Scoliosis Requires Treatment: What You Need To Know!

Scoliosis is a highly-prevalent spinal condition that involves the development of an unnatural sideways-bending and rotating spinal curve, and in order to counteract the condition's progressive nature, proactive treatment needs to be started as close to the time of diagnosis as possible, when the condition is going to be at its mildest.

What everyone needs to know about scoliosis is that it always requires treatment. Not only does scoliosis range widely in severity from mild to very severe, as a progressive condition, its nature is to get worse over time, hence the importance of proactive treatment.

As a patient's scoliosis journey starts with being diagnosed, let's explore how a diagnosis is reached.

Diagnosing Scoliosis

Diagnosing scoliosis means an unnatural spinal curve that bends to the side and also rotates has developed, and as a complex 3-dimensional spinal condition, a scoliotic curve also has to be of a minimum size to be considered a true scoliosis.

An X-ray is needed to reach a diagnosis, to confirm there is a rotational component, and to determine a patient's Cobb angle measurement; a minimum Cobb angle of 10 degrees is the diagnostic cutting point.

A patient's Cobb angle measurement is determined by drawing lines from the tops and bottoms of the curve's most-tilted vertebrae, and the resulting angle is expressed in degrees.

Cobb angle is known as the gold standard in the diagnosis and assessment of scoliosis because it indicates how far out of alignment a scoliotic spine is, and condition severity is also determined by the Cobb angle:

• Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
• Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
• Severe scoliosis: Cobb angle measurement of 40+ degrees
• Very-severe scoliosis: Cobb angle measurement of 80+ degrees

The higher a patient's Cobb angle, the more out of alignment the spine is, the more severe the condition, and the more likely it is that its effects will be noticeable.

When the spine's healthy and natural curves are in place, the spine is stronger, more flexible, and better able to absorb and distribute mechanical stress incurred during movement; if the spine loses a single healthy spinal curve, it doesn't just affect that single section of the spine, but also the spine's surroundings and the entire spine's biomechanics.

So in order to reach a diagnosis of scoliosis, there has to be an unnatural sideways bending and twisting spinal curve with a minimum Cobb angle measurement of 10 degrees.

Once a diagnosis is reached, the most important decision to make is how to respond with treatment; the choice will shape long-term spinal health and function.

Treatment and Progression

One of the biggest reasons proactive treatment is so important for scoliosis is that as a progressive condition, the nature of scoliosis is to get worse over time, and this means that it's incurable, but it can be highly treatable.

While there are never treatment guarantees, in cases that are diagnosed and treated early, there are fewer limits to what can be achieved.

Scoliosis treatment is going to be more about how to manage an ongoing condition than a permanent cure, and this is why choosing the right treatment approach to commit to can have such far-reaching effects.

As scoliosis progresses, the size of the unnatural spinal curve is increasing, as are the condition's uneven forces, and their effects.

As scoliosis progresses, the spine gets increasingly rigid, making it less responsive to treatment, and making it difficult for some patients to perform certain therapeutic exercises as part of treatment.

As scoliosis progresses, the condition is becoming more severe, more complex to treat, and more noticeable and painful (for adults).

Before getting to the specifics of how scoliosis can be treated, let's talk about condition effects because these are what impact a patient's overall quality of life, and being proactive with treatment can mean minimizing those effects.

Scoliosis Effects and Progression

Scoliosis can affect all ages, but is most commonly diagnosed in adolescents between the ages of 10 and 18 as adolescent idiopathic scoliosis.

The idiopathic designation means not clearly associated with a single-known cause, and approximately 80 percent of known cases are idiopathic scoliosis, and the remaining 20 percent are associated with known causes: neuromuscular scoliosis, congenital scoliosis, and degenerative scoliosis.

Types of scoliosis with known causes are considered atypical and can have unique treatment needs.

Neuromuscular scoliosis is caused by the presence of larger neuromuscular disorders such as cerebral palsy, spina bifida, and muscular dystrophy.

Congenital scoliosis is caused by a malformed spine that develops in utero, and degenerative scoliosis is caused by natural age-related spinal degeneration.

We don't know why most cases of scoliosis initially develop, but we do know what triggers them to progress: growth and development.

Adolescents are the age group most at risk for rapid-phase progression because of the rapid and unpredictable growth spurts during puberty.

While school screening programs for scoliosis were once common across the United States, that has since changed, shifting the onus of recognizing the condition's early signs onto the shoulders of parents, caregivers, and patients themselves.

In adolescents, and children of all ages, the main condition effect is postural deviation caused by the condition's uneven forces disrupting the body's overall symmetry.

Common postural changes associated with scoliosis can include:

• Uneven shoulders
• Uneven shoulder blades
• The development or a rib hump (arch in the rib cage)
• Uneven waistline
• Uneven hips
• Arms and legs that hang at different lengths

Additional changes to watch for can include disruptions to balance, coordination, and gait.

As scoliosis progresses in children, the postural changes become more overt, and scoliosis patients are likely to continue progressing alongside growth and maturity.

Because growth is the trigger for progression, effective treatment has to counteract the condition's progressive nature.

As scoliosis affects adults and children in different ways, let's take a minute to explore how scoliosis progression affects adult patients differently.

Adult Scoliosis and Progression

Although scoliosis is more commonly diagnosed in children, the actual rates of scoliosis increase with age, and the most common type of scoliosis to affect adults is idiopathic scoliosis, and these cases involve adolescents who weren't diagnosed or treated during adolescence.

It's a common scenario that people can live with scoliosis for years unaware, and this is because mild scoliosis isn't associated with functional deficits, its postural changes can be subtle, and for children, scoliosis isn't commonly painful.

Pain, however, is the condition's main effect in adults. Scoliosis doesn't become a compressive condition until skeletal maturity has been reached, and it's compression of the spine and its surrounding muscles and nerves that causes the majority of condition-related pain.

For those who develop scoliosis later in life with no prior history of the condition in childhood, this is degenerative scoliosis: the second most common condition type to affect adults.

As scoliosis progresses in adults, the condition is likely to get more painful as the uneven pressure of the unnatural spinal curve affects the spine, its surroundings, and the entire body.

Scoliosis pain can include back pain and pain that radiates into the extremities due to nerve compression, and as natural age-related spinal degeneration comes into play, adults can progress quickly, even though the progressive trigger of growth has been removed by the lack of skeletal growth.

Scoliosis can also cause muscle pain related to strained, sore, and unbalanced muscles.

As an unnatural spinal curve pulls its surrounding muscles in different directions, it can cause them to become unbalanced and painful as the muscles on one side of the spine can become sore and tight from overuse, while muscles on the opposite side can become weak from underuse.

So muscle pain can also increase as scoliosis progresses, and adults also experience noticeable postural changes, particularly a prominent lean to one side that's most noticeable when in a forward bend position.

Scoliosis Treatment Options

So now that we know why it's so important to treat all types and severity levels of scoliosis, what does treatment involve?

When it comes to understanding the different treatment options available, scoliosis patients have an important decision to make, one that can shape their long-term spinal health.

When scoliosis is first diagnosed, further evaluation classifies conditions based on key patient/condition variables, and treatment plans are shaped around them: patient age, condition type, curvature location, and condition severity.

We've already touched on condition severity and the Cobb angle, and patient age is important because while scoliosis is more commonly diagnosed in children, it affects all ages.

Babies can be born with the condition as congenital scoliosis, and infantile scoliosis refers to idiopathic scoliosis that develops in children between the ages of 6 months and 3 years; juvenile scoliosis refers to scoliosis diagnosed in children between the ages of 3 and 10, and then there is adolescent idiopathic scoliosis and adult scoliosis diagnosed once skeletal maturity has been reached.

Once again, condition type is determined by causation, and when known, a condition's underlying cause needs to be addressed in treatment, and with three main spinal sections, scoliosis can develop in any one section, or in more than one as a combined scoliosis: cervical spine (neck), thoracic spine (middle/upper back), and the lumbar spine (lower back).

Curvature location is important because it helps indicate the types of symptoms of scoliosis a patient can experience; in most spinal conditions, the area of the body located the closest to the affected spinal section is going to feel the majority of the condition's direct effects.

Once a condition is comprehensively classified, the next step is deciding on a treatment approach to commit, and there are two main approaches for patients to choose between: traditional and conservative treatment.

Traditional Scoliosis Treatment

What you need to know is that while all cases of scoliosis require treatment, not all types of treatment offer the same results, so it's important for patients, and their families, to understand the pros and cons of each treatment approach and make an informed decision.

I also want patients to know that while traditional surgical treatment was the dominant choice for many years, that doesn't mean it's the best or only option available, and nonsurgical treatment results show that not all cases of scoliosis require surgery.

Traditional scoliosis treatment commonly funnels patients towards surgical treatment because it doesn't have a strategy for treating mild scoliosis, which is precisely when the condition is likely to be its most responsive; remember, the benefits of early detection are only available to those who respond with proactive treatment.

Traditional treatment commonly recommends watching and waiting for signs of continued progression, but as a progressive condition, virtually every condition is going to get worse at some point, so why not start treatment under that assumption?

Traditional bracing is the only form of treatment applied prior to giving a surgical recommendation when/if patients progress into the severe classification, and this is associated with a number of shortcomings.

The most commonly-used traditional scoliosis brace is the boston brace, and the boston only addresses scoliosis as 2-dimensional, excessive squeezing can actually weaken the spine more over time, and as it's not customized to each patient and is made from rigid plastic, compliance is a challenge, and no brace can be effective if it's not worn exactly as prescribed.

If a patient has severe scoliosis and shows signs of continued progression, spinal fusion is commonly recommended, and this is an invasive, costly, and lengthy spinal surgery that can cost the spine in a number of ways.

Spinal fusion involves fusing the curve's most-tilted vertebrae into one solid bone, and in most cases, rods are attached to the spine with pedicle screws to hold it in place, but this approach is contrary to the spine's movement-based design and is associated with:

• Less strength
• More spinal injuries
• Less spinal flexibility
• A reduced range of motion
• Spinal rigidity and stiffness
• Muscle weakness and pain

When it comes to spinal fusion, just like all surgical procedures, there are risks involved so should be considered carefully, and there is also another treatment option for patients wanting a less-invasive approach.

Conservative Nonsurgical Treatment

What you need to know about conservative scoliosis treatment is that it works towards preventing progression, increasing condition severity and effects, and the need for invasive surgical treatment in the future.

Conservative scoliosis treatment has the goal of helping patients avoid surgery because I feel nonsurgical treatment is more aligned with the spine's natural and movement-based design, so it can offer patients the best possible quality of life.

Conservative treatment is also commonly referred to as functional treatment because it works to preserve as much of the spine's natural strength and function as possible.

Here at the Scoliosis Reduction Center, my patients benefit from a proactive treatment approach that's started as close to the time of diagnosis as possible; while there are never treatment guarantees, scoliosis is simpler to treat when mild and before significant progression has occurred.

Conservative treatment is also integrative and benefits from what multiple condition-specific treatment disciplines can offer, and patients of the Center benefit from being able to access multiple forms of treatment under one roof.

As the complex nature of scoliosis necessitates a customized treatment approach, I customize each and every treatment plan around the condition's classification points and combine chiropractic care, physical therapy and scoliosis-specific exercises, corrective bracing, and rehabilitation.

Chiropractic Care as Scoliosis Treatment

As a structural condition, scoliosis has to, first and foremost, be impacted on a structural level, and I work towards this through scoliosis-specific chiropractic care; general chiropractic is too general.

Through a series of chiropractic techniques and manual adjustments, I have the goal of adjusting the position of the curve's most-tilted vertebrae at the curve's apex back into alignment with the rest of the spine.

So while traditional scoliosis treatment chooses to fuse these bones together to eliminate movement (progression), conservative treatment looks to correct the curvature on a structural level, and this also impacts the spine's surroundings and can relieve pressure on nearby nerves, improving neurological function.

Once I start to see structural results, I want to help patients increase their core strength.

Physical Therapy and Scoliosis-Specific Exercises

It's not just the spine that's in charge of maintaining the spine's natural curves and alignment, but also the spine's surrounding muscles that provide the spine with support and stabilization.

Physical therapy and scoliosis-specific exercises (SSEs) can help improve posture, increase core strength, address areas of muscle imbalance, and stimulate specific areas of the brain for improved brain-body communication.

Guidance on how to lead a scoliosis-friendly lifestyle can also be helpful, particularly when it comes to preventing spinal degeneration.

Corrective Bracing

Corrective bracing is particularly effective on growing spines so wearing a brace is a common facet of treatment for adolescent scoliosis.

Modern corrective bracing can offer corrective potential as it addresses the condition's true 3-dimensional nature and vertebral rotation.

Corrective bracing like the ScoliBrace is also fully customized to suit a patient's body/curvature type so is more comfortable to wear and less bulky, making young patients more likely to comply.

While no brace on its own is enough to correct a scoliosis, when combined with other types of treatment, it can augment corrective treatment results by pushing the spine into a corrective position.

While corrective bracing has the goal of correcting scoliosis when it comes to childhood scoliosis, when used for adult scoliosis, the focus is more about stabilizing the spine and short-term pain management.

Rehabilitation

As a progressive condition, scoliosis is incurable, but it can be highly treatable, but patients need to understand that scoliosis treatment is more about managing an ongoing condition than working towards a permanent cure.

Rehabilitation involves further healing and stabilizing the spine through a series of custom-prescribed home exercises, and continued chiropractic care can also be important; think of how orthodontic braces work to correct crooked teeth by applying pressure over time.

Once the braces are removed, however, a retainer is commonly prescribed to hold the structural correction, and the same can be said of continued chiropractic care.

Chiropractic care and an exercise-based rehabilitation program that patients can do from home can help further heal and stabilize the spine for long-term sustainable treatment results.

Conclusion

Curve progression needs to be handled proactively in the best interest of sparing patients the hardships associated with increasing condition severity and invasive surgical treatment.

As a progressive condition, where a scoliosis is at the time of diagnosis is not indicative of where it will stay; only proactive treatment can work towards counteracting the condition's progressive nature.

While we don't always know what causes the majority of scoliosis cases to develop initially, we do know that it's growth that triggers its progression, which is why childhood scoliosis should be taken particularly seriously.

When scoliosis is diagnosed early in its progressive line and is met with a proactive treatment response, this means starting treatment when the condition is at its mildest and is likely going to be the simplest to treat.

Surgical treatment can help straighten a bent spine, but spinal fusion does come with some serious potential risks, side effects, and complications, so should be considered carefully, and in addition, many cases of scoliosis don't require surgical treatment, particularly when scoliosis screening leads to an early diagnosis.

Untreated scoliosis and/or particularly severe cases can lead to complications such as lung and cardiac issues, digestive issues, migraines, and more.

So what you need to know about scoliosis treatment is that it's necessary to manage an ongoing condition and achieve corrective results that can improve a patient's quality of life throughout treatment and beyond.