Scoliosis: Symptoms, Causes, and Treatment

What is scoliosis?

Scoliosis is a medical condition characterized by an abnormal curvature of the spine in an "S" or "C" shape. Instead of remaining straight as typically seen from the back, the spine in individuals with scoliosis may curve sideways. The curvature can range from mild and nearly unnoticeable to severe and prominent. The spine is a complex structure composed of vertebrae, intervertebral discs, ligaments, and muscles that provide stability and mobility to the body. In scoliosis, this balance is disrupted, causing the spine to curve in one or more directions. The curvature can affect any part of the spine, but it most commonly occurs in the thoracic (mid-back) or lumbar (lower back) regions. In some cases, scoliosis spans both regions, forming a double curvature that resembles an "S".

Although scoliosis is often diagnosed during adolescence, it can also occur in children or adults. In children and adolescents, it is mostly idiopathic scoliosis, meaning its exact cause is unknown. In adults, scoliosis can develop due to degenerative changes in the vertebrae and intervertebral discs. Understanding what scoliosis is, how to identify it, and what treatment options are available is crucial, as early diagnosis is key to effectively managing symptoms and preventing the progression of the curvature.

Scoliosis is not merely a visual deformation of the spine but a condition that can affect overall body balance, muscle function, and general quality of life. Early recognition and understanding of this condition are crucial for improving the situation and preventing more serious complications in the future.

Symptoms of scoliosis

The symptoms of scoliosis can be very subtle and are often difficult to notice, especially in the early stages when the curvature is not yet pronounced. For this reason, scoliosis is often detected only when changes become more apparent or when issues such as pain or other symptoms arise. Here are the most common signs and symptoms that may indicate the presence of scoliosis:

• Visible curvature of the spine: In scoliosis, the spine curves to the left or right, which can lead to asymmetry in the body. For example, one side of the ribs may protrude more than the other, or one shoulder may be higher than the other. This visible asymmetry is especially noticeable when the person bends forward.
• Uneven hips: In addition to the shoulders, scoliosis can also cause uneven hips, where one hip is higher or more pronounced than the other. This affects posture and can cause difficulties with walking or maintaining balance.
• Trunk tilt: In individuals with scoliosis, the upper body may tilt to one side, affecting overall posture and adding strain to the muscles, particularly in the lower back.
• Breathing difficulties: In severe cases, when the curvature is more pronounced, there can be a reduction in lung space, leading to breathing difficulties. This occurs because the rib deformation caused by scoliosis puts pressure on the lungs, limiting their ability to expand.
• Back pain: Although scoliosis typically does not cause pain in children and adolescents, adults may experience back pain, especially if nerves or muscles are compressed. Pain can also arise from prolonged strain on muscles trying to compensate for the spinal curvature.

The symptoms of scoliosis can vary greatly between individuals. It is important to pay attention to subtle changes in posture, as early detection and treatment can significantly reduce the risk of long-term problems such as chronic pain and reduced physical capacity.

Causes of scoliosis

Scoliosis can arise from various causes, but in most cases, the exact cause remains unknown. Such forms of scoliosis are called idiopathic scoliosis and are the most common type in children and adolescents. In addition to idiopathic scoliosis, there are other types:

• Congenital scoliosis: This form occurs due to improper development of the vertebrae during pregnancy. It is a congenital condition that becomes evident at birth or in early childhood. Vertebral malformations can cause some vertebrae to fuse incorrectly or have an irregular shape, leading to spinal curvature.
• Neuromuscular scoliosis: This type of scoliosis results from problems with the muscles and nerves that support the spine. It is often seen in individuals with neurological disorders such as cerebral palsy, spina bifida, or muscular dystrophy. Weakness or dysfunction of the muscles supporting the spine causes the spine to curve as the muscles cannot provide adequate stability.
• Degenerative scoliosis: This form usually occurs in adults as the spine begins to curve due to aging and wear. Degenerative changes in the intervertebral discs and joints can lead to spinal asymmetry, causing gradual curvature. It is commonly seen in older adults and results from osteoarthritis and other degenerative processes affecting the spine.
• Functional scoliosis: This type occurs due to external factors such as leg length discrepancies, muscle tension, or poor posture. In this form, the spine itself is not abnormal, but the curvature is caused by external factors. Functional scoliosis often resolves when the underlying causes are addressed, such as treating muscle tension or equalizing leg lengths.

Understanding the various causes of scoliosis helps in selecting the most appropriate treatment method. Identifying the specific cause allows treatment to be tailored to the individual's needs, increasing the likelihood of successfully managing this condition.

Diagnosis of scoliosis

The diagnosis of scoliosis is typically made by a doctor through a physical examination and imaging studies. The physical examination may include a forward-bending test, where the doctor checks for asymmetries in the back, such as uneven shoulder heights or rib prominence. This test helps assess whether a curvature is present and on which side of the body it is located. In addition to the physical examination, X-rays are often used to confirm the diagnosis. X-rays provide precise measurements of the degree of spinal curvature, aiding doctors in determining the severity of scoliosis and planning appropriate treatment. The degree of curvature is measured in degrees, with curvatures less than 10° typically requiring no treatment, while larger curvatures may necessitate monitoring or active intervention. In some cases, the doctor may also order additional imaging tests such as MRI (magnetic resonance imaging) or CT (computed tomography), especially if there is suspicion that scoliosis is caused by other health issues such as abnormalities in the spinal cord or nervous system.

An accurate diagnosis of scoliosis allows doctors to determine the appropriate course of treatment. Early diagnosis is crucial, as timely intervention can prevent the progression of curvature and reduce the risk of long-term complications such as pain and reduced mobility.

Treatment of scoliosis

Treatment of scoliosis depends on the severity of the curvature, the patient’s age, and the likelihood of progression. The goal of treatment is to prevent the curvature from worsening and to improve the quality of life for individuals with scoliosis. Here are the main treatment methods:

• Observation: For mild scoliosis, especially in children and adolescents who are still growing, observation is often recommended. Regular check-ups allow for monitoring changes in curvature and timely response if the condition worsens. Examinations are usually conducted every 4 to 6 months, depending on the child’s growth rate and the degree of curvature.
• Wearing a brace: For moderate scoliosis, where the curvature ranges between 25° and 40°, wearing a brace is often prescribed. A brace helps prevent the progression of curvature but cannot correct existing curves. It supports the spine and keeps the curvature stable while the child is still growing.
• Physiotherapy: Physiotherapy plays an important role in treating scoliosis by including specific exercises that help improve posture, increase spinal mobility, and strengthen the muscles supporting the spine. Schroth exercises are designed specifically for individuals with scoliosis, focusing on asymmetrical positions and breathing techniques that help correct the curvature. Physiotherapy also includes balance and coordination exercises, improving body control.
• Surgical treatment: In severe scoliosis, where the curvature exceeds 45° to 50° or causes significant issues such as breathing difficulties or pain, surgery may be required. The most common surgical procedure is spinal fusion, which stabilizes part of the spine using metal rods, screws, and plates. The goal of surgery is to prevent further progression of the curvature and maintain spinal stability.

The proper choice of treatment method depends on the individual characteristics of the patient, such as age, degree of curvature, and overall health condition. Scoliosis treatment is not the same for everyone, so collaboration between the patient, parents (in the case of children), and professionals is crucial to finding the best possible solution for improving quality of life.

The role of physiotherapy in treating scoliosis

Physiotherapy plays an important role in the treatment of scoliosis, especially in mild to moderate cases, where the goal is to prevent the progression of the curvature and improve functionality and quality of life. Physiotherapists use various techniques tailored to individual needs to maintain spinal mobility, enhance posture, and alleviate potential pain. Here are the key aspects of physiotherapy used in scoliosis treatment:

• Schroth method: One of the most recognized techniques for treating scoliosis is the Schroth method, originating from Germany. This technique aims to correct posture using specific asymmetrical exercises that strengthen weakened muscles and stretch shortened muscles along the spine. Schroth exercises are highly specific, focusing on the three-dimensional correction of the spine, improving stability and functionality, and breathing techniques to enhance lung capacity.
• Strength and flexibility exercises: Physiotherapy for scoliosis also includes specific exercises for strength and flexibility aimed at improving spinal stability and supporting proper posture. The exercises target strengthening the muscles of the core, back, and abdomen, helping to stabilize the spine and prevent further curvature progression.
• Breathing exercises: are an essential part of physiotherapy for scoliosis, especially when lung capacity is restricted due to spinal curvature. Physiotherapists teach individuals how to properly use the diaphragm and ribs during breathing to improve lung function.
• Balance and proprioception exercises: Scoliosis can affect body balance, increasing the risk of falls or injuries. Physiotherapy includes balance and proprioception exercises to improve the individual's body control.
• Manual therapy techniques: In addition to exercises, physiotherapists may use various manual therapy techniques such as joint mobilization, massage, and traction. These techniques help reduce muscle tension, improve blood flow, and relieve stiffness in areas that are additionally strained due to scoliosis.
• Education and ergonomics: Physiotherapists also play an important role in patient education. They teach patients how to sit, stand, and lift loads correctly to reduce additional strain on the spine.

Physiotherapy is an essential part of scoliosis treatment, enabling individuals to take an active role in managing their condition. With properly performed exercises, manual therapy, and education about ergonomics, patients can achieve significant improvements in posture, functionality, and overall quality of life.

How you can contribute to treating scoliosis

In addition to professional treatment, there are ways individuals with mild forms of scoliosis can contribute to improving their condition:

• Regular exercise: Activities like yoga or Pilates can help maintain spinal mobility and strengthen muscles. Properly performed exercises can improve posture and alleviate pain. However, it is important to consult a physiotherapist before starting an exercise regimen to ensure the exercises are tailored to your specific needs.
• Proper posture: Maintaining proper posture while sitting, standing, or walking can help prevent additional spine problems. Poor posture can worsen curvature and place extra strain on muscles and ligaments. Using ergonomically designed chairs and sitting correctly can help maintain the spine's natural curve.
• Avoiding heavy loads: Carrying heavy loads, especially on one side of the body, can worsen spinal curvature. When carrying school bags or other heavy items, it is recommended to use a backpack worn on both shoulders to evenly distribute the weight.

Adopting healthy lifestyle habits and maintaining proper posture can play an important role in managing mild forms of scoliosis. While these habits may not correct existing curvature, they can help prevent its progression and improve quality of life.