Understanding Scoliosis: Symptoms, Pain Patterns, and Causes

Scoliosis affects millions of people worldwide, yet many remain unaware of this spinal condition until it becomes noticeable. At Sancheti Hospital, we’ve been treating patients with scoliosis for decades, helping them understand their condition and navigate their treatment options.

Whether you’re a parent concerned about your teenager or an adult experiencing back pain, this comprehensive guide will help you understand scoliosis better.

What is Scoliosis?

Scoliosis is a medical condition where the spine curves sideways in an abnormal S-shaped or C-shaped pattern. Unlike the natural front-to-back curves of a healthy spine, scoliosis creates lateral curves that can range from mild to severe.

The condition most commonly develops during the early teenage years, particularly during growth spurts. However, it’s important to note that many cases are mild and can be monitored without immediate intervention. Understanding the different types and recognizing early symptoms is crucial for proper management.

Types of Scoliosis

Idiopathic Scoliosis

This is the most common type, accounting for roughly 80-90% of all cases. “Idiopathic” means the exact cause is unknown, though genetic factors play a significant role. Adolescent idiopathic scoliosis (AIS) typically appears between ages 10-18.

Congenital Scoliosis

This type is present at birth due to abnormal spine development in the womb. It’s relatively rare but requires early monitoring and intervention.

Neuromuscular Scoliosis

Caused by underlying conditions affecting the muscles and nerves, such as cerebral palsy or muscular dystrophy. These cases often progress more rapidly and require specialized care.

Degenerative Scoliosis

Also known as adult scoliosis, this develops later in life due to age-related changes in the spine. Prevalence markedly increases with age, affecting approximately 6% of adults over 50, with much higher rates in older populations.

Scoliosis Symptoms

Early detection is key to effective scoliosis management. Here are the most common signs to watch for:

Visual Signs

Uneven shoulders: One shoulder appears higher than the other
Uneven hips: Hip bones sit at different levels
Rib prominence: A visible hump appears on one side when bending forward
Uneven waistline: The space between arms and body differs on each side
Head positioning: The head doesn’t appear centered over the body

Physical Symptoms

Back pain: More common in adults than adolescents with scoliosis
Muscle fatigue: Particularly after standing or sitting for extended periods
Breathing difficulties: In severe cases where curves compress the lungs

It’s worth noting that back pain is typically more common in adults with scoliosis than in teenagers, as adolescent cases often don’t cause significant discomfort initially.

Understanding Pain Patterns

Adolescent Pain Patterns

Contrary to popular belief, most teenagers with mild to moderate scoliosis don’t experience significant pain. When pain does occur, it’s usually:

Mild and intermittent
Related to muscle fatigue rather than the curve itself
Often improves with rest and activity modification

Adult Pain Patterns

Adults with scoliosis, particularly those with degenerative forms, commonly experience:

Chronic lower back pain: Often worsens with activity
Leg pain or numbness: Due to nerve compression
Fatigue: From compensatory muscle tension
Breathing issues: In severe cases affecting lung capacity

What Causes Scoliosis?

Genetic Factors

Research shows that family history significantly increases risk. If a parent or sibling has scoliosis, there’s a higher likelihood of developing the condition.

Gender and Growth Factors

Females are at higher risk of curve progression, especially during growth spurts
The rapid growth phase during adolescence is a critical period for development
Hormonal changes during puberty may influence spinal development

Environmental and Lifestyle Factors

While most cases are idiopathic, some factors may contribute:

Poor posture (though not a direct cause)
Certain medical conditions
Leg length differences
Previous spinal injuries

When to Seek Medical Evaluation

Early professional assessment is crucial for proper scoliosis management. Consider consulting a specialist if you notice:

Visible spinal curvature or any asymmetry in the torso
Persistent back pain in adults
Changes in posture or walking pattern
Breathing difficulties or reduced exercise tolerance

At Sancheti Hospital, our orthopedic specialists use advanced diagnostic techniques to accurately assess spinal curvature and develop personalized treatment plans.

Diagnosis and Measurement

Clinical Screening

The initial assessment typically includes:

Physical examination: Checking for visible asymmetry
Forward bend test (Adam’s test): The gold standard for detecting spine rotation
Scoliometer measurement: Referral thresholds of 5-7 degrees are commonly used

Imaging Studies

X-rays: Essential for measuring curve severity
Cobb angle measurement: The standard method for quantifying curve magnitude
Advanced imaging: MRI may be needed in certain cases

The Cobb angle is crucial for treatment decisions:

10-25 degrees: Mild curves, typically monitored
25-40 degrees: Moderate curves, may require bracing
40+ degrees: Severe curves, often requiring surgical consideration

Treatment Options

Observation and Monitoring

Many mild curves (under 25 degrees) require only regular monitoring, especially in adults where growth is complete.

Bracing

Bracing is commonly considered for growing adolescents with curves in the 20-40 degree range. Modern braces are more comfortable and effective than ever, with success tied to:

Proper fit and design
Consistent wear (typically 16-23 hours daily)
Regular adjustments as the child grows

Recent research shows that nighttime bracing combined with physical activity can be effective in preventing curve progression.

Exercise Therapy

While general exercise is encouraged for overall health, specific approaches show promise:

Schroth exercises: Research indicates these specialized exercises can reduce Cobb angles and improve quality of life
Core strengthening: Important for spinal stability and pain management
Postural training: Helps with body awareness and alignment

Surgical Intervention

Surgery is typically considered when:

Curves exceed 45-50 degrees in adolescents
Progressive curves in adults causing significant symptoms
Breathing or cardiac function is compromised

Spinal fusion remains the gold standard for severe cases, with modern techniques offering excellent outcomes and faster recovery.

Screening Debate

The medical community has mixed views on routine scoliosis screening. The US Preventive Services Task Force issues an “I” (insufficient evidence) recommendation for routine screening in 10-18 year-olds. However, many specialty societies support targeted screening by trained professionals.

Living with Scoliosis

Lifestyle Modifications

Stay active: Regular exercise helps maintain flexibility and strength
Practice good posture: While not preventive, it helps with comfort
Use ergonomic supports: Proper seating and sleeping surfaces
Manage weight: Reduces stress on the spine

Emotional Support

Scoliosis can affect body image, particularly in teenagers. Professional counseling and support groups can be valuable resources for both patients and families.

Statistics and Prevalence

Understanding the scope of scoliosis helps put individual cases in perspective:

Adolescent idiopathic scoliosis affects approximately 0.5-2% of adolescents
Females are affected more frequently than males, especially in cases requiring treatment
Adult degenerative scoliosis prevalence increases significantly with age
Early detection remains key to successful management

Expert Care at Sancheti Hospital

At Sancheti Hospital in Pune, we understand that each scoliosis case is unique. Our multidisciplinary team of orthopedic specialists, physiotherapists, and support staff work together to provide:

Comprehensive evaluations using the latest diagnostic technology
Personalized treatment plans tailored to each patient’s needs and lifestyle
Advanced surgical techniques when conservative treatment isn’t sufficient
Ongoing support throughout the treatment journey

We believe in empowering our patients with knowledge while providing compassionate, expert care. Whether you’re dealing with a new diagnosis or seeking a second opinion, our team is here to guide you through every step of your scoliosis journey.

Frequently Asked Questions About Scoliosis

1. What early signs should I watch for in children and teens?

Look out for these warning signs:

Uneven shoulders – one shoulder sits higher than the other
Uneven hips – hip bones are at different heights
Rib hump – a bump appears on one side when your child bends forward
Clothes don’t hang straight – shirts or dresses appear uneven
Head doesn’t look centered over the body

2. Does scoliosis cause pain, and is pain more common in adults than teens?

This is one of the most common concerns we hear at Sancheti Hospital. Back pain is typically more common in adults with scoliosis than in teenagers. Most teens with mild to moderate scoliosis don’t experience significant pain. When adults develop scoliosis or have curves that worsen over time, they’re more likely to experience chronic back pain, muscle fatigue, and sometimes leg pain.

3. When should someone see a doctor and what tests are usually done?

You should see a doctor if you notice:

Any visible spine curvature or body asymmetry
Persistent back pain in adults
Changes in posture or walking
Breathing problems

During the visit, doctors typically perform a physical examination and forward bend test, followed by X-rays to measure the exact curve angle (called the Cobb angle).

4. What causes scoliosis and does it run in families?

Most cases of scoliosis are “idiopathic,” meaning we don’t know the exact cause. However, family history does increase the risk. If a parent or sibling has scoliosis, other family members have a higher chance of developing it. Girls are also more likely to have curves that get worse, especially during growth spurts.

5. How is the Cobb angle measured and why does it matter for treatment?

The Cobb angle is the standard way doctors measure how severe a scoliosis curve is. It’s measured on X-rays and helps determine treatment:

10-25 degrees: Mild – usually just watched
25-40 degrees: Moderate – may need bracing
40+ degrees: Severe – surgery might be needed

6. What is bracing, who benefits most, and how many hours matter?

Bracing is commonly used for growing teens with curves between 20-40 degrees. Modern braces are much more comfortable than old ones. For bracing to work well, teens typically need to wear the brace 16-23 hours per day. The brace doesn’t fix the curve but helps prevent it from getting worse during growth.

7. When is surgery recommended and why is 50 degrees often mentioned?

Surgery is usually considered when curves reach 45-50 degrees in growing teens, or when adult curves cause significant pain and disability. The 50-degree mark is important because curves this large tend to keep getting worse even after growth stops, and they can start affecting lung function.

8. Can severe scoliosis affect breathing, and at what curve size?

Yes, severe scoliosis can affect breathing when curves are very large (usually over 70-80 degrees). This happens because the curved spine can compress the lungs and reduce their space to expand. This is one reason why severe curves often require surgery.

9. Do exercises help, and what’s the evidence for special scoliosis programs?

Regular exercise is always good for overall health. For scoliosis specifically, research shows that Schroth exercises – a special type of physical therapy – can help reduce curve angles and improve quality of life. While general exercises don’t cure scoliosis, they help with strength, flexibility, and pain management.

10. How common is scoliosis in teens compared to adults?

Adolescent scoliosis affects about 0.5-2% of teens, with girls more likely to need treatment. Adult degenerative scoliosis is different – it becomes much more common with age, affecting about 6% of adults over 50 and even higher percentages in older adults.