Scoliosis

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 our osteopathic clinic in Melbourne!  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 femal

es. 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.

• 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.

Dr. Catriona Bauld
B.Sci (Clin.Sci), M.H.S.(Osteo) 

Member of Osteopathy Australia

References:

http://vsrc.com.au
http://www.scoliosis-australia.org/about_scoliosis.html
https://www.spine-health.com/conditions/scoliosis
https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716