Scoliosis: Curvature of the Spine

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Etymology

The word Scoliosis, also known as kyphosis, spinal curve, back curve, structural scoliosis, functional scoliosis, and spinal muscle atrophy (abbreviated as SMA) is a word from both Latin and Ancient Greek literally meaning  “twisting, torsion“.

scoliosis-vertebral-column      scoliosis-vertebral-column

Definition

Scoliosis is a medical condition regarding the deviation of the spine’s curvature. The biomechanical deformity, which most often originates during the prepubertal development of a person’s body, can also be caused by cerebral palsy, muscular dystrophy, Marfan syndrome, neurofibromatosis (a type of tumor), environmental, genetic, and unknown reasons. It affects about 3% of the population, mostly females between the ages of ten and twenty. There are different cases of scoliosis, some are mild and can be minded regularly, others are severe and require bracing or surgery for they might cause disability, respiratory problems and other complications within the chest area.

Anatomy of the vertebral column

The vertebral column is a flexible column composed of a series of bones, the vertebrae. The main function of the vertebrae is the protection of the spinal cord. Its other functions are:

Each vertebra has a central part or centrum, and a “Y” shaped neutral arch. The vertebra creates a cylindrical space (the vertebral foramen) for the spinal cord. They are separated by a cartilaginous disc that offers flexibility to the vertebral column and amortizes the shock in locomotion.

The vertebral column is characterized by a variable number of curves:

  • A sacral curve, in which the sacrum curves rearward and supports the ventral organs
  • An anterior cervical curve, which evolves soon after delivery as the head is lifted
  • A lumbar curve, also anterior, which evolves as the child rests and walks. The lumbar curve is a perpetual characteristic only of humans and their bipedal ancestors.

It is important to understand the structure of the vertebral column for it is the part of the body that is affected by this condition.

Signs and Symptoms

Since the signs and symptoms are not very evident during the initial stages, it is easy to ignore the condition.

This is especially true for children. It isn’t always easy to read the symptoms to find out about the condition until they reach adolescence and enter the phase where the growth of the condition becomes rapid.

For adults, the diagnosis can be even trickier. According to a study, more than 65 percent cases remained undiagnosed because the symptoms were not clear enough. Most adults with back pain often take the condition lightly – especially if the pain is mild. Moreover, it can become even harder to detect if the spinal curvature is also mild. Unfortunately, there have been instances where more than 10 percent people remained undiagnosed of scoliosis even with moderate to severe spinal curvature.

The key here is to know what exactly to look for. Having the right information will ensure you are more alert with any changes in the spine to detect the real problem. This way, you can identify scoliosis at its initial stages and treat it before it gets worse.

The following are some common symptoms you may experience with scoliosis:

Genetics

If you have a family history of having scoliosis, there are higher chances for you to have the same medical condition. As revealed by the American Academy of Orthopedic Surgeons, around 10 percent cases with scoliosis have also reported family history with the condition.

Various other associating conditions running in the genes of the patient may also increase the chances of scoliosis. An issue with the development of spine is also a major reason that could lead to scoliosis. This could be due to any injury or defect at birth. A major trauma during birth can also hamper the spine and its health.

Wrong Posture

Abnormal posture is usually the first symptom that is most evident in patients with scoliosis. Since the spine is grown in a curvy direction, it disturbs the natural alignment of the hips, waist, and even the shoulders. The posture may not always be extremely visible. However, if you notice carefully, the lack of alignment is quite visible.

Misaligned Clothes

Even if your body is not showing posture problems that are highly prominent, clothes can give you better signals. Clothes naturally appear asymmetrical and ill-fitted on a misaligned body. For instance, tilted hips in a skin-tight trouser or dropped shoulder are some easy catches to find out if there is a problem.

The symptoms may become even more prominent if the curves become more severe. When in doubt, see if there is a prominent unevenness in:

  • The sleeves of your shirt
  • Neckline
  • Pant legs
  • Hemline

Back Pain

Back pain associated with severe scoliosis is often constant and persists for longer. Moreover, runners should especially be very conscious about any sort of unexplained pain that lasts longer as it is often associated with scoliosis.

Since the spine is curved, it puts the entire pressure on the nerves and the cord. This does not only lead to constant pain in the lower back but also numbness and weakness in the lower extremities.

Fatigue

Having fatigue after standing or sitting for an extended time period is another strong indication of having scoliosis. However, this depends on the severity of the spinal curve. When the curves continue to become more pronounced, it makes it difficult for the muscles around it to function with efficiency. The harder the muscles work to operate the body with perfect balance and alignment, the more damage it may cause them. Moreover, as the severity continues to progress, it also puts additional pressure on the chest cavity. This makes breathing difficult for the patient and also leads to chronic fatigue.

All in all, it is imperative to remember that scoliosis is a serious and complex condition. Instead of diagnosing it on your own, you can observe the symptoms and let the diagnosis be handled by a professional medical expert only. An accurate diagnosis will include an x-ray of the spine.

Some Prominent Symptoms

Most symptoms are noticeable just by observing one’s bodily structure:

  • Uneven hips (one might lower than the other)
  • Asymmetrical shoulder blades
  • Uneven shoulders (one might be higher than the other)
  • Irregular waist
  • One side of the ribcage is more prominent than the other
  • Disproportionate musculature on one side of the back and spine area
  • The body tilts on one side

Other symptoms include:

Some symptoms may be more severe in some individuals than in others for every scoliosis case is different.

In some cases of structural scoliosis, along with other symptoms mentioned above, the individual may experience constipation and painful menstruations due to the curvature of the spine which can compress the stomach and other organs in the lower abdomen area. A mild kyphosis could even be overlooked by untrained eyes. Nonetheless, if the spinal curve advances the symptoms can become obvious.

Most people believe in the misconception that abnormal posture is one of the reasons behind scoliosis. However, in reality, it’s only a symptom. The real cause of scoliosis is not clear.

The progression in the spinal curve occurs because our brain fails to identify the misalignment of our body’s posture. Since the recognition is not made, it fails to send the right signals to the muscles. As a result, the spine continues to receive the wrong signals, and eventually, grows abnormally.

 

Types of scoliosis and causes

Idiopathic

65% of all cases of scoliosis are idiopathic which means that they are caused by unknown reasons.  Idiopathic kyphosis affects mostly individuals who go through adolescence when the individual’s skeleton is developing rapidly. Studies have shown that this type of SMA could potentially be heritable, therefore it could run in one’s family. Specific genes have not been clearly identified, although the CHD7 gene has been linked to idiopathic scoliosis as well as genes figuring bone metabolism and formation and the structure of connective tissue. Idiopathic scoliosis is cataloged by the age of the conditions’ development:

  • Infantile idiopathic scoliosis which evolves from birth to 3 years old (referred to as early onset scoliosis EOS)
  • Juvenile idiopathic scoliosis evolving from 4 to 9 years old (referred to as early onset scoliosis EOS)
  • Adolescent idiopathic scoliosis (referred to as AIS) evolving from 10 to 18 years old

A very wide-spread misconception is that carrying heavy objects and/or sleeping in certain positions might cause scoliosis.

Congenital scoliosis

Fifteen percent of all scoliosis cases are attributed to malconformations, such as abnormal formation and segmentation of the spine, during the first couple of weeks in utero, resulting in deformed vertebrae, fused vertebrae and leading to a sideways curvature of the spine.

Secondary scoliosis

A tenth of the scoliosis cases, known as secondary scoliosis, are caused by neuropathic and myopathic conditions such as poliomyelitis, cerebral palsy, spinal cord trauma, muscular dystrophy, spinal muscular atrophy, and myotonia. Secondary scoliosis can cause some muscle mass loss, especially in the back area and can lead to limited muscular support of the spine. As a consequence, the spine is drawn to unusual directions.

Degenerative scoliosis

There is also a type of scoliosis that is due to aging and other changes which evolve in an advanced stage of life: degenerative scoliosis. It is due to the disintegration of the vertebral column.

Functional scoliosis

There is another type of scoliosis, the functional or nonstructural scoliosis, that is caused by temporary causes that affect the lateral curvature of the spine. A difference in leg heights could cause this type of scoliosis and could easily be corrected.

Syndromic scoliosis

Some scoliosis (“syndromic scoliosis”) are linked to conditions, less or more related to bones, the skeleton and its muscles, such as Proteus syndrome, osteogenesis, Loeys-Dietz syndrome, and Marfan’s syndrome, and Prader–Willi syndrome, among others.  Some of these conditions can cause kyphosis (from Ancient Greek “hump”, also known as round back or Kelso’s hunchback) which is an unnatural and extreme convex curvature of the spine in the cervical, thoracic and sacral regions.  Furthermore, other conditions could lead to Lumbar hyperlordosis is also called hollow back, saddle back, and swayback. It is an eccentric lordosis, an unnatural inward curvature of the lower spine.

Scoliosis is known to be ruled by an orthopedic law, the  “Hueter-Volkmann Law” (created by two orthopedics Carl Hueter and Richard von Volkmann) which states that the development of bones is inhibited by compression forces and stimulated by tensile forces. This rule has been understood by cause of clinical observations and animal experiments. Some developing animals’ plates have been loaded. The effect of the weight was significant: the development of the plates has been inhibited by more than 40%. These studies could validate the law indeed.

The scoliosis curvature of the spine has a “C” or an “S” shape and it can present:

  • A right thoracic curve is the bending of the vertical curve in the center of the back to the right side of the upper back, in the thoracic area
  • A right thoracolumbar curve bending from the right upper back side to the lumbar region, in the lower back.
  • A right lumbar curve bending from the right side of the lower back to the same lower back region
  • A double major curve that involves a right thoracic curve and left lumbar curve. These two curves might counteract each other making scoliosis less obvious
  • A triple curve that is quite rare.

Diagnosing scoliosis and medical examinations

If one presents the signs and symptoms that have been mentioned above, one should seek medical help and assistance because even mild scoliosis can progress and cause trouble. Adolescents and young people, especially females, have a higher risk of developing this condition than the rest of the population. Periodical exams and check-ups are advised, specifically for young individuals still growing and developing their bodily structure.

Physical examination

During a typical exam, the doctor will need to know the detailed medical history and will ask about the recent growth of the patient. The patient might be asked to bend forward as far as possible ( the Adam’s Forward Bend Test). The orthopedic pediatrician will look for asymmetrical physical traits such as a more prominent shoulder blade, uneven hips, and waist. Along with that, there could be a neurological exam to identify possible numbness, unusual reflexes, and muscle weakness.

Scoliometer to Measure Spine Rotation

While the patient is bending forward the doctor might use a scoliometer, also known as  “inclinometer”, to determine the exact angle of trunk rotation (ATR).

X-ray and the Cobb angle measurement

If the orthopedic doctor suspects the patient of having scoliosis, a plain X-ray of the spine may be necessary in order to confirm the condition’s presence. Using the X-ray, the Cobb angle measurements follow. The Cobb angle is found by drawing two perpendicular lines: one is traced from the spine’s most tilted vertebra above the sideways curve’s apex, the other is traced from the most tilted vertebra beneath the apex. If t6he Cobb angle, found between the two perpendicular lines, is of at least 10 degrees, the patient shall be diagnosed with scoliosis.

cobb-angle-measurement-scoliosis-vertebral-column

Further exams, such as MRI, are required if the confirmed scoliosis is suspected to be caused by a tumor or other hidden conditions. As mentioned before, some types of scoliosis, known as syndromic scoliosis, are caused in fact by syndromes and could require other types of treatments.

There are some aspects to be taken into consideration to diagnose a patient with scoliosis:

  • Lateral curvature of the spine (measured by the Cobb angle)
  • Axial rotation, wich is the unusual vertical rotation of the spine could be added to the lateral curvature
  • Skeletal maturity is critical, specifically for teens and children, for deciding the scoliosis treatment.

The case of scoliosis which has nothing to do with congenital, secondary, degenerative, neuromuscular, syndromic and functional scoliosis is called idiopathic scoliosis. A patient can be diagnosed with idiopathic scoliosis only if the other types of scoliosis are excluded.

Risk factors

Some people have a higher risk of developing scoliosis:

  • Females are more prone to develop the condition than males, even though boys and girls develop scoliosis at the same rate.
  • Adolescents. The signs and symptoms usually reveal in the prepubertal phase when the adolescent structure grows more rapidly.

adolescents-girls-women-scoliosis

  • Individuals with a family history of scoliosis. Even though the studies have not yet identified the exact genes that are linked to scoliosis, it tends to be a hereditary condition

Those who have reached skeletal maturity have a lower risk of developing the condition, although some cases such as degenerative scoliosis, functional scoliosis, and syndromic scoliosis do not depend on the skeletal maturity and can evolve later in life. In some cases, if scoliosis is not treated and it becomes severe, it could cause a cardiac and respiratory difficulty and limited mobility.

The most common type of scoliosis, idiopathic scoliosis, causes little to moderate pain, physical disability, and cosmetic concerns.

Treatment

Before deciding the remedy for scoliosis, some aspects must be taken into consideration:

  • The severity of the curve is quite important to determine the remedy for scoliosis since some cases (90% of the scoliosis cases) might require just periodical checkups every four to six months to monitor the scoliosis progression while in other cases the spine’s curvature could be larger, therefore it could be more likely to progress.
  • The curve pattern such as the “S” shaped curvature is more likely to progress than the “C” curve pattern.
  • The location of the curve is important because curvatures in the thoracic area are more likely to progress than the curves located in the lower or upper areas of the back.
  • Gender is relevant, for girls are more likely to have a progression of the curvature than boys.
  • The skeletal maturity- The younger the patient is, the more they have potential further growth of the spine and therefore the spine’s deviation is more likely to progress, so early identification of the problem and intervention offers the best results. If the skeletal growth of the patient has stopped, there is a low risk of the evolution of the deformity.

Every treatment is specific for every patient, even though there are standard treatments for severe, moderate, and mild scoliosis.

Noninvasive treatment and self-management

Mild scoliosis can simply be monitored and treated with physical activity. Exercising can help strengthen the muscles of the back and helps the spine to become more flexible.

Although there are very few studies to prove the efficiency of physical therapy and manual manipulation to stop the progression of scoliosis, exercise and physical activities are known to only do good to the body.

Some Physiotherapeutic Specific Exercises (PSE) have proven to be useful in reducing scoliosis progression, but their efficiency depends on the amount therapeutic sessions and the patient’s cooperation with the caregivers.

Diet is also very important to prevent and cure scoliosis. All bone conditions require an adequate diet, scoliosis is one of them. The average American diet does not provide one with the necessary amount of vitamin D and calcium. Vitamin D is a vitamin that is produced by the human body as a consequence of the exposure to the Sun. Calcium is a mineral that the human body needs to maintain strong bones and to carry on many important functions. The vitamin D and/or calcium deficiency can lead to conditions and diseases such as osteoporosis, kidney disease, osteomalacia (bone softening in adults), psoriasis (disorder causing skin redness and irritation), rickets (bone weakening in children), thyroid conditions, muscle weakness/pain, renal osteodystrophy (bone problems due to chronic kidney failure), cancer, high blood pressure, cardiovascular disease, kidney stones.

Bracing

If mild scoliosis progresses (becomes moderate scoliosis) and the Cobb angle surpasses 25 or 30 degrees in addition to the fact that the individual has a long period of skeletal growth remaining, the next step is bracing. The same goes for mild scoliosis that has a Cobb angle 5-degree progression in the period of observation (four to six months).

bracing-scoliosis-vertebral-columnbrace-scoliosis-vertebral-column

Bracing is the only noninvasive, nonsurgical practice that has been proven to reduce the progression of scoliosis and to reduce the pain caused by scoliosis when the patient is an adult. Braces apply pressure on the curves in the spine and, in most cases, effectively prevent its progression. A plastic (or made from fiberglass) corset-like custom device is applied to one’s torso and sometimes, the one-piece brace, extends to the neck. Braces are usually prescribed to still growing individuals because they give better results. If the brace is well designed and it fits the patient’s body perfectly, then, the chances of the successful prevention of scoliosis’ additional progression increase and the brace can even be comfortable. The brace’s effectiveness increases with the number of hours a day it’s worn. The brace has to be worn for most of the day(full-time bracing from 16 to 23 hours) excluding bathing, skin care, and some physical activities. In some cases, only nighttime bracing (for at least eight hours) is required. Braces are discontinued:

  • When boys grow significant facial hair
  • About two years after girls begin to menstruate
  • When there are no further changes in height.

Recommendations

If you are considering the brace treatment for scoliosis here are some recommendations regarding bracing.

First of all, the orthopedist who is responsible for the treatment should have:

  • a previous master (MD with at least 5 years of experience in bracing) for at least 2 years
  • training by a previous master
  • a continuous practice in scoliosis bracing for at least 2 years
  • prescription of 45 braces at least a year over the last 2 years
  • evaluation of at least 150 patients per year over the last 2 years

The CPO constructing braces should have:

  • continuous working experience with and MD for at least 2 years
  • a continuous practice in scoliosis bracing for at least 2 years
  • at least 100 braces manufactured a year over the last 2 years.

Both the MD and the CPO will have to work together while consulting the patients and their case.

The brace should be built by the certified CPO with the indications of the MD and has to be checked by the CPO and MD accurately to fit the patient’s body and make sure the brace is tolerable and that it allows the patient to move. The check-ups (every 3 to 6 months) have to be regular to monitor the efficiency of the brace which has to be replaced as the patient develops.

Surgery

scoliosis-surgery-rodsscoliosis-surgery-spinal-manipulation

In cases of severe scoliosis, bracing usually fails and scoliosis needs to be treated surgically. Orthopedists encourage the patient to have surgical treatment if their curve is cosmetically unacceptable, if they have bone related conditions and syndromes, if the Cobb angle of their curvature is more than 45 degrees, if their curvature affects physiological functions like breathing. In the United States, the average hospital cost was $30,000 to $60,000 per patient in 2010 (for the cases that required surgical procedures)

The operation is performed by a surgeon specialized in spine surgery. In most cases, the surgery brings significant corrections, although it does not completely correct the deformity. There is a risk (20% chance of all surgeries) that after the surgery the lower back pain symptoms won’t be alleviated (“failed back surgery syndrome”). People who smoke have a lower rate of successful spine fusion. In some cases, another surgery is required to fix the screws that might have become loose or broken.

The objectives of the scoliosis surgery are:

  • Stopping the curvature’s progression. In most scoliosis cases, surgery is needed because of the unceasing progression of scoliosis. The procedure has to prevent the further evolution of the condition at the very least.
  • To reduce the deformity of the curve. In some cases, scoliosis includes the twisting of the spine and surgery might help with one’s posture while correcting the deformity.
  • Maintain trunk balance – the surgeon will try to maintain the natural curvature of the spine and the even hips and legs while correcting the deformity.

There are three main types of scoliosis surgery: the fusion surgery, the growing systems, and the fusionless surgery.

1. The fusion surgery

The fusion surgery is the safest and most efficient type of surgery which perpetually fuses two or more juxtaposed vertebrae to create a fixed solid bone while they grow together. The surgery involves the usage of rods, screws, hooks, and/or wires placed in the spine. The downside of the procedure is that the fused vertebrae lose mobility and can limit one’s spine flexibility. This type of surgery is not recommended for very young individuals as it can cause complications: it can take too much space in one’s chest, not allowing the lungs and other organs to grow normally. In this case, the growing systems are a valid alternative up until the patient is old enough to have the spinal fusion done.

These are the types of spinal fusion procedure:

  • The Posterior lumbar interbody fusion (PLIF) – the operation is completed from the posterior side of the trunk(the chest) and it removes the disc between two vertebrae and it inserts bone between the two
  • The Anterior lumbar interbody fusion (ALIF) – the operation is completed from the anterior part of the trunk(the chest) and it removes the disc between two vertebrae and it inserts bone between the two
  • The Transforaminal lumbar interbody fusion (TLIF) analogous to the PLIF
  • The Extreme Lateral Interbody Fusion (XLIF) – an interbody fusion in which the approach is from the side
  • The posterior fusion is a surgical approach through an incision on the back and involves the use of metal instrumentation to correct the curve
  • The anterior fusion is a surgical approach through an incision at the side of the chest wall and involves the use of metal instrumentation to correct the curve.
  • The duration of the operation (takes four to eight hours) depends on whether it is composed of both of these two surgical procedures.

There is a risk of pseudoarthrosis (5% to 10% of spine fusion surgeries) when the vertebrae don’t fuse together. Spinal fusion complications occur quite rarely nevertheless there are some possible difficulties such as:

  • Those that are related to most surgeries (infection, anesthetic complication, and bleeding)
  • Nerve damage -reduced sensibility and strength in arms and legs, reduced control over the bowel and bladder
  • Difficulties with ejaculation -there are some nerves that control ejaculation in front of the L5-S1 disc space. If those nerves are damaged a valve will not close. The sperm will then go on easiest track through the bladder. The most significant result would be the problematic conception. The sensation of sex remains mostly unchanged.

2. The growing systems

The growing systems, mostly for young patients,  involve the periodical anchoring of rods to the spine to maintain and correct the spine’s curvature. It is a periodical procedure because the rods have to be replaced as the patient grows(every 6 to 12 months) until he reaches skeletal maturity and can get a spinal fusion, therefore is a procedure to delay the fusion surgery. This method guides a growing spine and prevents the further deformation of one’s curvature. The surgery might cause pain, nerve damage, bleeding, and infections. In some cases, the patient might need a follow-up surgery if the bone has failed to heal.

3. The fusionless surgery

The fusionless surgery. In this procedure, pressure is applied to the outer side of a spinal curve to slow or stop its development while letting the inner side of the curve to develop normally, correcting the scoliosis curvature.  After the insertion of screws on the outer side of the scoliosis curve, the screws are pulled to correct the deformity. This procedure allows more spinal mobility, although it is a new procedure that has to be perfected. The method is based on the theory which states that a constantly pressured bone could grow slower and denser. This theory could be the “Hueter-Volkmann Law” (demonstrated by some studies) which states that the development of bones is inhibited by compression forces and stimulated by tensile forces.

 

Rehabilitation

The next step after surgery is rehabilitation since the patient must heal and start to return to daily normal life and normal activities. The rehabilitation can consist in exercising, such as stabilizing postural and respiratory exercises, for 5 1/2 to 7 hours every day. Along with that, there can be pain treatment such as pain physiotherapy, physical therapy, acupuncture, manual medicine, and psychological intervention and pain treatment by medication. With these methods, the postoperative pain can be reduced significantly in a lot of cases along with pain frequency, while chronic pain as a late result of surgery can be reduced although there aren’t any studies to prove their effectiveness. Every clinic has its own postoperative scoliosis rehabilitation program, it might differ from one to another. The rehabilitation is completed under the supervision of a physical therapist. In the following paragraphs,   the different means to reduce pain that the PT might utilize will be described.

Ice

The most common way to reduce pain and inflammation is to apply some ice on the affected area: the cold ice numbs the nerve receptors and minimizes pain.

ice-scoliosis-pain

Movements and positions

In some cases, the patient will feel less pain while standing in a certain position and/or while doing something. The PT will help the patient find his/her position or movement to minimize pain.

Electrical devices

The PT might use electrical devices that produce vibrations: if applied on the affected area, the vibrations will loosen up the muscles and nerves relaxing the area and minimizing pain. Some devices actually use electrical currents to relax the muscles and to stimulate the nerves. Electrodes, rubber suction cups or wires are placed over the skin of the body part that has to be stimulated. The patient only feels some tingling in the stimulated areas. The side effects include skin irritation and redness under the electrodes, chemical burns or cardiac fibrillation caused by electrical current and muscle soreness or spasm due to excessive stimulation.

Painkillers

scoliosis-drugs-painkiller

Nonsteroidal anti-inflammatory drugs (NSAIDs):

  • Ibuprofen is also known under the brand names of Genpril, Brufen, Midol, Advil, Nurofen, and Motrin.

It is very important to eat a fiber-rich meal beforehand as to avoid the fairly rare side-effect of gastrointestinal bleeding.

  • Naproxen is also known under the brand names of Naprelan, Anaprox, Aleve, Aflaxen, Flanax, Midol etc.

Also very important to eat a fiber-rich meal before taking the meds as to avoid the rare side-effect of developing stomach ulcers. Patients with stomach disease history should also be prescribed a proton-pump inhibitor meds which prevent ulcers by reducing the quantity of stomach acid.

Steroid medication and local anesthetic: if the pain progresses your doctor may prescribe you some injections to reduce inflammation.

Methyl salicylate-based analgesic gels are great for topic use and relieving pain. The wintergreen oil is natural, effective, and has low side-effects, it’s also known under a variety of brand names such as Deep Heat, Rub A535, Ben-gay, Heat Rub, Tiger Balm, IcyHot etc. Careful not to ingest or overdose the topic usage.

Exercises

The PT develops a personal program for every patient and usually focuses on muscle facilitation to strengthen the muscles in the area of the incision, weak muscles, small muscles that are helpful to stabilize the spine. In some cases, the therapy helps the patient regain the mobility and flexibility in their hips, shoulders, joints. Patients can learn the exercises with the PT and then do them at home on their own. The exercises are usually slow and of low intensity, because the patient’s body has to gradually regain its flexibility.

Prevention

A healthy lifestyle can help prevent scoliosis. Here are some things doctors recommend to prevent the condition.

Diet

A plant-based diet helps you healthy and strong, reduces inflammation and prevents all kinds of diseases such as heart disease, kidney failure, cancer, osteoporosis, high blood pressure, bone-related conditions, etc.

B12

B12 in micrograms (μg) is important for growth and brain functions. Its deficiency can really damage your body in numerous ways. Below there is a table with the daily recommended intake for adults and young people.

Age                            RDA (μg)

0-6 months……………….0.4

7-12 months……………..0.5

1-3 years…………………..0.9

4-8 years…………………..1.2

9-13 years…………………1.8

14+ years………………….2.4

pregnant women………2.6

lactating women……….2.8

Sunlight and water

Get your daily hour of sunlight. Drink 8 cups of water every day ( 2L a day).

Exercise

It helps you fit and strengthens your muscles, including the back muscles. Activities such as yoga, pilates, CrossFit, weight lifting, and competitive sports are recommended. For Crossfit and pilates, there are plenty of videos to help you exercise and to guide you through your fitness journey.

Yoga

It is an ancient oriental practice that combines awareness with light physical activity and relaxation. Here are some basic moves.

1. Mountain pose: stand tall with your feet altogether, raise your arms to the sky and inhale. This is a basic yoga pose that stretches muscles and invigorates the body.

2.Downward dog: start on all fours, spread your palms on the mat then press the hips towards the ceiling. Your body should resemble a boomerang. While you inhale and exhale, you will stretch your calves, your arms and your back muscles.

3. Warrior pose: Stand with feet 3 or 4 legs apart, bend one leg to the side, your arms should be away from your shoulder forming a straight horizontal line. Inhale and exhale. This pose will help you stretch your leg muscles and will force you to work on your stability.

4. Tree pose: stand tall and lift one leg with your knee to the outer side then rest your foot on your thigh; your arms should be away from your hips and they should be lifted. Don’t forget to inhale and exhale. This pose is very good for stability and it helps you to stretch your back muscles.

5. Cobra: Lay down on your belly. Your palms should be underneath your shoulders. Press into your palms and lift up. Inhale and exhale. This is a pose that will stretch your ab muscles and your back.

6. Child’s pose: sit on your knees, then on your the back of your feet. Try to touch the floor with your chest while elongating your arms in front of you.

7. Cat and cow: on all fours, while breathing, hunch your back and then press it down in the shape of a rounded “U”. This simple pose stretches your back like no other.

Going to the gym

Here are some simple exercises to do with weights. Only perform under the advice of your doctor and under a supervision of a trained medical professional.

1. Bicep curls: hold some dumbells or some water bottles in your hands, place your arms on the sides, then, palms facing the ceiling, lift the weights to your shoulders then bring them into the same starting position ( 3 sets of 15 each). This is an exercise that will work your biceps, triceps, shoulders and other back muscles.

2. Squats: stand tall, hold some weights on your shoulders, then feet apart (hips wide) lower yourself while keeping your back straight. Come back to the initial position(repeat for 3 sets of 10-15 each). This is an exercise that will work your whole body.

3. Deadlifts: stand tall, with feet apart, hold your weights down, below the hips, try to reach the floor with your weights while you keep your back straight (3 sets of 10-15 each). Return to your initial position. This exercise targets the back muscles and glutes.

4. Russian twist: on the floor with your back upright, knees bent and feet hovering, hold some weights on your chest and twist your torso to the sides (repeat until you feel the burn in your muscles). This is an exercise that targets the core, including the back muscles.

5. Lunges: stand tall while holding weights in your hands then step forward with one leg until both legs for a 90 degrees angle. Return to the initial position and repeat with the other leg. Do this for 3 sets of 20 lunges(10 lunges per leg).

6. Calf raises: stand tall with your weight and hands to the sides then lift your ankles off the ground and come back in the initial position. This exercise is meant to burn your legs so repeat until you can’t go on.

7. Lying press: stand on your back on the mat then start with your upper arms perpendicular with your torso then push the weights towards the ceiling and come back. Repeat for 3 sets of 10-15 repetitions.

 

Can Scoliosis Stop You from Running?

Muscles throughout the body (especially the ones closer to the spine) find it harder to function well, and therefore, result in wear and tear. Thus, moving perfectly with scoliosis can be challenging.

For runners, this can be a huge hurdle as the condition can have an impact over their flexibility and mobility to a great extent. It is natural for a runner or any other sports enthusiast to find it more difficult to engage in physical activities.

There are a number of ways scoliosis may affect your ability to run. The following are some of the most common ones explained:

  • As a runner, a misaligned spine can be painful for you. The curve could cause discomfort in moving and waling. This could have a huge impact on the endurance and stamina of your body, especially if the pain persists for longer. Therefore, running with scoliosis can be a challenging task. Still, if you want to indulge in some physical activity, swimming may be a more comfortable thing to do as compared to running.
  • In some extreme cases where the spinal curvature is severe, it could also affect the function of lungs. Reduced lung capacity may lead to breathing problems. Thus, this may hurt the stamina. Since running requires both breathing capacity and stamina, it could become fairly much more challenging for a runner to continue. This is especially true if you participate in long-distance running programs such as marathons. In addition to causing pain and discomfort, scoliosis can also cause breathing problems.
  • Since running requires immense amount of flexibility, the effects of scoliosis may damage your performance as a runner.

Could Running Worsen the Condition?

While runners may find running difficult with the condition, if continued, running could make spinal curvature severe. To avoid causing more damage to the spine and other muscles, it’s ideal to get the condition diagnosed in its early stages. Therefore, once diagnosed, it is highly recommended to discontinue running until the treatment is done.

Scoliosis tends to increase with time. However, putting more pressure on the curved spine along with other surrounding muscles can speed up the progress. Therefore, certain physical activities, especially running, should be avoided till the time when your symptoms are clear or the diagnosis has been made. In some cases, running with scoliosis can even increase the Cobb angle in some patients.

It can be concluded that running does make scoliosis worse. This is because running requires rotating the back and the flexes, especially if the patient is running on hard surfaces. Since the pressure is increased with every step, it tends to intensify the daily progress.

The Dos and Don’ts – Things to Consider as a Runner to Avoid Scoliosis

Since scoliosis is often misunderstood, it is therefore mistreated. Thus, it is crucial to understand it to the core to treat it accordingly. Not known by many, the condition has genetic roots and can be progressed due to various environmental factors.

If you are dealing with scoliosis, the following list of do’s and don’ts will help you get a better grip of the condition:

Don’ts

Do Not Delay the Treatment

Prefer a quick diagnosis to ensure that the scoliosis is treated on time. Doing so can halt the progression of your spinal curvature and can reduce the symptoms associated with it.

Don’t Use Too Much Phone for Texting

While using your phone, your body is in a constant, uneven position. This bent-head position can make the condition worse. It applies a lot of pressure on the spinal cord and affects the blood vessels too. With time, excessive use of phone in that position could damage the spinal cord to a great extent.

Don’t Swim for Too Long

Though it is still a better option as compared to running, it is better to avoid swimming that requires hours of daily practice.

Don’t Indulge in Sports that Requires Running

Sports like football and the like are high-contact sports and can lead to various spine and body injuries. As a runner, it’s unwise to let your spine bear more stress until the treatment is complete. Therefore, all sports and physical activities that require running should be stopped until the condition is completely treated.

Don’t Sleep Upside Down

Lying on your stomach while sleeping can make scoliosis worse. It is the worst position you could choose to sleep in with scoliosis as it flattens the thoracic spine. Since the spine is three-dimensional, its flattening would only worsen the condition.

Lying on your stomach also means you will have to keep your head turned to one side or the other. This also twists your spine. Therefore, it should be completely avoided.

Don’t Perform Exercises with Torso Extensions

In fact, anything that involves the extension of your torso should be avoided with scoliosis. Indulging into high jumps, gymnastics, backbends, yoga, or even dance steps that extend your torso could flatten your thoracic spine. They tend to create more space while making the spinal curvature hollow.

Doing so repeatedly could instantly boost the progression of the condition. Most runners stretch their muscles (including the torso) before running. Avoiding it is the best way to control the progression of scoliosis.

Don’t Run

Though running may not be the underlying cause of getting scoliosis, it could be a major reason why it could get worse. The spinal compression tends to increase with each step you take while running. Things take even a worse turn when runners continue running on uneven terrain and high hills.

Prolong jogging and running may worsen scoliosis. Therefore, it is advisable not to exceed 400 meters if you plan to run occasionally.

Don’t Carry Weight

Lifting heavy things tends to compress your curved spine. Look for assistance if you really have to move or lift a heavy object.

DOs

In addition to getting an early diagnosis with a doctor, there are other things that could help you with the condition. Read on to learn more.

Do Use a High Quality Mattress

Besides sleeping consciously on your back and not on your tummy, it’s a healthy initiative to invest in a firm mattress. While you may not find a specific one for your condition, you can use a medicated mattress with extra firmness and cushiony pads on top. Use extra pillows for additional comfort.

Do Move as Much as You Can

This does not in any way mean putting pressure on your spine. But standing or sitting for prolonged hours can stress your spine too. Inquire from a health professional if you can indulge in trying yoga positions that are specifically beneficial for scoliosis patients.

Do Seek for Assistance for Chores

While it’s good to move, do not do all chores yourself especially those that require bending. Doing anything that requires excessive bending could exacerbate scoliosis. There’s no harm in getting some assistance with the chores.

Do Some Stretches

While torso stretching could be harmful for your spine, some stretches can help with the discomfort and pain you may be experiencing. Some of these include:

  • Hanging from a bar
  • Stretching to bend in the direction towards the curve
  • Static chest stretch
  • Lie down on rolled towels placing one under the spine and another under the neck

Do Consider Nutritional Testing

It is also important to keep a check on hormonal and brain chemical imbalances since it could cause further progression to scoliosis. Maintaining a balance helps with retaining healthy neurotransmitters for proper alignment and reflex control.

The Right Way to Sleep with Scoliosis

Though sleeping in the wrong posture is not the underlying cause for scoliosis, it can definitely play a significant role in increasing the pain. Sleeping can become a challenge with scoliosis because of the abnormal curvature. The right sleeping posture is important to help relieve symptoms and pain associated with scoliosis.

Pay attention to your sleeping position and posture. To relieve scoliosis pain, learning about the following sleeping positions and adapting these while sleeping may help:

Thoracic Curve Position

An abnormal curvature in the thoracic or upper back spine is the most common type of scoliosis. Also, in such a case, it often curves to the right. Sleeping straight on your back could be slightly uncomfortable and painful. The best way is to place a thin pillow or a rolled towel under your spine and your shoulder blades before sleeping.

Placing a body pillow between your legs also helps with opening the spinal canal. Another way is to place a small pillow or rolled tower under your ribcage to fix spinal curvature.

Lumbar Curve Position

If the scoliosis is in the lower back spine, you may want to follow the same rule for sleeping. Place a small pillow or rolled towel under your lower spine as well as your neck and your head. Make sure you are comfortable with the placement of pillows and towels before falling asleep.

Warnings

If you suspect severe abnormal curvature in your spine, it is best to consult your physician before sleeping in any of the above-mentioned positions. This is important to protect the spinal fluid or blood circulation from being affected while you are asleep.

Besides seeing a doctor, you may also want to seek assistance from a physical therapist. An expert could make more specific and result-oriented recommendations for your sleeping posture to help you ease the symptoms of scoliosis.

 

Conclusion

Scoliosis is a condition that does not typically affect the quality of life if mild or moderate. Young people and females are more prone to develop the condition, but genes seem to play a significant part. If you have the symptoms mentioned before, schedule a check-up with your doctor. There are plenty of safe ways to treat it, even in its most severe cases. Nonetheless, preventing it is better than treating it, so make sure you have a proper lifestyle: plenty of exercise, a good nutrition, and proper sleep patterns.

Co-written by Jessy Faraday

Curated by Diana Rangaves, PharmD, RPh

This article utilized credible sources and is for information purposes only.  Please consult a healthcare provider for diagnosis, treatment, and additional information.

 

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