Twisted Spine or Scoliosis

Is your spine twisted or curved or have you noticed that your child’s spine is not straight?

If yes, then you may have a scoliosis.

A scoliosis is a lateral curvature of the spine. Scoliosis can be STRUCTURAL (organic with permanent changes in bone and soft tissues) or FUNCTIONAL (often temporary), where the disturbance is caused by a reflex or postural activity of the spinal muscles.

If you notice this DO NOT PANIC! Often a degree of spinal curve is normal, we are not all perfect like a textbook.


Structural Scoliosis

There are two types of structural scoliosis, IDIOPATHIC and SECONDARY. Normally affecting children, idiopathic scoliosis has an unknown or uncertain cause and typically accounts for 75-85% of all structural scoliosis. They are thought to be neurogenic nature or due to failure of segmental reflex development. A secondary scoliosis occurs as a result of a known disorder such as Marfan’s Syndrome, polio, musculodystrophy or cerebral palsy.

Both idiopathic and structural scoliosis can cause rib deformities, pain, heart and/or lung disorders and cosmetic and psychological problems.

Idiopathic Scoliosis

The idiopathic scoliosis is the most important type of structural scoliosis affecting females 9x more than males and with an incidence of 1-3%. When the onset is younger than 8 years old the prognosis is worse. If you notice a curve progress of 5-10% you should see an orthopod for assessment and monitoring.

Typically the onset is between the ages of 4 and 14 years most commonly affecting the upper back (thorax) or the upper and lower back (thoracolumbar). Major deformity develops prior to cessation of skeletal maturity.

Scoliosis usually consists of a primary curve with a secondary adjacent compensatory curse. Initially, the spinous processes rotate towards the convexity of the lateral curve. As the ribs start to rotate the centre line of weight bearing moves further from the spinal axis the rotation is reversed. The spinous processes rotate towards concavity, forming a true organic curve. The ribs are thrown back on the convex side further increasing the shape of the deformity. This can be seen on forward flexion from what is known as a skyline view. Vertebral disc spaces narrow on concave side and widen on convexity.


If lateral curve exceeds 60º, vertebral bodies will distort, decreasing vital capacity and lead to compression of the thoracic organs.

Active treatment is advised when the prognosis is poor. Active treatment is often surgery using Harrington Rods however, during the periods of maximal growth a brace is preferred.

Curves are monitored measuring the Cobb angle on an x-ray image. The angle is measured between the upper vertebra with the most angle and the lower vertebra with the most angle. Scoliosis is when the lateral curve is 10º or more.


Functional Scoliosis

There are 2 functional scoliosis categories:

Compensatory postural – from something like a longer leg

Sciatic – where you get a temporary deformity from an acute spasm

Compensatory scoliosis is a longer-term compensation that arise from problems outside the body. They can develop up from the lumbar region “Glove Puppet”or down from the upper spine “String Puppet”.

Sciatic scoliosis is a temporary deformity caused by the protective action of spinal muscles. It usually has an underlying painful conditions of the spine eg. prolapsed disc with a nerve root compression or a one sided protective muscular spasm.


How can an osteopath help you with scoliosis?

On daily basis osteopaths manage people with sciatic scoliosis as it typically results in low back pain and many people seek osteopathic treatment for low back pain.

If you visit an osteopath with acute low back pain or chronic low back pain, following assessment you may discover you have a difference in leg length leading to a compensatory functional scoliosis. The average discrepancy is less than 1.1cm. These individuals easily compensate for this and lengthen or shorten their lower extremities to minimise their asymmetry.

While osteopaths cannot “cure” people with structural scoliosis they will treat muscular aches and pains associated with the scoliosis.

Osteopaths may assess:

What degree of secondary tissue change has occurred?

Are soft tissue changes reversible?

Are there secondary boney changes?

Whether degeneration / adaptation has occurred that would make it unwise to reduce the changes.


For more information you can visit the American Academy of Orthopaedic Surgeons.


If you have lower back pain resulting from scoliosis or would like us to assess your spine feel free to contact us for advice or to make an appointment.