Each case of scoliosis is as unique as the patients themselves. There are a number of important patient and condition variables that come into play when diagnosing and classifying a condition, and these factors help us craft a customized treatment plan moving forward. Scoliosis isn’t always painful, but it can be. Keep reading to find out which patient and condition characteristics factor into whether the condition is painful or not.
There are many factors that shape a person’s experience of life with scoliosis. Regarding lower back pain, curvature location and patient age are big contributing factors. Lumbar curvatures are more likely to produce lower back pain in adults, but pain is far less common in young patients.
Before we get into the specifics of scoliosis and lower back pain, let’s first touch on the differences between the anatomy of a healthy spine and a scoliotic spine.
The spine is important because it helps us move, stand upright, balance, practice good posture, and provides the body with structure.
When looking at the spine from the side, there are naturally occurring curves having a characteristic curvature that either bends inwards towards the body’s center, or away from it.
The cervical spine (neck) features a lordotic curve, meaning it curves inwards in a reverse ‘C’ shape; the thoracic spine (middle and upper back) features a kyphotic curve, meaning it curves outwards in a soft ‘C’ shape, and the lumbar spine (lower back) also features a soft lordotic curve.
These natural and healthy curvatures give the spine added strength, flexibility, and facilitate its ability to evenly distribute weight and stress.
If one or more of these healthy curves are lost, it can disrupt the biomechanics of the entire spine as its structure and function are impacted by the introduction of adverse spinal tension.
The bones of the spine (vertebrae) are stacked on top of one another in a natural alignment, separated by intervertebral discs that help cushion the vertebrae, facilitate movement, and act as the spine’s shock absorbers.
So what happens to the spine when scoliosis develops?
When a person is diagnosed with scoliosis, it means their spine, when looking at it from the front, has developed an unnatural sideways curvature that rotates and has a minimum Cobb angle measurement of 10 degrees.
Cobb angle is a measurement obtained via X-ray that tells me how far out of alignment a scoliotic spine is. It involves drawing intersecting lines from the tops and bottoms of the curvature’s most-tilted vertebrae, and the resulting angle is measured in degrees.
A patient’s Cobb angle is an important piece of information as it places the condition on its severity scale of mild, moderate, or severe:
Mild scoliosis: Cobb angle measurement between 10 and 25 degrees
Moderate scoliosis: Cobb angle measurement between 25 and 40 degrees
Severe scoliosis: Cobb angle measurement of 40+ degrees
When a person has scoliosis, it means their spine is no longer aligned the way it should be, and this can cause varying levels of pain and postural changes.
While every case is different, condition severity, along with other factors such as patient age, condition form, curvature pattern and location, provides the information needed to design a comprehensive and customized treatment plan.
One of the most common questions I’m asked about scoliosis is how painful it is. However, there is no one-size-fits-all answer as multiple variables play into how a person experiences life with their condition, especially in terms of pain.
Let’s discuss patient age as this is perhaps the largest contributing factor to whether or not a scoliosis is painful.
When it comes to scoliosis-related back pain, adults experience it very differently than children and adolescents, and while scoliosis is far more commonly diagnosed in adolescents between the ages of 10 and 18, adults can develop it too.
Scoliosis can be painful for adults because they have reached skeletal maturity, meaning their spines are no longer growing. Once the spine has settled due to gravity and maturity, it is vulnerable to the compressive force of the abnormal curvature, as it’s compression felt by the spine and its surrounding muscles and nerves that causes pain.
In children and adolescents who are still growing, their spines are constantly being lengthened, and this counteracts the compressive force of the curvature, making it uncommon for the condition to be painful for young patients.
So when it comes to back pain and scoliosis, a large factor is the age of the patient. In addition, condition severity and curvature location can also play a role in whether or not a patient will experience scoliosis-related lower back pain.
When it comes to pain levels, condition severity can play a role as the curvature size and degree of rotation factors into the type of postural changes and other related symptoms a person can experience.
As mentioned, there are three main sections of the spine, and while compensatory curves can develop that are also capable of causing pain in different areas of the back, curvature location does play a large role in where the extent of that back pain is likely to be felt.
If an adult develops lumbar scoliosis, this means their abnormal sideways curvature has developed along the lumbar spine (lower back) and can cause lower back pain as the spine curves unnaturally and the muscles that surround it are strained in an effort to support and stabilize it.
As scoliotic curves introduce a lot of uneven forces to the body, they can put pressure at different points along and around the spine. If a lumbar curvature is compressing nearby nerves, this can produce pain that ranges from mild and periodic to severe and chronic.
Lumbar scoliosis can also cause sciatica pain as the sciatic nerve starts in the lower back and extends down the hips, buttocks, backs of the legs, and to the heels of the feet. This can cause pain felt not only at the site of the curvature, but also radiating pain into the hips, buttocks, and legs related to nerve compression.
As scoliosis is progressive, this means it’s in its nature to worsen over time, especially if left untreated or not treated proactively.
If lumbar scoliosis progresses, its related symptoms, such as pain, tend to worsen as well. Particularly in adults over the age of 40 whose spines are facing natural degenerative changes, the spine’s discs and joints can start to deteriorate: degenerative scoliosis.
In addition, scoliosis can also cause arthritis in the spinal joints which can lead to inflammation and pain.
There is no hard-and-fast rule when it comes to whether or not scoliosis will produce lower back pain.
While every case is different, lower back pain is most likely to be an aspect of life with scoliosis if the patient’s curvature has developed along the lumbar spine, if the patient is an adult, and/or if the patient is also facing other degenerative spinal changes.
However, even in people who have abnormal cervical curvatures (neck), in its attempt to compensate, the spine can put in a lumbar curve, and this can also cause pain in the lower back, even if the initial scoliotic curve didn’t originate there.
For older adults who develop degenerative scoliosis in the lumbar spine, this can be particularly painful as the spine not only faces the effects of the curvature, but also its additional degenerative effects.
When scoliosis is painful, it’s largely related to compression, which can be felt not only in the spine, but also its surrounding muscles and nerves. Nerve-related back pain is often described as one of the most debilitating forms of back pain, and while not everyone with lumbar scoliosis is guaranteed to have sciatica problems, it is a common complication.
Here at the CLEAR Scoliosis Institute, our team of certified scoliosis chiropractors address any and all scoliosis-related back pain by addressing its underlying cause: the condition itself.
Through a combination of treatment disciplines including different therapies used to prepare the body for treatment such as massage and warm-up exercises, targeted chiropractic adjustments, and specialized scoliosis-specific exercises designed to increase core strength and retrain the brain-body connection, we work towards impacting the condition on a structural level.
By impacting the condition structurally in the form of a curvature reduction, we are proactively addressing related symptoms such as postural changes and back pain.
If you or someone you care about is experiencing unexplained back pain and/or postural changes, don’t hesitate to seek help as there are many treatment benefits related to early detection.