Rotoscoliosis: Symptoms, Causes, and Treatment Options

Rotoscoliosis: Symptoms, Causes, and Treatment Options Image

Scoliosis is a complex condition with different severity levels and types. The severity of the unnatural spinal curve, and its level of rotation, are significant condition factors that shape the design of effective treatment plans. When a scoliotic spine has a lot of rotation, this is rotoscoliosis and factors into the types of symptoms it causes, and the condition’s treatment needs.

Scoliosis is an unnatural sideways spinal curvature, and a scoliotic spine doesn’t just bend to the side, but also twists; it’s the rotational component that makes scoliosis a 3-dimensional condition. When there is an excessive amount of rotation, this is called rotoscoliosis.

There are a number of different spinal conditions that involve a loss of its healthy curves, and to be diagnosed with scoliosis, certain parameters have to be met.

Being Diagnosed with Scoliosis

Being diagnosed with scoliosis means an unnatural sideways spinal curve has developed, with a rotational component, and a minimum Cobb angle of 10 degrees.

If a healthy spine was viewed from the front and/or back, it would appear straight, but when viewed from the sides, it takes on a soft ‘S’ shape, and this is due to the spine’s natural and healthy curves.

The spine’s healthy curves make it more flexible, better able to absorb/distribute mechanical stress, and stronger, like a coiled spring.

If the spine loses one or more of its natural curves, its overall health, biomechanics, and function are disrupted, as the spine’s vertebrae (bones) are no longer aligned.

When scoliosis is diagnosed, part of the process involves comprehensive assessment to further classify conditions based on key patient/condition variables: patient age, curvature location, condition type (cause), and severity.

Condition severity is classified based on a patient’s Cobb angle measurement which is taken during X-ray; it involves drawing lines from the tops and bottoms of the most-tilted vertebrae, at its apex, and the intersecting angle is expressed in degrees.

The higher a patient’s Cobb angle, the more out of alignment the spine is:

Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees

Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees

Severe scoliosis: Cobb angle measurement of 40+ degrees

So while Cobb angle measures the size of the unnatural sideways spinal curve, rotation refers to how much it twists from front to back, back to front, and just as there are different degrees of severity, the level of rotation also varies from patient to patient.

What is Rotoscoliosis?

Scoliosis is a structural condition, meaning it involves an abnormality within the spine itself, which is why effective treatment, first and foremost, has to impact the condition on a structural level.

True scoliosis is structural, not postural, and this means that along with the spine’s unnatural sideways bend, it also coincides with rotation, meaning it twists, making it a complex 3-dimensional condition.

although all types of Although all types of structural scoliosis include rotation, if the term rotoscoliosis is given in diagnosis, this means there is a high level of rotation; the spine has a severe twist to it.

Because of the excessive amount of rotation in rotoscoliosis cases, they are more complex to treat, making symptoms such as postural deviation and pain, more likely to be overt.

Rotoscoliosis Symptoms

With an increased rotational component in cases of rotoscoliosis, the spine’s misalignment is more pronounced, making its effects more noticeable.

As the spine and brain work in tandem to form the body’s central nervous system, it’s involved in the function of numerous systems at work within the body, which is why the effects of spinal conditions like scoliosis can be felt throughout the body.

Part of the reason scoliosis is so often referred to as a complex condition is because it ranges so widely in severity, which you’ll likely recall from the wide range of Cobb angle measurements; in fact, scoliotic curves can range from 10 to 100+ degrees.

As a progressive condition, scoliosis also has it in its nature to worsen over time, meaning where a scoliosis is at the time of diagnosis is not indicative of where it will stay; mild scoliosis can easily become moderate or severe, if left untreated, or not treated proactively.

Only proactive treatment can counteract the condition’s progressive nature.

In addition to a patient’s Cobb angle and amount of rotation, a patient’s progressive rate also factors into symptoms they are likely to experience.

While each case is different, which is why treatment plans have to be customized to address key patient/condition variables, common visual symptoms of rotoscoliosis include:

  • Uneven shoulders with one sitting higher than the other
  • Uneven shoulder blades with one protruding more on one side than the other
  • The development of a rib arch
  • An uneven waistline
  • Arms and legs that appear to hang at different lengths

it's the condition's uneven forces It’s the condition’s uneven forces that disrupt the body’s overall symmetry, and as a result, changes to balance, coordination, and gait are additional symptoms of rotoscoliosis.

In addition, rotoscoliosis is generally more painful as the spine’s unnatural twist is excessive, making the condition more severe, and this is particularly the case with scoliosis in adults, for whom the condition has become compressive.

Rotoscoliosis Causes

When it comes to rotoscoliosis causes, they are the same as scoliosis in general.

While there are different condition types a person can develop, the most prevalent is adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18.

The idiopathic designation means not clearly associated with a single-known cause, and idiopathic scoliosis is also the most common type to affect adults.

Approximately 80 percent of scoliosis cases are classified as idiopathic, while the remaining 20 percent of scoliosis cases are associated with known causes: neuromuscular, congenital, degenerative, and traumatic.

Neuromuscular Scoliosis Causes

In cases of neuromuscular scoliosis, the scoliosis is caused by the presence of a larger neuromuscular condition such as muscular dystrophy, cerebral palsy, or spina bifida, to name a few.

These types of cases are complex as communication between the brain and the muscles that support the spine is disrupted, causing the development of a scoliotic curve.

In treatment, it’s the neuromuscular condition that has to be the focus as it’s the underlying cause of the scoliosis.

Congenital Scoliosis Causes

Congenital scoliosis is rare, affecting approximately one in 10,000, and it develops in utero, due to a malformation within the spine itself that’s present at birth.

This can include misshapen vertebrae; healthy vertebrae are rectangular in shape so they can remain stacked on top of one another in a straight and neutral alignment, and when a vertebrae is more triangular in shape, it can affect the spine’s ability to maintain its natural curves and alignment.

Congenital scoliosis can also develop when vertebrae fail to develop into separate and distinct vertebral bodies, becoming fused together into one solid bone.

Degenerative Scoliosis Causes

Degenerative scoliosis is the second most common type to affect adults, is most common over the age of 40, and is caused by natural age-related spinal degeneration.

It’s more common in women than men, related to hormone and bone density changes caused by menopause, and most often, it’s the intervertebral discs that are the first spinal structures to deteriorate.

If a disc deteriorates and/or becomes desiccated, it will lose height, and its change in shape affects the position of adjacent vertebrae that attach to the disc in between, shifting the spine out of alignment.

Traumatic Scoliosis

As the name suggests, traumatic scoliosis is caused by a significant trauma experienced by the spine, such as in a car accident or fall.

In addition, the presence of tumors pressing on the spine can also force it out of alignment and cause the development of traumatic scoliosis.

So within these different types of scoliosis, just as the degree of severity can vary, so too can the degree of rotation, and the more severe the condition, and the higher the level of rotation, the more likely the condition is to be painful and cause noticeable disruptions to posture.


Following a diagnosis of rotoscoliosis, the most important decision is how to respond with treatment.

Different treatment approaches offer different potential outcomes, so it’s important for patients to be aware of all the options available to them.

The complex nature of scoliosis necessitates the customization of effective treatment plans by integrating different treatment disciplines so conditions can be impacted on every level.

As a structural condition, scoliosis has to, first and foremost, be impacted on a structural level, and this can be worked towards through a series of chiropractic techniques and manual adjustments that realign the spine.

When combined with a variety of therapies for increasing core strength so the spine is optimally supported by its surrounding muscles, and custom-prescribed scoliosis-specific exercises for rehabilitation, the spine can be further stabilized for long-term sustainable results.

As a CLEAR-certified scoliosis chiropractor, I treat patients with a proactive conservative chiropractic-centered treatment approach that strives to prevent progression, while preserving as much of the spine’s natural function as possible.

CLEAR photo

Author: Dr. Dio Kim

Dr. Dio Kim graduated from Palmer College of Chiropractic West in 2000 and practices in Tustin, California. He has been CLEAR Certified since 2011. Among the many certifications allowing him to be recognized as a CLEAR Fellow are the Cox Technic, Kinesio Taping, ScoliBrace, Scientific Exercise Approach to Scoliosis (SEAS) Level 1, and many more. Dr. Dio specializes in scoliosis, sports, and pediatric chiropractic. He holds a Diplomate in Clinical Chiropractic Pediatrics (DICCP) and Diplomate American Chiropractic Board of Sports Physicians (DACBSP®). The DICCP is a board-certified credential in pediatrics for doctors of chiropractic who specialize in children, from infants to teenagers. Moreover, he is one of only a few chiropractors invited by the United States Olympic & Paralympic Committees (USOPC) to the Olympic Training Center in Colorado Springs to treat elite athletes. He is a graduate of the World Masters of Scoliosis Conservative Treatment from ISICO, and is also a licensed acupuncturist.
Reach out to Dr. Dio Kim

Leave a Reply

Your email address will not be published. Required fields are marked *

Sign Up For Our Newsletter

CLEAR provides a unique and innovative way of understanding scoliosis. Sign up to receive facts and information you won’t find anywhere else.

  • This field is for validation purposes and should be left unchanged.

CLEAR scoliosis institute logo
CLEAR Scoliosis Institute is a 501(c)3 registered nonprofit.

Sign Up For Our Newsletter

  • This field is for validation purposes and should be left unchanged.

Copyright © 2022 CLEAR Scoliosis Institute 
This website is for informational and general purposes only. Information provided is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice because of something you have read on this site. 

CLEAR Scoliosis Centers are privately owned and operated chiropractic clinics. Doctors at CLEAR Scoliosis Centers are personally responsible for all clinical decision making. CLEAR Scoliosis Institute, a nonprofit organization, does not have any authority over the clinic, make any clinical recommendations, or dictate patient care.
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram