The purpose of this blog is to discuss 5 facts about scoliosis. These topics include diagnosis, natural history, “best” exercises, back pain, and performance.
Scoliosis is a general term which describes changes in the shape and position of the spine, thorax and trunk. When viewed from behind, the spine curves side to side and has a rotation component, so instead of the spine appearing straight, it might look more like a “S” or “C” shape.
About 20% of cases are due to an underlying condition or other causes. These include congenital (i.e. vertebrae not properly formed), neuromuscular (i.e. Spinal Muscle Atrophy), syndromic (i.e. Marfan Syndrome, Ehlers Danlos Syndrome), and other causes (i.e. surgery).
The other 80% of cases are idiopathic, which means the exact cause is unknown. Idiopathic scoliosis is generally classified by using a combination of the cobb angle (more on this later), age, and location (see picture below).
Since the majority of scoliosis cases are idiopathic in adolescents or adults, the information in this blog will pertain to these populations.
Fact 1: Scoliosis cannot be diagnosed by only observing someone’s posture
Observing someone’s standing or moving posture (commonly called the Adam’s test) may lead to suspicion, but by itself, is not diagnostic of scoliosis.
The spine curve must be measured via X ray using the Cobb angle, which is the angle formed between the 2 most tilted vertebrae. The diagnosis of scoliosis is confirmed if this angle is 10° or higher and axial rotation of the spine is present (Negrini et al. 2018).
When observing someone’s standing or moving posture, individuals may appear to have subtle differences in shoulder or hip height, or even present with a torso lean, but this information alone does not define scoliosis. Even in cases where it might seem more obvious, to confirm the diagnosis of scoliosis, imaging with a cobb angle >10° is still required.
Fact 2: As an adult, it is very rare for low to moderate scoliosis to progress
Here are some general thresholds:
- If you have a curve less than 10°, remember this is not scoliosis.
- Scoliosis curves less than 30° will often remain stable throughout adulthood.
- Once curves get above 30°, there is an increased risk for progression.
- Once you reach greater than 50°, it is almost certain scoliosis curves will progress (Negrini et al. 2018).
This means that for adults with scoliosis of low to moderate severity, or about 10 to 30°, your spinal curve is very unlikely to progress.
If you are an adolescent, and the spine is still growing, the cobb angle is often used to guide treatment options.
For example, if your curve is less than 25°, observation is the primary intervention, meaning your spinal curve is watched closely for progression, with your doctor determining the frequency of visits and imaging. Negrini et al. 2018 states “timing can range for 2-3 to 36-60 months according to the specific clinical situation.”
If your curve is between about 20/25° and 40/45°, bracing is often utilized in order to slow curve progression. It will not make your spine straight, but rather its goal is to reduce your risk for surgery.
With more severe cases, surgery might be warranted, but this decision is multifactorial. It takes into consideration curve severity, location, how much growth remains, etc. This is unique to each individual.
Other alternative treatments may promote a “fix” for scoliosis, but according to the Scoliosis Research Society “there is no scientific proof that any of these alternative treatments are effective in treating progressive scoliosis.”
Fact 3: There is currently no “best” exercise for scoliosis
If you search the internet for scoliosis specific exercises, you will find an array of exercise options, including breathing drills, spine stretches, postural exercises, back strengthening options, etc.
While these may help improve overall strength, increase function and even provide symptom relief, the current research suggests that these scoliosis specific exercises are not effective in reducing cobb angle or preventing curve progression in adolescent scoliosis.
- Day et al. 2019: “There is insufficient evidence to suggest that both Schroth and SEAS methods can effectively improve Cobb angles in patients with AIS compared to no intervention.”
- Fan et al. 2020: “Insufficient evidence is available to prove that SSE with or without other conservative treatments can reduce Cobb angle, improve trunk balance and QoL.”
- Tolo and Herring 2020: “We found no studies that provide valid evidence that an exercise method prevents progression of AIS (adolescent idiopathic scoliosis) in patients during their peak growth period.”
Now, you may find some studies demonstrating that it does improve spinal curves, but if you look closely, these are usually deemed clinically insignificant (no more than 4 to 6°) and as a whole, the current evidence on the topic is of very low quality (Kuru et al. 2016, Monticone et al. 2014, Thompson et al. 2019, Zhou et al. 2021)
High quality research comparing scoliosis specific exercises to general exercise for the long term management of idiopathic scoliosis is still needed, but there are still 2 positive takeaways.
The first is that exercise is still warranted for those with scoliosis, but it does not need to change cobb angle or spinal curve to be considered successful, as they are still very beneficial for improving overall function and perceived status (Scheiber et al 2019).
And two, the exercise approach does not seem to make a significant difference. For example, Yagaci et al. 2018 found that general core stabilization exercises had similar effects in the short term when compared to scoliosis specific exercises.
This suggests that any number of exercises are likely advantageous. Whether this is Pilates, resistance training, or another type of exercise, this makes it far more likely you will find something accessible and that you enjoy, which in turn means you are much more likely to stick with it in the long term.
Fact 4: Scoliosis of low to moderate severity does not cause back pain
According to the Scoliosis Research Society, adolescents “…with scoliosis get back pain at the same rate as their peers without scoliosis” and adults “with curves less than 30 degrees have the same risks for back pain as people without scoliosis.”
While scoliosis may be correlated, it is only one piece of a much larger puzzle.
There are many other factors associated with pain, including behavioral, lifestyle, contextual, social, work, individual, psychological, etc. (Cholewicki et al. 2019). All of these can contribute to pain, and that is why the saying “correlation is not causation” is so important in this context.
This means that you do not necessarily need to decrease the scoliosis curve in order to reduce back pain. Instead, focus on addressing one or two of these factors which are in your control. For example, engaging in regular physical activity, reducing stress, and improving sleep are low hanging fruits which can have a tremendous impact on both pain and function.
Fact 4: No exercise or activity is off limits
In their most recent guidelines, the International Society of Scoliosis Orthopaedic and Rehabilitation Treatment “recommends patients with scoliosis to remain active in sports activities, especially since participation does not seem to affect the occurrence or degree of scoliosis”
This means you can run, swim, lift weights, play sports, or do whatever other activities you desire, and you can even perform these at a high level.
Some examples include Lamar Gant, a world record-holding powerlifter; Jessica Ashwood, an Olympic swimmer and Australian record holder; and Usain Bolt, arguably the greatest sprinter of all time, who has been open about having scoliosis, attributing his hard work in developing a strong core and back as helping him throughout his career.
Here are the big takeaways you should know about scoliosis:
The first is that scoliosis cannot be diagnosed by only observing someone’s standing or moving posture. Many people have told me that my shoulders are different heights and my spine is slightly crooked, but these minor asymmetries are actually quite common, they don’t need to be corrected, and are generally nothing to be concerned about (Boulay et al. 2006, Oyama et al. 2008, Vandenbussche et al. 2008).
Second, as an adult, it is very rare for idiopathic scoliosis of low to moderate severity to progress. It is unlikely you will need to seek out active treatment, but if you have any concerns, this should be a conversation you have with your medical doctor.
And from this list of available treatments, there is currently not sufficient evidence to suggest one exercise is significantly better than the other. Exercise is highly encouraged for adolescents with idiopathic scoliosis, but limiting to only scoliosis specific exercises should not be a barrier to entry.
The next takeaway is that scoliosis of low to moderate severity does not cause back pain. Understanding that there are multiple factors which contribute to pain will allow you to focus on factors that are in your control. Engaging in regular physical activity, reducing stress, and improving sleep are a few examples.
And finally, no exercise or activity should be off limits. In fact it is highly encouraged you remain active in sports and feel confident knowing these activities do not cause or make scoliosis curves worse.
I understand that some of you may have experiences that differ from the information presented, and that is okay. The purpose of this blog is to provide the most up-to-date research and to highlight that individuals with scoliosis can still lead active, healthy lives.
If you do have any other questions about scoliosis that I didn’t cover in this blog, I encourage you to talk to your medical doctor. As well, below are some additional resources which should be able to provide more guidance.
Thanks for reading. Check out the video and please leave any questions or comments below.