Screening for Scoliosis

Children should be screened for scoliosis by a chiropractor to identify even slight curvatures in the spine. Chiropractors can adjust the spine while children are still growing to avoid problems later in adulthood.

What is scoliosis?

Dr. Gregg Rubinstein: Now, there’s a question for us. You know, very often one of the most common things parents are concerned about with their children are scoliosis. Now scoliosis are lateral curvatures of the spine. So, if I’m looking at someone from the back and I’m inspecting their spine, I’m going to be looking for things that make the spine look uneven. Perhaps if one shoulder is higher than the other, if the head is tilted to one side, if one hip is higher than the other, if you’re looking at the area where the mid back meets the lower back, you’re looking at those skin folds. Is one creased deeper than the other or higher than the other? Those are things that will cue a parent in, that there may be curvature of the spine.

Now, when we look at the spine from the front to back, it should be perfectly straight up and down. There shouldn’t any be any bends, curves or tilts in the spine. And a spine that’s straight is very strong. If you’ve ever played that game Jenga, where you start to pull those little wooden blocks out, as that column gets less perfectly straight or gets uneven, it becomes less stable. Stability is super important for the spine because the spine absorbs shock, it’s the center of all movement and activity, and your spine also has a very important job of protecting your central nervous system. And if those bones misalign and start to get into these curved patterns, it increases the likelihood of putting pressure or irritation to the delicate spinal nerves and/or the spinal cord, as it is housed inside that column of bone, which we call the spine.

How does scoliosis occur or what causes it?

Dr. Gregg Rubinstein: Now, that’s the best question to have asked. And this one is a little bit embarrassing because most scoliosis, when you look at them, how they classify them, they call them idiopathic. Idiopathic is fancy doctor talk that really just says that we don’t know what causes it. There are some theories and some people think that it’s about communication from the cerebellum, which is a part of the brain, which organizes posture and really helps the body maintain its balance. Other people think that when there’s uneven pressure on the growth plates, that that causes the curvatures to form. So, there’s a lot of discussion as to the actual causes of it. But the one thing I know for sure is if you spot it early enough and work on that spine and check the alignment with some frequency, you can really prevent it from progressing and becoming a bigger problem later.

A lot of schools have scoliosis screenings. Are the school nurses able to pick it up on those examinations?

Dr. Gregg Rubinstein: Absolutely. They can pick up some of the more advanced cases, but the subtle ones are a lot harder to see. There are certain signs like, if you remember your scoliosis screening from school, you went in there, the nurse had you lift up your shirt or take your shirt off, you bent forward. They look for a rib hump. They look for those signs I was talking about before, a high hip or a high shoulder or something like that, and they might be able to detect it. And typically, they might recommend, if it looked pretty significant, that you would go and see your family practitioner. But in the medical profession, the standard procedure would be to take an x-ray, if it’s anything less than 18 degrees, typically they’re just going to watch. They’re going to do this wait and see thing. And they’re not going to get too proactive.

However, a chiropractor, when they see a curve, even as little as five or six degrees, they’re going to be way more interested in doing some active care and correction of alignment to make sure that it doesn’t progress and become a bigger problem later. So, the school, they’ll pick up the significant scoliosis, but a lot of times they might miss more of the subtle things. And that just takes more of an examination procedure, a little bit more experience, something that a chiropractor is trained on and does every day, where a nurse might do a couple hundred screenings in a year, which is significant, but they don’t have the same tools and the ability to order the x-rays to really see what the curve is looking like in that child. So, they’re helpful, and they do catch a lot of things, but it’s not necessarily the be-all and end-all, because they’re only going to pick up the more advanced cases.

How is scoliosis treated?

Dr. Gregg Rubinstein: Well, like I was describing before for most kids, a subtle curve in medicine, they’re really just going to watch and see, right? They’re not going to do a whole lot of things. Maybe if it gets up to 18, 20 degrees, they might consider bracing. Anything more than 22 degrees, very often they consider these surgeries where they put rods up and down the spine mobilizing the entire spine. That could be a problem too. You know, some kids are wearing braces and kids can be pretty mean at school. If one kid’s wearing a brace, it can be pretty hard.

What a chiropractor will do is examine where’s the high hip, where’s the elevation, where’s the curve and try to work with the body’s alignment by making corrective adjustments to gently get the pressure off the nerves and gently realign these vertebrae and get the pressure off the growth plates so the spine will grow straighter. Sometimes we can straighten out some of the curves, sometimes we can only manage them and prevent them from getting worse. Other times, all we’re doing is really managing the symptoms if it’s progressed pretty significantly.

But, again, by keeping the best mechanics that we can and understanding that a child with scoliosis has some biomechanical disadvantage, but we can still manage that, minimize the body’s ability to kind of lock these vertebrae into place, keep them moving as best they can. Some movement is better than less movement, and so we always keep striving to keep the bones in the best alignment, without any pressure or irritation to the nerves, and you can manage the scoliosis. I don’t like to say treat it, because you can’t always cure something. So, we can manage that scoliosis and make sure it doesn’t become a bigger problem later in life.

Can scoliosis be a problem in an adult? And if yes, are they treated differently than children?

Dr. Gregg Rubinstein: It certainly is a problem in an adult, and if it’s not taken care of when they’re a child, it can be clinically more significant later with more arthritis or pain or discomfort or limited motion. You know, we’ve seen people kind of like walking all kind of twisted up. You’ve seen these people, and yeah, it’s a pretty significant problem in an adult. It’s definitely harder to treat in adulthood, than it is in a child, so it’s better for early detection. But the reality is you’re asking if they’re treated differently than children, not terribly. They’re just getting checked and adjusted. We’re making the corrective adjustments where we see the curvatures in the spine to help improve the mechanics.

So, in essence, the actual treatment or the way we work with an adult is similar to a child, we’re just using slightly different technique, lower energy levels in a child because they’re more flexible and the spine tends to be healthier and less arthritic. But, basically, the same idea. You’re going to x-ray, you’re going to look and find out where those misalignments are, and you’re going to make an appropriate corrective adjustment plan based on what you see on those films. In a child, you’re probably going to get a better response just because they’re younger and they heal faster. But again, it is important for adults and children, just about the same, because again, we’re always going back to the nerve system, which is that master system, which is protected by the spinal bones, and if those bones are out of alignment, they will irritate the nerves and cause a host of other issues.

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