Low back pain is a serious and scary condition. Those who are unlucky enough to experience low back pain at some point in their lives (almost 80% of us) often miss out on social events, or even work, due to the intensity of the pain. So it comes as no surprise that a lot of people think that their condition is a sign of something more serious. But how do you know?
What is Scoliosis?
When people think of serious diseases that could possibly cause the intensity of pain that low back pain brings, they often think of cancer, or kidney disease. But, when they look up specific conditions related to the spine, scoliosis is one of the diseases that pops up the most.
Scoliosis (idiopathic) is a condition that affects up to 2-3% of the US population (between 6 and 9 million people) so the good news is that it is not very common. Typically, most cases of acute low back pain are not due to anything serious and resolve on their own within a few weeks. If your back pain does not go away then it might be time to see your healthcare provider for red flag screening or to look at things related to chronic low back pain. One condition that can be a cause of chronic low back pain is Scoliosis. Scoliosis is a sideways curvature of your spine. Instead of having a spine that runs straight up your back, people with scoliosis tend to have a spine that curves slightly to the left, slightly to the right, it can curve both ways or be more of a 3 dimensional curve.
Causes of Scoliosis
Typically, scoliosis occurs during the growth spurt that happens right before puberty (between ages 10 and 15), so doctors and schools often screen for this condition during child wellness check ups. Scoliosis can be caused by conditions like muscular dystrophy and cerebral palsy, which are often diagnosed even earlier in childhood.
Scoliosis often appears to involve hereditary factors - meaning we inherit these issues from our parents or grandparents. Less often, scoliosis is the result of birth defects and injuries or infections of the spine. Unfortunately, most of the time, doctors don’t really know what causes scoliosis.
Risk Factors for Scoliosis
While we may not be able to always identify the cause of scoliosis, there are certain risk factors that doctors can look out for in order to see if you are at risk of developing the condition. Some of these risk factors include:
Age - most cases occur during the pre-pubescent growth spurt
Sex - girls have a much high risk of developing a more serious curvature of the spine, and are more likely to require treatment.
Genetics - although scoliosis can run in families, most children don’t have a family history of the disease.
Types of Scoliosis
While some healthcare professionals classify scoliosis into seven categories, there are three main categories that are most often referred to. These are idiopathic scoliosis, congenital scoliosis, and neuromuscular scoliosis. For the purposes of this article we are going to focus on idiopathic and congenital as those are most likely to be the cause of low back pain not related to a more serious condition.
Idiopathic scoliosis is a term that is used to describe scoliosis with no specific cause. Almost 80% of pediatric cases are idiopathic, making it the most common form of scoliosis. When an adolescent is diagnosed with idiopathic scoliosis it could be related to a number of different things. Genetics, hormones, abnormal bone or muscle growth, nervous system abnormalities, or environmental factors are all potential underlying causes but can be difficult to diagnose or single out.
Degenerative scoliosis is another common type of scoliosis, affecting almost 40% of the population - including up to 68% of people 60 years and older. Degenerative scoliosis is the result of wear and tear of your spinal discs over the years. It tends to affect the lumbar spine and is considered to be a milder form of scoliosis, meaning that the curve is not as pronounced as it can be in other forms of scoliosis.
People with degenerative scoliosis often have difficulty standing upright and can experience low back pain and sciatica (pain that radiates from your lower back, down your legs). Walking can be challenging for these patients and they often walk with their hips thrust out to one side.
Symptoms of Scoliosis
So, how can you tell if you have scoliosis? If it is mild, you may not notice a pronounced curve in your spine. So how can you identify it before it gets worse? Scoliosis symptoms can vary quite widely, depending on how severe it is. Here are some of the most common symptoms.
Mild Scoliosis symptoms:
One or both hips raised/ one higher than the other
Waistline looks uneven
Noticeable difference in hip and shoulder height
Uneven shoulders (blades might be pronounced)
The body might lean towards one side
Head is not centered directly above the pelvis
Asymmetry between rib cage heights - one side higher than the other.
More Serious Scoliosis Symptoms:
Difficulty standing upright
Pain in the legs/ numbness/weakness
Twisting or rotation of the spine
When To See A Doctor
As we mentioned before, back pain can be extremely debilitating and for those with scoliosis, the back can feel extremely stiff and tight, severely limiting their ability to perform daily activities. As the body tries to adjust to this new curved spine, the muscles and ligaments are not properly aligned and can experience straining from uneven use.
If you notice any of the signs and symptoms listed above it is important to schedule a visit with your healthcare provider. Most cases of scoliosis are mild but some can continue to get worse, with serious consequences. Severe scoliosis can be debilitating - even going so far as to reduce the amount of space in the chest for the lungs to function properly. Difficulty breathing is a serious issue!
Unfortunately quite often scoliosis can be hard to notice, especially if it is mild. This is why doctors perform routine checks during puberty. Sometimes scoliosis in adolescents is first identified by teachers or sports coaches during training and physical exercise. If your doctor notices anything during the screening they can use a tool, called a scoliometer to determine the angle of the curve and see how serious or advanced the condition is.
Treatment Options for Scoliosis
Mild cases of scoliosis are often not treated, but if you have moderate to severe scoliosis is it important to work out a treatment program with your healthcare provider. Untreated scoliosis can not only lead to increasing deformity, but it can be painful and even lead to damage in your heart and lungs as your body continues to lean to one side. There are several different types of treatments available to help alleviate the symptoms associated with this condition.
While a curved spine can make it difficult to participate in some sports, exercise can help to manage the symptoms. Low impact exercises like swimming or biking, along with stretching and strengthening your core, can help to reduce pain by strengthening muscles on the opposite side of the body. Natural endorphins are released during exercise, which can also help with feelings of pain.
Physical therapy is another great way to help reduce the symptoms of scoliosis. Trained therapists can make use of a variety of treatments like massage (manual therapy), TENS machines, ultrasound therapy, or special myofascial release massages. Ice and heat therapies are often recommended as they are easy to do at home and can help reduce inflammation, relieve tension in the muscles, help with circulation and improve range of motion during activities.
The Schroth method is a series of personalized exercises prescribed to you by your physical therapist that can help train the spine to return to a more neutral position. These exercises are designed to strengthen the muscles that surround the spine, while stretching out other muscles. By doing this, literature suggests that the progression of scoliosis can be slowed as the spine is elongated and stabilized.
Breathing is key for this type of treatment, and a special type of breathing, called rotational angular breathing is used. The breathing is intended to help restructure the rib cage. The Schroth method is most effective for those who have smaller curves of the spine and not for more serious cases of scoliosis.
Pain Management For Scoliosis
Pain is a serious part of this disease and is often what alerts people to the fact that something serious might be going on with their bodies. There are a variety of non-surgical options to help with managing the pain associated with scoliosis. Exercise and massages are effective ways to help release endorphins, which are the body’s natural pain relievers. NSAIDs are often recommended when medication is required, although more intense nerve blocks and epidural steroid injections can be used for more intense pain management.
It is good to remember that most cases of low back pain do end up resolving themselves without any intervention, or minimal treatment. If you are experiencing low back pain that isn't going away, a good place to start is to follow the international guidelines for low back pain, as well as speaking with your healthcare provider to make sure that you don't have any red flags for more serious underlying conditions. Once you have checked with your doctor to make sure that there is nothing more serious going on, following the biopsychosocial model for back pain is one of the best things that you can do.
This approach looks at combining aspects of exercise, meditation/relaxation and nutrition to help reduce inflammation in the body, keep your muscles strong and relaxed and helps to manage stress, all reducing your risk of future flare ups. If, by chance, you do happen to be diagnosed with scoliosis, your doctor will be able to put together a personalized treatment plan to help you manage your condition.