Scoliosis is an abnormal lateral curvature of the spine that can appear in a child or adult. Signs that someone may have scoliosis include having one shoulder or hip taller than the other and pain after exercise. There are exercises and treatments to help improve the condition.
Let’s start by explaining what scoliosis is and how it is diagnosed.
Dr. Gregg Rubinstein: Scoliosis is a nice Latin term, which basically means, abnormal lateral curvatures of the spine. It can be sometimes very easy to diagnose and it can be very obvious in a person, and sometimes it’s not. If you look at someone’s back, you’ll see that the spine should run straight up and down. You can see on someone who’s very lean, you’ll be able to see the spinous processes that stick out on the back, and you should be able to draw a straight line down the spine connecting those dots.
When a person has scoliosis, the backbone will curve off to the side and the angle could be very small or large or somewhere in between. But anything measures more than eight to ten degrees is considered scoliosis. Now, doctors use a letter C or a letter S to describe the curves of the backbone. Most people probably aren’t really looking directly at too many spines, but what you might notice on someone with scoliosis is you might notice the way they stand. They may lean to one side, they might have shoulders or hips that look uneven or one is higher than the other, or one shoulder blade might stick out posterior towards the back. On some people, you would look at them and you wouldn’t even know it and it’s not until you take an X ray and you can see how curved they look on the inside, and sometimes, it’s very surprising because they look like they have normal posture and they’re standing straight, but the spine can be very serpentine in its appearance on the X ray.
In many cases though, doctors don’t know the exact reasons for the curved spine. Scoliosis without a cause is very often referred to as what they call idiopathic. But the latest studies that I’ve seen sometimes point to the cerebellum and the communication errors between the brain and the muscles of the body causing these abnormal postures. Some of the scoliosis do have clear causes. You can divide those basically into two types; there’s structural and non-structural types of scoliosis.
In non-structural scoliosis, the spine works normally but looks curved. Why this happens is because there are a number of reasons. Sometimes it can be one leg shorter than the other one, other times it can be muscle spasms. Even inflammation, like appendicitis might cause someone to bend their spine. Typically, when those problems get treated, that type of scoliosis will go away. But there are congenital scoliosis that begin early in life as the baby’s back starts to develop. Sometimes there can be even problems before birth where the vertebrae can form in a wedged form. The incomplete development of a vertebrae can cause these different angles in the spine because if one of them is angled, then all the ones that stack up on top of it will be angled as well. Family history and genetics play a part in these risk factors for scoliosis.
If you or one of your children has this condition, make sure you want to check the other kids. It will usually show up most often around the growth spurts usually in kids or somewhere between 10 and 15 years old. Those are the basic things, but it can be diagnosed and usually managed through the teen years. If it is not corrected or treated in teen years, then it becomes more problematic in the adult that reaches skeletal maturity with those curves.
I know you touched on this, but for those who may have undiagnosed scoliosis, what symptoms might they be experiencing that could be signs of scoliosis?
Dr. Gregg Rubinstein: Typically, you are going to see the postural stuff that I described before. You will lean to the left or to the right, or there is a shoulder that’s higher, or the hips that look uneven. Pain is not always associated with scoliosis. Sometimes people will describe things like growing pains in the kids or pain after exercise, sports, significant physical activity, or even long periods of sitting.
Typically, scoliosis does modify or alter the mechanics of the spine. Things that could happen later are you could see advanced degenerative changes in the spine that’s curved and not functioning properly. But, the symptoms can vary from pain to no symptoms at all.
If scoliosis is discovered in a child or adolescent, what is the treatment protocol like? And its there a chance that it can be corrected?
Dr. Gregg Rubinstein: Depending on the cause and how early it is detected, that will dictate the outcomes that you’re going to get. Sometimes it can be corrected fully especially if it is the functional scoliosis that we described before. The congenital ones are a little bit more difficult if it’s due to an abnormal growth plate or some type of misalignment on an open growth plate when the child is young. And if you catch that early enough, you can certainly minimize the effects. But regardless, the curves in the spine over time will become more and more rigid, and more fixed. So, the earlier you tend to intervene to get them moving, break up the fixations, the straighter the spine will develop and the scoliosis could be stopped from progressing.
Sometimes though, when scoliosis gets beyond 20 to 22 degrees, they will use hard braces or even surgeries. They put in these things called Harrington rods to totally straighten out the spine. Now, I’m not really a big fan of the Harrington rods because those are not reversible and then you take away all the mobility of the spine. But, recently, I’ve had some friends of mine who are chiropractors and they’ve been traveling the world, and they opened a scoliosis center and they used the soft bracing technique that they found out about over in Germany. I don’t remember the exact name, I think it’s called the Schroth technique. They use these soft braces that are really good at helping the kids and keeping them in good positions. They use it a lot in dancers. They can be worn under clothes. You don’t even know that they are wearing them whereas the hard braces, if you’re wearing that in a public school, kids aren’t always so nice and it can lead to ridicule and psychological problems as well.
The treatment protocols in our office are just a series of adjustments to try and break up the fixations, get it as straight as possible and maintain it as straight as possible. In the older adult, again, these fixations and things will cause degenerative changes, so it is important to do mobilization and get these things moving and do adjustments to make sure that they line up well.
The benefits with chiropractic care affecting scoliosis are huge. We’re never going to make every curve go away. Some of them are fully adapted curves, and once it’s fully adapted, then we just want to manage it and make sure that they don’t progress and show up in any increased degenerative changes later in life.
If an adult discovers they have scoliosis is it too late to treat it or are there exercises and treatment plans they can follow to help correct it?
Dr. Gregg Rubinstein: You’re absolutely correct, there are exercise programs that they call de-rotation exercises. And the spinal adjustments really help to correct it. But what I always say is, it is never too late to improve the overall condition of health in your spine. It really bothers me when people say, “Oh, it’s too late for me, the curves are already there.” But even though the curves are there, the more you use a crooked spine, the faster it’s going to wear out. It’s analogous and I use this analogy a lot to driving your car with your front end out of alignment. If I run over a pothole and knock the front out of alignment, the car still drives, I can still drive it fast, but eventually I’m going to feel some vibration, and then the steering column is going to start to wobble and that can stress the U joint, and then after the U joints get messed up, it can affect the steering column. All you really need to do is really realign the front tires after you hit that pothole and you wouldn’t be having that problem. Well, it’s really no different in the spine. Early detection of those misalignments and subluxations and management will produce much better outcomes than waiting and doing nothing.
Why is it so important for one’s overall health to have their spine checked by a chiropractor?
Dr. Gregg Rubinstein: Well, that’s the million-dollar question Liz, that I’m always trying to answer for everyone who comes into my office or anyone who asks me anything about chiropractic. As you know, I could go on for hours talking about it.
But you and I know that getting your spine checked by a chiropractor would improve the alignment, and that’s important because if the bones are misaligned, they can pinch or irritate the nerves. The same nerves that are designed to sense pain and move muscle, are the same nerves that actually control and coordinate every function of every cell, tissue and organ system in your body. The same nerves that go to your lower back muscles, are the same ones that control your intestines, your digestion, your kidneys, your spleen. Everything is all controlled by the nerve system. So, any misalignment that irritates or puts pressure on a nerve will have an effect on the way your body functions. Since your brain is in charge of millions of processes every day that you don’t have to think about, if you put static in that communication line and break the lines of communication between the brain and the body, not only is it not going to function optimally, but over time, it will cause painful conditions and degeneration.
So, you’re more prone to degenerative changes and arthritis if the spine is not in proper alignment. But the main thing that I want to share is that in your neural system, only 10% of it is dedicated to sensing pain and moving muscle. The other 90% is constantly running and regulating your body, so your body can adapt and regenerate and heal. The crux of chiropractic, everyone thinks it’s about back pain and neck pain, but it’s truly about how well your nerve system functions. Our spine is designed to protect our central nervous system. If those bones misalign, they’re going to irritate the same nerves they’re designed to protect.
When most people think that I’m a back doctor, I really and try and tell them that I’m a nerve system doctor. I just use the spine as our avenue of approach to affect it.
To speak with Dr. Gregg Rubinstein, visit www.ChiropractorMidtown.com or call 917-534-6484 to schedule an appointment