I do x-ray spines for patients with scoliosis, and I have always wondered why some people are bone with it and some are not.
I also hear parents with children and teenagers who have just been diagnosed ask common questions about the condition.
In this article I will answer the most frequently asked questions based on my experience as a diagnostic radiographer as well as extensive reading of medical scientific publications on the subject matter.
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: July 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links. Happy reading!🙋
Summary: Scoliosis is where the spine twists and curves to the side. Most people with scoliosis can have normal, active lives with treatment, Support groups for children, teens, and their parents.
▶️Why do some people have scoliosis and others do not?
Scoliosis is likely a genetic condition known as idiopathic, in more than 80 percent of cases, the cause of scoliosis is unknown.
What really causes idiopathic scoliosis?
Idiopathic scoliosis affects 1% to 3% of U.S. adolescents. In around 8 in every 10 cases, the cause of scoliosis is unknown.
According to medical research, your genes may make you more likely to get it though, as it sometimes runs in families.
Idiopathic scoliosis cannot be prevented and is not thought to be linked to things such as bad posture, exercise or diet as some people think.
Genetic factors are thought to contribute to the development of scoliosis, but inheritance patterns are variable, and no single mode of genetic transmission has been identified (Horne,2019)
Some hypotheses think it is caused by muscle imbalance, hormonal or asymmetric growth.
▶️What are the three main types of scoliosis?
1️⃣Functional scoliosis, you will find that your spine is normal, but an abnormal curve develops because of a problem somewhere else in the body.
Sometimes when you have one leg shorter than the other or muscle spasms in the back.
2️⃣Neuromuscular scoliosis, here the bones of your spine while they are forming, they fail to form completely, or they fail to separate from each other during foetal development.
Your spine will have a C-shaped curve and weak muscles that are unable to hold you up straight.
This type of congenital scoliosis develops in people with other disorders, including birth defects, muscular dystrophy, cerebral palsy, or Marfan syndrome (an inherited connective tissue disease).
3️⃣Degenerative scoliosis is caused by the weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine.
This type of scoliosis is found in older adults sometimes caused by changes in the spine due to arthritis known as spondylosis, osteoporosis, vertebral compression fractures, and disc degeneration.
▶️At what age is scoliosis usually diagnosed and when do you see a doctor?
Scoliosis can affect people of any age, from babies to adults, but most often starts in children aged 10 to 15.
When you think your child has scoliosis, this does not mean that it is seriously wrong but it’s best to get it checked.
Even when you think it is a significant deformity this does not necessarily mean you have more back pain related to scoliosis
▶️At what age is it too late to treat scoliosis?
In summary, it is never too late to address scoliosis, although early detection and intervention are ideal.
Timely treatment during childhood and adolescence can prevent progression and reduce the need for more invasive measures later in life
▶️What are the beginning stages and signs of scoliosis?
🟣One shoulder blade appears more prominent than the other.
🟣One legs seems longer than the other.
🟣Your head has a forward position when viewed from the side.
🟣Lower back pain and headaches may become more frequent
▶️What Does Very Mild Scoliosis Look Like?
In cases of very mild scoliosis, the curvature of the spine may be subtle and difficult to detect without medical imaging.
Visual signs may include slight asymmetry in the shoulders, hips, or waistline when viewed from the front or back
10-year-old child with scoliosis. Image: from nhs.uk conditions scoliosis
Mild scoliosis is usually asymptomatic, you may feel some musculoskeletal back pain, but there is no evidence that it causes disability or functional impairment.
When you have Severe scoliosis, you may have physical pain, cosmetic deformity, psychosocial distress, or, rarely, pulmonary disorders
▶️How do you check for scoliosis or how is it confirmed?
X-rays are the main test for early onset scoliosis. Your doctor might order additional tests to gather more information.
Scoliosis can also be diagnosed after a physical examination of the spine, ribs, hips and shoulders.
You may be asked to bend forward to see if any areas are particularly prominent.
▶️ Can scoliosis be cured?
Scoliosis is a condition that can’t be cured. As such, there’s no option to “fix” scoliosis, at least not to 100%.
However, scoliosis can be treated in a way that helps “correct” the curvature, reducing the angle of the curvature and improving the spinal alignment.
▶️What are Treatments for scoliosis
Treatment for scoliosis will depend:
🟣on your age
🟣How severe the curve is.
🟣 Whether it’s likely to get worse with time.
Many people will not need any treatment and only a small number of people will need to have surgery on their spine.
Most people with scoliosis can live normal lives and can do most activities, including exercise and sports.
⏭️Non-surgical management
Brace therapy
Wearing a brace has been found effective showing positive correlation with rate of treatment success (Weinstein,2013)
Babies with scoliosis:
Babies and toddlers may not need treatment as the curve might improve over time.
A plaster cast or plastic brace may be fitted to their back to stop the curve getting worse as they grow.
Older children from 10 to 15 years of age with scoliosis
When your curve is from 25 to 45°, primary therapy may be bracing. Older children may wear a back brace to stop the curve getting worse until they stop growing.
This Boston brace is the most often used brace and it is well tolerated as it can be hidden under clothes.
For patients who have not reached skeletal maturity and have curves less than 25°, or patients who have reached skeletal maturity and have curves less than 45°.
The plan is usually observation through radiological x-rays and scans every 6 months until skeletal mature then every 2 years after that in adulthood
Several studies have shown modest benefit from bracing and scoliosis-specific physical therapy to limit progression in mild to moderate scoliosis.
But there were no effects on quality of life. Because no high-quality studies have proven that surgery is superior to bracing or observation, it should be reserved for severe cases. There is little evidence that treatments improve patient-oriented outcomes. (kuznia, 2020)
Adults with scoliosis:
Adults may need treatment to relieve pain, such as painkillers, spinal injections and, very occasionally, surgery.
The condition does not usually cause significant pain or any other health problems, and tends to stay the same after you stop growing
Having scoliosis or wearing a back brace can be tough and may cause problems with body image and self-esteem, particularly for children and teenagers.
Here in the UK, we have scoliosis support groups you can contact for support and resources to help with your self-esteem. (ssr.org)
⏭️Sometimes surgery may be needed to control the growth of the spine until an operation to straighten it can be done when you stop growing.
Usually, several factors such as the overall curve size and pattern, curve progression and skeletal maturity.
Surgery is considered in skeletally immature patients with structural thoracic curve Cobb angles over 40° or patients who show continued progression
Fig. 1 Posterior anterior and lateral preoperative radiographs of a female patient with adolescent idiopathic scoliosis (a, b) and postoperative radiographs after posterior surgical approach(c, d)
▶️Potential Risks of Untreated Scoliosis
As the spine continues to curve, it can cause the shoulders, hips and rib cage to become uneven, leading to a noticeable hump on one side of the back.
This can cause various physical problems, including muscle imbalances, back pain and reduced mobility.
▶️Do you need a physiotherapist to help with any exercises?
It’s not clear whether back exercises help improve scoliosis, but general exercise is good for overall health and should not be avoided unless advised by your doctor.
Therapy for idiopathic scoliosis patients is not only to correct the deformity but also helps to slow or stop altogether the curve progression.
In the UK and the US, physical therapy for scoliosis consists mainly of general strengthening and stretching exercises, along with exercise protocols with which the treating therapist must be familiar with.
In milder cases, exercise may be the main treatment, however it is uncertain whether therapeutic exercises are less effective than bracing in reducing curve progression in adolescents with moderate scoliosis.
▶️What sports are safe to play with scoliosis?
General exercise and sports are good for overall health with or without scoliosis and should not be avoided unless advised by your doctor.
I have seen people with scoliosis get involved in different sports though some people always wonder if sports are good for their back.
🟡Swimming is a great exercise which has been recommended for years if you have scoliosis.
It is highly recommended because it helps strengthen the spine in an almost weightless environment than any other sports.
🟡Cycling is another low-impact sport that gives a great cardiovascular workout without aggravating scoliosis curves. Just try to limit off- road cycling.
🟡Yoga may be good for some adults this should be done depending on your type of scoliosis because some yoga poses can cause a lot of extension to your spine.
🟡Regular flexibility training helps restore range of motion if done strategically it can help counteract the spine’s curvature.
▶️Sports to avoid with scoliosis
🔴Competitive gymnastics for hours at a time may trigger curve progression.
🔴Ballet swimming is a synchronised sequence of movements performed by a group of swimmers.
This activity may result in a more hyperkyphotic spine. If you have a thoracic type of scoliosis, you may want to avoid it.
🔴Jumping on a trampoline may be excellent for strengthening your leg muscles, but those with a lumbar type of scoliosis should avoid it. The downward landing force stresses the spine, causing scoliosis to worsen.
Summary: Building strength is critical for anyone with spinal problems, as stronger muscles are better able to support the spine.
However, it is important to do it properly and choose sports that you feel you can do, and you have been given a green light by your doctor.
▶️Does scoliosis hurt as you get older?
Patients with degenerative scoliosis, will often experience constant back and leg pain which makes it difficult for them to walk or stand for any period.
However, there are some activities that can put pressure and compression off the spine as you age that you can avoid
🔴Squatting
🔴Lifting weight over the head
🔴Hard landings.
🔴Long-distance running.
▶️Does having scoliosis reduce life expectancy?
No, the majority of people do live a normal life with scoliosis and do not have their life expectancy reduced because of this condition.
For these who have severe scoliosis and other health problems not related to scoliosis sometimes can be life-threatening.
But getting the care, treatment and help you need will not reduce your life expectancy.
It is important to stay on top of its progressive nature, begin treatment as soon as possible and stay positive in everything you do.
We have come to the end of this article, feel free to comment or ask a question, I will try to find answers for you.
Wishing you a quick recovery 🙋
📚Sources:
Kuznia AL, Hernandez AK, Lee LU. Adolescent Idiopathic Scoliosis: Common Questions and Answers. Am Fam Physician. 2020 Jan 1;101(1):19-23. PMID: 31894928.
Horne JP, Flannery R, Usman S. Adolescent idiopathic scoliosis: diagnosis and management. Am Fam Physician. 2014;89(3):193-198:
Yaman O, Dalbayrak S. Idiopathic scoliosis. Turk Neurosurg. 2014;24(5):646-57. doi: 10.5137/1019-5149.JTN.8838-13.0. PMID: 25269032.
Addai D, Zarkos J, Bowey AJ. Current concepts in the diagnosis and management of adolescent idiopathic scoliosis. Childs Nerv Syst. 2020 Jun;36(6):1111-1119. doi: 10.1007/s00381-020-04608-4. Epub 2020 Apr 21. PMID: 32314025; PMCID: PMC7250959.
Weinstein S, Dolan L, Wright J, Dobbs M (2013) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 369(16): 1512–1521
Romano M, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Kotwicki T, Maier-Hennes A, Negrini S. Exercises for adolescent idiopathic scoliosis. Cochrane Database Syst Rev. 2012 Aug 15;2012(8):CD007837. doi: 10.1002/14651858.CD007837.pub2. Update in: Cochrane Database Syst Rev. 2024 Feb 28;2:CD007837. doi: 10.1002/14651858.CD007837.pub3. PMID: 22895967; PMCID: PMC7386883.