Treating Early Stage Scoliosis

Early stage scoliosis is defined by the size of a scoliosis curve, not the age of the patient. You or your child may have early stage scoliosis, or a scoliosis curve that measures 25 degrees or less.

Girls age eight to 14 who have a thin, lanky body shape and have not begun menstruating comprise the majority of early stage scoliosis cases. All severe cases of idiopathic (of unknown cause) adolescent scoliosis (AIS) begin with an early stage development.

It's important to point out that your child's spinal curve is the most prominent symptom of scoliosis, not the cause. AIS stems from a combination of genetic pre-disposition and environmental influences. Its progression is caused by miscommunication between the brain and the muscles supporting the spine. The brain's postural control centers should tell your child's muscles how to respond to gravity while he or she grows to keep his or her spine straight. For reasons yet unknown, these messages aren't sent when your child has scoliosis.

Not all cases of AIS advance, but the chances of progression increase dramatically as the curve increases. A spinal curve measuring up to 19 degrees is considered mild scoliosis, which has the lowest risk of curve progression — a 22 percent probability. The probability of progression jumps to 68 percent once your child's spinal curve reaches 20 degrees. That statistic doesn't apply to adults. We only see the tripled risk in children whose spines are not yet fully developed. The risk of progression further increases to 90 percent when your child's curve reaches 50 degrees. That's why we believe it's imperative to stop scoliosis in the early stages.

No one knows why this dramatic rate of advancement occurs, but researchers suspect it's caused by increased torque from spinal rotation driven by adverse mechanical tension on the central nervous system (the brain and spinal cord). You may think scoliosis causes a one-dimensional curve, but it actually twists the spine around its axis as it progresses. This twisting causes severe torque and more lateral bending and rotation of the spine, like a twisting rubber band. We call this self-feeding loop the "coil-down effect." As the curvature increases, the twisting worsens proportionately.

You may be frustrated by a doctor's advice to monitor your child's curve for six months or a year to see if it progresses rather than treat the mild scoliosis. Many health care professionals don't even consider spinal curves measuring less than 10 degrees to be scoliosis. At ScoliSMART Clinics®, we focus on the high risk patterns of the spinal curvature rather than the size of the curve.

The treatment goal of ScoliSMART™ Early Stage Scoliosis Intervention is to keep the curve under 20 degrees during your child's growing years and a maximum of 25 degrees at skeletal maturity. There's no cure for AIS. Reducing curves to 10 degrees or smaller (or keeping them below 10 degrees) is the closest we get to a cure at this time.

Detecting scoliosis earlier is one of the most important aspects of early intervention. The most widely used scoliosis screening test, the Adam's forward bend test, often misses small curves. Your child basically bends forward at the waist while a doctor or school nurse looks for a bulge in the rib cage on one side, typically the right side. This bulging usually isn't obvious until the spinal curve is moderately advanced to near 30 degrees because that's when the upper spine really begins to rotate. We call the Adam's test the "too late test."

Mild scoliosis creates asymmetrical and distorted posture patterns long before the rib cage rotation is visible. You can detect these patterns by looking for an even line across your child's eyes, shoulders, and hips. Look from the front and the back.

Watching for these signs is especially important if scoliosis runs in your family, as it is hereditary. The more parents, gym teachers, coaches, and school nurses look for slight imbalances in these three lines, the more we will catch mild, early stage scoliosis. You may actually notice that your child's eyes, shoulders, or hips are a bit uneven, but not realize those are scoliosis indicators.

ScoliSMART™ Clinic doctors never recommend waiting and watching because all large curves begin as small curves. Scoliosis is a chronic, progressive disease. It often progresses throughout childhood and into adulthood, so we opt to start lifelong muscle retraining through the Early Stage Scoliosis Intervention (ESSI) program as soon as your child's curve is detected. ESSI is a one-week "Small Curve Camp" program followed by a home exercise program. Thousands of children have had their scoliosis curve reduced and progression stopped with this muscle retraining.

Other mild scoliosis signs:

• Your child's clothes hang unevenly
• One of your child's legs seems longer than the other
• Your child's head has a forward posture when viewed from the side

Have your child examined if you notice any of these signs. A tool called a Scolimeter measures spinal curvature, but x-rays taken by a scoliosis specialist are the most accurate measure of a mild curve; however, the radiology technician needs to be familiar with scoliosis screening to get the best images.