Adult Scoliosis

Unfortunately I have been diagnosed with (fairly mild) adult scoliosis. This is my research gathered from sources I could easily find online. Hopefully, back and posture exercises will keep it at bay.

Scoliosis is a sideways curvature of the spine that most often is diagnosed in adolescents. There is no cure for scoliosis, but the symptoms can be reduced.

Scoliosis is diagnosed when the curve exceeds 10 degrees.

SYMPTOMS

Signs and symptoms of scoliosis may include:

• Uneven shoulders

• One shoulder blade that appears more prominent than the other

• Uneven waist

• One hip higher than the other

• One side of the rib cage jutting forward

• A prominence on one side of the back when bending forward

Other common symptoms include:

• Muscle fatigue

• Back pain

• Feelings of stiffness, numbness and weakness in the back and legs

Posture may also be affected. In more severe cases, scoliosis can cause shooting pain down the leg (sciatica), an inability to stand up straight, and an inability to walk more than a short distance. Symptoms of severe, progressive scoliosis are similar to those of stenosis, but with visible spinal imbalance. This imbalance can result in strain on the hips and knees, the inability to walk a straight line, and falls.

In some cases, there is also muscular fatigue related pain due to muscles on the convex side working harder to maintain postural balance while the concave muscles are mechanically disadvantaged to function optimally. This results in fatigue and failure especially after activities on the convex side. Driving for example?

Degenerative (De Novo) Adult Scoliosis

De novo scoliosis is a term used in adult patients who have no history of scoliosis as adolescents but then develop a coronal plane deformity that may be of a progressive nature and is associated with degenerative changes in the spinal column. Degenerative scoliosis rarely presents before 40 years of age. De novo scoliosis is a sideways spinal curve that appears in adulthood. The difference between de novo scoliosis and degenerative scoliosis is that de novo scoliosis affects patients who have never had scoliosis in the past.

‘De novo’ means ‘new’, and this name refers to the fact that the condition occurs later in life, during the patient’s adulthood rather than their adolescence. It is uncommon for de novo scoliosis to arise before the age of 40-50.

While adult scoliosis can be managed through active treatment, no form of the condition can be fully 'corrected', meaning 'cured'. This is because as a progressive and incurable condition, scoliosis is virtually guaranteed to get worse over time.

From the studies that have been done so far, it looks like this type of scoliosis may be caused by unilateral (one-sided) disc degeneration. This can occur in the thoracic (mid-back) or lumbar (low back) spine. With a loss of disc height on one side, pressure is increased on the facet (spinal) joint on the same side. Muscle imbalance occurs and bone spurs form.

More Symptoms

Observations in the body may include:

• Height loss

• Uneven alignment of the pelvis and hips

Adult scoliosis patients will typically experience back pain and stiffness. As spinal degeneration increases, the intervertebral discs become narrowed and nerve compression develops resulting in sciatica, pins and needles, numbness or weakness in the legs (from pressure on the nerves in the lumbar spine. The spinal canal can also become narrowed and result in spinal stenosis where the spinal cord is squeezed so the patient experiences heaviness in the legs, leg pain and difficulty walking.

Pain and disability in adult scoliosis is not typically associated with size of the curve. It is more importantly associated with:

• Curve location – lumbar and thoraco-lumbar curves typically tend to be more painful especially if they are singe curves.

• Postural Balance – Adults with good postural balance will have less symptoms, thus often those who have double curves which are balanced will have less pain.

• Bent forward posture where an adult's head and chest is in front of their pelvis is often the primary determinant of the severity of pain and symptoms.

• Adults whose head or chest is shifted to the left or right will also experience pain than those who are in better alignment.

Individuals who suffer with conditions such as Osteoporosis (loss of bone mass), degenerative disk disease, compression fractures and spinal canal stenosis are at a higher risk of De-novo scoliosis, which should be considered as part of the diagnostic process.

More on Degenerative Scoliosis

Degenerative scoliosis is a common form of adult scoliosis. It develops out of the natural degenerative effects of ageing that impact the spine, most notably the intervertebral discs.

Most common in adults over the age of 40, degenerative scoliosis occurs when the spine and its individual parts start to feel the effects of years of wear and tear.

As bones get weaker and the ligaments and discs in the spine become worn due to age-related changes, the spine may begin to curve.

In most cases, de novo scoliosis is caused by the ageing of the facet joints and discs in the lower (lumbar) spine, leading to the vertebrae slipping out of place and the spine losing its shape. However, a number of other conditions – including spinal canal stenosis, compression fractures, and osteoporosis - have been known to contribute to the occurrence of de novo scoliosis.

This is most commonly experienced by the intervertebral discs. Once the intervertebral discs start to degenerate, the spine can easily slip out of alignment.

This is because the vertebrae of the spine are separated by the discs that act as cushions so the bones don’t grind up against each other.

If the discs start to deteriorate and are no longer giving support to the spine, this can speed up degenerative changes and lead to the spine slipping out of alignment and scoliosis developing.

While the discs of the spine don’t automatically degenerate with age, the cumulative effect of lifestyle choices contribute to the health of the spine and its intervertebral discs.

For example, choices such as sitting for long periods of time without good posture, not consuming enough water, leading an inactive life, or regularly lifting heavy objects improperly can lead to the cumulative effect of spinal-disc degeneration.

Other factors such as genetics can also play a role as some people’s discs are better at holding water, meaning they are less likely to deteriorate.

Lack of motion is a huge contributing factor to an unhealthy spine. The very design of the spine is to facilitate movement, and it is through movement that the spinal discs can replenish their water level and stay healthy.

Activity also increases blood flow, meaning nutrients and moisture are more readily available to the discs; if activity levels are low or nonexistent, the longevity of the discs is compromised, as is the overall health of the spine.

When it comes to treating adult scoliosis, having reached skeletal maturity, there are not as many treatment options available as there are for children and adolescents.

However, an adult with scoliosis still has options, and still has to make the important choice of how to manage and treat their condition moving forward.

Diagnosing De Novo Scoliosis

While most forms of scoliosis are not usually associated with severe pain, De-novo scoliosis is often discovered as the result of a back-pain investigation. Patients typically present with complaints ranging from debilitating back or lower extremity pain to spinal imbalances.

A physical examination and X-ray scan / imaging techniques are required to diagnose de novo scoliosis. A thorough inspection of the patient’s medical history also helps to determine whether any underlying issues have contributed to its development.

A complete assessment will include personal and family history, psychological status, and a structural evaluation of the body and spine. Because of the muscle imbalance that can occur, muscles must be tested carefully and thoroughly. Joint function, motion, and flexibility should also be evaluated. Nerve and muscles are tested and bowel and bladder function are reviewed.

Standard X-rays are still relied upon when making decisions about surgery to correct the deformity. Information about curve flexibility and segmental stability can be gained from X-rays. MRIs and CTs have some useful purpose in this diagnostic process. MRIs show the full extent of the stenosis. Pre-operative bone mineral density studies are necessary because of the risk of fractures in patients who have osteoporosis.

Treating Adult Scoliosis

We want to treat the whole patient; this means taking into account any and all areas of a patient’s life affected by their condition, and the treatment approach can greatly impact daily life.

As already mentioned, there are less treatment options available to adults than adolescents, and this is because of a few factors. Treating scoliosis becomes more challenging as a condition progresses. Not only is this because the condition is naturally moving into its more severe stage of progression over time, but also because the body has had years to adjust to any abnormal spinal curvature.

The body can be remarkably effective at adjusting to structural changes and compensating for these changes to preserve function.

After a person has been living with scoliosis for years, their spinal discs, muscles, and tendons gradually adjust to the spine’s unnatural position.

Also, keep in mind that as part of the central nervous system, the health of the spine impacts the brain. Just as the spine and closely-surrounding muscles and tendons can grow accustomed to the abnormal spinal curvature, so too does the brain as it becomes comfortable with the patterns reinforcing the curvature.

In addition, a spine that is no longer growing is less malleable and more rigid.

Sometimes, in cases where the spine is particularly rigid, we first have to work towards restoring some spinal flexibility before we concentrate our efforts on an actual curvature reduction.

Even though we are often dealing with adult patients who have already been progressing for years, or those dealing with degenerative scoliosis, treatment approaches are still important.

Traditional Treatment and Adult Scoliosis

The traditional scoliosis treatment approach is marked by watching and waiting.

Even with adolescent forms, these patients are often told that if their condition is mild at the time of diagnosis, the best recourse is to wait and observe to see if the condition actually gets worse.

The problem with this is, as we have already discussed, as a progressive condition, scoliosis is virtually guaranteed to get worse, and whether it happens rapidly or glacially, progression is, again, progression.

Bracing : while bracing can be an effective form of treatment, for adults, this is less so as their spine is no longer growing.

In adults, if a brace is used as part of treatment, it’s most often used to stabilise the spine and/or alleviate related pain and discomfort.

So, if an adult with scoliosis is walking the traditional treatment path, they might be told to wear a brace, but more likely, and especially if their curvature has already progressed past 40 degrees, they will be told that spinal-fusion surgery is their best option.

This is where I want patients to really do their due diligence in researching the potential cost, side effects, and complications associated with spinal fusion.

Functional Treatment and Adult Scoliosis

We want to address the underlying structural nature of the condition, which is why, first and foremost, we want to produce a structural change in the form of a curvature reduction.

We do this by combining the merits of scoliosis-specific treatment disciplines such as targeted chiropractic adjustments, exercise, therapy, and corrective bracing.

There is no cure for a progressive and incurable condition like scoliosis. The treatment goal is not to cure the condition, in the usual sense, but to instead control and manage its progression and related symptoms.

Scoliosis-specific exercise and stretches done from home, plus in-office rehabilitation, therapy, and chiropractic care all work together to sustain those results once the intense treatment phase is over.

There is always hope for people with scoliosis of any age. While adults may not have the treatment benefit of early detection while the spine is still growing and flexible, there are still active forms of treatment that can lead to symptom-relief, a curvature reduction, and a significant improvement to every-day life.

Physical therapy can improve the patient’s mobility, boost strength and correct abnormal posture.

Recent advances in non-surgical treatment have shown significant improvement in pain and symptoms in those with adult scoliosis. This involves the patient learning how to self-correct their abnormal posture, not just strengthen their lower back or core. When combined with a brace which helps to support the posture in a more comfortable position, pain is reduced and quality of life is improved.

When non-surgical treatment is ineffective, surgery is often the only option, especially when leg pain becomes incapacitating and walking is almost impossible. Unfortunately, surgery at this stage is always complex and with significant risk. This is why it is important to find not only a good spinal surgeon, but also one who specialises in scoliosis for the best possible outcome.

Surgery is done to reduce pain, stabilise the spine, and improve function. Pressure is taken off the spinal cord and spinal nerves by removing bone from around these tissues. This procedure is called surgical decompression. Patients must be selected carefully for this operation. The presence of any spinal instability may prevent the patient from having surgery that could make the instability worse.

This treatment is the last option because of the risks of complications from spinal surgery. Surgery may be suggested for the following reasons:

• Pain. Surgery may be needed if back and leg pain from the scoliosis becomes severe and ongoing, and doesn’t respond to conservative treatment.

• Spinal imbalance. Whether the spine remains balanced is important in assessing the scoliosis’ progression and the need for surgery. When we stand, the head should be balanced over the centre of the pelvis when looking from the front, and over the hip joints when looking from the side. If the curve progresses to the point that this is no longer possible, patients will tend to progress over time and have more pain and disability.

• Surgery is needed to improve quality of life. Although surgery is not recommended solely to improve appearance, some people find the symptoms of their spinal deformity unbearable. Their spinal imbalance, too, affects basic function and overall quality of life. Surgery is the only option in these cases. In younger adults the cosmetic deformity may be a major factor in the decision to have surgery but in older adults this is not usually the case. There are a variety of spinal surgical options, depending on each case. Generally, surgical procedures are designed to stabilise the spine, restore balance, and relieve pressure on nerves. Spine stabilisation surgery fuses the bones of the spine together using bone grafts and then metallic implants to hold the spine in place.

Advances in surgical techniques and computer-assisted navigation systems make less invasive approaches possible, and recovery time quicker.

The majority of cases of adult scoliosis can be managed nonoperatively through regular observation by a doctor, over-the-counter pain medications, and core-strengthening exercises to strengthen your abdomen and back and to improve flexibility. If you smoke, it’s important that you quit. Smoking has been shown to speed up the degenerative process. Smoking is also the leading preventable cause of back and neck problems.

In most cases, your doctor will recommend some forms of physical therapy, to both maintain strength and relieve pain. These may include:

• Working to improve posture

• Doing low-impact exercises, such as swimming

• Daily stretching

• Staying active

Most cases of scoliosis are mild and don’t need treatment. In adults, the degree of the spinal curve may not determine treatment. Treatment is geared towards relieving symptoms, and not necessarily fixing the curve. The goal is always to decrease pain and improve function.

Having the right equipment available can help. Supporting your spine’s weak areas and in some cases even enhancing the effectiveness of your exercises. Below are a few devices that are especially helpful for people with scoliosis.

• Stability ball: Specific exercises performed on a stability ball are helpful in strengthening the back and abdominal muscles. The ball provides balance and support for your spine while you work out. This is particularly helpful for mild scoliosis and should not be used with scoliosis bracing.

• BOSU Balance Trainer: Exercising while standing on this dome-shaped device adds an element of instability to your workout, engaging the muscles responsible for stabilising and balancing the spine. Make sure to promote correct posture at all times and the body remains in a neutral position.

• Wedges: Exercising with training wedges can provide extra support where you need it, especially if your form of scoliosis has many spinal curvatures. Depending on the type of scoliosis this can be very helpful in the thoracic spine or upper body spine curves.

• Foam roller: A foam roller is helpful for improving balance while you perform core-strengthening exercises. This should not be used with a scoliosis brace.

Below are some adult scoliosis exercises you can do at home to help strengthen your core:

Spider

Stand facing the wall with your feet together. Lean forward and place your hands on the wall at chest height. Tighten your abs and walk your fingers up the wall. As you extend your arms over your head, come up on your tiptoes. Once your arms are extended, with a straight line from hands to heels, walk your fingers back down. Repeat, keeping abs and lower back muscles engaged.

Pelvic tilts

Lie face-up on the floor with knees bent, feet flat and arms at your sides. Tighten your belly and buttocks to curl your pelvic bone inward, feeling your lower back flatten out against the floor. Hold for five seconds, breathing normally, before releasing. Repeat.

Cat-camel

Get on your hands and knees, with your abs tight and head straight. Take a deep breath in and lift your lower rib cage, rounding out your back and relaxing your neck. Breathe out, lowering your chest toward the floor and looking upward. Return to the beginning position, with your abs tight, and repeat.

Crunches

Lie with the small of your back on a stability ball and your feet on the floor. Place your fingertips behind your head, keeping your elbows wide. Sit up, making sure your abdominal muscles are engaged, then lie back.

Back extensions

Lie with your stomach and quads on a stability ball and your feet braced against the wall. Place your fingertips behind your ears. Lower your torso into the ball, then lift up (as if performing reverse crunches).

Leg and arm extension

Lie across the stability ball on your belly and place your hands and toes on the floor about shoulder-width apart. Contract your abs and lower back muscles while you steadily raise your right arm and left leg until parallel to the floor. Slowly lower and repeat on the other side.

Squats

Stand on a BOSU Balance Trainer and find your balance. Extend your arms in front of you and sit back and down like you’re easing into an imaginary chair. Lower until your thighs are parallel to the floor, with your knees over your ankles. Keep your body tight and push through your heels to return to the starting position.

Superman

Lie on your stomach with your arms extended in front of you, palms down. Lift both feet and arms. Hold, then release.

Foam roller balancing

Lie longwise on a foam roller with your tail on one end, head on the other and feet about hip-width apart. Lift one knee so your calf is parallel to the floor while lifting the opposite arm so straight up so your fingers are pointing at the ceiling. Return to the starting position and repeat on the other side.

OUTLOOK / PROGNOSIS

Non-operative treatment, with modalities such as physical therapy, a regular exercise program, and over the counter anti-inflammatory medications is always the first line of care.

Steroids, which reduce inflammation, may also be administered by an epidural, in which the injection needle is inserted into the spinal canal to deliver the drugs directly to the affected nerve root.

Maintaining an ideal body weight and maintaining a regular exercise program are excellent ways to minimise symptoms associated with adult scoliosis.