As the leading cause of spinal deformity in school-aged children in the United States, knowing how to tell if you have scoliosis is a relevant concern. With no known cure and the progressive nature of the condition, scoliosis screening and early detection are key elements of successful treatment. While the presence of scoliosis can be hard to spot, there are a few common indicators you can look for.
The Important Role of the Spine
The spinal cord serves vital functions in the body; along with the brain, it forms the central nervous system, responsible for relaying messages from the brain to various parts of the body. These messages help us perform actions, relay messages to the brain from sensory receptors, and coordinate reflexes.
The spinal cord forms the center of the body’s functions. Not only do we depend on it to support the body, it also allows us to stand, twist, and bend, and it does all this while protecting the delicate nerves that pass through the spinal canal on their way to and from the brain.
Because of the connection to the brain and the role the spinal column plays in providing the body with structural support, the effects of a spinal deformity such as scoliosis can be felt in multiple areas of the body.
The Many Forms of Scoliosis
Scoliosis is a complex condition that can take many forms. While there are some forms of the condition such as congenital, neuromuscular, degenerative and traumatic that have known causes, that only accounts for 20 percent of known diagnosed cases; the remaining 80 percent are classed as idiopathic, meaning no known single cause.
While the majority of cases have no known single cause, that doesn’t mean they don’t have multiple causes. Scoliosis is described as having ‘multifactorial causation’, meaning the condition is thought to have multiple causes that can vary from patient to patient.
Not only can the actual causes vary from patient to patient, how those variables combine and lead to the development of the condition is also unclear. The ambiguity that exists around the condition and its root causes contribute to the many different forms the condition can take, which is why it’s so important to fully customize a treatment plan to respond to the individual characteristics of each patient’s condition.
Why and how idiopathic scoliosis develops has been a subject of great debate in the medical community for decades, and while we are still unclear about many of the condition’s characteristics, we do know how to treat it. That being said, there’s a big difference between treating a condition and curing it.
No one and nothing can cure scoliosis, but we most certainly know how to achieve a curvature reduction and help patients experience the condition as positively as possible.
The Scoliosis Severity Scale
When a patient is given a scoliosis diagnosis, an important part of that diagnosis is classifying the existing condition as mild, moderate, or severe. The most common method of assessment is through an X-ray and taking a measurement known as the ‘Cobb angle’.
The Cobb angle measurement assigns a numerical value to the degree that a patient’s spine deviates from a straight alignment.
- Mild scoliosis: Cobb angle measurement of 25 degrees or less.
- Moderate scoliosis: Cobb angle measurement between 25 and 40 degrees.
- Severe scoliosis: Cobb angle measurement of 40-plus degrees in adolescents and 50-plus degrees in adults.
Understanding the various degrees of scoliosis is important because there is a huge variation in symptoms associated with mild, moderate, and severe forms of the condition.
Common Symptoms of Scoliosis in Adolescents
Adolescent idiopathic scoliosis (AIS) is the condition’s most common form, and it can be challenging for people to catch early on. This is unfortunate because the earlier a progressive condition is caught, the easier it is to treat.
While you might think that back pain would be a common symptom of AIS, adolescents don’t experience scoliosis-related pain in the same ways that adults do. AIS is often described as a painless condition; this is due to the upward movement of a growing adolescent’s spine, known to prevent compression of the spine and its surrounding nerves and tissues.
Approximately 20 percent of adolescents with scoliosis report muscle pain or headaches due to changing levels of cerebrospinal fluid, but that’s a small number and not a common symptom.
When it comes to common symptoms to look for to tell if you have scoliosis, the majority of those fall into the category of changes to posture and gait.
Scoliosis and Adults
As the adolescent age group makes up the majority of my patients, the current focus is on how adolescents can tell if they have scoliosis, but I would like to say something about how different symptoms present in adults with the condition.
While the following symptoms are relevant to adults as well, when it comes to signs of the condition, the big difference between the two age groups would be – pain. As adults have reached skeletal maturity, there is nothing to counteract the compression forces that an abnormal spinal curvature places on the spine and its surrounding muscles and nerves.
In adults, and in cases of severe scoliosis, chronic pain can be a very real factor, and that pain can be expressed in the back but is often worse in other areas such as the hips, knees, legs, and feet.
Whether young or old, any back pain or discomfort should be further investigated by a medical professional.
Posture Changes to Look for in Mild, Moderate, and Severe Scoliosis
When it comes to the signs of scoliosis to look for in adolescents, the changes in posture and gait can range from subtle to severe, based on the severity level of the condition.
Mild Scoliosis
Patients who come to me in the mild stage of their scoliosis have the most favorable chances of successful treatment. Conditions caught early on have extremely high success rates when it comes to achieving a sustainable curvature reduction. That being said, it is the mild stage that can be the hardest to catch as most postural changes start to appear at around 25 degrees; this is where early screening and knowing the subtle signs of mild scoliosis is so important.
Changes to How Clothing Fits
If your clothing suddenly seems to be fitting unevenly, this could be an indicator of a body asymmetry developing because of scoliosis. If shirt sleeves and cuffs appear to be uneven and shirt necklines pull more to one side than the other, these are additional signs.
While unevenly-fitting clothes aren’t proof positive of the condition, it is reason enough to prompt further investigation.
Changes in Gait
I can tell a lot about a patient’s condition by how they walk and changes to how an adolescent walks can indicate the presence of mild scoliosis. Signs to look for are arms that swing less, a reduction in the counter-rotating motion made by the hips and shoulders while walking, and general asymmetrical motion.
Uneven Posture
In addition to uneven shoulders and hips, here are additional posture changes to look for include:
- Head not appearing centered over the body.
- Arms hanging at different lengths.
- Ribs protruding more on one side than the other.
- Body tilts to one side when standing.
- Legs appear to be different lengths.
- Hips appear to sit differently.
- Waist that appears more curved on one side than the other.
- One-shoulder blade protrudes more prominently than the other.
- Space between arms and torso appears asymmetrical.
Basically, if your body appears asymmetrical in any of these ways, it can be an indication of mild scoliosis.
Impairment of Balance and Coordination
Teenagers are known to be awkward and gangly, but noticeable changes to balance and coordination could be an indication that something more is going on. If you’ve ever tried to balance on one leg when you’re tilted more to one side than the other, you can see how any asymmetry of the body can throw things off balance.
‘Proprioception’ refers to the body’s ability to recognize its orientation in its surroundings without visual cues, which is an important aspect of posture. If you’re noticing changes to your sense of proprioception, this could be another sign of mild scoliosis.
Moderate Scoliosis
The majority of my patients are in the moderate stage as this is when scoliosis-related symptoms start to become more noticeable to the average person. Once an abnormal spinal curvature reaches the moderate stage, it’s almost guaranteed to continue progressing; although, there’s no way to know exactly how fast or slowly any condition will progress.
The aforementioned symptoms related to mild scoliosis are still present in the moderate stage but are more extreme and noticeable. As the signs of moderate scoliosis are easier to spot, this is the stage many people are first diagnosed in. Additional common signs of moderate scoliosis include:
- The spine’s rotation and abnormal curvature is more noticeable.
- The characteristic rib hump appears.
- One-shoulder blade will likely protrude more than the other.
- Shoulders become more noticeably asymmetrical.
- The body is less symmetrical overall, causing the appearance of bad posture.
The most obvious indication of moderate scoliosis is a pronounced change to the body’s overall symmetry and posture. If you’ve noticed two or more of the aforementioned symptoms, it’s not a guarantee that you have scoliosis, but it’s certainly enough reason to pay a visit to a doctor for additional assessment.
Severe Scoliosis
Cases of severe scoliosis have a 90-percent risk of progression. While mild and even some cases of moderate scoliosis don’t impact too many areas of life in adolescents, that becomes less true for patients living with severe scoliosis.
At this level, obvious changes to posture, gait, and balance are present, along with additional scoliosis-related complications that can occur. Adolescents living with severe scoliosis are also more likely to experience pain in the neck, back or legs, as well as muscle tension and painful headaches that can reach migraine status.
Most people have received a diagnosis by the time they reach this stage, but it’s never too late to start treatment.
Body Symmetry and Posture Changes
With severe scoliosis, the most obvious changes are in body symmetry and posture. When severe scoliosis is a factor, the back, shoulders, and hips appear the most off-balance. Key indicators include:
- Clothing hanging unevenly.
- Arms that hang at different lengths.
- One hip appears higher than the other.
- One leg appearing longer than the other.
- Ribs or shoulder blades that protrude from the body more prominently on one side.
- Arms that seem to swing less and stay closer to the sides of the body.
- Waist and shoulders appearing unbalanced.
Lung-Function Impairment
Especially in the severe stage, the effects of scoliosis can be felt throughout the body. The larger the spinal curvature, the more it can affect pulmonary function. During times of exercise or physical activity, the ability of the lungs to move air is particularly impacted, but even at times of rest, lung function can be impaired in extreme cases.
Chronic Pain
When the body is experiencing pain and discomfort, it’s telling us something wrong is happening. When it comes to severe scoliosis, chronic pain in the neck, back, and legs can be present. Muscle tension and headaches can also be an indication that you are living with severe scoliosis.
Disturbed Sleep
Scoliosis can seem to have a domino effect as a change in the spine can cause one functional change after the next. Sleep can be disturbed due to the presence of pain, or difficulty breathing when lung impairment is a factor.
Issues with Digestion
While the digestive system may not seem overly associated with the spine, it’s one of the many systems the spine is connected to and can impact. An abnormal spinal curvature can affect the digestive system as significantly as it affects the muscles closest to the spine. Scoliosis-related complications can include impairing the digestive system and bowel function.
Irregular Menstrual Cycles
Irregular menstrual cycles can also occur in cases of severe scoliosis, which only further reflects the ripple effect that the condition can cause throughout the body.
The nerves that pass through the spinal canal connect the brain with every organ and virtually every system at work within the body; this is why sleep, digestion, and even menstrual cycles can be affected.
Changes to Balance and Equilibrium
Most average people can close their eyes and still comprehend their body’s position in its surroundings and maintain balance, but people with scoliosis can find this quite difficult.
Maintaining balance and equilibrium can be a challenge for people with varying degrees of scoliosis. If you’ve noticed a significant, or seemingly sudden, change to your ability to balance on one leg with your eyes closed for at least 30 seconds, this could be another indicator of scoliosis.
Forward Bend Test
- In addition to knowing the signs of each stage of scoliosis, there is an effective and reliable screening test that can be done from home. Also known as the ‘Adam’s test’, the forward bend test doesn’t require any equipment, other than the eyes of another person.
- In the forward bend test, you would have someone sit behind you while you bend forward at a 90-degree angle – as if you’re going to touch your toes, with your hands hanging down in front and the back rounded.
In this position, spinal deformities are maximized as the spinous process (the bumpy backsides of the vertebrae you feel when you run your hand down your spine) is more pronounced.
The person sitting behind you can visually assess if there are any asymmetries to the back, shoulders, hips, and waist. They can even run their fingers down your spine to further detect any unusual rib humps caused by a spinal curvature.
If a doctor was performing this exam, they would use an instrument called a ‘scoliometer’ that measures the angle of trunk rotation (ATR).
- The scoliometer looks like a rounded ruler with a notched-out portion that sits over the spinous process. There’s a tiny ball inside the scoliometer that can move from side to side.
- As the scoliometer moves down the spine, any rib humps will cause the ball to move and land alongside a number. That number represents the degree of ATR. A scoliometer reading of 5 degrees would suggest there are some indicators for the condition present and warrant further testing.
Even without a scoliometer, the forward bend test is a good early screening method you can have regularly performed by a friend or loved one to check for any rib humps or asymmetries. There are even digital scoliometer apps that can turn your phone into a scoliometer.
Although a forward bend test is a good method for caregivers and parents to try at home for additional early screening, nothing can replace a physical exam and assessment by a medical professional.
Here at the Scoliosis Reduction Center®, our team of doctors are certified in multiple scoliosis-specific modalities, and we would be more than happy to conduct the necessary exams and assessments to officially tell you whether or not you have scoliosis.
Diagnosis and X-Ray
The best way to really know if you have scoliosis is to get an X-ray done by a scoliosis specialist. X-rays are the most reliable way to see what’s happening with the spine, and the Cobb angle measurement classifies the condition as mild, moderate, or severe.
The reason I suggest seeking the help of a scoliosis specialist, rather than a general practitioner, is that the information provided in a scoliosis X-ray is extremely important when it comes to customizing an effective treatment plan.
Comprehensively reading a scoliosis X-ray is about much more than just measuring the Cobb angle; it’s about knowing how to take X-ray images from multiple angles so changes to the spine are assessed on all three dimensions; after all, a scoliosis X-ray is a 2-dimensional image of a 3-dimensional condition.
While receiving a scoliosis diagnosis can be frightening, a diagnosis does mean the condition has been discovered and can then be treated. Remember, the earlier a condition is diagnosed, the sooner treatment can be started, and the more likely it is that treatment will be successful.
Conclusion
One of the most challenging aspects of scoliosis is reaching a diagnosis early on. While it’s never too late to start treatment, it’s often not until a condition has reached the moderate or severe stage that many people start to notice symptoms and seek professional help.
As the nature of scoliosis is progressive, meaning it will worsen over time, early detection is key to successfully treating the patient and their condition. Here at the Scoliosis Reduction Center®, we’re not interested in only treating the symptoms of the condition, our treatment plans are based on the belief that the condition itself has to be addressed.
Through a unique combination of exercise, therapy, custom 3-D bracing, and scoliosis-specific chiropractic care, our first priority is to achieve a reduction that changes the structure and function of the abnormally-curved spine. Our treatment plans are augmented by at-home exercises and stretches that help to maintain the reduction while keeping the spine as functional and flexible as possible.
While scoliosis is a complex condition that people experience across a wide spectrum of symptoms and severity levels, there are some common signs to look for to help you know if you have scoliosis.
While the presence of pain is a very real sign that scoliosis is present in adults, that pain is often expressed in areas other than the back, such as the hips, knees, legs, and feet. In adolescents, the most common signs to look for include changes to posture and gait.
In the mild stage of the condition, changes can be difficult for anyone to spot, other than a specialist who knows exactly what to look for. As a condition gets more severe, signs and symptoms become more noticeable, which is why many patients don’t find out they have the condition until it has already progressed significantly.
In order to benefit from early detection, screening and knowing what signs to look for are key. Here at the Scoliosis Reduction Center®, we can help you with reaching a diagnosis and implementing a treatment plan to help you move forward with the condition positively and proactively.
