Scoliosis
1. Introduction
Scoliosis is a condition that causes a lateral (sideways) curve of the spine, specifically one over 10°, which can also be accompanied by a degree of rotation (5,14,9,12,14). It is often described as appearing like an ‘S’ or a ‘C’ shape when viewed from behind. It most typically affects the mid-spine (thoracic) but can also occur in the lower back (lumbar) (9).
Scoliosis can vary greatly between people as there are several different types and causes. It can often be very mild and totally pain free, meaning people can be unaware they have scoliosis as their quality of life is not impacted at all. However, within the minority of more advanced cases, scoliosis can cause pain, impact day-to-day life and cause anxiety regarding physical appearance.
The four different types of scoliosis are:
- Idiopathic (unknown cause) – can be classified further by age of onset.
– Infantile/early onset – 0 to 2/3 years.
– Juvenile/early onset – 3/4 to 9/10 years.
– Adolescent – 11 to 18 years. - Congenital – begins before birth.
- Neuromuscular – secondary to conditions that impact spinal muscles.
- Degenerative – adult onset. (12,14,16,9).
Frequently Asked Questions
Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty (7).
- Uncommon.
- It affects 2 – 3% of children between 12 - 16 years of age and 3 – 4% of the general population (7).
- No.
- Scoliosis varies greatly in severity and some people can often have no symptoms (2).
- With early detection and the correct management approach, most people with the condition will lead a normal life.
- The prevalence and severity are often higher in females than in males (2, 3).
- There are different types of scoliosis that each affect different age groups.
- Most affected are children of growing age and individuals over 60 (2, 12).
- Spinal curvature (9,12,14).
- Misaligned shoulders – (one shoulder is higher) (8,1).
- Hip misalignment – (one side being higher than the other) (8,1).
- More prominent shoulder blade/ribs one side (8,1).
- Back pain (9,10,14).
- Shortness of breath in more advanced cases (1).
- Physiotherapy will be helpful to manage your scoliosis and symptoms.
- You will be advised on how to stay physically active to help maintain flexibility and strength in your back, which will include activity modifications to allow movement with less pain.
- This is very dependent on the severity of your scoliosis and your treatment plan.
- In most cases, the right exercises and management plan will allow you to lead a normal life.
- Only in extreme cases are things like bracing and surgery necessary.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
Signs and symptoms vary between types and severity of scoliosis; however, these are experienced the most:
- Lateral (sideways) spinal curvature, usually in the mid or lower back (5,1,4,9,12,14).
- Misaligned shoulders – one shoulder is higher than the other (8,1).
- Hip misalignment – one side is higher than the other (8,1).
- More prominent shoulder blade/ribs one side (8,1).
- Back pain and inflexibility of the back (9,10,14,1).
- Decrease in lumbar lordosis (inward curve of the lower back) (9).
- Psychological impact regarding appearance (14).
- Shortness of breath in more advanced cases (1).
3. Causes
Scoliosis often has no known cause. In these cases, it is described as ‘idiopathic’ (4,8). Idiopathic scoliosis can occur at any age but usually develops in children and adolescents. This is because changes in the spine can occur during the growth phases or spurts of younger individuals (8,10,15). Idiopathic scoliosis is the most common type of scoliosis, accounting for 80-90% of cases (1, 13,16).
Idiopathic scoliosis can also be split into structural and functional curves (8). Structural scoliosis means that the curve is due to the spinal structure itself, so it is fixed and generally permanent (8). Functional curves, however, are not fixed and can be improved as they usually have causes that can be treated, such as disc problems, leg length discrepancy or posture (8).
Congenital scoliosis occurs before birth when the vertebrae of the spine develop abnormally (12,14). It may not be evident straight after birth as it can develop through to adolescence (12). This type of scoliosis makes up for 10% of cases (13).
Scoliosis can also be caused by conditions affecting the spinal musculature, resulting in muscular abnormalities. This can include cerebral palsy, muscle atrophy or muscular dystrophy (weakening or wasting of muscles) (12).
It is also common for a scoliosis to develop in later life due to age related changes of the spine. This is called degenerative scoliosis and is more prevalent in people over 60 (9). It can sometimes result from having decreased bone density (due to a condition called osteoporosis), disc degeneration or vertebral fractures (9).
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing scoliosis. It does not mean everyone with these risk factors will develop symptoms.
- Gender – females are more likely to develop scoliosis and to experience more advanced scoliosis (2,3,8,9,12,15).
- Age – scoliosis is more prevalent after growth spurts or puberty as a child or adolescent (8, 10, 15).
- Family history – there is evidence that scoliosis has a genetic component so, if a close relative has the condition, it could increase the likelihood of you developing scoliosis (8,14).
5. Prevalence
Idiopathic scoliosis affects approximately 2 – 3% of children between 12-16 years of age (7,3,4,15,16) and 3 – 4% of the general population (7). It is more prevalent in females, with a prevalence of 1.5% in males and 3.1% in females (2).
Degenerative scoliosis has a prevalence between 20 – 68% of the population (6,12) and is more common in females and those over 60 years of age (9,12).
6. Assessment & Diagnosis
Your physiotherapist will ask you to talk in detail about the history and nature of your symptoms so they can understand how it is affecting you. They will also carry out a physical assessment to measure your level of function, range of motion, strength, and balance (14). They can then work with you to make individualised rehabilitation goals.
You will most likely already have a diagnosis, but in cases where there has been no previous investigation, an X-ray may be recommended (3). This can be used to determine the degree or type of scoliosis and to also monitor any spinal changes (13).
The criterion for a scoliosis diagnosis is usually a curvature angle of over 10° (9). However, imaging is usually only necessary if your function is limited, and your symptoms are severe. Having an accurate diagnosis will ensure the most appropriate management is put in place quickly, to facilitate optimal outcomes.
7. Self-Management
Your physiotherapist will discuss your condition with you and provide you with useful information. Following your physiotherapist’s advice, as well as other health professionals, will be helpful to manage your scoliosis and symptoms. You will be advised on how to stay physically active to help maintain flexibility/mobility and strength in your back, which will include activity modifications to allow movement with less pain. Physical activity is essential for scoliosis where it causes pain.
8. Rehabilitation
As stated previously, scoliosis can be pain free. However, some cases may require physiotherapy input which can be beneficial. Your physiotherapist will design a personalised and progressive rehabilitation plan, with scoliosis-specific exercises based on your goals to help you build strength and maintain mobility and spinal stability (10). This exercise plan could involve stretching and conditioning exercises for the muscles surrounding the spine. With regular reassessment, your clinician will make appropriate adjustments to your programme to ensure progression towards your chosen goals.
9. Scoliosis
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
Our initial programme focuses on some basic range of movement exercises and cardiovascular activity to try and improve the ability for the spine to move well.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a higher level of function or return to sport, we would encourage meeting with your physiotherapist. This is because you will likely benefit from further progression beyond the advanced rehabilitation stage, but this should be discussed first to ensure a safe and gradual increase in difficulty. There will be an opportunity to try new, more complex exercises that challenge your body more to reach an enhanced performance level.
11. Other Treatment Options
Your physiotherapist may also use suitable manual therapy techniques, such as massage, for short term symptom relief.
Treatment for scoliosis is varied as it is based on your age, the degree, type and location of the curve, and predicted progression or worsening of the curve (14,1). Back braces can be used in children/adolescents to effectively help restrict and control curvature development (5,10) whilst still allowing a degree of mobility in day-to-day tasks (11). This technique is only recommended for younger patients with curvatures between 25 and 40 degrees (15,10).
Conservative management is recommended wherever possible as it is non-invasive with fewer risks. However, in a small minority of severe cases onward referral for surgical input might be required. This is uncommon and only considered if symptoms are not manageable and function is greatly limited (8,12,14,15).
12. Links for Further Reading
NHS – Pilates for scoliosis https://www.nhs.uk/conditions/nhs-fitness-studio/scoliosis-pilates-exercise-video/
NHS – https://www.nhs.uk/conditions/Scoliosis/
References
- Rousseau, C. and Bessette, A. (2012) Scoliosis: Causes, Symptoms & Treatment. Nova Science Publishers, Inc.
- Yılmaz, H. et al. (2020) Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study. The spine journal 20. Elsevier. https://doi.org/10.1016/j.spinee.2020.01.008
- Moalej, S. et al. (2018) Screening of scoliosis in school children in Tehran: The prevalence rate of idiopathic scoliosis. Journal of Back and Musculoskeletal Rehabilitation 31. IOS Press. DOI 10.3233/BMR-171078.
- Bozkurt, S. et al. (2019) Hypermobility Frequency in School Children: Relationship With Idiopathic Scoliosis, Age, Sex and Musculoskeletal Problems. Arch Rheumatol. 34(3). doi: 10.5606/ArchRheumatol.2019.7181
- Saeedi, M. et al. (2020) The effects of bracing on sagittal spinopelvic parameters and Cobb angle in adolescents with idiopathic scoliosis: A before-after clinical study. Turk J Phys Med Rehab. 66(4). DOI: 10.5606/tftrd.2020.4955
- Lizuka, Y. et al. (2016) Epidemiology and associated radiographic spinopelvic parameters of symptomatic degenerative lumbar scoliosis: are radiographic spinopelvic parameters associated with the presence of symptoms or decreased quality of life in degenerative lumbar scoliosis? Eur Spine J. Springer. DOI 10.1007/s00586-015-4256-8.
- Black, J. et al. (2017) Current knowledge of scoliosis in physiotherapy students trained in the United Kingdom. Scoliosis and Spinal Disorders. 12(34). Biomed Central. DOI 10.1186/s13013-017-0141-z
- Du Toit, A. et al. (2020) Current knowledge of idiopathic scoliosis among practising physiotherapists in South Africa. South African Journal of Physiotherapy. 76(1). https://doi.org/10.4102/sajp.v76i1.1500
- McAviney, J. et al. (2020) The prevalence of adult de novo scoliosis: A systematic review and metaanalysis. European Spine Journal. Springer. https://doi.org/10.1007/s00586-020-06453-0
- Negrini, S. at al. (2019) Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: A practical clinical trial. Annals of Physical and Rehabilitation Medicine 62. Elsevier Masson. https://doi.org/10.1016/j.rehab.2018.07.010
- Rożek, K. et al (2016) Effectiveness of Treatment of Idiopathic Scoliosis by SpineCor Dynamic Bracing with Special Physiotherapy Programme in SpineCor System. Ortopedia Traumatologia Rehabilitacja. MEDSPORTPRESS. DOI: 10.5604/15093492.1224616
- Konieczny, M. et al. (2013) Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. DOI 10.1007/s11832-012-0457-4
- Cassar-pullicinos, V. and Eisenstein, M. (2002) Imaging in Scoliosis: What, Why and How? Clinical Radiology. The Royal College of Radiologists. doi:10.1053/crad.2001.0909
- Janicki, J. and Alman, B. (2007) Scoliosis: Review of diagnosis and treatment. Paediatr Child Health. 12(9). Pulsus Group Inc.
- Hawary, R. et al. (2019). Brace treatment in adolescent idiopathic scoliosis: risk factors for failure—a literature review. The Spine Journal 19. Elsevier Inc. https://doi.org/10.1016/j.spinee.2019.07.008
- Horne, J. et al. (2014) Adolescent Idiopathic Scoliosis: Diagnosis and Management. American Academy of Family Physicians. 89(3).
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