Scoliosis affects 5 to 7 million people in the United
States. More than a half million visits are made to
doctors’ offices each year for evaluation and treatment
of scoliosis. Although scoliosis can begin at any age,
it most often develops in adolescents between the ages
of 10 and 15. Girls are more commonly affected than
boys. Because scoliosis can be inherited, children whose
parents or siblings are affected by it should definitely
be evaluated by a trained professional.
What is scoliosis?
Because we walk on 2 feet, the human nervous system
constantly works through reflexes and postural control
to keep our spine in a straight line from side to side.
Occasionally, a lateral (sideways) curvature develops.
If the curvature is larger than 10 degrees, it is called
scoliosis. Curves less than 10 degrees are often just
postural changes. Scoliosis can also be accompanied by
lordosis (abnormal curvature toward the front) or
kyphosis (abnormal curvature toward the back). In most
cases, the vertebrae are also rotated.
In more than 80% of cases, the cause of scoliotic
curvatures is unknown; we call this condition idiopathic
scoliosis. In other cases, trauma, neurological disease,
tumors, and the like are responsible. Functional
scoliosis is often caused by some postural problem,
muscle spasm, or leg-length inequality, which can often
be addressed. Structural scoliosis does not reduce with
postural maneuvers. Either type can be idiopathic or
have an underlying cause.
What are the symptoms of scoliosis?
Scoliosis can significantly affect the quality of life
by limiting activity, causing pain, reducing lung
function, or affecting heart function. Diminished
self-esteem and other psychological problems are also
seen. Because scoliosis occurs most commonly during
adolescence, teens with extreme spinal deviations from
the norm are often teased by their peers.
Fortunately, 4 out of 5 people with scoliosis have
curves of less than 20 degrees, which are usually not
detectable to the untrained eye. These small curves are
typically no cause for great concern, provided there are
no signs of further progression. In growing children and
adolescents, however, mild curvatures can worsen quite
rapidly—by 10 degrees or more—in a few months.
Therefore, frequent checkups are often necessary for
this age group.
How is scoliosis evaluated?
Evaluation begins with a thorough history and physical
examination, including postural analysis. If a scoliotic
curvature is discovered, a more in-depth evaluation is
needed. This might include a search for birth defects,
trauma, and other factors that can cause structural
Patients with substantial spinal curvatures very often
require an x-ray evaluation of the spine. The procedure
helps determine the location and magnitude of the
scoliosis, along with an underlying cause not evident on
physical examination, other associated curvatures, and
the health of other organ systems that might be affected
by the scoliosis. In addition, x-rays of the wrist are
often performed. These films help determine the skeletal
age of the person, to see if it matches an accepted
standard, which helps the doctor determine the
likelihood of progression. Depending on the scoliosis
severity, x-rays may need to be repeated as often as
every 3 to 4 months to as little as once every few
Other tests, including evaluation by a Scoliometer™,
might also be ordered by the doctor. This device
measures the size, by angle, of the rib hump associated
with the scoliosis. It is non-invasive, painless, and
requires no special procedures. A Scoliometer™ is best
used as a guide concerning progression in a person with
a known scoliosis—not as a screening device.
Is scoliosis always progressive?
Generally, it is not. In fact, the vast majority of
scolioses remains mild, is not progressive, and requires
little treatment, if any.
In one group of patients, however, scoliosis is often
more progressive. This group is made up of young girls
who have scolioses of 25 degrees or larger, but who have
not yet had their first menstrual period. Girls
generally grow quite quickly during the 12 months before
their first period and if they have scolioses, the
curvatures tend to progress rapidly. In girls who have
already had their first periods, the rate of growth is
slower, so their curves tend to progress more slowly.
What is the treatment for scoliosis?
There are generally three treatment options for
scoliosis—careful observation, bracing, and surgery.
Careful observation is the most common “treatment,” as
most mild scolioses do not progress and cause few, if
any, physical problems. Bracing is generally reserved
for children who have not reached skeletal maturity (the
time when the skeleton stops growing), and who have
curves between 25 and 45 degrees. Surgery is generally
used in the few cases where the curves are greater than
45 degrees and progressive, and/or when the scoliosis
may affect the function of the heart, lungs, or other
Spinal manipulation, therapeutic exercise, and
electrical muscle stimulation have also been advocated
in the treatment of scoliosis. None of these therapies
alone has been shown to consistently reduce scoliosis or
to make the curvatures worse. For patients with back
pain along with the scoliosis, manipulation and exercise
may be of help.
Most people with scoliosis lead normal, happy, and
productive lives. Physical activity including exercise
is generally well-tolerated and should be encouraged in
Source: The American Chiropractic