Scoliosis (big guide)
Scoliosis is a medical condition in which the spine has an abnormally large bend or deviation.
Often, scoliosis can produce a characteristic S-curve or C-curve on the spine compared to a normal, straight spine. And therefore the condition is also known as S-back or crooked spine. In this big guide you will learn everything you need to know about this diagnosis. We also go through exciting, recent research that can explain more about why 65% of scoliosis cases have unknown origin.
Table of contents
1. Causes of scoliosis
2. Symptoms of scoliosis
3. Clinical signs of scoliosis
4. Diagnosis of scoliosis
5. Treatment of scoliosis
6. Exercise for scoliosis
If desired, you can jump straight to specific parts of the article by clicking on the titles in the table of contents.
"The article has been written and quality checked by publicly authorized health personnel. This includes both physiotherapists and chiropractors at Pain clinics Interdisciplinary Health (see clinic overview here). We always recommend having your pain assessed by knowledgeable healthcare personnel."
Tips: Further down in the guide you will get good advice on knitwear training, use of foam roll and answer whether you should use it attitude vest.
1. Causes of scoliosis
Scoliosis can be caused by both genetic, degenerative and neuromuscular causes. We divide the causes into primary categories and secondary categories.
The two primary categories
Scoliosis is mainly classified into two primary categories:
Congenital (genetic)
Idiopathic (unknown origin)
It is estimated that up to 65% of scoliosis conditions have an unknown origin (idiopathic). 15% are congenital and 10% are secondary scoliosis.
Idiopathic scoliosis: Not unknown origin after all?
Very interesting studies have been published showing biomechanical findings among babies who later have a higher risk of developing scoliosis. This has primarily found its basis in the work of Professor Hans Mau (1960s and 70s), which has later been continued by the pediatric doctor and Professor Tomasz Karski - and published in the Journal of Advanced Pediatrics and Child Health (2020).¹ The studies of Mau (i "Syndrome of contractures") referred to seven findings in babies that they believed were directly associated with scoliosis later in life.
7 findings for "syndrome of contractures"
1. Plagiocephaly (flat or asymmetrical back of the head)
2. Torticollis muscularis (locked neck due to short muscles)
3. Scoliosis infantilis (early signs of spinal misalignment)
4. Reduced abduction movement in the left hip. Untreated, this can lead to hip dysplasia (according to the study).¹
5. Shortened muscles in the abductor muscles and the soft tissue in the right hip. They link this to distorted pelvic position (which can be the basis of scoliosis).
6. Pelvic asymmetry due to shortened muscles in the adductors in the left hip and shortened abductor muscles in the right hip.¹
7. Foot deformities (for example pes equino-varus, pes equino-valgus or pes calcaneo-valgus).
In the study from the medical journal Journal of Advanced Pediatrics and Child Health, doctor and professor Karski also describes what the causes of "syndrome of contractures" can be.
Reasons for "syndrome of contractures"
In the study, he writes that these are possible reasons for the above findings:
"In SofCD the anomalies of the child's body are caused by "improper, too small space in the mother's uterus for the fetus". Exactly, the causes of SofCD are: higher weight of the fetus, greater length of the fetus's body and from the mother's side: small abdomen during pregnancy, lack of amniotic fluids (oligohydramion) and inconvenient – “androidal” or “platypeloidal” pelvic bone anatomy.”
Citation: (Karski T, Karski J. “Syndrome of Contractures and Deformities” according to Prof. Hans Mau. Symptoms, diagnosis, treatment: Recommendations for parents. J Adv Pediatr Child Health. 2020; 3: 021-023.)
Translated into Norwegian
In other words, they believe that too little space for the fetus is the big main reason, and mention in particular:
High weight on the child
Bigger body than space
Small belly during pregnancy
Little amniotic fluid
Abnormal pelvic skeletal structure
They also mention that adaptations should be made from when the child is a newborn, and that it is important to think about how best to address the biomechanical findings at "syndrome of contractures". Among other things, they give concrete advice on how best to carry the child - and how to counteract these muscle imbalances over time.
Secondary scoliosis
Scoliosis can also occur secondarily – that is, due to another diagnosis. This can include neuromuscular causes, among other things. Such as spina bifida, cerebral parese, muscular atrophy or due to syndromes such as Chiari syndrome.
2. Symptoms of scoliosis
It is important to diagnose scoliosis early, so that the person can be started early on with specific exercises and training. But with that said, it can be difficult to detect scoliosis in its earlier stages. But there are five symptoms in particular that you should look out for in the early stages:
Clothes that don't fit (seem asymmetrical)
Poor posture (see next section for details)
Back pain (especially in the lower back)
Uneven gait (mild limp)
Exhaustion
Here it is important to note, which will surely be clear, that this is particularly about symptoms associated with early scoliosis. For adults, the symptoms will overlap, but then also often include reduced breathing function in combination with back pain. In addition, you will be able to get compensatory pain and muscle pain according to how the curve of the back is.
3. Clinical signs of scoliosis
By clinical signs we mean physical findings and the like. Some of the most common signs of scoliosis include:
One shoulder blade protrudes more than the other
One leg seems shorter (twisted, tilted pelvis)
The body leans slightly to one side
The center of the eyes is not aligned with the center of the hips
Muscle imbalance (due to compensation)
Rib hump (clearer ribs on one side when bending forward)
Uneven hip height (one is higher up than the other)
Uneven shoulder height
These are some of the most prominent signs to look for in an early phase.
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4. Diagnosis of scoliosis
[Illustration 1: Vondtklinikkenne department Råholt Chiropractor Center and Physiotherapy]
If the spine has an increased deviation of more than 10 degrees, then this is classified as a scoliosis. A therapist will observe and do several examinations, including Adam's test, to evaluate the spine of a patient. An examination will consist of a functional assessment and an imaging examination (X-ray to measure Cobb's angle).
Different types of scoliosis
If you look at the picture above (illustration 1) you can see that there are several types of scoliosis. Some of the types we mention above include:
Thoracic scoliosis (crooked spine in the thoracic spine)
Lumbar scoliosis (crooked lower back)
Thoracic-lumbar scoliosis (crooked lumbar and thoracic spine)
Combined scoliosis
Physical treatment and rehabilitation training must take into account the type of scoliosis and where it is located. In addition, it must also take into account whether it is going to the left or right. For example, we will call a scoliosis that goes to the right a dextroscoliosis - and a scoliosis where the arch goes to the left levoscoliosis. Dextro therefore refers to the right arch and levo to the left arch. Let's consider one more example there, and say we have one lumbar levoscoliosis. Where does the arc go? Just right. Towards the left.
Functional assessment of scoliosis
As mentioned in the list «clinical signs of scoliosis» are several signs a trained clinician can look for. In addition to this, our physiotherapists and chiropractors will The pain clinics carrying out various orthopedic tests to evaluate the spine - and to look for any signs of scoliosis. The examination may include, among other things:
Observation according to known scoliosis findings
Specific tests (Adams test)
Mobility survey
Palpation of the vertebrae
Examination of gait layers
Check pelvic position
Measurement of leg length
If there are indications of scoliosis, it will be possible to refer to an X-ray to investigate this. Our chiropractors have the right to refer to such examinations where a picture of the entire spine is taken (total columnalis) and then measures the extent of the scoliosis.
Imaging examination of scoliosis (Cobb's angle)
If it is suspected and findings indicate that the patient has scoliosis, the next step may be referral for an X-ray examination. The radiographer will then take a picture of the entire spine in a standing position with a picture taken from both the side and the front. To measure the degrees of scoliosis, a radiologist will evaluate Cobb's angle and see how many degrees the scoliosis is.
"Cobb's angle is measured by comparing the angle of the top vertebra involved in the scoliosis condition to the bottom vertebra involved."
Here you can see an example of how to measure Cobb's angle.
Higher degree = More severe scoliosis
We divide scoliosis into the following rankings:
Mild scoliosis: 10–30 degrees
Moderate scoliosis: 30–45 degrees
Severe scoliosis: Above 45 degrees
But here it is important to remember that there is a significant difference between a spinal column in growth and one that has fully grown. Due to progression and worsening, milder scoliosis will therefore also be considered serious among younger children. In adults, the risk of negative development is not the same.
Adapted scoliosis training can slow down development
A larger meta-analysis showed that individualized scoliosis training can reduce negative development in the spine and produce less pain. In addition, they pointed out that such training also improved quality of life and everyday function.³ At the same time, they emphasized that larger and more comprehensive studies must be carried out on this topic to ensure better evidence.
- You cannot stop scoliosis, but you can slow it down
You cannot completely stop idiopathic or genetic scoliosis, but you can help limit it. Detecting it early is important, so that you can take the right measures against it. Age and development are very important in the prevention of scoliosis. This is because, for example, a 12-year-old with scoliosis will continue to grow and thus the degree of scoliosis will increase. If the patient receives early follow-up, you can help limit the development.
5. Treatment of scoliosis
Much of the treatment for scoliosis is aimed at specific rehabilitation and physical follow-up. In certain severe cases, a scoliosis brace or even surgery is appropriate. Treatment differs depending on the maturity of the spine. In the case of a fully developed spine, as in adult scoliosis, there will be no purpose in using a corset. On this basis, we must therefore divide the treatment of scoliosis into two categories:
Treatment of child scoliosis
Treatment of adult scoliosis
Treatment of child scoliosis
One of the most important things about scoliosis in children is to detect it early. In this way, measures and training can be started in an early phase of the problem. If scoliosis is discovered, the development will also be monitored regularly as the child grows (with X-ray measurement - approximately once a year).
"Again, we want to emphasize that the training and treatment must be individually adapted. Among other things based on what type of scoliosis it is (ref: illustration 1)."
In severe cases, it may be appropriate to use a scoliosis brace to prevent further development. And in very rare cases, it may also be relevant to have surgery where part of the spine is stiffened. But this is something that is only done in the most serious cases, and thus occurs very rarely. Treatment of childhood scoliosis may include:
Physical treatment and massage
Control X-ray (measurement of progression with Cobb's angle, approximately once a year)
Joint mobilization and stretching
Breathing exercises (scoliosis can lead to reduced breathing function)
Regular follow-up (to check progress)
Regular training (2-3 times a week)
Specific rehabilitation exercises
Treatment of adult scoliosis
In an adult, the spine is already fully developed. This also means that the focus of the treatment is different than for children and young people in growth. The main aims of treating adult scoliosis include:
Correction of muscle imbalances (to reduce the load on the spine)
Relieve compensatory pain (for example, muscle pain due to the curvature)
Normalize joint mobility (with scoliosis, the lowest vertebra in the curve in particular can become very stiff)
Exercise and physical therapy are two important main ingredients for people with adult scoliosis. Because there is a misalignment in the spine, this will mean that certain areas regularly become very tense and painful. Precisely for this reason, many people with scoliosis receive regular follow-up by a physiotherapist and/or chiropractor. Own measures such as use of foam roll og massage balls can be very useful for this patient group. The links to the products open in a new browser window.
Our recommendation: Large foam roller (60 cm)
Being able to relieve sore muscles and stiff joints yourself is very important for scoliosis patients. Scoliosis is something you have for life, and which will require you to regularly (often daily) work on the compensatory pain that occurs. You can read more about it here .
Recommendation: Massage ball
Massage balls are used to dissolve tight muscles and sore muscle knots. For example, you can lie on it and work on muscle knots between the shoulder blades or in the seat. read more here .
The vast majority of us, even people without scoliosis, can benefit from using a foam roller and massage ball. It is worth mentioning that the vast majority of professional athletes use foam rollers regularly.
6. Exercise for scoliosis
As mentioned, exercises and training should be aimed particularly at core muscles and deep spinal muscles - this in particular to relieve the vertebrae and joints. In addition, it is important that the exercises and training take account of the type of scoliosis involved. Here at Vondtklinikkene - interdisciplinary health, this is something our physiotherapists have particularly good expertise in.
"Studies have shown that both core training and Schroth exercises have a documented effect when it comes to preventing and correcting scoliosis (3 times a week).3«
What is the Schroth method?
The Schroth method is specific exercises that are based on your scoliosis and curvature. Ultimately, there are rehabilitation exercises that take into account your personal scoliosis design.
VIDEO: 5 good core exercises for the back
In the video below shows chiropractor Alexander Andorff came up with a good training program for the back and core with a therapy ball. Using a therapy ball is the x-factor in this program for scoliosis patients. When you use such a ball for such exercises, you will automatically have to activate the weak side more to compensate for the scoliosis. The program can therefore be experienced as demanding at the start, but you will also be able to notice a big difference within just a few weeks. Feel free to let us know about your experience.
Feel free to subscribe for free our Youtube channel if desired. It contains a number of good training videos and treatment videos. Also remember that you can always ask us questions if you have any questions - either directly to individual clinic departments or to our main social media channels.
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Article: Scoliosis (big guide)
Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene
Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.
Sources and research
- Karski et al, 2020. "Syndrome of Contractures and Deformities" according to Prof. Hans Mau. Symptoms, diagnosis, treatment: Recommendations for parents. J Adv Pediatr Child Health. 2020; 3: 021-023.
- Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6.
- Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and meta-analysis. Physiotherapy. 2019 Jun;105(2):214-234.
Frequently asked questions about scoliosis (FAQ)
Should I use a posture vest for scoliosis?
Restraint vests can be good for short periods, but should not be used for too long at a time. The reason why they are good for shorter periods is that they also provide neuromuscular signals about the optimal position the spine should be kept in. But if you use them for too long at a time, the spine can almost become too dependent on the extra support - which is not beneficial .
Our recommendation: Attitude vest
As mentioned, a posture vest can be beneficial when used for shorter periods. But use over long periods should be avoided. You can read more about it here .
Diet and diet of scoliosis?
Correct and good nutrition is important for growing children, so following national recommendations is important. For the elderly, where the scoliosis may be affected by degenerative changes, it is important to maintain good skeletal health - and then extra calcium may be appropriate, among other things.
What is the best training for scoliosis?
To answer this quite generally, this will vary depending on the degree of the scoliosis, but a safe answer will always be core exercises and training aimed at deep back muscles. Increased muscle function here can have a relieving effect on exposed joints and muscles. Many people with scoliosis also find value in adapted yoga and pilates exercises.
Can scoliosis hurt your back?
Yes, it is a common symptom. Just think of the strain that scoliosis causes on both joints and muscles. As a result, in many cases one will experience stiffness in joints and tense muscles - it may therefore be necessary to go to a physiotherapist or chiropractor for maintenance treatment. Scoliosis can also cause pain between the shoulder blades, neck pain and headaches.
Scoliosis surgery: When do you operate? To what degree is surgery an alternative?
As a rule, there will have to be considerable scoliosis before one even thinks about surgery, but when it is around 45 degrees and above, surgery is appropriate. Even at somewhat lower degrees, it may be relevant if one considers that the curve of the spine can expose the lungs or the heart to pressure in the event of deterioration.
