Most of you are familiar with the term scoliosis. You are aware that it involves some type of curving of the spine; although most people are not familiar with the reasons why someone develops it and what can be done to treat it. As a chiropractor it is very common for someone to enter my office with some degree of a spinal curvature. In fact, it is rare to see a truly straight spine. That is one reason that back pain is such a common malady. Scoliosis can be present in adults as well as children even though most scolioses present in adults most likely began when they were adolescents. In order to understand what a scoliosis is lets first take a look at what a normal spine should look like.
A “normal” spine when viewed from the front or from behind should appear straight up and down. When viewed from the side there should be three apparent curves. There should be a curve towards the front of the body in the neck or cervical region, this is a lordotic curve; a curve towards the back of the body in the middle back or thoracic region, a kyphotic curve; and a curve towards the front in the lower back or lumbar region, again a lordotic curve. It is the alteration of the straight up and down posture of the spine that constitutes a scoliosis; that is when the resultant curve is greater than ten degrees.
Most curvatures, greater than 80% of the time, are of unknown causes or idiopathic. Sometimes trauma, tumors, neurologic disorders or birth anomalies affecting the shape of the bones of the spine may be the underlying cause. In a lot of cases the cause may be as simple as having one leg congenitally shorter than the other, which can also happen post-leg fracture or by having inequalities of the feet. Most people who have scoliosis have curves less than twenty degrees which are not usually of any great clinical significance other than they can contribute to back pain. These are not of any great concern as long as they are stable and not progressing. These curves do have the ability to progress rapidly, especially in children and adolescents, and particularly in young girls who have not yet had their first menses. They therefore need to be monitored closely early on in those situations.
Scolioses are generally found on spinal screenings which are commonly done in the school systems. Parents may notice that their child has one shoulder or hip higher than the other or that one pants leg needs to be hemmed a bit higher. Also, there may be a noticeable “hump” on one side of the spine while a child is bent over at the waist. Sometimes the curves may be very subtle and may be missed during a mass screening as is done in the schools so I always encourage my patients to bring their children in so that I can screen them also. If a curvature is found x-rays are generally performed to assess the degree and extent of the curve and to see if the cause of it can be determined. Occasionally a MRI of the spine may be necessary to rule out any pathology that may be instigating the problem.
Scoliosis can affect the patient’s quality of life by restricting movements, causing pain and restricting lung and heart function. In some cases there can even be psychological scarring as the curves can be disfiguring affecting the patient’s self-esteem.
Treatment for scoliosis primarily depends on the degree of the curvature. When a curve is mild, generally less than 25 degrees, the patient is monitored with periodic screenings and x-rays to insure that the curve is not progressing. As long as the curve does not appear to be progressing no treatment is needed unless the patient is experiencing pain. If the curve does progress to between 25 to 45 degrees then the patient may be a candidate for bracing. Bracing can help stop the progression of a curve but won’t reverse it. If the curve progresses to beyond 45 degrees then surgery is generally performed which usually entails the implantation of a metal rod to stabilize the curvature.
As a chiropractor, my role in the treatment of scoliosis, involves the early detection and treatment of the subsequent pain that my be present as a result of the condition. Spinal manipulation has not been shown to be effective for stopping or reducing scoliosis but it can help restore some of the mobility that is lost due to the abnormal positions that are assumed by the vertebrae and thus help in relieving some of the pain that the patient may have. Another role that I can play is in determining if the scoliosis is present due to a leg length deficiency or inequalities in the feet. I have seen this many times over the years in my practice. These conditions can usually be addressed with orthotics or by simply adding height inside the shoe of the short leg. Another recommendation I make is to do stretching and mobility exercises which is best addressed by joining a yoga class.
The key to scoliosis is the early detection of such. It is a condition that can be potentially life threatening if it is progressive and left unchecked. Luckily, most scolioses are not of the progressive type and never need any intervention. If you should have any concerns you should discuss them with your chiropractor or primary care physician.
Dr. David D. Godwin
Chiropractic Physician
Salisbury, NC
704-633-9335
www.salisburychiropractic.us