will be discussed in greater detail in the next post.

 

References:

  1. Nachemson, A. (1979). Adult scoliosis and back pain. Spine, 4(6), 513-517.
  2. Reamy, B. V., & Slakey, J. B. (2001). Adolescent idiopathic scoliosis: review and current concepts. American family physician, 64(1), 111-116.
  3. Soucacos, P. N., Zacharis, K., Soultanis, K., Gelalis, J., Xenakis, T., & Beris, A. E. (2000). Risk factors for idiopathic scoliosis: review of a 6-year prospective study. Orthopedics, 23(8), 833-838.
  4. Hawes, M. C. (2003). The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature. Developmental Neurorehabilitation, 6(3-4), 171-182.

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  • Susanna Gaertner January 12, 2015 at 1:22 pm

    This is a problem I commonly see in my practice as well as in my own body. Pilates can be very beneficial in minor cases by strengthening the spinal muscles as well as the rib muscles (serratus anterior) that feed into it.
    While my scoliosis is visible on X-rays, it is not visible to the naked eye and I have no pain. I hope that your readers will explore this often helpful modality.

    Reply
    • mary griffin July 8, 2021 at 1:55 pm

      Just discovered your organization in researching my recently diagnosed scoliosis (C shaped, over 25-degree curvature). I’m looking forward to your newsletter and any recommendations for treatment, exercise programs, such as Pilates, rowing machine. Thank you.

      Reply