This guide is not intended to replace the advice of a healthcare professional. Each case of scoliosis is unique and must be evaluated on an individual basis. Please consult with a scoliosis specialist before deciding upon a treatment plan.
Receiving a diagnosis of scoliosis can be stressful and scary. If you or your loved one have recently been diagnosed with scoliosis, this article can hopefully help guide you through some important steps, and help you to feel less anxious about what it means to have scoliosis.
Scoliosis can only be truly diagnosed by taking an x-ray; the scoliosis screenings that involve bending forward at the hip can only determine who might have scoliosis. Taking an x-ray is necessary to confirm that scoliosis is present. This article assumes that an x-ray has been taken, and the Cobb angle(s) have been measured.
Traditional orthopedic practice divides scoliosis into mild scoliosis (below 20 degrees), moderate scoliosis (20 to 40 degrees), and severe scoliosis (above 40 degrees). If the Cobb angle is above 40 degrees, surgery will most likely be recommended; this will be a topic for a future article.
Below 20 degrees, most orthopedic doctors will recommend “watchful waiting,” this refers to monitoring a curve and doing nothing unless it gets worse. However, what this actually means is that mild cases of scoliosis might not need to be braced, or have surgery. It does not mean that mild cases of scoliosis do not affect a person’s health. Even small curves can limit the body’s ability to exercise, increase the risk of back pain, and lead to reduced activity levels. People with mild cases of scoliosis tend to miss more days of school than people without scoliosis. It can also affect people’s self-image and emotional state.
It’s important to think, realistically, upon the way that the scoliosis is currently affecting your health, and how it might affect you in the future. If you are currently in no pain, have no problems breathing or sleeping, and have no noticeable postural asymmetries, it might seem reasonable to monitor it and do nothing. However, down the road, small imbalances cause greater wear and tear over time, and could lead to problems that are more difficult to treat.
At 20 to 40 degrees, bracing will probably be recommended. Have a discussion about bracing right away to determine if this is something your teenager is prepared to do, as it can be socially awkward for some. If the patient is not committed to wearing the brace, it will most likely not be effective. If you are considering braces, explore not just the traditional Boston brace, but also new brace designs coming out of Europe, such as the Rigo-Cheneau. Insist that an x-ray be taken in the brace; if the Cobb angle does not reduce by at least 50%, it is highly unlikely that the brace will prove to be effective in the long-term.
Look for scoliosis specialists in your area, and try to arrange at least one consultation within the month; if there are multiple scoliosis doctors or clinics, it’s never a bad idea to receive information from more than one source. Don’t hesitate to reach out to other specialists outside of your area via e-mail and telephone as well.
Decide whether or not you would consider traveling to receive care. The effectiveness of a brace and the outcome of the surgery depend heavily upon the physician’s experience with scoliosis, and some hospitals may have larger orthopedic departments with more resources dedicated specifically to scoliosis. There are also physical therapy clinics, chiropractic scoliosis clinics, and specialized bracing centers that will offer one, two, or four week treatment plans for patients who come and stay in the area.
When consulting with a scoliosis specialist, pay close attention to where they received their training from; their advice and recommendations to you will depend very heavily upon what they were taught. Most chiropractors receive very little training about scoliosis as a part of their formal education; unless they have attended additional postgraduate courses and seminars specifically on scoliosis, it is not very likely that they have an advanced understanding of the condition. Similarly, physical therapists are not taught how to deal specifically with scoliosis; you need to find a physical therapist who specializes in scoliosis-specific programs such as Schroth, SEAS, ScoliGold, or others. Yoga practitioners as well could prescribe exercises and stretches that may be harmful for some curve types; Elise Miller’s Yoga For Scoliosis program is developed specifically for scoliosis patients, and includes careful instruction to ensure that you only perform the maneuvers which are right for your spine.
General orthopedic surgeons might not have as much experience with scoliosis and bracing as orthopedic surgeons who choose to specialize in scoliosis, so try to find one that does if you can. Orthopedic scoliosis specialists know a great deal about bracing and surgery, but most won’t know much about chiropractic, physical therapy, or yoga besides commenting that there isn’t enough research on these methods. Some orthopedic surgeons may discourage you from pursuing these alternative methods of care; understand that in many cases, their opinion is based upon the lack of research, the poor track record of non-scoliosis-specific approaches, and their lack of familiarity with new scoliosis rehabilitation approaches.
Focus upon what is important to you, and how your scoliosis is affecting those aspects of your life. Make sure the treatment you select will improve your quality of life, and help you to maintain your function for years to come.