The case for delayed back pain…

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Scoliosis, the case for delayed back pain… 

For some, scoliosis can strike at any age, and many times it goes undetected for quite some time.

Most people don't realize that scoliosis is marked by an abnormal curvature of the spine, and it also affects adults including those with no history of the condition at all as a child.

1. The most common scoliosis patients are children age 10 to 12, often with idiopathic scoliosis.  This is due to children and teens’ fast growth rate.

2. Patients with idiopathic scoliosis, the most common type of scoliosis, is more commonly found in girls than boys in their same age groups.

3. Scoliosis can be hereditary. If a close family member suffers from a significant scoliosis, consider regular doctor’s checkups.

4. Some cases of scoliosis have unknown causes, where some cases have known causes ranging from injuries, birth defects, infections, or diseases.
 
5. Contrary to popular belief, scoliosis is not caused by activities such as carrying heavy loads, poor posture, or arms and legs of slightly unequal lengths.
 
6. People with scoliosis are often initially asymptomatic. The condition is usually noticed first by family or friends who see an unlevel hemline or one shoulder held higher than the other.
 
7. An x ray is an important scoliosis diagnostic tool. X rays can help a doctor to determine the degree and pattern of curvature of the scoliosis.
 
8. Options for treating scoliosis are based on factors including a person’s age, type of scoliosis, expected amount of continued growth, and the pattern and degree of the curvature.
 
9. Exercise has not been proven to improve an existing scoliosis, but regular exercise remains an important factor in keeping bones strong and growing healthily, especially in youth.
 
10. Surgery is a treatment option for scoliosis exceeding 50 degrees of curvature, and hospital stays for such surgeries are an average of 5 to 6 days.

You may have heard of scoliosis when you were in middle school or high school, or the school nurse checked for it during gym class or before playing a team sport with a special trip to their office.  Most people think of scoliosis as a problem that strikes only children and teenagers especially girls between the ages of 9 and 15.  

You might be asking yourself why is this so important? For adults scoliosis can be an undiagnosed cause of back pain especially when it’s accompanied with radiating complaints into the legs or buttocks.  Numbness or even weakness in the leg or foot may also occur but less commonly.

These symptoms can go on for many years without scoliosis ever being discovered as the reason why.  In fact, the characteristic “S-curve” or "hump-back" of adult scoliosis is sometimes severe enough that it's quite easy to see when barely clothed walking on a beach, or at a pool wearing swim shorts or a bikini while viewed from behind.  But in other cases, the curve is barely noticeable even to the untrained eye, and measurable only on an x-ray by a specialist. 

What actually happens to the spine when scoliosis is discovered as an adult very likely started during childhood… but never diagnosed.  Or, the condition may have first developed in adulthood.  If you're over 40 years of age and develop scoliosis for the first time, then you probably have degenerative scoliosis sometimes referred to as a form of spondylosis... age related degenerative osteoarthritis of the spine.  

Do you have scoliosis?

Here are some signs that you may have scoliosis…

• You've lost more than 1 inch of height
• When looking in the mirror, one shoulder appears higher than the other
• One hip is higher than the other
• The sole or heel of one shoe is wearing faster or differently than the other
• Pant cuffs are wearing unequally
• You sleep comfortably laying on one side but not the other

Here's what begins to occur:

As we get older the discs and the facet joints between the vertebra begin to degenerate. As the discs begin to dehydrate and telescope they lose their vertical height and this collapse over time is what leads to degeneration leading to scoliosis as an adult. It's important to know if you have osteoporosis (bone brittleness, which is far worse than naturally occurring bone degeneration) and you develop scoliosis.  In that event, the scoliosis will progress more rapidly than it would in persons without osteoporosis or osteopenia, (loss of bone density).  

All in all, for adults who had scoliosis has children, the degenerative process can cause the condition to worsen with age. And if this occurs, the S-curve will generally progress by about 1° per year. Scoliosis is diagnosed when the spine is curved vertically or twisted by more than 10°. 

How about spinal stenosis?

Other complications of scoliosis is spinal stenosis. If you find you are more comfortable standing or walking while leaning forward, or if you like to lean on a counter or on a shopping cart while at a grocery store, then this may be the telltale sign of spinal stenosis contributing to your scoliosis. This is a condition that causes narrowing of the bony spinal canal, which protects the spinal cord running the length of the spine.

Also, the degenerative process affecting the spine puts adults at increased risk for scoliosis, even though genetics may also play a role, adult onset scoliosis is usually the result of wear and tear accompanied with the aging process. Scoliosis tends to run in families, and the good news is for most adults with scoliosis they have no symptoms.

How can you have a happy and healthy spine?

If you know you had scoliosis as a child, or you think you may have it as an adult, get professional advice. If your childhood curvature was more than 30° you'd be best advised to go to a spine specialist every 3 to 5 years in order to monitor the progress of changes. On the other hand, if you suspect that you have adult scoliosis, there are certain red flags that signal the condition. Scoliosis is relatively easy for a spine specialist to diagnose with a physical examination and spine imaging such as x-rays, CT or MRI scans.

Important for anyone who has scoliosis is to keep a close eye on his or her weight, (being overweight puts additional stress on your spine) and remember to remain physically active.   The reason why is inactivity can worsen symptoms by allowing trunk muscles to weaken, which can increase the muscle pain associated with scoliosis and accelerate the loss of bone density, strength, and endurance.

Here's how to help yourself:

Once you have scoliosis, exercise won't strain your spine nor will it stop the disorder from progressing. Not even chiropractic adjustments will straighten your spine so don't be misled by someone who says it can. What periodic chiropractic adjustments will do with someone with adult scoliosis will maintain resiliency and flexibility, which in turn helps to reduce pain and stiffness. Exercise will also help you keep your spine supported as best as possible, and reduce pain and keep you feeling stronger, looking and acting younger.

Even though cardiovascular exercise such as Nordic Pole Walking, swimming, or racquetball is a good idea for most people, a core-strengthening program is crucial for anyone with adult scoliosis. If you think of your spine as a radio transmission tower think of your muscles as the guy wires, because it's easy to visualize how the muscles help support the spine much like guy wires support the tower. The goal of core exercises is to strengthen the little tiny muscles of the back and pelvis that attach directly to the spine.  The sling muscles of the abdomen and the lateral oblique muscles, and the strong hip flexor muscles are generally strong enough to handle most any load.

Depending upon your overall fitness and flexibility, a core workout and exercise routine might include abdominal sit back exercises as well as lateral planks, and others that strengthen the front belly muscles rather than the ones behind the stomach, which attach directly to the spine. Because scoliosis can limit movement of the spine, stretching can also  help ease joint stiffness.

Many people with scoliosis are able to alleviate their pain if they work with a skilled and competent chiropractor or physical therapist that can help them design an exercise program that targets their specific areas of weakness. The one program that I have been infinitely impressed with is the BackPower Program endorsed by the National Safety Council, and I've recommended this program to thousands of patients over the past 20+ years with resounding success.

For more help:

Because of the severity of other problems associated with adult scoliosis because of the way it can vary so much from person to person, no one size fits all treatment is appropriate. Daily treatment for two weeks then three times a week for two months, and twice a week for six months, and then once a week for the remainder of the year is simply unnecessary, and not sound advise.  Periodic spinal adjustments however are.  How often?  About every 90- days or about twice as often as you'd typically get your teeth cleaned. 

In addition to a well thought out and focused exercise program there are many non-drug therapies that are helpful these include:

1. Chiropractic care, especially to maintain power, strength, coordination, flexibility and balance. 2. Massage, and sometimes 3. Acupuncture, which seems to help some people with the pain associated with scoliosis. 

Even though bracing is often prescribed for young scoliosis patients especially those who are still growing, it's rarely offered or advised for adults since it restricts motion and weakens the core muscles that can in turn increase symptoms and other problems.  

Bless and be blessed ALWAYS,

Lewis Meltz