The prevalence of scoliosis in the United States is estimated to be relatively low, but it affects 6-7 million people.
Generally speaking, lateral curvatures greater than 10 degrees are diagnosed as scoliosis. Curvatures of less than 10 degrees are often excluded from consideration; a factor that may artificially contribute to this low prevalence.
According to the National Scoliosis Foundation, curvatures up to 20 degrees are considered “mild.” However, talk to any individual with scoliosis of 20 degrees, especially if there are other factors such as obesity or arthritis present, and most will tell you that their functional limitations are anything but “mild.” Scoliosis alone can be a lifelong challenge; when combined with other factors, it can lead to significant impairment.
To understand the management strategies for scoliosis, it’s best to view them from their causal factors. Most scoliotic conditions can be divided into one of two categories: structural/congenital and functional.
As the terms imply, structural/congenital scoliosis has a structural component that is inherited. The degree of curvature is relatively fixed, though it can progress over time. Viewed from behind, this curvature does not correct when the individual bends forward — at which time an asymmetrical rib or shoulder blade elevation will be apparent on the side of the curvature’s convexity. If the scoliosis is determined to be structural, the primary goal is to arrest the progression of the curvature.
Functional scoliosis, on the other hand, is caused by an underlying condition such as an anatomic leg-length inequality, muscle imbalances, muscle spasms after injury, or any combination. Behavioral factors such as chronic poor posture and one-sided recreational or occupational activities will also play a role. The curvature of functional scoliosis is not fixed and, depending on the duration and extent, can be reduced and often corrected through various treatment protocols. Viewed from behind, the functional scoliosis will correct when the individual bends forward.
In most cases scoliosis becomes apparent in adolescent ages, though functional scoliosis can develop anytime in an adult’s life.
Treatment varies based on age and severity. Training in self-care stretches and strengthening exercises are an important part of the treatment protocol, as muscle imbalances are usually present with any form of scoliosis. Manual therapies, such as spinal manipulation, soft-tissue mobilization and therapeutic massage, can also be of value in reducing curvatures and restoring spinal alignment. However, any reductions in curvature as a result of manual therapies are best sustained through an individualized self-care program.
I also have a number of patients who manage their structural scoliosis with regular supportive care.
If an adolescent begins to develop scoliosis, monitoring in conjunction with conservative treatment will give the youth an opportunity to arrest the progression of the curvature and, if functional, reverse it. If, however, the curvature continues to progress to 20 degrees or beyond, bracing is strongly advised.
In rare cases where the scoliosis is severe and causing marked impairment or contributing to progressive spinal degeneration, surgical options may offer a viable strategy to improve function.
Most healthcare providers would agree that a straight spine will function better than a spine with scoliotic curvatures. My experience tells me that it is always better to do something proactive about any form of scoliosis, especially early on when the body is most pliable and able to adapt. Additionally, any contributing and modifiable risk factors, such as obesity, postural weakness or leg-length inequality, should be addressed for maximal success.
Ultimately, most individuals with scoliosis can lead productive lives and manage their condition with a little bit of professional assistance and commitment to self-care.
— Sevak Khodabakhshian is a doctor of chiropractic with Thousand Oaks-based Omega Rehab & Sport, where a team of physical therapists, chiropractors and athletic trainers applies an active-care approach to healthcare. He can be reached for comments, questions or suggestions by e-mail, at Sevakk@omega-rehab.com.