Scoliosis
My inspiration for this blog is based off a weekend course I recently attended on the assessment, management and rehabilitation of the spinal Scoliosis. It was one of the best courses I’ve been on in a long time, as the information was all relevant, to the point and easy to put to use immediately. I suppose what helped was that the topic itself was not new information. Chiropractors, Osteopaths and Physios all learn about this spinal variation at University. As a Chiropractor, we are also trained to take and read x-rays. Which in turn helps us identify and diagnose these things too.
So, I guess the best place to start is with is the description of what it is and what does it mean…
What is a Scoliosis?
A Scoliosis is a condition of the spine where it rotates or curves to one side. This is from the visual plane of looking directly at someone’s back, rather than side on. We are supposed to have an S shaped curve when looking from the side. According to “textbook normal” (which none of us are by the way, so don’t worry) we are supposed to have a straight spine when looking from back to front.
Now I would say that a lot of the general public have a slight one. So small that strictly speaking it wouldn’t be classified as a Scoliosis, as it has to be at least a 20 degree angle of curve when measurements are performed on an x-ray. A lot of people have a mild version, including myself, due to the fact that we have a dominant side and lots of asymmetrical daily habits. This can include crossing our legs when we sit, standing predominantly on one leg when standing, being right handed, playing a racket sport… the list could go on and on. Most of us won’t even be aware of the adaptions that have taken place in our spine. This is as they occur very slowly over time.
I went through Chiropractic College without anyone detecting I had a very minor one in my lower back, therefore invisible to the naked eye in front of professionals. It was only picked up when I had an x-ray at the first clinic I worked in.
What does having Scoliosis mean?
Having a Scoliosis can mean a lot of different things to different people, like most things in life. This can vary from the severity of the curve, if it causes you much or any pain at all, to what professional you seek for an assessment and advice. Some people don’t even realise they have one until they reach their adult life. I have certainly conducted consultations during my career, where I am telling middle aged patients for the first time that they have a Scoliosis. It can be quite the shock! Therefore, it shows that the curve doesn’t always affect people or mean they are cursed to a lifetime of pain and immobility. Unfortunately, some health professionals can leave you with this lasting worry.
Additionally, it is extremely rare that having a Scoliosis is the reason someone is booking in for a consultation at the clinic. Having a scoliosis can be an incidental finding. It can also be the reason for having a painful complaint, such as back pain, neck pain, headaches etc… These complaints are much more likely to be the cause of someone seeking help, not the Scoliosis itself.
Having a Scoliosis may predispose you to having some sort of niggle somewhere, but that’s also not guaranteed. There really is no crystal ball, so don’t let anyone scaremonger you into thinking you will. The theory to having some niggles is based on the fact that your spine and therefore overall biomechanics aren’t symmetrical. Leading to the forces placed through your body not being evenly distributed between your left, right, front and back. This can lead to over and under worked compensations of your body.
What is the cause?
The most common cause of this spinal variation is completely unknown! Don’t worry though. Unknown reasons doesn’t mean anything sinister or untoward. These types of curves tend to develop in children before they’ve fully grown. Now even though there is nothing to worry about, these do require proper assessments with full spinal x-rays taken with a 6 month gap in between. This is in order to assess how quickly the curve is progressing. Just for added information, as I like my patients to know what to expect and equally what to ask for when seeking medical advice. These images really should be done standing and include the top of the pelvis and a full spine. To include the top of the pelvis is really important in assessing the individuals skeletal growth. This is because it essential in creating the best plan of management for a young person with a Scoliosis.
Either way, if you notice you might have a Scoliosis at any time of your life, I’d recommend getting it properly assessed professionally.
Do you need surgery?
Absolutely not! The take home message from the course was that surgery could only really be justified under one situation -If someone’s mental health was so badly affected by the way the curve looked. But if someone was looking for less pain and more movement… this was probably not the best option.
The surgery is in the form of having Harrington rods fixed throughout the whole spine. This usually reduces movement and the risk is that once this is placed in your spine, it could cause more pain from the structures that it’s had to be fixed to. I haven’t met many individuals that have had this operation performed. Maybe 3 across my personal and professional lifetime. But out of those 3 people, 1 had to have the rods removed due to complications of them breaking.
Like most medical interventions in our modern world, there is a time and place for them all. I would say to have this type of operation though, the clinical need would need to be very extreme. Therefore, if you have a Scoliosis, please do not worry and think that this is what your outcome would be.
What can be done?
Loads, so please don’t think there is no other alternative to surgery. The only unfortunate thing about the alternatives are that you are probably only going to be offered them in the private sector. The NHS does not offer a wide range of conservative options for this spinal variation. They definitely do not offer options on a long term basis, which could be needed. Especially if the individual is a child and still growing.
Other things that can really help manage it are:
– Advice
– Manual treatment
– Bracing
– Exercises
Chiropractic treatment is gentle, specific, holistic, drug-free and safe. The aim of treatment is centred around eliminating any pain you may be suffering with and increasing movement in areas that are restricted.
Exercises are aimed at rebalancing the mechanics with the asymmetry that is present. This is where conventional exercising in the gym isn’t always appropriate. It doesn’t do any harm, but it’s not specific enough to spinal changes that occur with a Scoliosis. Training both sides equally isn’t appropriate when both sides of the spine aren’t equal in the first place. Treatment or exercises won’t “cure” or “fix” the curve, but it will help manage symptoms.
I’d love to give you some examples of things to try, but the exercises are specific to what type of curve you have.
You can book in for a Chiropractic Consultation here if you suspect you have a Scoliosis and would like a professional to assess, whilst offering some advice and a specific treatment plan. Help is at hand!!!
Read onto our next article, ‘Rehabilitation of Lower Limb Injuries’ by our Physiotherapist and APPI Certified Pilates Instructor, Rachel.