I have been prompted to write this blog, having met a lady recently who came with an undiagnosed back complaint.
It is often the case that when I meet people with a mild to significant Scoliosis, that historically they would have been aware of this and have received information on the “do” and “don’ts” and when necessary, have ongoing monitoring of their condition.
As this was not the case in this situation, I have put together some of the information I shared with her. I have also encouraged that an orthopaedic consultation is undertaken.
I have the permission of the lady to share the photo of her back and her review, which she hopes will encourage others to seek advice.
Looking back, she is aware that this condition has gone unrecognised for many years and she can even recall as a child be told to “stand up straight”!
Scoliosis is when your spine permanently bends to the side at a noticeable angle – this can make you look lopsided. Usually, with scoliosis, your spine bends at your lower back or chest area making a C or S shape. Your spine may also twist or tilt forward or backwards.
It’s generally seen in children and adolescents, but it can also come about in adulthood. Scoliosis in adults can occur due to a variety of reasons, including genetics, uneven pelvic position, past spinal or joint surgeries, knee or foot distortions, or even head injuries. Some curves are deeper than others.
The difference between a typical spine and that of a person with scoliosis is that the former can move from side to side. For instance, when you walk, your spine bends and rotates left and right, ultimately reverting back to the centre. People with scoliosis can have a difficult time moving in one direction due to the curvature of their spine.
Symptoms of scoliosis
The main way to spot scoliosis is by noticing changes in how your body looks. One shoulder – often the right one – may look higher than the other. A shoulder blade or your ribs may stick out more. Your middle (waist) may seem off centre because your hips are uneven.
When babies and young children develop scoliosis, their parents may notice these changes or health professionals may spot them in routine checks. Adults and older children usually see the early signs during everyday activities, especially when washing, dressing or looking in the mirror. Clothes may not fit or hang as well as they did before.
A symptom of scoliosis can be pain in your lower back that gets worse as the bend in your spine increases. This pain may spread down the legs in older people. You may notice a feeling of tiredness in your back after sitting or standing for a long time.
A GP should refer you to an orthopaedic specialist. This is a doctor who specialises in identifying and treating bone conditions.
The orthopaedic specialist may ask you to do the Adams' forward bend test (sometimes called a back-bend test). During this test, you bend forward from your waist, with the palms of your hands together. This will help show if your shoulders, ribs, hips and waist are level or not, or if your ribs are more prominent on one side. Your specialist may use an instrument called a scoliometer, which is placed against your back to measure the curve.
The orthopaedic specialist may want to refer you for further tests, including the following.
- X-rays of your back– these are taken while you’re lying down and while you’re standing.
- A CT scan or MRI scan
These tests allow your doctor to look at your spine in more detail. They can help to identify what might or might not be the cause of a curved spine. Using the X-rays, your doctor can measure what’s called the Cobb angle. This is a method for diagnosing scoliosis, which is defined as a spinal curvature of more than 10 degrees.
Observation. Typically, a doctor will advise observation for a scoliosis curve that has not yet reached 25 degrees. Every 4 to 6 months, the doctor will take another X-ray of the spine to see if the scoliosis is progressing or not.
Treatment of scoliosis
Treatment for scoliosis depends on how severe the curve in your spine is, whether or not it’s likely to get worse, and its overall effect on you. Your age is a factor too. The main aims of treatment are to slow or stop the curve’s progression and relieve or prevent symptoms or complications like pain or breathing difficulties.
If pain from adult scoliosis is affecting your everyday life, combined steroid and local anaesthetic injections into joints and nerves in your back may help.
Your doctor may recommend surgery to treat scoliosis. It can stop the spine curving and reduce related problems. They will consider:
- what age you were when your spine first started curving
- the size of the curve and where it begins (your chest or back)
- how quickly it’s getting worse
- how you’ve responded to other treatments
- increased risks because of your age or other health conditions such as osteoporosis
- how scoliosis affects you, including pain
The most common type of surgery is called spinal fusion. Metal implants and rods are connected to bones in your spine (vertebrae) to correct the curve. They hold the bones in place until the bones straighten and fuse (join) together.
There are different ways to carry out spinal fusion. Some procedures are more complex than others. For instance, an operation may also involve cutting and reshaping vertebrae. In adults, if pain is the main problem, there’s a simpler procedure called decompression to relieve this.
What can we do at Healthy Harmony Tenerife?
Prolonged inactivity can actually increase back pain as the back becomes stiff, weak, and deconditioned, resulting in even more back pain and aggravating the cycle of inactivity and back pain recurrence.
You may want to try complementary therapies alongside treatments you are getting through your orthopaedic specialist. Connective fascia is one of the most significant contributors to lengthening resistance in a relaxed muscle and overall range of motion at a joint. Because of the compromised integrity of the spine specific to scoliosis, the myofascial alignment can be altered, resulting in dysfunction. Myofascial Release Massage can allow for the loosening of the fascial connective tissue where the shortened musculature exists so that improved posture and range of motion can be achieved improving your mobility and balance, helping the spine relax by increasing blood flow and elongating tightened areas. Although not one of the treatment options for correcting this condition, massage therapy can help relieve some of the resulting back pain, shallow breathing, sciatica, headaches and insomnia brought on by this aberrant spinal structure.
We also offer ‘One to One’ exercise/rehabilitation sessions and group exercise classes as many of our clients have found exercise and movement are the natural stimuli for the healing process. Controlled, gradual and progressive exercise, rather than inactivity and bed rest most often provides the best long-term solution for reducing pain and preventing (or lessening) future episodes of pain!
If you’ve got scoliosis, another important effect of exercise is that it stretches, strengthens, and repairs muscles that help to support the back. The back and abdominal muscles act as an internal corset supporting the vertebrae discs, facet joints, and ligaments. When back and abdominal muscles are weak they cannot support the back properly.
Core stabilisation is fundamental to performance factors such as the transmission of power, balance and posture. These factors are crucial to being able to successfully execute activities of daily living such as negotiating stairs, standing from a chair and picking up objects. Incorporating core stabilisation into a program of an individual with scoliosis can dramatically improve postural symmetry and functional strength.
Also engaging in exercise and rehabilitation activities helps keep all joints and especially the spine healthy by allowing discs to exchange fluids which is how the disc receives its nutrition. A healthy disc will swell with water and squeeze it out, similar to the action of a sponge. This sponge action distributes nutrients to the disc.
In addition, fluid exchange helps to reduce the swelling in the other soft tissues that naturally occurs surrounding injured discs. When there is a lack of exercise, swelling increases and discs become malnourished and degenerated.
Exercising the back reduces stiffness by keeping the connective fibres of ligaments and tendons flexible. Improved mobility through back exercise helps to prevent the connective fibers from tearing under stress, which in turn prevents injury and back pain.
Some do’s and don’ts for you to think about…
Use a Quality Mattress
While there's no best bed for scoliosis, typically, a firm or medium-firm mattress is the best scoliosis Skip the cushiony mattress padbut use extra pillows for comfort.
Sitting or standing in one place for too long stresses the spine. Stretch or take a walk as often as possible. Choose a chair with great support if you must sit for extended periods of time.
Get Help with Chores
Activities that require bending like cleaning bathrooms and floors can exacerbate scoliosis, get help with these chores.
Stretching helps mitigate pain and discomfort.
Improve Core Strength
Do exercises to improve core strength. Core exercises are the best exercises for scoliosis because core muscles support the spine.
Dancers with scoliosis need not fret! Some dance movements like repeated back bends can aggravate scoliosis, but avoiding those movements makes more sense than eliminating dance altogether.
Scoliosis muscle retraining treatment is a long-term commitment. Restricting activities you love is psychologically damaging.
Activities that May Trigger Scoliosis Problems
The forward, bent-head position of texting is terrible for people with scoliosis. It's not good for anyone, actually. It puts pressure on the spinal cord and compresses blood vessels to the spinal cord. Texting can damage the spinal cord and degenerate vertebra over time.
Check out our blog ‘Have you heard of text neck’
Texting can trigger scoliosis progression. Using talk to text functions, holding the phone at eye level and lying on a cervical roll are the safest ways to text.
Competitive swimming and scoliosis are nota good fit. Swimming laps for hours daily causes the thoracic spine (spine from the base of the neck to the bottom of the ribs) to flatten, which can drive curve progression.
This is an example of scoliosis and sports notbeing a good fit. Football is a high-contact sport even when it's played safely, so it can result in traumatic body and spine injuries. Traumatic sports like football put significant stress on your spine.
Sleeping on Your Stomach
Sleeping with scoliosis can be a challenge. Sleeping on your stomach is the worst scoliosis sleeping positionbecause it causes the thoracic spine to become flatter. Scoliosis is three dimensional; if one dimension gets worse, the others follow. Sleeping on your belly also requires you turn your head to the side, which twists your spine.
Check out our blog ‘Do you waken with neck pain’
Performing Torso Extensions
Repeatedly extending your thoracic spine in backbends, gymnastics, high jumps, dance maneuvers (especially in ballet) and certain yoga positions causes vertebrae to rotate further into the hollow of the scoliosis curve. Rather than not doing these activities, limit back bends and use modified poses.
Sleeping with the Lights On
Melatonin is a hormone secreted by the pineal gland when you sleep. Studies show that people with scoliosis have lower melatonin levels. Since melatonin is secreted primarily while you sleep, even the faintest light can slow or stop its release. A streetlight shining in the window also disrupts sleep and melatonin secretion.
Running Long Distances
Long-distance running with scoliosis can pose several problems. Spinal compression occurs every time you take a step, jump or run. Running over hills and uneven terrain also makes you bend or rotate your back. Prolonged running or jogging creates a great risk of scoliosis progression. If you pound a bent nail with a hammer, it becomes more bent. Note: Horseback riding also compresses and jars the spine.
Playing on Trampolines
Jumping on trampolines is disastrous a child or person that has scoliosis (even mild scoliosis). It can lead to a rapid advancement of spine curvature and postural collapse because jumping compresses the spine with every bounce.
Carrying Heavy Things
Carrying heavy things, especially on one side, adds to the natural pull of gravity and compresses your spine further.
Check out our blog ‘Understanding the Principles of Soft Tissue Dysfunction - Part Two’