I have patients often explain to me that they were told they have a scoliosis but they feel fine, whilst another will tell me that their niece has a scoliosis and needs an operation! So are these the same thing? What is a scoliosis?

Time to define . . .

The term scoliosis technically describes a curve or curves in the spine that are not meant to be there. And there are many variations and degrees.

If I look at your back from behind you whilst you are standing up straight, your spine should be a straight line from your tail to your head. No deviation right or left. Now any deviation in any of the joints of your spine to the right or left is technically, medically termed scoliosis. I am not referring to the natural curves present in your spine visible from side on. Naturally you will see the curves go ‘in’ at the lower back, ‘out’ at the upper back and ‘in’ at the neck. (You can see these curves described in more detail in the ‘Back pain: The secret to good sitting posture’ articles.) When talking scoliosis I am describing curves right or left, viewing the spine from behind. From this view point the spine should be a straight line.

Great variation . . .

Now if a scoliosis is any deviation in the joints of the spine to the right or to the left then by this definition, 80 per cent of the population has a scoliosis to some degree. Yes my friends, very few of us are actually symmetrical. As humans our DNA is corrupted and we all carry multiple asymmetries and variations all over our bodies. Ever seriously looked at your face in the mirror? Is your nose perfectly straight? Are your ears identical? Anyone got the same number of freckles on the right and left cheek? No human is perfectly uniform. Your spine is no different.

Variations . . .

A scoliosis can be as minor as one vertebral joint being on a slight angle. A scoliosis can be an angulation in just two or three joints. The first image here demonstrates a relatively mild scoliosis. If you look closely you can see that the ball joints of the hips are not equal heights and this is causing the asymmetry. The second image shows a severe S-shaped scoliosis and its surgical correction.

Most of us with asymmetry in our spine will never even know it is there. The scoliosis like the one above that has had the surgery, make up only a small percentage of cases. Scoliosis severity is measured by degree. If the angle of the primary curve is greater than 25 degrees then this is described as a moderate scoliosis. When the angle of the primary curve is 40 degrees or greater this is described as a severe scoliosis and is likely to require surgery.

Is a scoliosis painful?

Technically no.

An asymmetry in one or more of your spinal joints is rarely a painful thing. A scoliosis will cause pain as a result of the muscles around the spine being overloaded as they naturally attempt to compensate for the curve.

Most people don’t find out they even have a scoliosis until they become more sedentary due to age or occupation and the back starts to give them pain.

Why does the scoliosis give pain now and not earlier?

Because earlier in life while Jenny was still playing netball the muscles around her spine were fit and healthy and could compensate for her spinal asymmetry with little effort. But now since she has taken up her desk job full time and has given away the netball, the muscles working to compensate for the curve in her spine are unfit and stationary. You only need to read ‘4 tips on preventing your desk work from giving you a headache’ to learn that muscles hate effort without movement. And that is exactly what is happening with Jenny’s back. When she sits still all day in front of her computer, some of the muscles in her back are working without movement for hours on end, compensating for the curve.

Do I need to get my scoliosis fixed?

Most scoliosis are genetic. As I said before, all of us have corrupted DNA and we all carry asymmetries of many sorts. Most of us never need to get our scoliosis corrected. Most of us will never know we have one. And even if you do, the best therapy to prevent a scoliosis from giving you pain is to keep fit. If the muscles are kept moving they are less likely to complain.

In most cases Myotherapy can correct Jenny’s pain with a few treatments on the complaining muscles and instruction to ‘return to netball!’ Or at least some regular walking. In some cases the scoliosis is a not genetic asymmetry of the joints but spasming muscles that are literally pulling the spine out of line. In this scenario Myotherapy treatment will, by releasing those spasming muscles, actually correct the scoliosis.

In yet other scenarios like the image above, a heel lift in one shoe to raise a genetically shorter leg will level the pelvis and actually reduce the scoliosis. And in other cases skilled remedial corrective exercises can make a huge difference. In the worst case scenario, and just a small percentage of cases, surgery is the only option.

If you are getting back pain, a good therapist will be able to determine if you have a scoliosis, and whether it has anything to do with the pain. Often it doesn’t. They will then be able to treat and advise you accordingly. In short if you have no back pain, then keep fit. If you have a scoliosis but no pain, join the club and enjoy life.

 

Keep fit,

Tim