Scoliosis is a progressive condition, meaning its nature is to worsen over time. Reaching a diagnosis early in the condition’s progressive line means proactive treatment can be started while the condition is going to be its most responsive to treatment.
Early detection can increase the chances of treatment success, and scoliosis testing and screening is the first step. Combining an Adam’s forward bend test with the use of a Scoliometer is standard when it comes to screening for condition indicators that warrant the need for further testing.
Before getting to the specifics of scoliosis testing, let’s first talk generally about the condition.
Scoliosis and its Effects
Being diagnosed with scoliosis means an unnatural sideways spinal curvature has developed, with rotation, making it a 3-dimensional condition.
A scoliotic curve also has to be of a minimum size to be considered a true scoliosis; a measurement known as Cobb angle determines how far out of alignment a scoliotic spine is and classifies conditions in terms of severity.
- 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: 80+ degrees
As a progressive condition, however, where a scoliosis is at the time of diagnosis is not indicative of where it will stay.
Only proactive treatment can counteract the condition’s progressive nature; if left untreated, mild scoliosis can easily progress to moderate, severe, and very severe.
Proactive treatment, however, can only be applied if a diagnosis is reached, and that’s not always a simple process.
As there are different types of scoliosis a person can develop, for our current purposes, let’s focus on the most prevalent condition form: adolescent idiopathic scoliosis.
Adolescent Idiopathic Scoliosis
While scoliosis affects all ages, adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18 is the most prevalent.
The idiopathic designation means not clearly associated with a single-known cause, and idiopathic scoliosis accounts for approximately 80 percent of known diagnosed cases; the remaining 20 percent are associated with known causes: degenerative, neuromuscular, congenital, and traumatic scoliosis.
Although we don’t fully understand the condition’s etiology, we know how to treat it, and we know what triggers it to progress: growth and development.
Adolescent Idiopathic Scoliosis and Progression
Considering the stage of puberty, characterized by rapid and unpredictable growth spurts, adolescents are at risk for rapid-phase progression.
The most prevalent form of scoliosis in adults is also idiopathic scoliosis, and these cases are adolescents who had AIS but didn’t receive a diagnosis or treatment in adolescence; this is quite common because the signs and symptoms of adolescent idiopathic scoliosis can be subtle.
Particularly in mild forms, AIS isn’t commonly associated with functional deficits, and for patients who are still growing, the condition is not yet compressive.
In addition, adolescents don’t always find the condition painful as it doesn’t start causing compression until skeletal maturity has been reached and the condition becomes compressive.
Once skeletal maturity is reached, the spine and its surrounding muscles and nerves are vulnerable to the compressive force of the unnatural spinal curve.
Scoliosis affects the body in different ways because of the uneven forces it introduces, and in adolescents, the condition’s main symptom is postural deviation caused by a disruption to the body’s overall symmetry.
When it comes to screening for scoliosis in adolescents, we’re talking about looking for condition indicators that reveal the need for further testing, so let’s talk about the types of symptoms screening tests for scoliosis are looking for.
How to Assess for Scoliosis
Part of diagnosing scoliosis involves comprehensively assessing conditions to further classify them based on key patient/condition variables: patient age, condition type (cause), curvature location, and condition severity.
While scoliosis screening used to be mandatory in schools across the United States, that has since changed, putting the onus onto the shoulders of parents and caregivers, and adolescents themselves, to notice the condition’s subtle early signs.
While each case is unique and will produce its own unique set of symptoms, the following are common symptoms of adolescent idiopathic scoliosis that are considered condition indicators:
- Uneven shoulders
- Uneven shoulder blades
- The development of a rib arch
- Uneven waistline
- Uneven hips
- Arms and legs that appear to hang at different lengths
- Changes to gait
- Changes to balance and coordination
Due to the condition’s uneven forces, the body’s overall symmetry is disrupted, and clothing can become ill-fitting, which is another sign of the condition.
If you notice one or two of the aforementioned symptoms in someone you care about, the next step is taking them in for a screening exam, and a key part of that is what’s known as the Adam’s forward bend test.
Scoliosis Forward Bend Test
The Adam’s forward bend test helps reveal postural deviation and the angle of trunk rotation (ATR) by putting the spine in a position where it’s the most visible.
In addition to taking the patient’s medical/family history, with a focus on the prevalence of spinal conditions within the family, I observe how a patient holds themselves (posture) and walks.
Watching how a patient walks is an important part of a physical examination, and then I perform a forward bend test.
I sit or stand behind a patient who bends forward, with arms dangling at the sides, as if trying to touch the toes and hinging forward at the hips.
In this position, the spine is protruding from the back and is its most visible, as are certain postural asymmetries such as uneven shoulders, shoulder blades, a rib arch, and uneven hips.
Scoliometer
When combined with the use of a Scoliometer, I can find out how much rotation there is for more specific results, and this looks somewhat like a ruler with a bubble in its center.
Aligning the scoliometer with the spine, in its notched-out portion, and running it along the spine, measures trunk asymmetry as the bubble aligns with the angle of trunk rotation (ATR) that’s detected.
While it’s normal to have a small degree of spinal rotation, the Adam’s forward bend test and the Scoliometer help determine if there is an excessive degree that warrants the need for further testing.
If a patient’s screening exam finds indicators of the condition, this warrants further testing, which comes in the form of an X-ray to confirm a diagnosis or not.
How Do They Test for Scoliosis?
In terms of reaching an official diagnosis of scoliosis, an X-ray is needed, and this is so we can see exactly what’s happening in and around the spine.
As mentioned earlier, an unnatural spinal curve has to be of a minimum size to be officially diagnosed as scoliosis, and that’s a Cobb angle measurement of at least 10 degrees, which is considered mild scoliosis.
A scoliosis X-ray tells me what I need to know in order to craft a customized treatment plan moving forward.
Cobb angle tells me how far out of alignment the spine is, and this is based on the most-tilted vertebrae at the curve’s apex, and taking measurements and images of the spine from a variety of angles also helps us confirm the degree of rotation.
Condition severity is a key factor that treatment is shaped around as the goal of treatment for AIS is to counteract progression, despite the constant trigger of growth and development throughout adolescence.
So if an Adam’s forward bend test and Scoliometer have revealed a number of condition indicators, I order an X-ray so an official diagnosis can be reached and treatment can be started as close to the time of diagnosis as possible; this is going to be when the condition is most responsive to treatment, the spine will be at its most flexible, and before the body has had time to adjust to the unnatural spinal curve’s presence.
Conclusion
Particularly when it comes to diagnosing scoliosis in children and adolescents, starting treatment early in a condition’s progressive line means there are fewer limits to what can be achieved.
Here at the Scoliosis Reduction Center®, I want to prevent progression through being proactive with treatment that impacts the condition on every level, but treatment can’t be started unless scoliosis testing & screening has helped us get there.
Through a physical exam that commonly includes an Adam’s forward bend test and a Scoliometer, I can gauge whether or not there are enough condition indicators to warrant the need for a scoliosis X-ray.
If an X-ray further confirms that the spine is unnaturally bent to the side, with significant rotation, and a minimum Cobb angle measurement of 10 degrees, an official diagnosis of scoliosis can be reached, and the first steps towards proactive treatment and condition improvement can be made.
