What is Scoliosis?

Scoliosis is a structural change in the spine - looking from behind, the spine appears bent or out of alignment.  This typically occurs in the thoracic region of the spine - where that ribs are attached. 

Teenagers may develop a scoliosis as they grow and it is important to monitor the progression of the scoliosis during the growing years.  If the scoliosis develops further during this time, brace treatment or surgery may be necessary. 

Scoliosis exercises may help to keep the spine strong and flexible during the growing phase of a teenager.  A trained McKenzie physiotherapist is able to provide key exercises to help people who suffer from spinal pain.

 As Sandra McFaul has stated, the definition of scoliosis is a lateral deviation (side to side curve)  of the spine. When a scoliosis develops the spine bends sideways and rotates along its vertical axis. These changes have cosmetic and physiological effects with long-term consequences which may result in significant health problems with severe curves.

Scoliosis Australia places the most common type of scoliosis (idiopathic scoliosis) into three categories.

INFANTILE  – A curvature that develops before a child is two years old. Nine out of ten of these curves will spontaneously resolve. This type of scoliosis is very rare in Australia.

JUVENILE IDIOPATHIC  – A curve that develops in the age range of two to ten years. This type is also rare in this country.

ADOLESCENT IDIOPATHIC SCOLIOSIS (AIS) – This type appears in early adolescence and is much more common in girls than boys. While the incidence of very small curves is similar in both sexes, the ratio of boys to girls for curves in the treatment category is 1 : 8-10. AIS in girls accounts for about 90 percent of curves seen in clinical practice.

Both Ryan and Sandra have given very good definitions of scolosis.  Working with teenagers, I see the adolescent idiopathic scolosis (AIS).  Iiopathic means that there is no known reason for the scoliosis developing.  

Adolescent idiopathic scoliosis (AIS) affects 2-3% of the population & is 9x more likely to affect girls. AIS is a true 3D structural deformity involving vertebral & disc torsions (lateral flexion, rotation and changes in flexion/extension of the spine).  Asymmetrical loading of the vertebral bodies means that AIS will progress with growth, thus monitoring throughout adolescence is important. It is also important to screen (particularly in girls 11-14yrs) for scoliosis so it can be detected early on and monitored.

Screening and monitoring usually consists of measuring the ‘rib hump’ when bending over and radiology to measure the degree of the curve - this is called the cobb angle. The severity of the curve & skeletal maturity will determine whether management involves observation, bracing or surgery. 

There is no quality evidence that supports the use of exercise to treat scoliosis, but there is also no evidence that exercises worsens scoliosis.  Some authors suggest exercises done in addition to monitoring and bracing is worth trying.  Exercises that have been proposed in the treatment of scoliosis include exercises to maintain trunk (abdominal and back) muscle control, strength and endurance whilst in the brace and exercises that are performed in directions opposite to the curves so as to reduce/minimise the curve. It is important to note that exercises should not be undertaken in isolation and the management of scoliosis should include, at a minimum,  your GP, orthopaedic surgeon and physiotherapist.

AIS is not causative of pain & nor is it caused by bad posture or back packs - the incidence of LBP is the same in adolescents with & without AIS.  And thus treatment of any pain that may be associated with AIS is similar to treatment of other back pain in adolescents.

AIS is uncommon in males and thus AIS in males should be referred immediately to a spinal surgeon, as should: rapidly progressing curves, significant pain, onset in childhood and a thoracic curve convex to the left.

There is often a significant psychological aspect to AIS due largely to the asthetic of the curve/rib hump and also wearing of a brace if needed.  At the very time when AIS is likely to development, teenagers are becoming more aware of their bodies, more self conscious, more impacted by peer pressure and so forth.  This is important to consider as a health practitioner and a parent - it may be necessary for a psychologist to be involved in the treatment of AIS.

We also see a lot of teenagers who have minor non-structural, or postural scolosis due to poor posture, a leg length difference or playing high level sport with the dominance of one hand - eg tennis - this is very common, quite normal and is NOT AIS.  This type of postural scoliosis is very easily treated with physiotherapy.

Thanks for your words, Sandra, Ryan, Loretta. I will add that indeed I see many folk with a scoliosis who speak to me of back pain, and who are actively choosing targeted ‘exercise’, or yoga therapy to evoke real change in their scoliosis and functionality of their spine.

Pain is well documented in the scientific literature, as being a significant feature in the lived experience of a scoliosis inhabitant. Curve increment has been demonstrated to have a significant relationship with curve ‘flexibility’, the latter being inversely correlated with both pain and progression. Commonly, the people who walk into my yoga therapy studio, announce this feature, along with their concern for future comfort in their body and future movement ease, as being their primary reason for seeking out yoga therapy for scoliosis. I hear people from mid 20's to mid 50's (and beyond) claiming this experiential change and move toward developing a strong, fluid spine, with significantly diminished pain levels.

Initially one has to know well and understand the topography of one's body; one's curve pattern. Each scoliosis is unique, the pathway of lateral deviation and rotation of the spine along its central axis. Remember, that, if the scoliosis is in the thoracic region, it will take with it the ribs. And your lungs. Lung function changes in scoliosis are well reported in the peer reviewed literature. That's your capacity to breathe.

In my work, knowing your scoliotic curve pattern enables intelligent and precise work to be undertaken, with modified yoga poses and with the support of specialised yoga equipment. Home practice enables empowerment, rather than dependency.The body responds to clear, incisive, consistent action! The functionality of the body, and indeed of the whole organism changes. Spines change, breathing changes. A caveat; not all ‘yoga’ is appropriate in a scoliosis. The body must learn great clarity, and in particular, how to work the legs and feet correctly-your foundation!

One of the great challenges in a scoliosis, is how to sense the body; its position in space and its position, one body part to another. Balance is significantly compromised in scoliosis, with imbalances in the vestibular apparatus, again, this phenomenon being well documented in the literature. Gait (walking) parameters are altered in scoliosis, along with fatiguability and recovery of muscles and the cardiopulmonary system during exercise. Osteopenia (lower bone mineral density) is another significant parameter reported as common within this population. Along with the propensity for disc and facet joint injury/lesions within the asymmetric spinal structure-gravity and asymmetric body use are hard task masters.

Scoliosis is a complex phenomenon, impacting the entire ecology of the organism. Human development movement patterns are often underdeveloped, or awry. In particular, developmental patterns of naval radiation, (the body's organisation to its core and the relationships of limb to core), functional head to tail connection the the midline/spine, homolateral (same side) connectivity.

Gosh! That sounds a lot. And it is. And how to manage the terrain becomes the question? How to live with ease of movement, high functionality, strength, and stability? I know what my answer is.

Travel on!