It was the same for most of us. In middle school, the school nurse or your pediatrician telling you to get down to your skivvies and having you touch your toes. That was the Adam’s Forward Bend Test, a test for early signs of scoliosis. Scoliosis is a lateral curvature of the spine. The spine is supposed to have several front-to-back curves, but no side-to-side curves. What causes scoliosis is a matter of debate. It is classically divided into three categories based on proposed cause: idiopathic, congenital and secondary to neuromuscular disease. A full 65% of cases are idiopathic, meaning of unknown origin. Scoliosis usually comes on during early adolescence, but onset typically ranges from age 10-20. Girls are disproportionately affected.
Signs and symptoms of scoliosis include:
- Uneven muscular between left and right sides of the spine
- Prominence of one side of the ribcage or one shoulder blade (giving the appearance of a hump, sometimes)
- Altered leg length with uneven hips/arms
- Pain in the neck, back, shoulders and butt
- Reduced or limited mobility
- Possible respiratory or cardiac problems
Typical treatment for scoliosis is predominantly bracing, surgery (including metal rods inserted into the spine) or both. However, remember those three types of scoliosis I mentioned above? Each can be further subdivided into one of two types: structural or functional.
– A structural scoliosis is one where the spine has grown into a curved position and has undergone morphologic changes over time.
– In a functional scoliosis, the spine is merely being held in a faulty position by the soft-tissues of the body.
Functional scoliosis is far more common and far more easily corrected. Most cases of scoliosis are in fact functional, and I’ve seen it resolve in my office sometimes in minutes. Even structural cases are often also functional in part, meaning the spine has both grown crooked and is being held so. To the extent that a scoliosis is functional, it can be resolved without bracing or surgery. In my clinic, my approach to scoliosis isn’t limited to the spine. The faulty curvatures in the spine are often just a result of forces applied to the spine from dysfunctions elsewhere in the body. For me, that usually means I end up working on balancing out the feet, hips, pelvis, jaw and skull. Usually included is also some soft-tissue work to mobilize scar tissue that has formed over time and corrective exercises to retrain de-conditioned muscles and postures.
While no one can offer a definitive explanation for how idiopathic scoliosis begins, as it frequently tends to begin during a growth spurt, it’s clear that growth is a factor. It’s my assertion that idiopathic scoliosis most frequently results (in adolescents) due to existing musculoskeletal imbalances present during a growth spurt, causing the spine to grow into faulty curvatures. That isn’t the end of it, though. Scoliosis can begin much later in life as well. It often results from asymmetrical alignment in other parts of the body. For example, a simple rotation in the pelvis can create a functional difference in leg length from left to right, resulting in lateral curvatures to the spine.
Regardless of the cause, scoliosis doesn’t get better over time simply due to the passage of time. It requires intervention. I suggest not waiting, especially because of this equation: functional scoliosis + time = possible structural scoliosis. That’s right, if a functional scoliosis is present long enough, it can lead to permanent degenerative changes in the spine. Don’t wait. Have it dealt with at a low level while it still can be. Prevent it from becoming something more.