SCOLIOSIS
What is Scoliosis?
Scoliosis is a condition characterized by lateral curvatures of the spine that results in spiral or rotational deformities. The curvatures are usually “C” or “S” shaped over three dimensions and the thoracic spine usually compensates by the reposition of the rib cage. Scoliosis not only affects the aesthetics of the patient but potentially disrupts cardiovascular and respiratory function.
Types of Scoliosis
Can be categorized into two types; congenital and secondary
Congenital
Congenital scoliosis accounts for approximately 80% of the general scoliosis database, mostly genetic and inherited conditions. Due to its congenital nature, if either parent has scoliosis, the risk of inheritance increases. Signs of scoliosis are rarely present prior to puberty, although prognosis dramatically increases when detected early. Screening is recommended starting at the age of 8 with check-ups between 10-15 to ensure normal spinal development. Research have shown that for every 100 adolescent, 2-3 will have signs of scoliosis, females are 8-9 times more likely to develop congenital scoliosis than males.
Secondary
Secondary or neuromuscular scoliosis is usually found post-puberty (although the modern posture is starting to trend in adolescent). The causes of secondary scoliosis range from chronic poor posture, pelvic imbalance, muscular development, leg length differences etc., moderate to severe injuries to the spine or lower extremities have also been found as a contributor.
Symptoms
Depending on severity, patients with scoliosis may suffer from headaches, dizziness, chest tightness, numbness in the upper and lower limbs, soreness and malaise, insomnia etc. The lateral curvature of the spine in the cervical, thoracic or lumbar may cause nerve impingement resulting in other neurological symptoms. In extreme cases, thoracic scoliosis may cause distortion in the rib cage affect the lungs and heart.
Misconception
Scoliosis is a condition that is often misused and misdiagnosed in modern society. The assessment of scoliosis requires a thorough examination and full spine x-ray analysis to determine the severity of the curvature. By definition, the curvature (Cobb’s angle) has to be greater than 10 degrees to be categorized as mild scoliosis. Many healthcare providers would even set the threshold at 15-20 degrees to be considered for medical intervention. Research have shown that non-invasive treatments and therapies are very beneficial in the prognosis of scoliosis under 15 degrees.
Patients with a Cobb’s angle of 20 or above should be fully examined and assessed for an optimal treatment option to prevent further increase. When the Cobb’s angle approaches 30 degrees, more aggressive treatment options should be considered and invasive treatments can be discussed. Progress examination and check-ups are highly recommended at this level to ensure stabilization of the curvature. Lastly, Cobb’s angle of over 40 degrees is considered severe. Orthopaedic surgeons should be consulted and invasive or more aggressive treatment options are usually recommended. Early detection has the biggest impact on prognosis thus screening is utmost important before and during puberty.
How to self-test?
Research has shown that up to 80% of scoliosis cases are congenital. Adults can perform self-observations to look for signs of potential scoliosis; head tilt, shoulder and pelvic height balance etc. Shoe wear comparison can also signify weight bearing and loading which can indicate pelvic imbalance. Due to the nature of scoliosis development, curvature and structural malformation usually start to appear during childhood and adolescent puberty. Parents can perform Adam’s test at home to screen for potential structural scoliosis. Adam’s test is applied in most primary and secondary school screenings and has an accuracy of up to 80%. With that said, any suspected cases of scoliosis must be referral to a healthcare professional for further examinations for diagnosis.
Adam’s test or Forward bend test is performed when the patient is bent forward at the waist while standing, feet together, arms hanging and knees extended. The examiner is standing directly behind the patient looking along the horizontal plane of the spine, checking for spinal asymmetry, unlevel shoulders, scapular asymmetry (humps), unlevel hips etc. A normal spine should look symmetrical on both sides; left and right.
Treatment Option
There are four common treatment options for scoliosis, depending on severity and patient condition such as age and other spinal complications. Chiropractic treatment, rehabilitation exercises, scoliosis brace and surgery.
If a patient is suspected of scoliosis, a referral to a healthcare professional is required for a full spine examination. An X-ray of the patient’s spine is typically recommended to allow the practitioner’s detailed analysis. After a full assessment of the patient’s condition and severity, treatment options will be explained accordingly. A mild to moderate curvature can usually be managed by chiropractic care with a combination of rehabilitation exercises. Our goal is to achieve stability in the spinal structure to prevent further development of a lateral curvature. The patient’s centre of gravity and plum loading is essential in structural management of the spine. As the spine progresses with stability, we start to incorporate additional exercises to further strengthen the spine.
In moderate to severe cases, your healthcare provider might discuss options such as scoliosis brace or surgery to improve the prognosis. It is important to note that treatment options hugely depend on the assessment and the severity of the case.
Dr. Lai’s Recommendations:
Scoliosis and other structural problems of the spine are becoming more common as the modern lifestyle changes. We should always practise good posture habitats to prevent chronic changes to the spine. We recommend 30mins. of exercising, three times per week at a minimum to allow adequate movement in the spine. Minimize anterior head carriage or text neck while on mobile phones or computer can contribute to better spinal health.
Lastly, if you suspect a case scoliosis, please seek professional advice and diagnosis. This page is for educational purposes only, it is not intended for self-diagnosis or treatment.
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