Moderate Scoliosis: Symptoms, Diagnosis, Treatment, & More

As a progressive condition, where scoliosis is at the time of diagnosis is not indicative of where it will stay. Mild scoliosis can easily become moderate, and moderate can easily progress to severe or very severe, particularly if left untreated or not treated proactively. Continue reading to learn more about moderate scoliosis, including symptoms, diagnosis, and treatment.

Scoliosis is a complex condition to treat; not only are there different condition types, it affects all ages and ranges from mild to moderate and severe to very severe. The majority of scoliosis patients are diagnosed in the moderate stage, as this is when symptoms tend to become noticeable.

Let’s start with the parameters that have to be met in order to be diagnosed with moderate scoliosis.

Being Diagnosed with Moderate Scoliosis

When viewed from the sides, the spine will have a soft ‘S’ shape, and when viewed from the front or back, it will appear straight. This is due to the spine’s natural and healthy curves at each of its main sections.

The spine has three main sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back).

The spine’s natural curves make it stronger, more flexible, and better able to absorb stress, like a coiled spring.

There are a number of spinal conditions that involve a loss of its healthy and natural curve, scoliosis being one of them.

Scoliosis is a highly-prevalent structural spinal condition with close to 7 million people currently living with the condition in the United States alone, and it is the leading spinal condition among school-aged children.

Scoliosis is an unnatural sideways spinal curve with rotation and a minimum Cobb angle measurement of 10 degrees.

Part of diagnosing scoliosis involves comprehensively assessing conditions to further classify them based on specific patient/condition variables such as patient age, condition type, curvature location, and condition severity.

Condition severity is determined by a patient’s Cobb angle, which is a measurement taken during an X-ray that tells me how far out of alignment a scoliotic spine is.

Lines are drawn from the tops and bottoms of the most-tilted vertebrae of the curve, and the resulting angle is expressed in degrees:

• 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

So what is moderate scoliosis: an unnatural sideways spinal curve, with rotation, and a Cobb angle measurement of between 25 and 40 degrees.

In a healthy spine, the vertebrae are rectangular in shape and are stacked on top of one another in a straight and neutral alignment.

When the spine is misaligned, it doesn't function properly, and the biomechanics of the entire spine is disrupted.

As each curve is dependent on the health of the others, if the spine loses one healthy curve, it can respond by putting in compensatory curves, which is why the entire spine is affected.

The higher the Cobb angle, the more out of alignment the spine is, the more severe the condition, and the more likely it is that its symptoms are going to be noticeable.

Proactive treatment works towards preventing increasing condition severity (progression), escalating symptoms, and the need for more invasive treatment in the future; the benefits of early detection are only available when a diagnosis is responded to with proactive treatment.

So what does moderate scoliosis look like? Is it easy to detect?

What are the Symptoms of Moderate Scoliosis?

As you see from the wide range of Cobb angle measurements, condition severity ranges widely.

As scoliosis progresses from mild to moderate, its symptoms tend to become more noticeable, which is why the majority of patients get diagnosed after they have progressed from mild to moderate.

At the mild level, the condition’s symptoms can be subtle, and functional deficits don’t commonly become noticeable until the later stages of progression.

Scoliosis introduces a lot of uneven forces to the body, and those uneven forces can disrupt its overall symmetry.

As the condition’s most prevalent type is adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18, this is the form we’ll focus on for our current purposes.

Again, while each case is different, and even within the range of 25 to 40 degrees, symptoms of moderate scoliosis can still vary from patient to patient; however, common symptoms of moderate scoliosis in adolescents include:

• Uneven shoulders
• Uneven shoulder blades, with one protruding more than the other
• The development of a rib arch (especially common with thoracic scoliosis)
• An uneven waistline
• Uneven hips with one sitting higher than the other
• Arms and legs that appear to hang at different lengths

In addition to these kinds of postural deviation, changes to gait, balance, coordination, and ill-fitting clothing are further indicators of moderate scoliosis.

While having one or two asymmetries present doesn’t guarantee a person has scoliosis, it does warrant the need for further testing, particularly as early detection can be so beneficial when it comes to treatment.

Moderate Scoliosis Symptoms in Adults

In adults, moderate scoliosis can cause the same types of postural deviation as in adolescents, but moderate scoliosis pain can also be an issue.

Once skeletal maturity has been reached, the condition becomes compressive, and it’s compression of the spine and its surrounding muscles and nerves that causes the majority of condition-related pain.

So, in addition to the aforementioned postural changes, a prominent lean to one side and pain are common symptoms of moderate adult scoliosis.

Pain can involve localized back pain or radicular pain felt throughout the body. Remember, nerves are like branches of a tree, fanning off in multiple directions, which is why a nerve that’s compressed along the spine can cause pain felt far from its source.

In fact, most adults who come to see me for a diagnosis complain of pain felt in the arms, hands, and feet.

Moderate scoliosis back pain in adults can range from mild and intermittent to chronic and debilitating. Moderate scoliosis hip pain can be due to stretched ligaments. If a scoliotic curve has caused the pelvis to become tilted, one hip takes on more weight than the other, leading to uneven wear and tear on surrounding tendons and supportive muscles and more pain.

The uneven forces the condition introduces equals uneven pressure on the spine and its surrounding muscles and nerves.

So once a diagnosis of moderate scoliosis is given, I’m commonly asked if it will stay the same or get worse.

Can/Will Moderate Scoliosis Get Worse?

As mentioned earlier, as a progressive condition, scoliosis has, in its very nature to worsen over time.

In adolescent idiopathic scoliosis, the idiopathic designation means not clearly associated with a single causative source; instead, scoliosis is thought to be multifactorial, meaning caused by the combination of multiple variables that can vary from patient to patient.

While we don’t know what causes idiopathic scoliosis to develop, we do know what triggers its progression: growth and development.

I also like to point out to my patients that just because we don’t know why a condition developed doesn’t mean we don't know how to treat it, and fully understanding its etiology wouldn’t necessarily change the course of treatment or its outcome.

Considering the stage of growth and development teenagers are in, or are entering into, rapid and unpredictable growth spurts put them at risk for rapid-phase progression.

So will it get worse: virtually every case of scoliosis will get worse at some point, and in patients who have growth yet to go through, progression is likely to be faster, while adult patients who’ve reached skeletal maturity tend to progress at a slower rate.

The best time to start treatment, regardless of age, is always now.

The only way to manage a condition’s progressive nature is through the application of a proactive treatment, so let’s move on to how to treat moderate scoliosis.

How to Treat Moderate Scoliosis

Once a diagnosis of moderate scoliosis is given, the most important decision to be made is how to treat it moving forward; there are two main scoliosis treatment approaches for patients to choose between, differing in their end goals and potential outcomes.

So when it comes to moderate scoliosis treatment options, we’re talking about the difference between a traditional surgical approach and a modern conservative non-surgical treatment approach.

Again, each approach offers patients very different outcomes, so I caution patients to make sure they are aware of all treatment options available to them, including the pros and cons of each.

Traditional Scoliosis Treatment Approach for Moderate Scoliosis

I keep mentioning proactive treatment, but a traditional approach is more accurately described as reactive than proactive.

Traditional scoliosis treatment doesn’t have a strategy for treating scoliosis while mild, and instead chooses to watch and wait until conditions progress past the surgical-level threshold into the severe classification.

The only form of treatment applied prior to a surgical recommendation is traditional scoliosis bracing, typically applied while in the moderate classification level.

There are a number of different types of scoliosis braces, and not all are created equal.

The most commonly-used traditional brace is the Boston brace, and it has remained unchanged since its design in the ‘70s.

The Boston brace is associated with a number of shortcomings:

• Mass-produced = uncomfortable and bulky to wear
• Squeezes spine unnaturally = weakens spine over time
• Increase postural deviation
• Squeezes the spine from the sides = only addressing it as a 2-dimensional condition, not 3-dimensional
• Compliance issues

Because of the rotational component, scoliosis is 3-dimensional, and as the Boston only addresses it as 2-dimensional, its efficacy is limited.

Due to its mass-produced design, the brace isn’t customized to suit individual body/condition types, making it less comfortable and bulkier to wear, and this leads to compliance issues.

For a brace to be effective, it has to be worn correctly, as prescribed, and the Boston is often prescribed for full-time wear (18-23 hours a day for anywhere up to 5 years).

If traditional bracing is applied during the moderate or severe stage but doesn’t slow progression, patients are commonly funneled toward spinal fusion surgery.

Does Moderate Scoliosis Require Surgery?

All surgical procedures come with their share of risks, and spinal fusion surgery is no exception.

Spinal fusion is a lengthy, costly, and invasive procedure that aims at stopping progression by fusing the most-tilted vertebrae at the apex of the curve into one solid bone; this eliminates movement in the area, and related progression.

While there are different types of spinal fusion, the spine is commonly held in place by rods and screws that are attached to the spine permanently; in fact, if there is a hardware-related issue, the only recourse is more surgery.

Keep in mind that the younger a patient is, the longer those rods have to last, and there is a significant gap in the research/data on hardware longevity.

As mentioned, the end goal of spinal fusion is stopping progression, not correction.

In the context of scoliosis, achieving a correction means the condition is impacted on a structural level: scoliosis is a structural spinal condition, so treatment has to, first and foremost, impact it on a structural level.

So while spinal fusion can successfully straighten a crooked spine, that’s not the same as working towards corrective results that preserve the spine’s natural function and strength.

A spine that’s held in a corrective position is more prone to injury, weaker, and tends to be less flexible.

Following are some risks and potential complications associated with the procedure itself:

• Excessive blood loss
• Nerve damage
• Infection
• Adverse reaction to the hardware used

In addition to the procedure itself, spinal fusion is associated with a number of potential side effects, both short and long-term:

• Pain at the fusion site
• Nerve damage
• Hardware malfunction
• Loss of spinal flexibility
• Decreased range of motion
• Increased risk of injury

The biggest complaint of patients post-surgery is the loss of spinal flexibility and range of motion, making it difficult for some to partake in once-loved activities.

There is also the recovery time to consider, and while each patient will respond to surgery in their own way, restrictions immediately following surgery generally include bending, lifting, driving, etc.

In addition, the main reason patients opt for a surgical response to their scoliosis is they think the procedure will return their pre-scoliosis bodies, but as the procedure focuses on the spine and the spine alone, it does little to address related postural deviation, such as uneven hips.

There is also the very real psychological impact of living with a fused spine: fear of trying new things can impact the overall quality of life.

Fortunately, the majority of scoliosis cases can be treated non-surgically, so let’s move on to a modern non-surgical treatment approach.

Conservative Scoliosis Treatment Approach for Moderate Scoliosis

Here at the Scoliosis Reduction Center, I offer patients a modern conservative chiropractic-centered treatment approach that has correction as its end goal.

My treatment approach is proactive because it applies multiple forms of treatment as close to the time of diagnosis as possible.

While there are no treatment guarantees, the earlier treatment is started, the more likely it is to be a success.

It’s easier to treat scoliosis when the curve is at its smallest, prior to significant progression and increasing spinal rigidity, and before the body has had time to adjust to the unnatural curve’s presence.

As an unnatural spinal curve increases in size, the spine gets more rigid, and this makes it less responsive to treatment.

In fact, when it comes to treating moderate scoliosis in adults, often work has to be done to first restore a baseline level of spinal flexibility before starting the regular course of treatment.

My approach is integrative, meaning I combine multiple condition-specific treatment modalities for the best results: chiropractic care, in-office therapy, corrective bracing, and custom-prescribed home exercises.

Through chiropractic care, I work towards adjusting the most-tilted vertebrae back into alignment with the rest of the spine.

Through a variety of therapies and scoliosis-specific exercises (SSEs), I help patients increase their core strength, so the spine is optimally supported by its surrounding muscles.

In addition, certain scoliosis-specific exercises are known to activate specific areas of the brain for enhanced brain-body communication, postural remodeling, and improved body positioning.

Custom-prescribed home exercises can also help establish a home-rehabilitation program to further stabilize the spine for long-term sustainable results.

As an incurable condition, people with scoliosis will have it for life, but the condition is highly treatable, and work will just need to continue to sustain treatment results: similar to getting braces removed from the teeth and having to wear a retainer after.

The moderate scoliosis brace I favor is the ultra-corrective ScoliBrace, which addresses many of the shortcomings associated with traditional bracing and represents the culmination of what we’ve learned about scoliosis and bracing efficacy over the years.

Modern Corrective Bracing and Moderate Scoliosis

The ScoliBrace is a 3-dimensional scoliosis brace for children, adolescents and adults.

The first significant difference between the ScoliBrace and the Boston is that, unlike the Boston, the ScoliBrace is custom designed to address the specifics of each patient’s body type and curvature type.

Using state-of-the-art scanning technology, each brace is as bespoke to its wearer as possible, making it more comfortable and less bulky to wear, improving compliance rates.

In addition, the ScoliBrace works by pushing, rather than squeezing, the spine, so it’s not known to weaken the spine, and as a 3-dimensional brace, it addresses the condition’s true 3-dimensional nature.

The over-corrective design uses spinal coupling rather than the 3-point pressure system of traditional bracing, and when combined with other forms of proactive treatment, the ScoliBrace can help augment corrective results.

So to summarize, the ScoliBrace addresses the issues associated with traditional bracing in the following ways:

• Each brace being unique and customized to suit the patient’s body/condition type
• The ScoliBrace pushes the spine, instead of squeezing it
• Improving postural deviation
• Addressing the condition’s true 3-dimensional nature (rotational component)
• The brace is more comfortable and easy to put on and take off, resulting in better compliance
• Can help augment corrective results

While no one form of treatment on its own will be able to impact scoliosis on every level, as its complex nature necessitates, when multiple treatment types are integrated into a proactive treatment plan, there are fewer limits to what we can achieve.

Conclusion

Scoliosis is a highly-complex structural spinal condition that involves the development of an unnatural sideways spinal curve, with rotation, making it a 3-dimensional condition.

A measurement known as the Cobb angle places conditions on a severity scale based on how far out of alignment the spine is.

For a diagnosis of moderate scoliosis to be given, the unnatural spinal curve has to have a Cobb angle measurement of between 25 and 40 degrees.

The majority of my patients are moderate scoliosis patients because it’s not uncommon that mild scoliosis goes unnoticed until it progresses to moderate when symptoms tend to become more noticeable.

The most common symptom of moderate scoliosis in adolescents is postural deviation: uneven shoulders, and hips, the development of a rib arch, an uneven waistline, and arms and legs that appear to hang at different lengths.

The most common symptom of moderate scoliosis in adults is pain: back or radicular pain felt throughout the body, like in the arms, hands, and feet.

When it comes to treatment for moderate scoliosis, the two main approaches to choose between are traditional and conservative.

While a traditional treatment approach funnels patients towards surgery, a modern conservative chiropractic-centered approach strives to preserve as much natural spinal function as possible while helping patients avoid surgery.