If someone has given you a diagnosis of scoliosis, you’re probably wondering what to do. Here’s your guide to scoliosis types, treatment and the therapies that we offer those with scoliosis in Hong Kong.

What is scoliosis?

If someone has told you that you have a scoliosis, you’ve probably Googled the condition. You may have seen some pretty terrifying images. Don’t panic. Scoliosis is a condition that has many causes, and that means it varies a lot in severity and symptoms. For most people with scoliosis, it’s mild and manageable, and it affects their lives little, if at all.

The term ‘scoliosis’ comes from the Greek ‘skoliόs’, meaning ‘curved’ or ‘bent’. It describes a lateral curve of the spine – that is, a sideways curve when viewed from the back. It’s normal to have front-to-back curves in your spine, which is S-shaped when viewed from the side. Side-to-side curves develop for a reason, which may be biomechanical, medical or genetic.

Scoliosis can range from mild to severe. In its severe forms, it can compromise your breathing and give you some pain. When mild, though, it can often be symptom-free.

Scoliosis types

A scoliosis can be ‘structural’ or ‘functional’. Structural scoliosis involves bony changes in the spine, whereas functional scoliosis is secondary to a cause elsewhere in the body. If this cause is treated, the scoliosis can often be resolved entirely.

Structural scoliosis 

We can think about structural scoliosis in two ways – cause and position.

Cause 

These categories are based on medical understanding of the underlying factors that have resulted in someone developing a scoliosis. They include:

1. Idiopathic 

This is by far the most common type of scoliosis, accounting for around 80% of cases. It’s most common in adolescents between 10 and 18 years old, although it can develop in people of any age.

Although we list it as a cause, ‘idiopathic’ actually means ‘of unknown cause’! We don’t fully understand the reasons that it develops, although there seems to be a genetic factor. There’s also a link to puberty and a child’s growth and development. It’s also likely that there are multiple factors that come together to initiate a scoliosis. These might be environmental, hormonal, genetic, muscular – it just isn’t yet clear.

2. Congenital

Someone has a congenital scoliosis if it is present when they are born. This is because one or more of the spinal bones fails to develop properly and has a ‘wedge’ shape, causing the spine to tilt.

3. Neuromuscular

A neuromuscular scoliosis happens as a secondary effect of a neuromuscular disorder. These may be conditions such as spina bifida, cerebral palsy, muscular dystrophy or Marfan syndrome. The disorder impairs muscular control of the spine. Having a condition like this significantly increases the chance of a scoliosis developing. For instance, in the general population, 2-3% of people have a scoliosis. In people who have cerebral palsy, that increases to 20-25%.

4. Adult onset or ‘de novo’ scoliosis

This category comprises people who develop scoliosis beyond adolescence. This may happen for one of several reasons:

Degenerative changes – age-related changes in the spine, such as degeneration of the discs or spinal joints. This can result in a tilt of the vertebral column and progresses over time.

Trauma – sometimes a severe trauma, such as a bad road traffic accident, can lead to the onset of scoliosis. The reason isn’t clear but may be to do with damage to the spinal ligaments.

Pathology – sometimes a tumour growing in the spinal column causes fractures or collapse of part of the bony structure, resulting in a scoliosis forming.

Idiopathic – and sometimes, there’s no clear reason. Again, there is probably a combination of factors.

Position

You might hear people describe scoliosis in terms of its position in the spine.

1. Lumbar – the main curve of the scoliosis is in the lumbar spine (the lower part of your back).

2. Thoracic – this refers to a scoliosis in the mid-back, where the ribcage attaches. It’s the most common position for a scoliosis.

3. Thoracolumbar – a curve that sits at the junction between the thoracic and lumbar regions, roughly in line with your waist.

As well as the affected area of the spine, you may hear the terms ‘levo’ or ‘dextro’ added to the description. These simply refer to the direction of the curve, meaning ‘left’ and ‘right’, respectively.

Functional scoliosis

If your curve reduces with changes in your position, then it’s a functional scoliosis. Treatment with a physical therapist is therefore likely to help.

Functional scoliosis is often due to biomechanical issues in the body. For instance, a twist in the pelvis or a slight leg-length difference can shift the spine, causing a lateral curve. Because it’s compensating for a lower-body issue, this kind of curve disappears when you sit down. If the originating issue can be fixed, the curve will go completely.

Bodies sometimes adopt a scoliotic posture in response to pain. If you’re suffering with back pain, for instance, you may notice a side-shift in your posture. This isn’t unusual. Osteopathy is proven to be effective for the treatment of back problems, and you’ll see your curve disappear with your pain.

How do I know if I have scoliosis?

A mild scoliosis isn’t always obvious. It may not be picked up until you have a physical examination for another reason. Things that may indicate a scoliosis include:

• One shoulder appearing higher than the other
• One hip bone looking higher than the other, or an asymmetry in the waist
• The ribcage being higher on one side, viewed from behind, when you bend forward

None of these things mean for certain that a scoliosis is present. But if you notice any of them, it’s a good idea to get a check from your osteopath, physical therapist or GP. They may wish to do further tests.

How is scoliosis diagnosed?

If your doctor thinks you may have a scoliosis, they will examine you physically and perform other tests to check that your nerves and muscles are functioning normally. The doctor may then send you for an X-ray, which will show whether there’s a curve in your spine and how severe it is. Your doctor may also want to perform other tests to look for any condition that might have triggered a scoliosis to develop. This could include tests such as blood tests, an MRI (magnetic resonance imaging) or other form of imaging.

After assessing you, your doctor will talk to you about your options. That might simply be regular checks (usually every year or six months) to see if your scoliosis is changing.

If your scoliosis is already moderate and you are still growing, your doctor may offer you a brace. Alongside physical therapy, this can prevent the curve becoming severe and requiring surgery later in life.

How is the severity of a scoliosis measured?

A curve’s severity is measured on an X-ray. Every scoliosis has its own three-dimensional pattern. In a structural scoliosis, vertebrae rotate as well as tilt. The uppermost and lowermost vertebrae in a curve are those that have the most tilt, but the least rotation.

The doctor takes a line from the lower edge of the lowest vertebra in the curve and the upper edge of the top one. The angle between these two lines, where they intersect, determines the severity of the curve. This is known as the Cobb angle.

In children and adolescents, a curve of less than 25o undergoes monitoring, and bracing where necessary. A curve is considered moderate if it’s 25o or over, and bracing can help these from developing further. If the Cobb angle is 40o or over, the doctor may offer bracing. But some curves will continue to develop to 50o. For these scoliosis types, treatment is usually surgical to correct the spine and prevent complications.

Our treatment options for scoliosis

Should you have any concerns about a scoliosis, get an assessment from a specialist. Our osteopathic team have plenty of experience in the evaluation and treatment of scoliosis. We’ll always refer you to a medical professional if necessary.

If your evaluation shows you have a mild structural scoliosis, your medical specialist may advise a ‘watch and wait’ approach. However, appropriate physical therapy may help to slow the progression of a mild scoliosis, so it’s still worth seeking help.

Osteopathy for scoliosis

The focus of all osteopathic treatment is to remove barriers to the body’s natural healing processes. Because of that, it’s well-placed to treat functional scoliosis. Your osteopath assesses the body as an integrated unit, understanding how the different parts affect each other. For example, your scoliosis may be related to poor muscle control in your lower leg. The muscles here support the arch of the foot, and if this support is lacking, you may develop a flat foot. This can alter your leg length, shifting your pelvis and curving the spine above.

If you have another scoliosis type, treatment with an osteopath can ease pain and maximize function. Adolescents with idiopathic scoliosis often find they can continue with their normal sport and other activities with the support that osteopathic treatment provides. 

Osteopathy can also benefit adults with a de novo scoliosis. Treatment can increase joint mobility, stimulate circulation and improve muscle balance. Osteopathic techniques for scoliosis can include maximizing your rib and diaphragm function, lengthening muscles, and working the joints of the pelvis and legs. Your osteopath can also give you lifestyle advice so you can stay in control of your symptoms. This may include breathing exercises, dietary advice, and support for when you’re sitting or sleeping.

Corrective exercise for scoliosis

At the Osteopathic Centre Hong Kong, our team includes specialists in corrective exercise. They can provide treatment for scoliosis by slowing progression, or even by reducing the curve.

Our corrective exercise experts will assess your abilities and your goals. They will then work with you to devise an individualised exercise programme. We tailor the programme to the unique requirements of your scoliosis type.

Treatment targets shortened or weakened muscles, lengthening and strengthening them. It also seeks to integrate the neurological and muscular systems, effectively re-educating the postural muscles. It may include work with weights or equipment – your therapist will ensure that you perform each exercise correctly.  You’ll find improvements in your flexibility, balance, coordination and posture – and in your self-confidence too.

Counselling for scoliosis

It’s important not to underestimate the impact of a scoliosis on mental health. Negative body image can be devastating. Given that scoliosis affects more teenagers that any other age group, we should give mental health as much consideration in a treatment plan as physical health.

Our counsellors are experienced in treating young people, and those of all ages, who are struggling with issues of poor body image, lack of self-esteem and anxiety related to their scoliosis.

Looking for scoliosis treatment in Hong Kong?

At the Osteopathic Centre Hong Kong, our team of experienced therapists can work together to help you overcome pain, anxiety and discomfort related to scoliosis. Call us now to find out more, or book with one of our experts today.