Did you know that everybody has curves in their back? We actually have three distinct and purposeful curves – and they’re perfectly normal. In fact, this curvature is necessary as they provide shock absorption and allow mobility in all different ways in our spine. The curves are found in the neck (cervical spine), the mid back (thoracic spine), and the lower back (lumbar spine). These curves must bend in three planes; side bent (coronal plane), flexed forwards and backwards (sagittal plane) and rotated (transverse plane).
Scoliosis is a Greek work meaning curved or bent and we often hear it at St Kilda Osteopathy!! Scoliosis is a descriptive word use to explain curvatures in the spine that differ from the three natural curves.
Scoliosis occurs most frequently in females, in fact it’s four times more likely to occur in females. As much as 2.5% of the population present with a scoliosis, however only .25% require interventional treatment. This is proof that scoliosis is, in the most part, a condition in which you can still maintain a very functional and active life without limitations. In most cases, scoliosis is dependent on growth. As a consequence of this, most initial scoliosis cases present during adolescence.
Scoliosis can have many causes, though 80% of them are idiopathic. Idiopathic is when a disease or condition is self limiting, spontaneous and often have an unknown cause.
There are three main types of idiopathic scoliosis and these are categorized by age.
- Infantile Idiopathic Scoliosis: Before a child is two. 90% of these rare curves spontaneously resolve
- Juvenile Idiopathic Scoliosis: Aged 2-10
- Adolescent Idiopathic Scoliosis: The most common type occurring in early adolescents.
A curvature found with an early onset, below the age of five, has a greater risk of having a major impact on health if left untreated. The difficulty of treating a scoliosis with an early onset is controlling the curve without impacting the growth of the spine or other vital organs. A misshapen spine can affect the development of the heart and lungs leading to potential complications later in life. Therefore early management, monitoring, X-rays, manual therapy, muscle strength work and medical intervention, is recommended.
Scoliosis can also occur in adults, but is less frequent, and is mainly caused by degeneration. If there is degeneration of the inter-vertebral discs or facets joints found in the spine, this can cause uneven loading of the spine itself. Due to the uneven loading on the joints of the spine, it can continue to cause asymmetrical (uneven) growth and degeneration of the spine, muscle spasm, weakness and pain, and therefore lead to further progression of the curve. This form of scoliosis starts to occur later in life or may be due to an adolescent scoliosis (often with poor muscle strength and fitness of the individual).
Other forms of structural scoliosis can be:
- Congenital; Spinal malformation at birth
- Neuromuscular; this is frequently seen in patients with spina bifida or cerebral palsy.
- Paralytic; caused by paralysis of spinal muscles on one side.
There is also anther type of scoliosis which is often caused by a muscle spasm or leg length discrepancy. It is described as a functional scoliosis. Unlike the other types of structural scoliosis, a functional scoliosis may be reversed.
Diagnosis of your scoliosis can often be done by pure observation of the spine and body.
- One shoulder or hip looks higher than the other,
- The head does not look centered over the body,
- One shoulder blade sticks out more than the other,
- The waistline is flat on one side, or the ribs look higher on one side when bending forward at the waist, ie, a rib hump is noted when in flexion
If the above signs are notes and is significant, an X-Ray may be recommended.
An X-Ray is performed to give a clear visual of the bone structure, curve, development and possible progression if several X-Ray’s are taken over a period of time to watch the development or improvement of the scoliosis. With this picture we can clearly measure the curves and the angles giving us a guide to help monitor any changes over time.
Scoliosis signs are often first noticed by others. They might comment on their clothes fitting unevenly or notice a sideways curve in their spine. Approximately 10% of idiopathic scoliosis cases have a curve that progresses beyond mild and needs medical treatment.
Some of these more severe or intense symptoms may include:
- Trouble breathing:
A severe change in the spine and rib cage can tighten the function available to the lungs. This may be more apparent on exercise or exertion.
- Restricted range of motion:
Curvatures in the spine can increase rigidity, reducing the flexibility, mobility and active and passive movement of the spine.
- Changes in gait or walking:
The body will compensate for the spinal changes by moving differently to offload or decrease any potential pain in the spine. This may cause the hips and pelvis start to change how they move and muscle tightness to accommodate the spinal curves, leading to a change in the way you walk. All these compensations occur for your body to stay erect and maintain balance, and use minimal energy and avoid pain.
Musculature and connective tissues can become prone to fatigued and muscle spasms resulting in pain
Other risks associated can include:
- Cardiovascular problems:
Similarly to compensations to our lung function and respiratory system, the heart can be placed under stress due to a change and decrease in the space available. This can cause complications to the hearts ability to pump blood. This is apparent in the most sever cases of scoliosis.
- Lower self-esteem:
This can be a significant factor for those with a spinal deformity that are more visible and can lead to psychological issues such as depression, anxiety, and eating disorders.
Although manual therapy such as Osteopathy will not “correct” or reverse a structural scoliosis it can assist with associated compensations, promote optimal joint and muscle function and help strengthen the spine and surrounding tissues with prescribed exercises.
With a vast array of techniques, osteopaths will work with the muscles, ligaments, fascia (all the connective tissues) and with the joints.
Your Osteopath will be able to:
- Relieve over worked or fatigued muscles
- Mobilize restricted joints, not just around the spine and connecting ribs, but other areas that are compensating for the scoliosis. This can include the hips, knees, feet, shoulder blade region, neck and shoulders!
- Activate and retrain muscles and the way we function
- Decrease stresses and strains placed around surrounding supporting structures of the scoliosis
- Educate on breathing and stretching techniques to help improve spinal, rib and diaphragm mobility and function that allows conscious awareness to decrease strain of the scoliosis.
By looking at your whole body, not just the isolated curvature, your Osteopath will work with your function in all different ranges and planes of motion. This will involve addressing movements performed on a daily basis such as lifting, pushing, walking, sitting, driving and even breathing.
Your Osteopath will also be able to discuss other options of treatment that you may find beneficial.
The Schroth method is an exercise-based program designed to realign and lengthen the spine. Each exercise is individualized to “correct” the spinal curvature, or do the opposite to your scoliosis. Once in this position, deep breathing is performed. This is based on improving lung capacity, spinal and rib mobility as well as diaphragm function. As you exhale, muscle tension assists with stabilization of this position.
Other types of medical surgical treatment which would occur under specialist orthopaedic care and referral from a GP can include:
- Bracing or casting. Used before skeletal maturity to assist with spinal correction.
- Growing rods/Harrington Rods. This surgical procedure is used when other methods have failed. Rods are inserted under the skin, attaching to anchors, to act as an internal splint and are most commonly inserted once growing has ceased.
Your Osteopaths approach to treating your scoliosis may differ from other allied health practitioners. If you present with backpain due to your scoliosis, your Osteopath may look and treat surrounding areas. This may include your diaphragm (a muscular dome which sits underneath your rib cage), your hip flexors, your neck and even as far as your feet. This is due to structural connections formed by different tissues – everything really is connected.
If you’re requiring further guidance, support and musculoskeletal care with your scoliosis, please contact your GP, paediatrician or us to help and advise in further care, management and understanding.
Curves are a normal part of the spine’s structure, however the size and the shape of each individual’s spine will differ. In this blog I will discuss the different types of curves that can occur, what to look for and when medical intervention may be required.
Different Spinal Curves:
- Lordosis/kyphosis – The human spine has four naturally occurring curves, which are categorized as either a lordosis or a kyphosis. When looking at a person from side on we can see the neck & low back have lordotic curves as they dip inwards whereas the mid back & pelvis takes on a rounded kyphotic curve. The degree of each of these curvatures may differ between individuals based on lifestyle and/or postural habits.
- Scoliosis – A scoliosis is a lateral (or side-to-side) curvature of the spine. When looking at a person from the front or back the spine should appear straight. An individual with a scoliosis will have either a “C” shaped or “S” shaped curve when looking from this direction.
Types of Scoliosis:
Scoliosis can be classified into one of either two major categories:
- Functional – Functional scoliosis is a curvature that forms due to a problem that does not involve the spine.
These causes include:
- Difference in leg length
- Postural habits or participating in asymmetrical sports which can result in overuse in the muscles on one side of the spine & underuse of the muscles on the other side
- Pain & muscle spasm due to an injury
Functional scoliosis’ are reversible and can be treated effectively with manual therapy & exercise prescription.
- Structural – A structural scoliosis is a fixed curvature of the spine and cannot be reversed. According to the Scoliosis Research Society (SRS) around 80% of structural scoliosis’ are idiopathic, which means that the cause is unknown and not related to any other disease or disorder. The other 20% are due to birth defects, neurological disorders & congenital conditions.
Idiopathic scoliosis presents during one of the periods of rapid growth, with around 80% occurring during the adolescent (10-18 years old) growth spurt. The incidence of boys & girls developing small spinal curvatures is equal, however girls have a much higher risk of the curve progressing and requiring treatment.
Once scoliosis is detected it is important to monitor its progression. X-rays will typically be ordered to determine the degree of the curve and thus its severity. Curves that are less than 10 degrees are not considered to represent scoliosis but rather they are considered an asymmetry in the spine. These curves are unlikely to progress and generally don’t need treatment but should be monitored. Curves greater than 25 degrees need to be monitored for change regularly and will typically require medical intervention because as the scoliosis gets bigger it can begin to impact on the internal organs. It is recommended that the scoliosis should be imaged every 4 – 6 months in growing children and every 5 – 7 years in adults.
What to look for:
Typically adolescent idiopathic scoliosis does not result in back pain, therefore it is important to be able to notice any change in their posture. Common signs of scoliosis include:
- One shoulder higher than the other
- One shoulder blade that sticks out more than the other
- One hip higher than the other
- “C” shaped or “S” shaped curve in the spine
- Uneven gaps between the arms & the trunk
- Ribs more prominent or one side of the back
- Head not centered over the body
Treatment of scoliosis depends on the degree of the spinal curve as well the skeletal maturity of the patient, or how much growth can be expected. These are some of the different treatment options that can help with scoliosis:
- Osteopathy/manual therapy – Osteopathy can help in the treatment of both functional and structural scoliosis. In the case of functional scoliosis, the cause of the scoliosis, whether that is muscular tension or joint restriction, can be identified and addressed. In terms of treating structural scoliosis, although the curve cannot be reversed, treatment can help to release the tissues that are under excessive strain due to the curve.
- Exercise prescription – Exercise can help to increase muscle strength & endurance, which can result in an improvement in posture, pain and quality of life.
- Bracing – Bracing is recommended for children & adolescents who are still growing and they have a scoliosis between 25 & 50 degrees. It is a rigid brace that is fitted to the individual’s trunk and is worn 23 hours per day to prevent progression of the curve.
- Surgery – Surgical treatment is used for patients whose curves are greater than 45 – 50 degrees. The goal of surgery is to prevent the progression of the curve and maintain some curve correction. The surgery involves metal rods, which are attached along the length of the spine to create an internal splint.
If you suspect you or your child may have a scoliosis give us a call or make an appointment so that we can discuss what the best treatment/management plan should be.