What is scoliosis

What is scoliosis?

Scoliosis is a general term that describes changes in the shape and position of the spine, thorax, and trunk, it’s a three-dimensional deformity of the spine.

So instead of the spine appearing straight, it might look more like an “S” or “C” shape.

This three-dimensional definition is given secondary to the fact that the vertebrae, the individual bones that make up the spine, shift in the frontal plane, but also rotate in the direction of the curve. For example, if individual states that they have a “right thoracic curve”, this means that the vertebrae in their thoracic spine have shifted to the right and are rotating to the right. With the shifting and rotation, changes will be seen in the posture of the trunk and pelvis, the ribs, and the arms and legs.

Around 80% of cases are idiopathic, which means the exact cause is unknown. Idiopathic scoliosis is generally classified by using a combination of the Cobb angle (more on this later), age, and location (see picture below). And 20% of cases are due to an underlying condition or other causes. These include congenital, neuromuscular (Spinal Muscle Atrophy), and other causes (surgery).

How is scoliosis diagnosed?

Observing someone’s standing or moving posture (commonly called Adam’s test) may lead to suspicion, but by itself, is not diagnostic of scoliosis.

In Adma’s test, the patient has to take off his/her t-shirt so that the spine is visible. The patient needs to bend forward, starting at the waist until the back comes in the horizontal plane, with the feet together, arms hanging, and the knees in extension. The palms are held together. The examiner stands at the back of the patient and looks along the horizontal plane of the spine, searching for abnormalities of the spinal curve, like increased or decreased lordosis/ kyphosis, and an asymmetry of the trunk

If notable asymmetries are recognized, further imaging is often the next step. Once an x-ray has been performed, a confirmed Cobb angle is needed for a diagnosis of scoliosis.

A Cobb angle is the sum of the tilt of both the upper-end vertebrae and lower-end vertebrae that, together, determine the significance of the curve.

The Scoliosis Research Society has determined that a Cobb angle of more than 10 degrees with notable rotation confirms an idiopathic scoliosis diagnosis. Remember it is important to be evaluated by a skilled clinician who is an expert in scoliosis and can put tailored and appropriate care based on the severity of the case.

Who does scoliosis tend to affect?

Both males and females can be diagnosed with scoliosis, however, females are likely to progress at a greater rate. Most of the time we see a progression during the period of rapid growth, and during puberty. That’s why this period should be well monitored by the parents and a healthcare professional in can they notice any deviation in the spine.

With all of this being said, there is no need to be afraid. Since the majority of the cases respond great to conservative care, which is often multifactorial. Conservative treatment of scoliosis may include scoliosis-specific exercises, brace wear, and modification of certain activities and movements.

Is it possible for scoliosis to progress in adults?

Briefly:

• If you have a curve less than 10°, remember this is not scoliosis.
• Scoliosis curves less than 30° will often remain stable throughout adulthood.
• Once curves get above 30°, there is an increased risk for progression.
• Once you reach greater than 50°, it is almost certain scoliosis curves will progress.
• if you are an adolescent, and the spine is still growing, the cobb angle is often used to guide treatment options.
• For example, having a curve of 25 degrees, you should observe the evolution by following up with your doctor, who will order imaging for the spine according to your clinical examination.
• If you have a curve between 40 and 45 degrees, bracing is usually utilized with the goal is to slow down the progression.

There is currently no “best” exercise for scoliosis

If you search the internet for scoliosis-specific exercises, you will find a lot of exercise options, from functional to breathing techniques from postural correction to strengthening exercises.

While these may help improve overall strength, increase function and even provide symptom relief, the current research suggests that these scoliosis-specific exercises are not effective in reducing cobb angle or preventing curve progression in adolescent scoliosis.

• Day et al. 2019: “There is insufficient evidence to suggest that both Schroth and SEAS methods can improve the Cobb angles in patients who have AIS compared to no intervention.
• Fan et al. 2020: “this study has proven that there is no Insufficient evidence to prove that SSE with or without other conservative treatments can reduce Cobb angle.
• Tolo and Herring 2020: “We found no studies that provide valid evidence that an exercise method prevents progression of AIS (adolescent idiopathic scoliosis) in patients during their peak growth period.”

For sure there are a lot of studies that demonstrating that exercising does improve spinal curves, but if you look closely, these are usually deemed clinically insignificant (no more than 4 to 6°) (Kuru et al. 2016, Monticone et al. 2014, Thompson et al. 2019, Zhou et al. 2021)

High quality research comparing scoliosis-specific exercises to general exercise for the long term management of idiopathic scoliosis is still needed, but there are still 2 positive takeaways.

The first is that exercise is still warranted for those with scoliosis, but it does not need to change cobb angle or spinal curve to be considered successful, as they are still very beneficial for improving overall function and perceived status (Scheiber et al 2019).

And two, the exercise approach does not seem to make a significant difference. For example, Yagaci et al. 2018 found that general core stabilization exercises had similar effects in the short term when compared to scoliosis specific exercises.

This suggests that being active is likely recommended. From resistance training to Pilates or any type of sport you like and you love. which in turn means you are much more likely to stick with it in the long term.