Scoliosis is a diagnosis that can be a bit scary when you
first here it. People imagine all sorts
of deformities associated with that diagnosis.
As a chiropractor in the Woodbridge, Dale City Virginia area it is my
job to fully explain the diagnosis so the patient has a better
understanding. Once you understand the
diagnosis in most cases it isn’t as bad as you imagined.
Scoliosis
Scoliosis affects 5 to 7 million people in the United
States. More than a half million visits are made to doctors’ offices each year
for evaluation and treatment of scoliosis. Although scoliosis can begin at any
age, it most often develops in adolescents between the ages of 10 and 15. Girls
are more commonly affected than boys. Because scoliosis can be inherited,
children whose parents or siblings are affected by it should definitely be
evaluated by a trained professional.
What is scoliosis?
Because we walk on 2 feet, the human nervous system
constantly works through reflexes and postural control to keep our spine in a
straight line from side to side. Occasionally, a lateral (sideways) curvature
develops. If the curvature is larger than 10 degrees, it is called scoliosis.
Curves less than 10 degrees are often just postural changes. Scoliosis can also
be accompanied by lordosis (abnormal curvature toward the front) or kyphosis
(abnormal curvature toward the back). In most cases, the vertebrae are also rotated.
In more than 80% of
cases, the cause of scoliotic curvatures is unknown; we call this condition
idiopathic scoliosis. In other cases, trauma, neurological disease, tumors, and
the like are responsible. Functional scoliosis is often caused by some postural
problem, muscle spasm, or leg-length inequality, which can often be addressed.
Structural scoliosis does not reduce with postural maneuvers. Either type can
be idiopathic or have an underlying cause.
What are the symptoms of scoliosis?
Scoliosis can significantly affect the quality of life by
limiting activity, causing pain, reducing lung function, or affecting heart
function. Diminished self-esteem and other psychological problems are also
seen. Because scoliosis occurs most commonly during adolescence, teens with
extreme spinal deviations from the norm are often teased by their peers.
Fortunately, 4 out of 5 people with scoliosis have curves of
less than 20 degrees, which are usually not detectable to the untrained eye.
These small curves are typically no cause for great concern, provided there are
no signs of further progression. In growing children and adolescents, however,
mild curvatures can worsen quite rapidly—by 10 degrees or more—in a few months.
Therefore, frequent checkups are often necessary for this age group.
How is scoliosis evaluated?
Evaluation begins with a thorough history and physical
examination, including postural analysis. If a scoliotic curvature is
discovered, a more in-depth evaluation is needed. This might include a search
for birth defects, trauma, and other factors that can cause structural curves.
Patients with
substantial spinal curvatures very often require an x-ray evaluation of the
spine. The procedure helps determine the location and magnitude of the scoliosis,
along with an underlying cause not evident on physical examination, other
associated curvatures, and the health of other organ systems that might be
affected by the scoliosis. In addition, x-rays of the wrist are often
performed. These films help determine the skeletal age of the person, to see if
it matches an accepted standard, which helps the doctor determine the
likelihood of progression. Depending on the scoliosis severity, x-rays may need
to be repeated as often as every 3 to 4 months to as little as once every few
years.
Other tests,
including evaluation by a Scoliometer™, might also be ordered by the doctor.
This device measures the size, by angle, of the rib hump associated with the
scoliosis. It is non-invasive, painless, and requires no special procedures. A
Scoliometer™ is best used as a guide concerning progression in a person with a
known scoliosis—not as a screening device.
Is scoliosis always
progressive?
Generally, it is not.
In fact, the vast majority of scolioses remains mild, is not progressive, and
requires little treatment, if any. In one group of
patients, however, scoliosis is often more progressive. This group is made up
of young girls who have scolioses of 25 degrees or larger, but who have not yet
had their first menstrual period. Girls generally grow quite quickly during the
12 months before their first period and if they have scolioses, the curvatures
tend to progress rapidly. In girls who have already had their first periods,
the rate of growth is slower, so their curves tend to progress more slowly.
What is the treatment for scoliosis?
There are generally three treatment options for
scoliosis—careful observation, bracing, and surgery. Careful observation is the
most common “treatment,” as most mild scolioses do not progress and cause few,
if any, physical problems. Bracing is generally reserved for children who have
not reached skeletal maturity (the time when the skeleton stops growing), and
who have curves between 25 and 45 degrees. Surgery is generally used in the few
cases where the curves are greater than 45 degrees and progressive, and/or when
the scoliosis may affect the function of the heart, lungs, or other vital
organs.
Spinal manipulation,
therapeutic exercise, and electrical muscle stimulation have also been
advocated in the treatment of scoliosis. None of these therapies alone has been
shown to consistently reduce scoliosis or to make the curvatures worse. For
patients with back pain along with the scoliosis, manipulation and exercise may
be of help.
Most people with scoliosis lead normal, happy, and productive
lives. Physical activity including exercise is generally well-tolerated and
should be encouraged in most cases.
3122 Golansky Blvd, Ste 102
Woodbridge VA 22192
703 730 9588
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