March 15, 2021


The diagnosis “scoliosis”

Scoliosis is a term used to describe the shape of the spine; the original Greek root means crookedness or screw-shaped. The term describes lateral curves in the spine that are additional to the three standard curves. Anatomy and physiology talk about the ’normal’, or ordinary curvatures of the spine (as the body is seen from the side): we have a lumbar curve, or “lordosis”; a thoracic curve in the opposite direction in the trunk, or “kyphosis” (though sometimes this curve is almost flat); and a neck (or “cervical”) curve. In someone with scoliosis, we see additional curves in the plane of the shoulders (as might be seen from behind) in addition to the standard curves, and these additional curves feature vertebral rotations as well. There are a number of different presentations of these additional curves. Scoliosis affects about seven times as many young women as men, and its cause is described in the literature as “idiopathic”*. The changes to the spine that results in the characteristic shape happen in the first or second growth spurts in teenage years, usually.

Many instances of scoliosis are misdiagnosed. And even severe scoliosis can be helped by conservative, exercise-based, solutions. One of the very best of these is the Schroth Method**, taught at the Asklepios-Katharina-Schroth Klinik at Bad Sobernheim, Germany. I will return to this below.

In this brief article, I want to explore the term ‘scoliosis’ a little more deeply. Like many medical diagnoses, hearing your body described by a term like this used by an expert or authority can be immensely disturbing for child and parent alike, but some scolioses are completely benign—I have one myself, and it causes me no problems at all, and never has. One important aspect of “scoliosis” is to work out whether it is functional (like mine) and, in fact, necessary, or whether it is developmental, where the shapes produced are more fixed. Next is to decide on an effective conservative treatment; more on this below.

If you have a leg-length difference, as I do, you will have a scoliosis for sure – because as you look at the body from the front or back, the pelvis is tilted to one side (one hip will be lower than the other in the standing, load-bearing position). One side of the lumbar spine will be tilted to that side as a result; most commonly the reverse of this curve will occur in the thoracic spine and the lumbar side curve will be reproduced in the cervical spine, but to a smaller degree. I have written extensively about this, and you can find details and illustrations in my book Overcome Neck & Back Pain. These kinds of scolioses are described as a necessary, or functional, scoliosis. Why is this? It’s what the body needs to do in order to distribute its weight as widely throughout its structure as possible. This is Engineering 101, but so often forgotten—if the forces acting on any complex system are not distributed widely, then stress concentrations will develop. If this happens in a mechanical structure, stress fractures can be the result. In living organisms, stress concentrations manifest as tension, initially, and if the process continues, pain. All living things will try to adapt to stresses to minimise their effects. Unlike other mammals, though, humans stand on two legs, in a sea of gravity, and the spine itself has to adapt to this. If anyone with no leg-length difference stands on a side slope, the lateral curves we re talking about will appear, and if the person turns around on the same slope to face the other way, the curves will reappear, but reversed.

In other words, this is how the body works. The majority of scolioses is the functional type. What are the implications, and how this can be improved, will be discussed below.

The second type of scoliosis is the true, or developmental type. It is named this because at some point in the growth period, the left and right sides of the vertebrae (as seen from the front or behind) grow at slightly different rates. This change forces a new set of curves into the spine, in addition to the ordinary three. If you look at an X-ray of a person with this change, you will see that the vertebrae are slightly wedge-shaped, and the disc spaces are usually normal. I mention this because in the functional type described above, the vertebrae are symmetrical, and the discs are slightly wedge shaped, the softer tissues of the discs helping the spine to adapt to the additional stress caused by the uneven pelvis.

There is a simple, effective test for true, or developmental, scoliosis: the shocking thing to me is many practitioners who deal with scoliosis do not routinely use this test. Do not confuse this test I will describe with the 'slump test' from physiotherapy, which a net search will find and which is used for completely different reasons. If there is someone you know who has been told they have scoliosis, ask him or her to sit on a chair, facing the chair back, and ask her to carefully slump: backwards in the lumbar spine and forwards in the thoracic spine, very slowly and gently. If done correctly, her shoulders will not move forward or backwards, but rather just sink towards the floor a bit as the whole spine curves and starts to look like the letter “C” as viewed from the side. If the person has a genuine, developmental scoliosis, one side of her rib cage will pop out towards you, becoming visibly more curved and the other side will flatten. This is a 100% accurate test. If this asymmetric change doesn’t happen she does not have a developmental scoliosis—the point is that in the case of a developmental scoliosis a more-or-less permanent set of curves is set into the spine because of the shapes of the vertebrae themselves, together with their resulting rotation in relation to each other make this change in the rib cage shape happen. When the person sits up again, these new changes to the rib cage are reduced, or disappear.

In my case, with my significant leg length difference and its attendant functional scoliosis, when I sit on a chair my spine is perfectly straight, and when I slump nothing happens in the rib cage at all, except it uniformly curves forwards on both sides. And we're not talking about something subtle here: in true scoliosis, the rib cage shape changes visibly, and everyone can see it—you do not need to be a trained professional to see this. As well, in the case of an actual leg-length difference like mine (about 18mm), if I stand on a paperback book under the foot of my shorter right leg, the curves in the spine lessen, and this is easy to see as well. It’s even easier to see when the natural curves caused by a leg-length difference are made even greater by putting the book under my left (the longer) leg: everything looks wrong. I made a video on this, and it’s up on YouTube:

You may care to do this simple test yourself.

In the case of a functional scoliosis, the person will have marked differences in their patterns of strength and flexibility, when comparing their left and right sides’ functions. In Stretch Therapy, we have been working with these patterns for 30 years—we have found that reducing uneven patterns of strength and flexibility always results in the person feeling more comfortable in their bodies, and function always improves as well. The book Overcome Neck & Back Pain goes into these patterns in much more detail, but for now the key functions to compare are left–right lateral flexion, particularly in the lumbar spine; left–right rotation in the whole spine; left–right comparison of hip flexors strength and range of movement, and the same with the hamstrings.

If someone you know does have a developmental scoliosis, try to find a Schroth Method practitioner, and have the scoliosis assessed. The Schroth Method uses a range of novel and effective isometric bracing exercises; some other strengthening and postural awareness exercises; and some stretches to help the body reduce the additional curves in the spine by itself, over time. The URL at the end of this article shows the kinds of positions used. 

There is one more aspect to this problem. Whether you have a developmental or a functional scoliosis, simple muscle spasm can dramatically increase the scoliosis overnight: the additional curves in the spine caused by either kind of scoliosis can be enhanced by simple muscular spasm (perhaps caused by moving a different way, or moving awkwardly, or lifting something). The results can be dramatic—and if you seek a practitioner’s advice during this period, often a diagnosis will be made that will lump both types of scoliosis together, usually with negative consequences for the patient. And here it will be helpful to note that either type of scoliosis can be a contributing cause to low or middle back, or neck pain—but be assured that when the spasm itself is over (stats. below***), your back will return to its normal state.

Footnotes and comments

* Idiopathic: a doctor friend told me once that this term meant, “the doctor is an idiot, and the patient is pathetic”; harsh, but sometimes accurate. Strictly speaking, idiopathic means that the cause is unknown. In my view, in any patient–practitioner interaction, it would be more useful (and certainly more honest) to say, “we don’t know what the causes are, but the condition can be helped, and usually helped a great deal, by conservative treatments”. In my view, for most patients, hearing a technical, non-every-day word like ‘idiopathic' out of a doctor’s mouth suggests that, at the least, there is an understanding of the problem, and that some kind of treatment might be available, but this faith may be misplaced: in medical anthropology and psychiatry, there is a term for this: the Rumpelstiltskin effect—"The patient's anxiety decreases thanks to the fact that a respected and trusted specialist has shown that he understands what is the matter”. The power of a name, in other words. 

** The Asklepios-Katharina-Schroth Klinik in Bad Sobernheim in Germany practises and teaches the gold standard of non-invasive scoliosis treatment internationally. Approximately 200 patients are taken in every six weeks for intensive treatment. The Klinik has an unusually high ratio of practitioners to patients and the atmosphere is positive and wonderful! The Klinik is famous worldwide.

Three Stretch Therapy Teachers have been through the school; we all went together; we all got the best marks in the various examination units there, and we were publicly praised by the presenter. He said that after attending their basic training, all of their students at the Klinik "should continue on to do Stretch Therapy". The Schroth Method is completely consistent with ST. One of us, Malcolm Boulter (who alone scored 100% in the final exam), went on to do post graduate study at the same Klinik, with the senior lecturer, Axel Hennes. Malcolm is now fully certified in the Schroth Method.

*** Statistics from recovery from rapid-onset low back pain, derived from 18 studies, one of them a 25,000 patients study, where the patients were followed over five years:

After one week, if a large enough cohort of rapid-onset acute back pain is followed, 50% of all patients are completely well—independent of treatment type or no treatment at all.
After two weeks, 65% are well,
After four weeks: 85% are well, and
After two months: 2–3% of the original group have on-going problems. 

This is the reason (assuming the patient can walk around, at least, and who does not have serious neurological deficits, we recommend waiting for two months before requesting that diagnostic technology be used. This is because, in fact, pathology is normal (in the statistical sense) and this has been shown by many studies since the first groundbreaking one: the July 1990 issue of the New England Journal of Medicine discussed of a study of 97 people, who were assessed in the Bethseda Teaching Hospital, using the then-latest MRI equipment.

67% of this group had ‘pathology’ of such severity that had any of these patients been examined there for the cause of their back pain, the researchers said in their introduction, the pathology identified would have been assessed as a sufficient cause. 37% had pathology at more than one pair of vertebrae, and one woman had four fully extruded intervetebral discs. None of the 97 people had, or ever had had, back pain. 

Malcolm’s site:

Overcome neck & back pain, 4th edition, can be found here.

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