The spine has three main sections, each with a characteristic spinal curvature. As healthy spines have curvatures that are natural and normal, people can wonder if their spine has an unnatural curvature and how to tell the difference. Keep reading to find out what constitutes an abnormal spinal curvature in need of assessment and treatment.
While the spine has healthy curvatures that give it added strength, flexibility, and allow it to evenly distribute stress, it can also develop unhealthy curves. When a spine’s curves bend to the side, include rotation, or are over-or under-pronounced, this can indicate the development of a spinal deformity.
Before we get into the natural and unnatural curvatures of the spine, and symptoms that indicate the difference, let’s first explore some basic spinal anatomy; this will give us a better overall understanding of spinal biomechanics and how healthy and unhealthy curvatures can affect the spine’s function.
Basic Anatomy of the Spinal Column
The spine is an important structure in human anatomy. It allows us to stand upright and maintain good posture, engage in flexible movement, and gives the body structure and support.
The spine is made up of three main sections: cervical (neck), thoracic (middle and upper back), and lumbar (lower back). A bone called the ‘sacrum’ is located below the lumbar spine, and this is part of the pelvis. Each section of the spine has a natural spinal curve that is crucial for its function and overall health.
Each of these spinal sections consists of individual bones, called vertebrae. The cervical spine is home to 7 vertebrae; the thoracic spine has 12, and the lumbar spine has 5.
Parts of the Vertebrae
The individual bones that make up the spine have several parts. Each vertebral body is the main weight-bearing source of the spine, and it also is the resting place for the intervertebral discs that sit between adjacent vertebrae.
The holes in the center of each vertebra form the spinal canal, and this canal is where the spinal nerves pass through; the spine and brain work in tandem to form the body’s central nervous system (CNS), controlling many of the body’s essential functions.
If you were to run your hand down the center of a spine, you would feel bony protrusions, and this is what’s called ‘the spinous process’, providing an area of attachment for the back muscles charged with supporting and stabilizing the spine.
When an abnormal spinal curvature develops, it can affect multiple areas of the back, including the surrounding muscles, vessels, and nerves. In cases of severe scoliosis, the abnormal curvature can significantly impact the alignment and function of the vertebrae.
Each vertebra has four facet joints, a pair that faces upwards, and a pair that faces downwards; these interlock with the facet joints of adjacent vertebrae to give the spine stability and structure.
The spine’s vertebrae are what need to be in a healthy alignment with one another to maintain the healthy spinal curvatures.
Adjacent vertebrae are separated by intervertebral discs, and these discs also play a role in maintaining normal spinal curvatures and optimal spinal biomechanics.
Intervertebral Discs
The spine’s intervertebral discs sit between adjacent vertebrae, acting as cushions guarding against friction occurring during movement.
Each disc has two main parts. Its outer portion is a hard tough durable layer called the ‘annulus’, and the inner portion consists of a gelatinous center, called the ‘nucleus’.
In addition to guarding against degeneration of the vertebrae caused by the spinal bones rubbing up against one another, the discs also facilitate the spine’s flexibility, thanks to its soft gel-like interior that allows for flexible motion.
The tough outer annulus provides the spine with structure holding everything together. The discs also help the spine absorb mechanical stress that’s incurred during movement and rest by spreading it evenly throughout so no one section of the spine is taking on excess weight and/or stress.
The discs help the spine maintain its natural and healthy curvatures by protecting the health of the vertebrae, providing the spine with structure, and facilitating movement.
When the spine’s intervertebral discs start to degenerate, either due to age, or the cumulative effect of negative lifestyle choices, their ability to provide the spine with structure and support is compromised, and this commonly leads to the development of a number of spinal conditions, including degenerative scoliosis.
Regular monitoring of spinal health is crucial, especially in cases of mild scoliosis, to ensure that the curvature does not worsen over time.
Now that we have explored the structure and parts of the spine that help maintain its normal curvatures, let’s discuss the different curvature types that characterize each of the three main spinal sections.
Understanding Spine Curvature
The spine, also known as the spinal column, is a complex structure made up of 33 vertebrae that provide support and flexibility to the body.
A healthy spine has a natural curvature that helps to absorb shock and distribute weight evenly. These natural curves are essential for maintaining balance and allowing for a range of movements.
However, in some cases, the spine can develop an abnormal curvature, leading to conditions such as scoliosis, lordosis, and kyphosis. Understanding the causes and types of spine curvature disorders is essential for proper diagnosis and treatment.
The Spine’s Healthy Spinal Curvature
When viewed from the side, a healthy spine has a soft ‘S’ shape; when viewed from the front, a healthy spine appears vertically straight from the neck to the tailbone.
As mentioned, the spine’s three main sections each have a corresponding normal curvature that are important parts of the spine’s structure and function.
The spine’s normal curves are referred to as ‘lordosis‘ and ‘kyphosis’. Early detection is key, and having scoliosis diagnosed at an early stage can significantly improve treatment outcomes.
Lordosis and Kyphosis
Healthy spinal curvatures either curve inward, towards the body’s center, or outwards, away from the body’s center.
Normal lordosis refers to the two forward curves found in the cervical spine (neck) and the lumbar spine (lower back); normal kyphosis refers to the two outward curves found in the thoracic spine (chest) and the hip areas sacral spine (pelvis).
These naturally-occurring soft curves make the spine stronger, more flexible, and help distribute mechanical stress.
When there is a loss of one of these curves, bad curves and adverse spinal tension are introduced, and this can impact the spine’s overall health, biomechanics, and function.
When there is an unnatural curve, this means that the spine’s vertebrae are no longer aligned, and in order for an abnormal spinal curvature to be reduced, those vertebrae need to be realigned.
Unhealthy Curvatures of the Spine
When a person loses one or more of their healthy spinal curvatures, it can be due to certain lifestyle choices and/or the development of a number of spinal conditions.
Abnormal lordosis, kyphosis, and scoliosis are three common spinal conditions that can lead to a loss of the spine’s natural curvatures as they are replaced with unnatural ones.
Abnormal Lordosis
Now, let’s say a person’s lordotic curve of the lumbar spine becomes over-pronounced, meaning it curves forward excessively, this is not a normal lordosis and forms an unhealthy lumbar curvature that can impact the rest of the spine.
While abnormal lordosis most commonly affects the lumbar spine, it can occur in the cervical spine as well. If a patient has an excessive lumbar lordosis, the buttocks can become more prominent, and their overall posture will appear exaggerated.
Lordosis can affect people of all ages, and when it affects the lumbar spine, common symptoms, in addition to postural changes, are lower back pain and mobility issues.
Abnormal Kyphosis
When a person has an abnormal kyphosis, this means they have an excessive outward curve, most commonly found in the thoracic spine, but like lordosis, it can also affect the cervical spine.
When there is an excessive outward curvature in the thoracic spine, it can give the back a pitched-forward appearance. Additional symptoms include back pain, muscle fatigue, and stiffness felt in the back.
There are two forms of abnormal kyphosis to be aware of: postural and structural. When a condition is described as ‘postural’, this means that it’s related to posture and when a person’s position or posture is changed, the kyphosis is altered; when a condition is structural, it means it’s caused by an actual change to the spine’s structure and a change in position won’t alter it.
Therefore, any form of effective treatment for a structural condition has to impact it on a structural level.
Additional spinal conditions such as spondylolisthesis, osteoporosis, and negative lifestyle choices, such as not maintaining a healthy weight or activity level, can lead to the development of an abnormal kyphosis.
In addition to excessive inward and outward curves, the spine can also develop abnormal sideways curves that also rotate: scoliosis.
Types of Spine Curvature Disorders
There are several types of spine curvature disorders, each with unique characteristics and implications for spinal health:
- Scoliosis: This is a sideways curvature of the spine that can occur in both children and adults. It often includes a rotational component, making the spine twist as it curves.
- Lordosis: An excessive inward curvature of the spine, typically affecting the lower back. This condition can lead to a pronounced arch in the lumbar region.
- Kyphosis: An excessive outward curvature of the spine, usually found in the upper back. This can result in a hunched or rounded back appearance.
- Degenerative Scoliosis: A type of scoliosis that occurs in adults due to wear and tear on the spine. This condition often develops as a result of aging and the cumulative effects of spinal degeneration.
Each of these conditions can significantly impact the spine’s function and overall health, making early detection and treatment crucial.
Idiopathic Scoliosis
Scoliosis is a highly-prevalent spinal condition, affecting close to 7 million people in the United States alone, and that number only includes known diagnosed cases; if we were to add the amount of people living with the condition unaware, around the world, that number would increase exponentially.
While scoliosis can develop at any age, it’s most commonly diagnosed between the ages of 10 and 18 in the form of adolescent idiopathic scoliosis (AIS).
Scoliosis is also the leading spinal condition affecting school-aged children.
When a person develops scoliosis, they have developed an abnormal sideways curvature of the spine that includes rotation.
Scoliosis is a progressive and incurable spinal condition with condition characteristics that range greatly from one patient to the next, which is why every patient has a unique treatment plan.
When a person is diagnosed with scoliosis, the condition is further classified based on the patient’s age, cause (if known), curvature location, and condition severity.
Condition severity ranges from mild to moderate and severe to very severe. In cases of severe scoliosis, surgical intervention may be necessary to prevent further complications.
Through a comprehensive physical exam, including taking the patient’s medical history, and the results of their scoliosis X-ray, I can learn what’s needed to design a customized and effective treatment plan.
One of the most significant condition characteristics that shapes a patient’s treatment plan, as well as their experience of life with the condition is severity, determined by what’s known as ‘Cobb angle’.
Scoliosis: Causes and Risk Factors
Scoliosis is a complex condition with various potential causes and risk factors:
- Idiopathic Scoliosis: The most common type of scoliosis, idiopathic scoliosis, has no known cause. It typically develops during adolescence and is more prevalent in females.
- Congenital Scoliosis: This type of scoliosis is present at birth and results from a genetic mutation that affects the spine’s development.
- Neuromuscular Scoliosis: This form of scoliosis occurs in individuals with conditions such as cerebral palsy and spina bifida. These conditions affect the muscles and nerves that support the spine, leading to curvature.
- Degenerative Scoliosis: In adults, degenerative scoliosis can develop due to the wear and tear on the spine over time. Factors such as aging, osteoporosis, and spinal stenosis contribute to this condition.
Risk factors for developing scoliosis include a family history of the condition, being female, and having other medical conditions like cerebral palsy and spina bifida. Understanding these risk factors can help in early detection and management.
Symptoms and Diagnosis
The symptoms of scoliosis can vary depending on the severity of the condition. Common symptoms include:
- Uneven shoulders or hips
- A visible curvature of the spine
- Back pain or discomfort
- Fatigue
- Difficulty standing up straight
Diagnosing scoliosis typically involves a physical examination and imaging tests such as X-rays, MRI, or CT scans. A healthcare provider may also perform a scoliosis screening, which involves examining the spine and checking for any abnormalities. Early diagnosis is key to managing the condition effectively and preventing further progression.
Cobb Angle
Cobb angle is a measurement obtained via X-ray that determines how far out of alignment a scoliotic spine is. Lines are drawn from the tops and bottoms of the curvature’s most-tilted vertebrae, and the resulting angle is measured in degrees.
Generally speaking, the higher the Cobb angle, the more severe the condition is and the more likely it is that noticeable symptoms such as postural changes and pain (in adults) will appear.
- Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
- Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
- Severe scoliosis: Cobb angle measurement of 40+ degrees
- Very-severe scoliosis: Cobb angle measurement of 80+ degrees
Common postural changes related to scoliosis include uneven shoulders, hips, a rib arch, and a visibly crooked spine; however, it’s not uncommon that in mild forms of the condition, postural changes are subtle and unnoticeable to anyone other than an expert who knows precisely what to look for, which is why early detection can be a challenge.
As scoliosis is progressive, if left untreated, a patient’s curvature will increase over time, which leads us nicely into an important related question: what should a person do to assess and treat an abnormal sideways curvature of the spine?
When it comes to assessing and treating scoliosis, there are different approaches that offer different potential treatment outcomes. Here at the Scoliosis Reduction Center®, we offer our patients a proactive and functional chiropractic-centered approach.
Degenerative Scoliosis: A Common Condition in Adults
Degenerative scoliosis is a type of scoliosis that occurs in adults due to wear and tear on the spine. It is a common condition that can cause back pain, discomfort, and difficulty standing up straight. Degenerative scoliosis can be caused by a variety of factors, including:
- Aging: As we age, the spine can become worn and curved, leading to degenerative changes.
- Osteoporosis: This condition causes the bones to become weak and brittle, increasing the risk of spinal curvature.
- Spinal Stenosis: A condition that causes the spinal canal to narrow, putting pressure on the spinal cord and nerves.
- Herniated Discs: When the discs in the spine become damaged, they can lead to abnormal curvature and pain.
Treatment for degenerative scoliosis typically involves a combination of physical therapy, bracing, and surgery. In some cases, spinal fusion surgery may be necessary to relieve pain and stabilize the spine. Physical therapy can help strengthen the muscles supporting the spine, while bracing can provide additional support and prevent further curvature.
Scoliosis Reduction Center® Treatment
Here at the Center, we prioritize a proactive response to the development of abnormal sideways spinal curvatures. While other approaches might respond by watching and waiting to monitor for progression; I believe that as progressive conditions are going to worsen naturally over time, waiting is wasting valuable treatment time.
When scoliosis is diagnosed early, before the condition has progressed significantly, there are fewer limits to what we can achieve treatment-wise.
Smaller curvatures are easier to treat because they are less complex, generally more flexible, and when treatment is started early on in the condition’s progressive line, the body has had less time to adjust to the abnormal curvature’s presence.
An important aspect of treatment to understand is that when a condition, like scoliosis, is structural, it has to be impacted on a structural level to achieve any form of long-term correction.
Another important treatment-related factor to consider is the treatment’s end goal. Treatment plans aren’t just shaped by patient/condition characteristics, but also the end goal of the treatment approach.
Here at the Center, our end goal is achieving a curvature reduction while preserving function. We want to address the underlying cause of scoliosis, which is structural, so first and foremost, we want to impact it on a structural level by achieving a curvature reduction; however, we want to do this in such a way that the spine’s overall function is preserved because I feel this is what gives patients the best possible quality of life moving forward.
My approach is also integrative, combining multiple treatment disciplines so patients have access to the benefits that different treatment modalities offer; this also enables full customization of each and every treatment plan so the individual characteristics of both the patient and their scoliosis are addressed and responded to accordingly.
I combine scoliosis-specific forms of treatment: chiropractic care, in-office therapy, custom-prescribed home exercises, and specialized corrective bracing.
As we work towards a curvature reduction, we monitor for progression and adjust our treatment plans accordingly.
If you or a loved one has concerns that they have developed an abnormal curvature of the spine, don’t hesitate to reach out to us here at the Scoliosis Reduction Center®.
I’m dedicated to educating and empowering patients with information so they can ensure their treatment expectations are aligned with the reality of their chosen treatment approach.
Conclusion
While a healthy spine has natural curvatures that make it stronger, more flexible, and better able to handle mechanical stress, the spine can also develop unhealthy curvatures.
If you are experiencing postural changes and/or back pain, it’s time to reach out to a medical professional to determine if you have developed a spinal condition marked by the development of an abnormal spinal curvature.
Common examples of spinal conditions that involve the development of an abnormal spinal curvature include abnormal lordosis, abnormal kyphosis, and scoliosis.
When the spine loses one or more of its healthy curves, the body responds by putting in counteracting unhealthy curves, and as these curvatures increase over time, related symptoms tend to become more severe and noticeable.
Here at the Scoliosis Reduction Center®, we provide patients with access to multiple forms of treatment under one roof. Through a customized combination of scoliosis-specific chiropractic care, in-office therapy, custom-prescribed home exercises, and specialized corrective bracing, we work towards reducing the abnormal spinal curvature, thus restoring as much of the spine’s healthy curvatures as possible and improving the spine’s overall health, function, and biomechanics.
