It may have been years since you’ve heard anyone mention scoliosis. We tend to think of it as an ailment that strikes only children and adolescents.
What most people don’t realize: Scoliosis, marked by an abnormal curvature of the spine, also affects adults, including those who have no history of the condition.
Why this is important: For adults, in particular, scoliosis can be an undiagnosed cause of pain in the back, legs or buttocks. Numbness or weakness in a leg or foot also may occur.
And these symptoms can go on for years without scoliosis being discovered as the culprit! In fact, the telltale “S” curve of adult scoliosis is sometimes severe enough that it’s quite easy to see when the person is unclothed and viewed from behind, but in other cases, the curve is barely noticeable to the untrained eye.
When scoliosis is discovered in an adult, it could have started in childhood but was never diagnosed…or the condition may have first developed in adulthood. If you’re over age 40 and develop scoliosis for the first time, then you probably have degenerative scoliosis.
Here’s what happens: As we grow older, the disks and facet joints (located between the vertebrae) of our spines degenerate. Over time, the degeneration can lead to scoliosis.
Important: If you have osteoporosis (bone thinning that is worse than the degeneration that naturally occurs with age) and develop scoliosis, the scoliosis will pro-gress more rapidly than it would in a person without osteoporosis.
In some adults who had scoliosis as children, the degenerative process can cause the condition to worsen with age. If this occurs, the curve generally progresses by about one degree per year (scoliosis is diagnosed when the spine is curved vertically by more than 10 degrees).
In addition to the degenerative process that puts adults at -increased risk for scoliosis, genetics may also play a role. The condition tends to run in families. The good news is that most adults with scoliosis have no symptoms.
If you know that you had scoliosis as a child or think that you may have it as an adult, see your doctor for advice. If your childhood curvature was more than 30 degrees, you should go to a spine specialist every three to five years to monitor whether the curve is progressing.*
If you suspect that you have adult scoliosis, there are red flags that may signal the condition. Scoliosis is relatively easy for a spine specialist to diagnose with a physical exam and spine imaging tests, such as X-rays and/or CT or MRI scans.
It’s important for anyone who has scoliosis to keep a close eye on his/her body weight (being overweight puts additional stress on your spine)…and to stay physically active (inactivity can worsen symptoms by allowing trunk muscles to weaken, which can increase the muscle pain associated with scoliosis).
Once you have scoliosis, exercise won’t straighten your spine—nor will it stop the disorder from progressing. But it will help you keep your spine as supported as possible, reduce pain and keep you feeling strong.
While cardiovascular exercise (such as walking, swimming and biking) is a good idea for most people, a core-strengthening program is crucial for anyone with scoliosis. If you think of your spine as a flagpole with the muscles as guy wires, it’s easy to visualize how the muscles help support the spine. The goal of core exercises is to strengthen the muscles of the abdomen, back and pelvis.
Depending on your overall fitness and agility, a core workout might include abdominal exercises as well as an exercise called the plank, which strengthens the abdominal and back muscles. How to do the plank: Start in a raised push-up position with your toes perpendicular to the floor, then bend your elbows and rest your weight on your forearms. Keep your body in a straight line from your shoulders to your ankles. Stay still in this position—that is the exercise. If you can, begin by doing the plank for about 20 seconds and work up to about a minute daily. Because scoliosis can limit movement of the spine, stretching also can help ease stiffness.
Helpful: Many people with scoliosis are able to curb pain if they work with a physical therapist, who can help them design an exercise program that targets their specific issues.
Because the severity of adult scoliosis varies so much from person to person, there is no one-size-fits-all treatment for the condition.
In addition to exercise, here’s what often helps…
• Nondrug therapies. Chiropractic care (especially for acute episodes of pain), massage and acupuncture seem to help some people with scoliosis.
Note: Bracing, which is often prescribed for young scoliosis patients (whose skeletons are still growing), is rarely offered to adults, since it weakens the core muscles and can increase symptoms.
• Medication. A nonsteroidal anti–inflammatory drug (NSAID), such as ibuprofen (Motrin), sometimes helps control pain. Note: If you take an NSAID for long periods, be sure that your doctor supervises your use to help you avoid side effects such as stomach irritation.
If your scoliosis pain is caused or worsened by narrowing or pressure on nerve roots, you may benefit from a steroid injection. The frequency and timing will depend on symptoms, but you should get no more than a few injections per year.
• Surgery. Contrary to what you might assume, the degree of your spinal curve is not used to determine whether surgery is needed. Instead, surgery is an option when pain—regardless of the severity of the curve—interferes with your ability to go about your daily activities.
Decompression surgery helps ease the pressure that is placed on nerves where the spine has weakened. This type of surgery usually involves removing (totally or partially) a bony structure or ligament that is applying pressure.
Another option is spine-stabilization surgery, which is performed to help straighten the spine. With this procedure, bones of the spine are fused together with bone grafts to stabilize the spine and eliminate as much of the spinal curve as possible. In most cases, a combination of both surgeries may be needed. The extent of surgery also varies. Major surgery is sometimes done to correct and stabilize the spine. In other cases, a small part of the curve can be addressed with a less extensive, lower-risk surgery.
The risk for complications, such as subsequent pain, increases with the magnitude of the surgery and can be as high as 30% in major reconstructions. There is a small (one in 3,000) risk for paralysis with major spine surgery. The patient’s age and the presence of other conditions (such as diabetes) also affect risk for complications. Recovery times range from six weeks up to a year. A spine surgeon is best qualified to perform these procedures.
Signs that you may have scoliosis…
• You have lost more than one inch of height.
• One shoulder appears higher than the other.
• One hip is higher than the other.
• If you find it more comfortable to stand or walk leaning forward, or if you like to lean on a shopping cart in the grocery store, you may have spinal stenosis (a condition that causes narrowing in the spine), which is associated with adult scoliosis.
*For a referral to a spine specialist or a scoliosis support group near you, contact the National Scoliosis Foundation, Scoliosis.org.
