‘… my body is not symmetrical. One side is shorter and more compressed than the other. My right shoulder feels tight and rigid. My hip rotates forward and my right foot naturally turns outward. I have a tilt in my neck…’
The word scoliosis is taken from the Greek word, meaning ‘bent’. Scoliosis (pronounced sko-lee-o-sis). Scoliosis is a progressive, abnormal curvature and rotation of the spine to either the left or right, along the vertical axis. The most common type is called “Adolescent Idiopathic Scoliosis”. Idiopathic means “of unknown origin”.
The normal spine has 3 curves. One in the neck, one in the upper back and one in the lower back. These curves can be seen from the side, but when you look from behind the spine should appear straight. If the spine has a sideways curve, as seen from the back, this is Scoliosis.
About 1 in 20 girls develop a mild scoliosis from the age of about 9 to 14 years, but the curve is slight and does not need treatment. Only about 3 in 1000 children have curves that are large enough to need treatment. While boys and girls are about as likely to have mild scoliosis, girls are more than 7 times as likely to have their spinal curves progress to moderate or severe scoliosis and require treatment. In children it can be a more serious condition because it can rapidly progress as the child grows. A scoliosis curve located in the upper back is more likely to progress than a curve located lower in the back
What Causes Scoliosis?
The cause of most scoliosis is not known which is why, it is called Idiopathic Scoliosis. Sometimes, it is hereditary and other members of a family may also have scoliosis.
Some people mistakenly think that carrying heavy book bags, sleeping on their side or repetitive biomechanics, etc. causes scoliosis, but that is not the case. The cause of scoliosis, not due to an injury or spinal degeneration, is still unknown.
Scoliosis at a Glance
One shoulder is higher than the other
One of scapulars is winged (protruding shoulder blade)
Rib cage appears higher on one side (also called a rib hump)
One hip appears higher with a slight anterior (forward) rotation
The waist appears uneven
The body tilts to one side
One leg may appear shorter than the other
A spinal rotation of the vertebrae as they form a curve.
Types of Scoliosis
Infantile Idiopathic Scoliosis – develops in children under the age of 2 years and is rarely seen in Australia
Juvenile Idiopathic Scoliosis - develops in children between the age of 3 and 10 years and is rarely seen in Australia.
Adolescent Idiopathic Scoliosis (AIS) – develops in early adolescence and is much more common in girls than boys.
De Novo Scoliosis - can also occur in adults with no previous history, due to spinal degeneration and advancing age.
Right Thoracic Curve. If a straight line were drawn down the center of the back, this curve bends to the right side of the upper back (thoracic region).
Right Thoracolumbar Curve. This curve bends to the right side—starting in the upper back (thoracic) and ending in the lower back (lumbar).
Right Lumbar Curve. This curve bends to the right side—starting and ending in the lower back.
Double Major Curve. Typically, a double curve involves right thoracic curve on top and left lumbar curve on bottom. People who have a double major curve may initially have a less obvious deformity because the two curves balance each other out more. (www.spine-health.com)
Effects of Scoliosis
The effects of scoliosis include:
poor posture – a person needs to compensate to maintain balance with uneven hips and legs causing muscle weakness of one side of the body and contracted tight muscles on the compensation side.
Body imbalances – when a spine twists abnormally and bends sideways, it can cause the hips to be out of alignment, changing a person’s gait or how they stand.
Shoulder humping – putting undue stress on the neck and shoulders
Reduced range of movement – the abnormal spinal twist can increase rigidity, reducing the spine’s flexibility
Muscle spasm – from continual and excessive unilateral use of certain muscles due to the curvature, back muscles can become prone to painful spasms
Pain – from local inflammation that can develop around strained muscles. It is possible for the spinal discs and facet joints to start to degenerate due to higher loads
Limited function – in other muscles and joints that can occur from nerve’s restricted due to tight muscles and skeletal imbalances
In rare cases scoliosis can lead to heart and lung problems. If scoliosis is detected and treated early, patients can avoid these symptoms in many cases. (www.scoliosis-australia.org)
Treatment of Scoliosis
There is no cure for scoliosis. This does not mean that there is no relief. Treatments focus on reducing the progression of the curve and/or associated pain and discomfort.
‘In a case study conducted by the Katharina Schroth Hospital, they attempted to find out the impact of massage therapy in the treatment of scoliosis, costovertebral dysfunction, and thoracic outlet syndrome. The results were overwhelmingly positive, with the patients numbering 813 out of the 1000 in total, all of which suffering from scoliosis, immediately showing improvements in certain aspects of their physical and mental health. The study, which took place over a period of three years, brought many strong arguments to the case of massage therapy being used as a serious form of treatment for scoliosis.’ (Katharina Schroth Hospital)
The goal of Schroth exercises is to de-rotate, elongate and stabilize the spine in a three-dimensional plane. This is achieved through physical therapy that focuses on:
Restoring muscular symmetry and alignment of posture
Breathing into the concave side of the body
Teaching you to be aware of your posture
The changes in the curvature of your spine has a massive effect on the muscles in your back. The muscles on the inside of the curvature may be weakened and stretched. On the outside of the curve, the muscles may be overworked, tight and prominent, increasing the curve of the spine if not treated. Spaces between the vertebrae may also become compressed in some areas and stretched in others.
Remedial Massage Therapy
The main goal of massage is to prevent scoliosis from advancing and minimize the negative impact of scoliosis. It assists in correcting body compensating patterns. It can reduce pressure and pain in the spinal column and relaxes the surrounding areas improving spinal rotation and releasing impeded nerves.
Massage, including Deep Tissue and Trigger Point Therapy, increases flexibility and range of movement in the spine and decreases the incidence of muscle spasms. It breaks down adhesions, elongating tightened areas, improving core stability and strength and increasing the spine’s mobility.
Massage Therapy reduces tension in the muscles by increasing circulation, allowing blood and oxygen to flow more freely throughout the muscles. The boost in circulation helps increase flexibility and supports healing in the muscles surrounding the spine.
Myofascial Release assists in relaxing the nervous system, stretching the fascia therefore helping create new body patterns.
Myofascial Dry Needling
Myofascial trigger points are taut musculature bands formed within the muscle. Myofascial trigger points cause motor dysfunction or muscle weakness, restricted motion, and muscular stiffness. Dry needling allows access to deep musculature that may be too deep to reach without the use of a needle.
The insertion of a fine filament needle into a trigger point produces a short contraction (twitch response) of the muscle being needled. The twitch of the muscle is the desired response, however, benefits can occur even without a twitch of the muscle. The simple insertion of the needle into the muscle can interrupt the pathogenic process and produce mechanical changes in the tissue.
Releasing myofascial restrictions through trigger point dry needling can enhance a clients movement and return to function. Trigger point dry needling can disrupt the neurological feedback loop eliciting pain in the musculoskeletal system.
Cupping and Vacuum Therapy draws inflammation out from deep in the tissues to be released. It increases the local blood supply to the muscles and allows for toxins to be carried away via the lymph. It assists in softening tense muscles, releasing restricted fascia and stimulates knots and areas of rigid tissue. Cupping separates the tissue layers and hydrates the tissues. Cupping assists in balancing the areas around the spine, reducing the twist by creating a space between the vertebrae and increasing movement.
Being aware of the position of your spine is the first step to correcting it. Postural awareness is especially important when it comes to activities in daily living. If you have scoliosis, you will always need to be mindful of the positions that may make it worse. Improving your movement and decreasing your scoliosis curvature is a daily mindset that requires patience and determination as any improvement happens gradually.
Exercises can help in managing or reversing the effects of scoliosis. One of the most effective treatments is walking. It strengthens your core, stabilizes your body and increases the flow of blood and oxygen through your muscles.
Yoga and Pilates are also recommended daily treatments if you wish to maintain healthy body movement. The key benefits of these programs are to introduce asymmetrical movement with an emphasis on the weaker side. Through these programs you can explore your strengths and realign your body. Traditional poses can be modified to avoid discomfort.
Swimming as a bilateral movement helps with stretching out of both sides of the body equally. When sitting and standing it is important not to shorten the contracted/concave side. Become aware of repetitive everyday actions. They may be easier for you to do (always stepping up through a doorway with the same foot) but may contribute to the deepening of the dysfunction of your body.
The use of breath is very important both in your daily life and during exercise. It is important to enlarge the lungs and breathe into the concave side of your body expanding your ribcage and stretching the fascia and muscles along the concave side.