To begin this conversation it is important to understand that there are two things the body doesn’t like; compression and tension. Compression is the act of flattening through use of pressure (think of someone gently squeezing your head for hours on end, uncomfortable right?). Tension is the state of being stretched (think of someone bending your finger back for prolonged periods, also uncomfortable!). What leads to these normal forces becoming disrupting forces is repetition. Repetition is what your body consistently does over a period of time. In the end, our body is controlled by our brain, which can learn bad habits very quickly in its pursuit to be efficient but sometimes what is efficient is not effective. For example, if you were standing on your left leg when first reading this, that stance is resting on the hip joint and not using the hip muscles for support. Using the hip muscles requires energy, which for survival, it is more efficient to save that energy. For musculoskeletal pain, it is a worthwhile and effective use of energy to use those hip muscles. Nearly all injuries can be broken down into this idea of repetitive forces (compression or tension).
When it comes to scoliosis, broken down simply it is a miscommunication between your shoulders and hips and the spine gets caught in the middle. We explain it best in this capacity because it literally is your spine bending from the top and from the bottom. The goal of treatment is not to manually put the spine back in alignment but to figure out where this miscommunication is happening. There may be a deficiency in your shoulders and/or hips, or what connects the two together (your core). Identify where this is happening, relearn that movement pattern and the spine will respond in a positive fashion.
Typically, patients ask: how can I fix my back pain or how can I correct my scoliosis? In order to answer this question, you have to know the why? More often than not, treatment first requires a mindset shift and new questions asked: How do your hips work? How do your shoulders work? (followed up by why don’t they work well?) Typically one hip/shoulder works completely different than the other. How on earth can the spine feel good and stay straight when above and below it is out of balance and can’t function? The body takes the path of least resistance so the spine bending to accommodate repetitive use is easier than learning how to move through the hip or shoulder resistance.
In more clinical language, scoliosis is a condition that refers to the abnormal sideways or rotational curvature of the spine. There are two different subsets of scoliosis; structural and functional. Structural is typically the one found in childhood. Functional refers to the repetitive asymmetrical use explained above, where your functional use has created a curve. Although scoliosis can happen at any time, it is less likely during adulthood once a person has reached skeletal maturity. So if you were just diagnosed with scoliosis at 25/45/65, its most likely functional scoliosis (again think about the questions above, do you use your body asymmetrically?) Most often, scoliosis occurs in children just before puberty—ages 10-20—and affects 2-3% of the population in the U.S. (an estimated 7 million people). Standard treatment for scoliosis that you’ll hear from your PCP or orthopedic doctor varies and depends on the severity of the curve, the location of the curve and the patient’s age, and for more severe cases surgery is recommended. Causes may be genetic, environmental or oftentimes, unknown. However, beginning to identify the asymmetries through the use of physical therapy, we can help slow the progression of the spinal curve or when a patient begins to develop other conditions (pains) as a result.
When viewed from the back, a healthy spine appears as a straight line. A person with scoliosis will appear to have a side-to-side curve in their spine. An x-ray is the gold-standard to measure spinal curvature (the point of the first shift of the vertebrae and the last shift of the vertebrae), known as the Cobb angle. There are two types of curvatures, a C-curve (1 curve) or an S-curve (2 curves), the severity of which depends on the degree of the curve’s angle. A spinal curve of 10 degrees or greater is classified as scoliosis while a curve measured greater than 25-30 degrees is considered severe.
We all probably remember going through a scoliosis check back in grade school. During this test, known as the Adam’s Forward Bend Test, a medical professional looks for one or more of the following signs:
Scoliosis is not always associated with pain although changes in a patient’s alignment, posture and movement patterns may affect the surrounding muscles and joints, resulting in irritation and painful symptoms. The body doesn’t like compression and it doesn’t like being stretched too much, both of which take place with scoliosis. If you have a Right C-curve (a backwards ‘C’ when looking from the back), the left side of your body is compressed including the facet joints in the back, discs, ribs and muscles throughout your rib cage, back and chest. The same right side tissues are being excessively stretched. All of these things have the potential to be pain sources.
Remember the scenario above of squeezing your head or bending your finger back? Which would be more bothersome to you? The majority of people would think an excessive head squeeze would bother them more. Remember that’s compression. The body typically feels the same way, meaning the painful side is typically the compressed side.
Anytime! Clinically, treatment for scoliosis is based on the patient’s age, how likely they’re able to continue growing and the degree of the spinal curve. However, the body is very resilient and efficient at healing when given the proper environment so it’s important to seek out treatment for scoliosis as soon as possible if there is any concern that it may be present. As you may imagine, it’s best to begin treatment before the curve progresses (better to treat someone with a 10 degree curve rather than a 40 degree curve). Based on the severity, medical professionals may recommend intrinsic or extrinsic bracing to counteract further progression of the curve. If return to function can’t be achieved, surgery consult may be the next steps.