Simplifying Scoliosis in Children

Male osteopath (chiropractor) healing a young boy by touching his lower back.

4 Important Facts Parents Should Know

Scoliosis is the medical term for an abnormality in the curvature of the spine that causes a visible deformity. The spine has 4 natural curvatures: cervical, thoracic, lumbar, and sacral. These can be seen from the side view of the body. With scoliosis, an abnormal curvature in the spine occurs laterally, which can be seen when looking at a person from behind. Often there is a rotational component to the curvature as well as a lessening of the normal spinal curvatures. The curve can be a single thoracic or lumbar curve or a double curve with both a thoracic and a lumbar curve present. Below are 4 facts every parent should know about scoliosis in children.

The Cause is Unknown

Two types of scoliosis can occur in children, congenital and idiopathic. Congenital scoliosis is present from birth and a result of abnormal formation of the spinal bones during pregnancy. Idiopathic scoliosis develops as the spine grows during childhood into adolescence. However, the cause of the abnormal development is unknown and there is no known prevention method. It is also important to know that bad posture and carrying heavy backpacks do not cause scoliosis and 80% of childhood scoliosis cases are idiopathic in nature. After the age of 10, idiopathic scoliosis occurs more prevalently in girls than boys at a rate of 4:1.

Early Screening Is Key

The earlier scoliosis is identified, the easier it is to prevent further progression or worsening of the curve. Common signs that can indicate scoliosis include the head not being centered over the body, uneven hips or shoulders, one shoulder higher than the other, one shoulder blade sticking out more than the other, an unequal gap between the trunk and the arms, and a curve in the spine. Recommended screening age is between 11 and14 years at the beginning of puberty when the rate of development of spinal curvatures is most rapid. Current evidence suggests that spine examinations are the best screening tool, indicating regular physical exams are especially important during adolescence. During a spine examination, a health practitioner will assess the child’s overall posture and spinal alignment and perform a forward bending test. A positive forward bending test will determine the need for further examination of the spine.

Diagnosis Requires a Spine X-Ray

If further examination is indicated based on the results of the screening, a standing X-Ray of the spine is recommended. From the X-Ray image, the degree of lateral curvature of the spine, called the Cobb Angle, can be measured to determine if scoliosis is in fact present. A minimum Cobb Angle of 10 degrees is required in order to make a diagnosis of scoliosis. Scoliosis curves are then classified based on the measured Cobb Angle (see table below).

Low: Up to 10
Moderate: 21 – 35
Moderate to Severe: 36 – 40
Severe: 41 – 50
Severe to Very Severe: 51 – 55
Very Severe: 56 or more

Furthermore, the amount of bone growth remaining for the child, using the RISSER Scale, can also be determined from the X-Ray upon examination of the pelvis. The combination of the Cobb Angle, the Risser Scale score, and the age of the child at diagnosis will determine the treatment approach as well as help to predict the likelihood of progression prior to the end of bone growth.

Conservative Treatments Are Available

The goals of conservative treatment for scoliosis are to stop curve progression at puberty (and possibly reduce the curve), prevent or treat breathing dysfunctions, prevent or treat spinal pain syndromes, and to improve the aesthetics of the spine using postural correction. In order to achieve these goals, one or more of the following treatment approaches may be used: observation, education, scoliosis specific exercises, and bracing.

If you think your child may have an issue with their spine or you would like them to be screened for scoliosis don’t hesitate to seek medical care. The sooner scoliosis is caught, the better the outcome.

This information is based on The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2016 Guidelines for Idiopathic Scoliosis.

Jessica Lott is a Doctor of Physical Therapy living in Taipei since 2021. She is from the United States and has been living and working in Asia since 2014. Prior to living in Taiwan, she lived in Shanghai, China where she worked as a Physical Therapist at Shanghai United Family Hospital and UP Clinic. Jessica has experience treating various conditions and injuries, and works with individuals of all ages. She is passionate about physical health, wellness, and helping people achieve their goals.

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