What is Scoliosis?

Dr. Clayton J Stitzel
Dr. Clayton J. Stitzel
Last updated on
October 28, 2021

Idiopathic scoliosis, which makes up over 80% of all cases, has no known cause. Yet, that doesn't mean we don't know much about the condition or its treatment. Below is an up-to-date summary of facts to answer the question of what scoliosis is.

Idiopathic scoliosis appears to be a "neuro-hormonal condition" driven by genetic predisposition. The 3-D change in the spine's alignment — the spine curvature — is the primary and most obvious symptom of the condition. That is why scoliosis is a whole-body condition that requires a comprehensive treatment. This is one of the great obstacles that has challenged health care professionals worldwide for centuries.

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"The spine curve seen with scoliosis is only the most visible symptom.  There is so much more to treating the condition."

- Clayton J. Stitzel DC

How Common Is Scoliosis?

Scoliosis occurs most often in children aged 9 to 14, affecting females 7 times more than males. Scoliosis is a broad term that may describe a spinal curve of 10 degrees or higher. The curve occurs at different points of the spine in each case, but develops in 1 of 4 common curve patterns. It may or may not tilt the pelvis. 

Scoliosis causes a bent spine, curvy spine, or even an S-shaped spine. Scoliosis may only have a curve on one side, elevate one shoulder, or make one shoulder blade prominent. But it is not life-threatening after the age of 5, prompting many doctors to conclude it does not need treatment. 

The spine condition is often progressive; but, ScoliSMART doctors know more about and how to treat scoliosis now than ever before. Get free scoliosis treatment recommendations sent to your email.

What Is the Main Cause of Scoliosis?

Is scoliosis hereditary? Is scoliosis genetic? Curvature of the spine (scoliosis meaning "crookedness") has been documented in medical records dating back to 450 BC.  Historically, it has been considered and treated only like a spinal problem. But a growing and overwhelming volume of evidence supports curves of the spine are so much more than a curved spine. 

Adolescent idiopathic scoliosis stems from a family history of genetic variant patterns.  These affect neurotransmitters and hormones. These combine to create an incorrect "posture memory" of spine alignment during periods of rapid growth. These clinical findings are the suspected causes of scoliosis and result in a twisted spine. Non-invasive, home-collected saliva and urine samples can help determine if scoliosis in children could become severe or get worse as they grow.

What Scoliosis Looks Like

Scoliosis patients lose some degree of curvature in their necks, resulting in forward head posture. The sideways curve of a scoliosis spine is greater than 10 degrees. It causes the rib cage to twist and the normal curve of the spine to flatten. A scoliosis curve looks flat where the spine is curved when viewed from the front or side. It appears twisted where there is no twist when viewed from the top down. 

Understanding the faulty "postural memory" of a scoliosis spine on an x-ray is like watching the wind outside a window. You cannot actually see the wind, yet you can tell the direction and force in which it is blowing by the way it affects the grass, trees, and leaves.

There are four types of scoliosis:


Idiopathic Scoliosis

The most common type of scoliosis, idiopathic means of unknown origin. Depending on the age of onset, it may be infantile (birth to 3 years), juvenile (age 3 to 8), adolescent (age 9 to 18), or adult scoliosis (after age 18)


Congenital Scoliosis

A rare form of scoliosis, affecting one in 10,000 babies in utero


Neuromuscular or Syndromic Scoliosis

Developed by children who have neuromuscular disorders like muscular dystrophy or cerebral palsy


Degenerative Scoliosis

Adult scoliosis; a degenerative condition that typically occurs after age 40

What Are the Early Signs of Scoliosis?

Catching scoliosis early is critical because once a curve measures 25 degrees or more, there is a 68 percent chance scoliosis may get worse. You may detect signs of mild idiopathic scoliosis in its early stages by observing five different points on your child's body.

  • Eye line Are your child's eyes level or is the eye line tilted?
  • Shoulder level Do your child's shoulders hang even or is one higher than the other?
  • Hips Are your child's hips even or is one hip higher or more pronounced?
  • Forward head posture When you look from the side, does your child's mid-ear line up with the tip of the shoulder?
  • Head to hip line Would a line from the center of your child's eyes line up horizontal to the center of the hips?

You may also use a detection method called Adam's forward bend test. Have your child do a full forward bend to see if the rib cage (shoulder blade) sticks out on one side, especially on the right side. If your child appears out of line using any of these views, he or she may have a spinal curvature. A trained posture analysis expert will help you determine if your child needs early-stage scoliosis intervention. Make sure any evaluation for scoliosis includes a standing full spine x-ray.

Scoliosis often is associated with family history. Although progressive scoliosis of the spine affects girls more often, your boys will be just as likely to develop it. Remind your pediatrician to check your children for scoliosis, especially if it runs in the family. Many parents are opting for genetic testing for scoliosis in children who are still growing. This very simple and safe saliva test may predict if patients are at higher risk for severe scoliosis, differentiate different types of scoliosis, determine their need for treatment, and even predict symptoms of scoliosis.

What Will Happen If Scoliosis Is Not Treated?

Adolescent idiopathic scoliosis is a neurological-hormonal condition rooted in a genetic predisposition. This is vital when it comes to choosing scoliosis treatments. Usually, a doctor who only measures a Cobb angle will recommend no treatment.  Only observation. They may recommend a rigid spinal brace for up to 23 hours a day for a curve measuring 25 to 39 degrees. Fusion surgery may be recommended for people with curves measuring over 50 degrees using the Cobb angle.
All three options may be limiting and frustrating to you and your child. These are not the only options, nor the best. The ScoliSMART Clinic doctors prefer to improve the patient's posture memory in a way that corrects scoliosis. We don't wait for a curve to get worse, use rigid braces, or recommend surgery unless it is a last resort.

Don't Wait & Watch Mild Scoliosis

ScoliSMART Clinics doctors never recommend waiting and watching. This is because all large curves begin as small curves. Scoliosis is a chronic, progressive condition. It often progresses throughout childhood and into adulthood. We recommend starting a posture memory retraining approach like Small Curve Camp for Scoliosis as soon as your child's curve is detected. 

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 approach.

what is scoliosis early stage intervention

Cobb Angle vs Scoliosis DNA Testing

Historically, doctors have used a measurement called a Cobb angle to determine the degree of scoliosis. The doctors at ScoliSMART Clinics use this measurement along with a gravitational comparison line to further understand the biomechanics of a patient's curvature. The Cobb angle measurement only shows the degree of lateral bending on an x-ray. Scoliosis DNA testing and other clinical testing can provide more personalized data to determine the root causes of childhood scoliosis. It can determine if it will remain mild/moderate scoliosis or progress to severe scoliosis. 

Plus, you need to consider the impact of scoliosis on your child or yourself before considering treatment. How does it affect breathing, digestion, mobility, daily activities, and psychological health? How much back pain is involved? Often, patients don't have pain or symptoms of scoliosis.

Why We Don't Support Full-Time Scoliosis Bracing

Bracing is commonly recommended for children with a scoliosis curve measuring 25 to 40 degrees. We do not support the dated treatment of rigid scoliosis bracing for 20 hours a day or at nighttime, nor do we support newer/softer braces. Here are a few reasons why:

  • Scoliosis braces cause the muscles to weaken or atrophy because they aren't used
  • The joints around the spine need movement, or other degenerative issues may develop
  • The brace stresses the ribs and often creates or worsens a rib-hump deformity
  • Bracing is not proven to stop scoliosis progression or reduce the need for scoliosis surgery
  • Studies show that bracing significantly decreases lung function, causing respiratory distress
  • Respiratory distress causes headaches, anxiety, sleep problems, and cognitive dysfunction

Hard braces and softer "dynamic corrective braces" often cause pain. This is very disturbing since many children have no scoliosis pain before bracing. All the corrective benefits of bracing fade as soon as your child stops wearing the brace. It seems counterintuitive to risk the side effects and pain for the possibility of a short-term solution.

Scoliosis (Fusion) Surgery

Spinal fusion is rarely recommended for children who have a curve measuring less than 50 degrees. Even then, surgery is risky, and comes with many complications (short- and long-term). Spinal fusion surgery is almost never medically necessary because of heart or lung compromise. Typically, it is primarily recommended to reduce the cosmetic spine deformity. Despite the risks, though, about 20,000 children and teens have spinal fusion annually. 

German researchers in 2002 found that 40 percent of people who had surgery were severely handicapped within 17 years. A study done at the University of Iowa found that adults who don't have scoliosis surgery have a much better quality of life. In 2007, another report stated that no studies prove that scoliosis patients get long-term benefits from surgery.

What is scoliosis related to spinal fusion

While doctors may debate statics, most agree that the hardware used in spinal fusions cannot last 60+ years. The ScoliSMART Clinics doctors only recommend surgery in rare cases of an extreme curvature.  Research cannot prove the benefits of spinal surgery and we have talked to thousands of adults who developed lifelong chronic pain after surgery (many of whom had no pain prior to surgery). 

Do orthopedic specialists support the ScoliSMART Approach? 

Yes!  Many orthopedic surgeons support scoliosis exercise treatments. Our hope is to help families catch scoliosis early so children can start Posture Memory retraining exercises that halt progression and reduce curvature. Early Stage Scoliosis Intervention is ideal; but, every child (and adult) with scoliosis deserves a better way to treat scoliosis regardless of their age or curve size!

Don’t know where to start?  Take our FREE “ScoliQuiz.”  (No x-ray required)

ScoliSMART Clinics is committed to treating the WHOLE scoliosis condition, not only the curve. Genetic & clinical testing with targeted nutrient therapies, expert in-office treatment programs, and the world’s only ScoliSMART Activity Suit provides patients of all ages with the most comprehensive, most effective, and least invasive treatment options available worldwide.

Need more information about the ScoliSMART Approach?

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World's Only Scoliosis Activity Suit

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Meet the ScoliSMART Doctors

Click the images below to get more information about the ScoliSMART Doctors.

Dr. Clayton J Stitzel

Dr. Clayton J. Stitzel

504 W. Orange Street
Lititz, PA 17543
Dr. Mark Morningstar

Dr. Mark Morningstar

8293 Office Park Drive
Grand Blanc, MI 48439
Dr. Brian T Dovorany

Dr. Brian T. Dovorany

26940 Aliso Viejo Parkway, Suite 105
Aliso Viejo, CA 92656
Dr. Aatif Siddiqui

Dr. Aatif Siddiqui

34 w 119th st
New York, New York 10026