Scoliosis is a general term consisting of a group of conditions consisting of changes in the position and shape of the spine, thorax and trunk. Spinal deviations were first observed in Greece by Hippocrates during 400 B.C. Although the term scoliosis was only later formally defined by Galen in 200 A.D. Since then many methods of diagnosis, treatment and management of scoliosis have been trialed with varying degrees of success. It can be brought on by certain conditions – neuromuscular (i.e. cerebral palsy), degenerative or congenital (since birth) – or more commonly for no reason at all. We will cover an overview to keep you better informed if you do currently or suspect you have a curve in your spine, for a reason that cannot be explained.
Kleinberg introduced the term idiopathic scoliosis, which refers to all people in which it is not possible to find a specific disease causing the deformity. It can occur in seemingly healthy children and accounts for up to 80% of all scoliosis cases.
The diagnosis and degree of scoliosis is determined using a collection of clinical and radiological testing procedures. Your Osteopath may initially ask you to bend side to side or bend forward at your waist (Adams forward bend test) looking for changes in spinal curvature or rib heights (rib humps). Depending on the outcome of these primary tests and severity of your pain, a complete spinal x-ray may be requested. In analysing your scan, the radiologist will examine for three main factors – Cobb angle, axial rotation and skeletal maturity – to determine if you have scoliosis.
The Cobb angle is paramount in determining your management and future outlook. It is a measurement of the side to side (lateral) curvature of the spine. An angle of 10 degrees or below is considered to be insignificant, however, anything above is often when we start referring to it as a scoliosis. Within this range you may be prone to more aches and pains and require treatment to calm the symptoms down. Once we begin approaching a Cobb angle of 30 to 50 degrees that is when we are at greater risk of health problems and associated reduced quality of life. Anything over 50 degrees we are certain to have health implications and require surgical intervention. As you can see it is vital to identify a scoliosis early as you may be able to hasten the side effects.
Furthermore, having awareness of warning signs may alert you to when things do not seem right. A major risk factor for scoliosis and its progression is gender. Females are much more likely to suffer from a scoliotic curve. Depending on the Cobb angle severity, females are five to seven times more likely than males to be diagnosed. Additionally, another component is spinal deviations during childhood and adolescence. As children grow the curve may grow with it similar to leaves on a tree. The most common periods of skeletal growth are from the first months of life to 24 months, ages 5 to 8 and 11 to 14 (puberty). Being more conscientious of these timeframes and that a female complaining of back or neck pain, may warrant further investigation. However, once diagnosed it is often daunting and disconcerting when determining your next steps.
Treatment and management can vary significantly depending on the curve progression. It should involve a team of health practitioners including but not limited to your general practitioner, orthopaedic surgeon and osteopath. Whether surgery or bracing is involved, conservative osteopathic treatment will more than likely be required throughout your life. The combined goals of treatment by your team should include stopping curve progression (at puberty), improve appearance or deformity via postural correction, prevent or treat spinal related pain and respiratory dysfunctions.
Moreover, you are now much more educated and well-equipped to take action when you are or know someone diagnosed with scoliosis. If you have any queries please do not hesitate to contact me at the clinic or book in with one of our health practitioners to discuss your management outlook.