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Can You Have Scoliosis And Not Know It?

It's more prevalent than you think.
PHOTO: istockphoto

Living with scolio, or scoliosis, can be painful both physiologically and emotionally. This condition can impact your everyday comfort and range of activities; it can also affect your appearance and, as a result, your self-image or confidence levels.

But what you may not realize is that this is a condition that can be managed. There are more options than just managing pain levels, suffering through it, or opting for surgical correction. Keep reading to learn more!

What is scoliosis?

"Scoliosis is actually a deformity of the spine," says Dr. Byron Garcia, a rehabilitation medicine specialist with sub-specialties in sports medicine and scoliosis. "What happens is, there's a lateral deviation of the spine of more than 10 degrees."

He goes on to explain that, since even normal patients almost never get zero-degrees of curvature or rotation, a scoliosis diagnosis requires at least 10 degrees, and this can only be properly diagnosed with a whole-spine x-ray. This often cannot be captured by your standard chest x-ray. "It has to be the whole spine for you to have a better idea as to how big the curve is, how many curves there actually are on the spine."

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What are the different types of scoliosis?

Dr. Garcia says one way to determine the type of scoliosis (and therefore the best way to treat it) a patient has is by age. If it's congenital, a person is born with it. Early-onset scoliosis, in children under 10 years old, are also difficult to treat. Adult scoliosis can also be an issue, particularly among women, as well as the types that develop as a result of other conditions or diseases, but these are not as common as the type that develops in adolescence.

The most common type of scoliosis is adolescent idiopathic scoliosis (AIS), which affects children between the ages of 10 and 18 and may be found in as much as four percent of adolescents, according to the Scoliosis Research Society.

On the belief that scoliosis can result from bad posture, Dr. Garcia says, "Postural scoliosis is somehow more of a misconception. If you think about it, scoliosis is really something related with growth…The bones weren't able to adapt to your growing, and that's why you have scoliosis. There's always been the stigma—'Oh she's carrying this load, that's why she has scoliosis.' It can happen, but it's [rare]. Because it actually takes time to develop that curve. The correction also takes time."

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The doctor points out that it's common for his patients to ask whether they can carry heavy backpacks or other kinds of bags; he's quick to tell them that scoliosis or not, "you just really have to be prepared to carry that load."

What causes scoliosis, and what raises a patient's risk factors for it?

"A common misconception with scoliosis is that there's a scoliosis gene, that it runs in the family," Dr. Garcia explains. But even though scoliosis occurs between family members about 30 percent of the time, it isn't really an issue of genetic predisposition.

"The more common explanation I give to my patients is, the bones can't keep up with your growth, that's why you actually develop [adolescent idiopathic] scoliosis…That's why, even when teeth would have some deformity, if you brace them up, you get good results anyway. So it's really something related with growth rather than a singular scoliosis gene. At this point in time, they still can't pinpoint what actually triggers it."

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According to the Mayo Clinic, other causes for scoliosis include:

  • Neuromuscular conditions like cerebral palsy or muscular dystrophy
  • Birth defects
  • Spinal injuries or infections

Adolescent idiopathic scoliosis, the most common type, is eight times more likely to develop to the point of requiring treatment in females than males. "Scoliosis is actually more common among females than males, with a 1:3 female dominance in having scoliosis," Dr. Garcia says.

Can I have scoliosis and not know it? What are symptoms of scoliosis?

Scoliosis can go undiagnosed, especially if you're not watching for it or if the curve is mild enough that it appears gradually and causes no pain.

Mild scoliosis may not have a severe impact on a person's physical health, but the fact that it affects your posture and appearance means that it can still have effects on quality of life and self-image or self-esteem.

Common visible symptoms of scoliosis are:

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  • Uneven shoulders and/or waist
  • One shoulder blade appearing more prominent than the other
  • One hip being higher than the other
  • In advanced cases, spinal rotation or twisting, causing a rib "hump"—when ribs on one side of the body to stick out more than the other side

Severe cases may mean day-to-day pain for patients and may even affect lung and heart function.

What are scoliosis' effects on a patient's quality of life?

As for scoliosis's effects on the lifestyle of diagnosed patients, this will often depend on severity. However, Dr. Garcia points out, "Even if you check the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) guidelines, which are the best guidelines you would see for conservative management of scoliosis, it's not only about the pain.

"Aesthetics is actually quite high—it affects the woman's confidence. Even when they're young, when they're growing up, it can affect how they go about their day-to-day activities because there's going to be pain. Sometimes it limits the activities that they do.

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"There's been a common misconception that if you have scoliosis, you can't do sports. It's actually not [true]. Because we found out that if you're active, there's a bigger chance that your scoliosis might not actually progress as fast because you’re working your spinal muscles more."

However, he points out, when severe cases get out of hand or go untreated for too long, there can be a significant amount of pain, and it can compress the lungs and heart, affecting their functions.

How is scoliosis diagnosed? What should I do if I was already diagnosed with scoliosis?

Scoliosis symptoms can often be identified by sight, and a health care professional may conduct what's called an Adam's forward bend test to confirm that there is spinal curvature. A doctor would likely request an x-ray for anything above five degrees, but you would need an x-ray for an actual diagnosis. This will not only confirm the spinal curvature but also identify its severity. Normally a doctor will rely on a whole-spine x-ray for the diagnosis but if underlying causes are suspected, other tests may be requested as well.

Your doctor will be looking to check your x-rays for the following so as to identify next steps, particularly when it comes to treatment, since these will also determine the likely progress of the condition:

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  • Curve severity – severe cases can affect lung and heart function, and are also more likely to worsen without interference
  • Curve pattern – single curvature, or C-shaped curves, are less likely to become more severe than double curvature, or S-shaped curves
  • Curve location – if the curve is located in the upper or lower portion of the spine, it is less likely to worsen over time than a curve found at the center of the spine

A scoliometer will likely also be used to estimate the asymmetry of the spine.

"Half the patients that I see when they're in their 20s to 30s, ironically, they already know they have scoliosis," Dr. Garcia says. If you suffer from scoliosis and were told to simply observe the condition, see a specialist for an accurate measurement and to discuss your options, as even minor improvements to the curvature of the spine from exercises or bracing may make a big difference in your day-to-day quality of living.

Previously observation was a common recommendation for mild or even moderate scoliosis, with bracing or surgery recommended for moderate to severe cases. But awareness about this issue has increased over time, and other measures or treatments have also been identified as beneficial to scoliosis patients.

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What treatment options do I have for scoliosis?

Treatment varies from patient to patient is determined by the severity, shape or pattern, and location of the spinal curvature. "The measurement is important—if a curve is 15 degrees, then it actually is scoliosis," Dr. Garcia says. "But the thing is, that curve can be managed by exercise. And if it's 20 [degrees] and above, ideally the patient will brace it up because there's no point in waiting for it to grow. If you can prevent it from growing, all the better."

Dr. Garcia is the first to admit that there will be severe cases in which the treatment will really be surgery, but he is also quick to recommend other options for mild or moderate cases. These include exercises and bracing. And although previously, hard braces were the only option available locally, he and his colleagues have spent the past few years also working to increase awareness of the availability of soft braces as well.

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These soft braces are less restrictive to movement and visible than hard braces, and while they are more expensive than hard braces initially, Dr. Garcia says they actually are an equivalent or even more affordable option in the long run. Many patients who dislike hard braces are also more willing to comply with the need to wear the braces for most of the day when they switch to soft braces.

Exercises are also an option, if you are willing to do them correctly. "Even if you’re financially constrained, I can still give you options, specific exercises for you to [do] long-term. I had a patient who wasn't ready to buy a brace, but I gave her exercises, and she complied with the program. Her pain went away even without pain medication."

Can I still do something about scoliosis as an adult?

Scoliosis is treatable—and the earlier, the better! However, it should be noted that once a patient is an adult (and has stopped growing), the extent of correction that comes from non-surgical measures would be reduced. But that doesn't mean you should give up if you are older!

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"Even when you're 20, 25, we can give more options for you," Dr. Garcia says. "I have a patient who is 44 years old, has scoliosis, and for the longest time has been on painkillers. She's been my patient for one and a half years, [and] she's actually pain-free now. She's in the stage that we've actually convinced her to be more active, more mobile, to get the most out of what you're having now. So we always try to advise our patients to be much more active to strengthen their spinal muscles."

To learn more about scoliosis, consult a specialist. Many major metropolitan hospitals have doctors on staff who specialize in scoliosis or related conditions.

Dr. Byron Garcia, for example, currently works at the Perpetual Succour Hospital’s Rehab Solutions Inc. and at UCMed Sports Medicine and Rehabilitation Center, both in Cebu City, Philippines.

You may also want to learn more about scoliosis via the events and information provided by the Scoliosis Philippines nonprofit organization, which also maintains a closed scoliosis support group for patients living with scoliosis.

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