Scoliosis Deserves Special Consideration

by Christina Lasich, MD Health Professional

The chronic pain from scoliosis deserves special consideration. This skeletal deformity of the spine can be obvious or obscure. Either way, scoliosis can cause a pain in the neck, mid-back, or low back. What exactly is scoliosis? In technical terms, scoliosis is a lateral curvature of the spine occurring in the coronal plane.

What the heck does that mean?

If you look at a normal spine from the back, the spine lines up, like an "I", straight from head to tail. If you look at a spine with scoliosis from the back, the normal straight line of the spine is curved like a "C" or an "S" or an evil looking snake. Seventy percent of the cases are classified as "Idiopathic Scoliosis", meaning that the cause is unknown. Sometimes scoliosis occurs in the infantile stage (below the age of 4 years old). Sometimes scoliosis occurs in the juvenile stage (ages 4 years to 9 years). However, most of the time, scoliosis occurs in adolescents (from age 10 years old to skeletal maturity). A majority of Adolescent Idiopathic Scoliosis is seen in girls, by far, rather than boys.

Getting back to the concept of "skeletal maturity"; as one grows, the bones grow also until the growth plates (the place in the bone where new bone is formed) fuse. Once the growth plates fuse together that skeleton is considered mature and stops growing. Why is bone growth important? Not only is the degree of curvature important for determining treatment, but the maturity of the skeleton is also very important to evaluate. As a young girl's bones and spine grows, the severity of the scoliosis can rapidly progress (very rapidly in some cases). Thus, during this adolescent stage, young girls should be screened for scoliosis and, if scoliosis is present, frequent and regular monitoring is extremely important. Without proper treatment, the spinal curve can progress into an evil "snake" that can cause problems like chronic pain or breathing problems (thoracic insufficiency). All the problems associated with this skeletal deformity of the spine deserve special consideration, especially pain.

The pain associated with scoliosis is primarily due to poor alignment and poor balance. An improperly aligned spine can lead to a greater degree of degeneration of the spinal discs, a greater load on the ligaments that hold the spine together, and a greater amount of stress on the small joints in the spine. All of this adds up to pains in the neck, mid-back, and low back. Sometimes surgery can correct the alignment by straightening the spine with heavy metal: rods, screws, and wire. These types of surgery are very complex and can be very risky. Besides, surgery may not necessarily cure the pains, but it can definitely help relieve pinched nerves or crowded internal organs. Another consideration when talking about spine alignment is its effect on the shoulders and the pelvis. Both of these areas can become greatly impaired by misalignment and should be the focus of a rehabilitation program. Strengthening of the shoulder muscles and butt muscles can relieve the chronic pain associated with scoliosis by helping to maintain better alignment of these joints. Muscle strength can compensate for skeletal deformities and poor alignment to a certain extent.

The other factor that leads to chronic pain in those with scoliosis is poor balance. Because of the shape of the spine, the center of gravity can be off, way off. One can have a tendency to fall forward, backward or to the side. The body tries to compensate for the off-center plumb line. Sometimes the compensation effort can lead to problems in many areas of the body like the feet, knees, and hips. Furthermore, a person with scoliosis can have extremely weak "core" muscles that help maintain balance. Eventually, balance becomes not only a problem causing pain, but also a problem jeopardizing safety. With poor balance, a person has a greater fall risk especially as he/she gets older. One tumble down the stairs can be a disaster. A rehabilitation program for someone with scoliosis should include balance exercises like sitting on the exercise ball or standing on one leg. With an improved sense of balance, a person can control pain to a better degree and stay safe.

Scoliosis poses special problems: poor alignment and poor balance. By considering these issues, one can understand the special treatments necessary for addressing chronic pain associated with scoliosis. Improving muscle strength in key areas and improving one's ability to maintain balance can greatly improve the quality of life of someone with a crooked spine. Unfortunately, scoliosis is a life-long problem with no known cause and no known cure, but there are those who manage quite well despite a snake-like spine. For example, James Blake, a professional tennis player who was recently in the Olympics, was diagnosed with severe scoliosis at the age of 13 years old. James Blake took charge of his health at a young age and wore his brace faithfully throughout high school. Because of his diligence, He was able to avoid major spine surgery that could have ended his bright tennis future. His story is an inspirational lesson for all young people with scoliosis about the importance of brace compliance, frequent check-ups, and exercises (Read More). With special consideration and treatment, the future can be bright despite scoliosis of the spine.

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.