Adult scoliosis for this context is someone that has noticed their shoulders are uneven, their hips are uneven, or they can just tell there’s a spinal curvature happening in their body. Patients may have been told by a massage therapist, physical therapist, friend or family member that they look “crooked.” They may or may not even have pain with their crookedness… yet. They just know something’s not right and they have the back pain to prove it.
We are going to look at what’s “crooked.” I am also assuming for the purpose of this blog post that you didn’t have scoliosis as a kid, that you just more recently noticed you aren’t straight. No one had previously diagnosed you with scoliosis, so we are most likely dealing with misalignments leading to a spinal curve.
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How do you know how big the curve actually is?
We take spinal x-rays before doing spinal adjustments, because we want to see what’s actually happening to your spine beyond what we can feel with our hands. When we take our x-rays, we go one step further beyond looking for pathology. We measure. We take x-rays of your neck (cervical spine), your mid back (thoracic spine), your lower back (lumbar spine), and your pelvis. We can then put those digital images together into one image that captures the entirety of your spine from neck to pelvis.
Then we measure pelvis alignment, femur heads, spinal curves, and the tilt and rotation of each spinal segment. When we look at a spine from the side, it should have 3 curves, one in each region of the spine. When we look at the spine from the back, it should not have any curve. If there is a curve, we can measure it.
Why does a curve start causing symptoms in your forties or fifties?
The curve has likely been there for awhile and your body has been doing it’s best to compensate around the curve. That means some spinal segments have been doing more work and they eventually cross the threshold into symptoms. The muscles, the joints, the soft tissue can all be affected by how gravity is reacting to your spine and the scoliosis curve does not make your spine stronger. There is more strain at each area of the “kink” in the curve.
We also evaluate for leg length discrepancy, which is often the silent difference that no one has checked. I’m not talking about an inch difference, it’s usually a difference in millimeters that has been building for a long time, causing the pelvis to rotate and twist and then lead to a curve in the spine. We take a special leg length x-ray that will determine the actual anatomical difference in your leg lengths down to the millimeter.
What is care actually aimed at?
There are two main goals; reduce pain and keep it from coming back. Once we take our measurements, the spinal adjustments are focused on restoring range of motion and untwisting anything in the pelvis that is causing the spine to curve. We will also address any leg length difference. Depending on the size of the leg discrepancy, a small heel lift or a full insert will be recommended.
Ideally, the patient dealing with adult scoliosis will also undergo spinal decompression therapy. Our machines gently lay you back and can pull your spine through different protocols to lengthen and create more space. Anywhere the spine has been kinked up will be pulled to increase space and allow discs to return better to their natural shape. This helps to create more space, better range of motion, and less curvature.
What does a re-check look like?
Our initial care plan typically runs for about 3 months. Then we take another x-ray and compare it to the first one. We make any changes to your treatment plan and recommendations are provided then. Follow up x-rays are typically performed about every 2 years unless something significantly changes. We can measure and remeasure, so it’s not just your symptoms that we are using to evaluate your progress or any regression.
Frequently asked questions
Can adult scoliosis get worse over time? Some adult curves do change slowly, and a measured number compared across standing x-rays is the only way to know. This is something we can check via x-ray periodically. According to PubMed, a systematic review found strong evidence linking three factors to a curve getting worse (Faraj 2016)
Is exercise safe with adult scoliosis? For most adults, movement and strength work are part of the plan rather than something to avoid. We will guide you as to the best exercises for you to do. A 2019 Lancet review calls non-surgical care the first-line approach (Diebo 2019).
Does a curve always cause pain? No. In 75 healthy volunteers over 60 with no known scoliosis, 68% had a curve on a standing x-ray (Schwab 2005). Many patients didn’t even know they had a curve for years until it eventually caused pain.