Can Chiropractic Spinal Manipulations Help Scoliosis
A December 2020 study To investigate the effect of spinal manipulation on degenerative scoliosis by evaluating patients visual analog scale scores, Cobb angles , the sagittal vertical axis which is a measurement of the spine to assess imbalance , and apical vertebral rotation and to explore factors that influence treatment effect.
What were the results of this study?
- A total of 55 patients with degenerative scoliosis received 4 weeks of spinal manipulation. Spinal manipulation relieved pain and improved sagittal imbalance in patients with degenerative scoliosis. It did not lessen the severity of coronal curvature of vertebral rotation.
An earlier study suggested: that Spinal leveraging manipulation for degenerative scoliosis could regulate muscle balance on both sides of the spine, correct coronal imbalances in the spine, recover the normal sequence of the spine, reduce and remove oppressions and stimulation of nerve root, relieve pain in leg and waist and further improve quality of life.
A May 2022 paper investigated chiropractic care for scoliosis.
Scoliosis Back Pain And Exercise: 7 Things You Should Know
Although a myth has persisted for many years that there isnt a link between a curved spine and pain, doctors now recognize that scoliosis does, in fact, increase the chance of back pain in youth and adults. While it may seem counter-intuitive, exercising can actually help reduce and manage scoliosis back pain rather than make it worse.
Adolescent Idiopathic Scoliosis And Pain
Adolescent idiopathic scoliosis is the conditions most common form it makes up approximately 80 percent of known diagnosed cases. Idiopathic means no known single cause. The remaining 20 percent have known causes such as neuromuscular, congenital, degenerative, and traumatic.
Its not easy to be clear when answering questions about whether or not scoliosis is painful because even within one form of the condition, such as AIS, severity levels and related symptoms can range so substantially.
So before I move on to the common adolescent experience of scoliosis pain, the caveat is that there are always exceptions and each individuals experience of scoliosis will be uniquely their own this is why treating scoliosis effectively demands such a customized approach.
Early Diagnosis and Pain in AISAn indicator of the absence of pain in AIS is how challenging early detection can be. We know that treatment started early on in the conditions progressive line has better results, so why doesnt everyone start treatment early: because scoliosis, especially milder forms, often doesnt produce noticeable symptoms, such as pain.
If you really think about what prompts the majority of your doctor, clinic, or hospital visits, its likely pain. While different medical conditions/diseases produce different related symptoms, a common signifier that something wrong is happening in the body is pain.
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Scoliosis Causes And Risk Factors
Some kinds of scoliosis have clear causes. Doctors divide those curves into two categories — structural and nonstructural.
In nonstructural scoliosis, the spine works normally but looks curved. This happens for a number of reasons, such as having one leg that’s longer than the other, muscle spasms, and inflammations like appendicitis. When these problems are treated, the scoliosis often goes away.
In structural scoliosis, the curve of the spine is rigid and canât be reversed.
Causes include:
- Genetic conditions like and Down syndrome
For idiopathic scoliosis, family history and genetics can be risk factors. If you or one of your children has this condition, make sure your other kids are checked regularly.
Scoliosis shows up most often during growth spurts, usually when kids are between 10 and 15 years old. About the same number of boys and girls are diagnosed with minor idiopathic scoliosis. But curves in girls are 10 times more likely to get worse and may need to be treated.
Scoliosis diagnosed during the teen years can continue into adulthood. The more your spine is curved, the more likely it is to get worse over time. If you had scoliosis in the past, have your doctor check your back regularly.
Does Scoliosis Cause Pain How Scoliosis Is Linked With Pain
There are multiple factors that go into determining the type of symptoms a persons scoliosis is likely to produce. Patient age, amount of degeneration in the spinal joints, curvature location, and posture changes all play a role. Interestingly, there is no correlation between curve size and the amount of pain produced by the scoliosis people with small curves can experience strong pain and people with large curves may have little or no pain.
Scoliosis is a highly variable spinal condition, meaning every case is different. Scoliosis is not generally known as painful in children and adolescents, but adults experience scoliosis-related pain very differently this is due to how compression is felt by the spine and its surroundings.
Before moving on to the specific topic of how scoliosis is linked with pain, lets first take a general look at what defines the condition, in addition to what is happening inside the body of a person with scoliosis.
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The Symptoms Of Sciatic Nerve Pain
As the sciatic nerve runs from the lower back to the bottom of both legs, the pain usually centers in these areas. The severity of the pain varies from case to case, but its generally known as one of the most debilitating nerve issues in the back. The mobility of patients suffering from this pain can be limited, even when doing simple tasks.
Muscle Degeneration At The Local Level
An August 2021 paper in the Global Spine Journal investigated the effect of paraspinal muscle degeneration in degenerative lumbar scoliosis cases where patients had corrective surgery. In this study:
- 98 degenerative lumbar scoliosis patients were examined through an average 38.3 months follow-up after corrective surgery.
- The T1 pelvic angle, lumbar lordosis, and pelvic incidence were measured preoperatively, immediately postoperatively, and at last follow-up.
- Patients were divided into the lumbar lordosis maintenance group and the lumbar lordosis loss group .
- Explanatory note. Lumbar Lordosis Loss or Flat Back Syndrome has been described for decades. In 1988 Dr. Michael O. LaGrone wrote in the journal The Orthopedic clinics of North America: Symptomatic loss of lumbar lordosis is a disabling complication of scoliosis surgery. This so-called flat-back syndrome is characterized by an inability to stand erect and by upper back pain. Distraction instrumentation extending into the lower lumbar spine or sacrum is the most frequently identified etiologic factor responsible for loss of lordosis.
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How Is Degenerative Scoliosis Diagnosed
An orthopedic surgeon will get the patientâs history, conduct a physical exam and order full spine images, low-dose radiation images or, in some cases, a to confirm a diagnosis for degenerative scoliosis.
These images will be taken of the full spine from both the front and from the side. EOS imaging allows these to be taken simultaneously, without requiring the patient to reposition. CT scans can can provide additional detail, including evidence of arthrosis of the facet joints or the presence of small spinal fractures that may not be visible on X-ray images.
Figures 1 & 2: X-rays showing degenerative scoliosis in its first stages and in a more progressive case .
Figure 3 : CT scan showing normal facet joints with a green arrow pointing to the smooth and regular joint surfaces. Figure 4 : CT scan showing abnormal, osteoarthritic facet joints with thinned and irregular joint surfaces and bone spurs .
may also be used to obtain information about the nerves, discs, and soft tissue in the spine. This is particularly helpful in determining the cause of radicular symptoms in the legs.
Figure 5 : MRI of a patient with a facet cyst causing compression of nerves. Figure 6 : MRI of same patient after facet injection and cyst rupture , completely relieving the compression and eliminating the patientâs pain.
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How Do The Effects Of Exercise Compare To Bracing Or Surgery
In many ways, exercise has the opposite effect of bracing, which offers short-term relief but leads to pain in the long-term because the body doesnt build the strength it needs to maintain alignment after treatment. And when it comes to surgery, you might be surprised to learn that the latest research says there isnt evidence that scoliosis surgery is better at relieving pain than non-surgical methods. The CLEAR approach uses exercise in complement to chiropractic adjustments and other non-surgical treatments.
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Scoliosis Pain: How Scoliosis Affects And Causes Pain
When it comes to living with the conditions most common form, adolescent idiopathic scoliosis , pain isnt generally a big part of the experience adults, however, experience scoliosis-related pain very differently. This difference is largely based on condition severity, compression, and the degenerative effects of aging.
Before we get into the more specific types of scoliosis-related pain and how it affects multiple areas of the body, lets first take a general look at scoliosis and why the typical AIS experience does not include pain.
What Does Scoliosis Pain Feel Like
Scoliosis pain can be felt in the back, the muscles surrounding the back, and also pain radiating to other areas of the body, particularly if nerve compression is involved.
As mentioned, feeling the effects of compression isnt a common issue for young patients, but for adults, nerve-related pain down the arms and legs, and pain felt especially in the lower and middle back, can range from mild to debilitating.
Nerves are like branches on a tree, fanning off in multiple directions. If an abnormal spinal curvature is compressing a nerve, related pain can be felt far from its site of origin. In addition to back pain, its common for adults to complain of related muscle pain, in addition to radiating pain and numbness felt in the legs and feet.
Curvature location can also play a role in pain location, as a curvature of the cervical spine , for example, is more likely to produce pain in the upper back, shoulders, arms, and neck, not to mention potential lower back pain as the result of developing a secondary curve.
As a condition gets more severe, its potential effects on posture also increase, and the more postural deviation that occurs, the more strained the bodys affected musculature becomes.
In addition, scoliosis does also have the potential to cause painful headaches, some reaching migraine status, due to nerve pressure and/or muscle spasms.
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Scoliosis Surgery And Back Pain
Anyone who has done their due diligence in researching scoliosis and pain management will have come across scoliosis surgery as a form of treatment.
During scoliosis surgery, also known as spinal fusion, the most-tilted vertebrae of the curvature are fused together into solid bone. Rods and screws are attached to the spine in order to hold it in place while the vertebrae fuse into one solid bone.
Its important to remember that the end goal of scoliosis surgery is not to correct the abnormal curvature, but to stop it from progressing further. While surgery can be successful at stopping progression, there is no guarantee that it will do so.
One of the primary reasons people opt for scoliosis surgery is pain relief. Many patients end up disappointed with the pain-reduction results of surgery, and some find they are in more pain.
In the portion of the spine thats fused, movement is eliminated, which is why, in theory, it stops progression however, the stiffness and loss of flexibility in that area can lead to an increase in scoliosis-related pain post surgery.
For the above reasons, and the fact that spinal-fusion is irreversible and lacks data on long-term effects, I feel that regardless of the motivation, scoliosis surgery should only be considered as a last resort.
But Does It Cause Pain
Most scoliosis cases go undetected for several years. Thats because the condition is generally painless. Over time, as the curvature increases, adults can experience back pain. This can be for several reasons. For example, the shift in the spine causes undue pressure on the lower discs. Scoliosis can also cause the spine to rest on surrounding nerves, causing inflammation and intense back pain. Also, persons with scoliosis may feel stiffness and fatigue. About 40% of persons with scoliosis will have chronic back pain.
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What Treatments Are Available
Treatment for mild to moderate spine deformity in adults is determined by the severity of the symptoms, not the size of the curve. It begins with a trial period of pain management, physical therapy, and nonsurgical options. If pain is caused by inflammation of the facet joints, treatment involves facet joint therapy. If the curvature is mild, the deformity is not treated. If the curvature is severe, complex spinal surgery may be recommended. Barring serious “red flags,” such as a neurologic impairment, conservative care is used for 3 to 6 months before surgery is considered.
Self care: Using correct posture and keeping your spine in alignment are the most important things you can do for your back. The lower back bears most of your weight, so proper alignment of this section can prevent injury to your vertebrae and discs. You may need to make adjustments to your daily standing, sitting, and sleeping habits. You may also need to learn proper ways to lift and bend. If you smoke or are overweight, you may be able to reduce your symptoms by quitting smoking and/or achieving a healthy weight appropriate for your body frame.
Medication: Over-the-counter and prescription medications can help you cope with back pain.
Bracing: Wearing a brace is often used for childhood scoliosis, but it will not straighten the adult spine. A brace may help reduce pain in the short-term, but it also will allow the muscles to get weaker, eventually leading to more back pain.
Scoliosis Symptoms In Adults
Some adults who have this condition have had it since they were teenagers. Over time, the curves can grow.
Thereâs another form of scoliosis that starts in adulthood. As you get older, wear and tear damages the bones and joints in your spine. The disks that sit between them start to break down. As this happens, the disks lose height and start to tilt. This causes your spine to curve.
Often, back pain is the first sign of scoliosis in adults. The pain may be from bone damage in the back — not the scoliosis itself. As the spine curves, it can put pressure on nearby nerves and cause symptoms like weakness and numbness.
In adults, scoliosis causes symptoms like these:
- Uneven shoulders and/or hips
- Bump in the lower back
- Numbness, weakness, or pain in the legs
- Trouble walking
- Bone spurs — bony bumps in the joints of the spine from bone and joint damage
- Feeling full quickly while you eat. This is because your spine is putting pressure on your belly.
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Can Scoliosis Cause Back Pain
While pain isnt a common part of the scoliosis experience for children and adolescents, back and/or radicular pain is the main scoliosis symptom in adults. Keep reading to find out why age makes such a big difference in terms of whether or not scoliosis is likely to cause back pain.
Scoliosis develops across a wide severity spectrum of mild to very severe there are also multiple condition types with varying causative sources and treatment needs. Scoliosis can cause back pain, but its more common in adults, severe forms, or if a condition is left untreated.
Lets start our exploration of scoliosis and back pain by first discussing the condition, then comparing the adolescent and adult experiences in terms of common symptoms.
The Relationship Between Scoliosis And Sciatic Pain
Scoliosis is a spinal condition that leads to a curvature that can cause pinching and constriction along the vertebrae.
Sciatic pain is a source of extreme discomfort and sensitivity along the sciatic nerve. This nerve starts in the lower lumbar spine, leading down near the heel of both legs.
So, what is the relationship between scoliosis and sciatic pain? Since scoliosis pinches and compresses the spine indirectly through unnatural curvature, it can squeeze the sciatic nerve. This squeezing produces troubling sciatic pain that can often be debilitating for people who have scoliosis.
The symptoms of sciatic nerve pain can be similar to the symptoms of scoliosis. If you want to learn the causes, symptoms, and treatments of scoliosis and sciatic nerve pain, read on.
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Scoliosis Pain Management Treatment
Depending on the type of pain, there are treatments called complementary therapies that might help, in addition to pain medication. These include things like hydrotherapy and massage and are usually done alongside medical treatments.
An exercise that strengthens the core muscles such as yoga, Pilates, stretching, and swimming can also help with back pain.
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Scoliosis And Back Pain Current Opinion
Research is unclear, but many believe scoliosis causes back pain
For some time, it has been suggested that scoliosis might be responsible for back pain. Although the issue has been debated, some evidence suggests there is a link A recent study of almost 2000 patients less than 21 years-old referred for a spine evaluation reported that when an underlying condition was identified as the cause of the pain, the most frequent diagnosis was scoliosis , followed by Scheuermanns kyphosis.
Although this evidence suggests there may be a link, other studies which have considered the issue have produced mixed results. On the one hand, Ramirez et al. reported on more than 2400 subjects with AIS. Of these, 23 % reported back pain at the time of diagnosis a substantial number. An additional 9%, initially free of pain and managed with observation alone, developed pain during follow-up.
Sato et al. examined more than 30,000 adolescents with various spinal issues and concluded that the subgroup with scoliosis had an approximately 3 to 5 fold increased risk of back pain in the upper and middle right part of the back.
On the other hand, Lonner et al. compared three groups of adolescents including 894 with AIS and 31 control individuals without, when considering pain score using the SRS pain score method, they found that the differences between the AIS and control group were not significant.
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