Scoliosis describes the most common type of spinal curvature. It is simply a descriptive term, like backache, not an actual condition.
A scoliosis is described when the spine develops a sideways bend and rotates along its vertical axis. Pain develops as a result of postural malalignment, putting excessive pressure on the discs, vertebrae, ligaments, and soft tissue structures.
The most important part of the management of scoliosis is the early detection of its presence, as early management may prevent the need for surgery. The Spine Society of Australia recommends that screening for scoliosis should be done on Year 7 and Year 9 schoolgirls.
Scoliosis is seen in one of two different groups:
- A Structural Scoliosis is the worst type of scoliosis, and it can be progressive. It usually produces a bulge of one side of the rib cage. This is most notable when a person bends forward.
The most common (up to 90 %) Structural Scoliosis is idiopathic. This type most commonly appears in early adolescence and is much more common in girls than boys. It can often be a progressive scoliosis. It appears that genetic inheritance is a major contributor to a scoliosis. Other types of Structural Scoliosis are: Congenital, Neuromuscular, and Paralytic. The management of these types of scoliosis needs to be tailored to the individual patient and the underlying condition.
- In the Functional (mobile) Scoliosis, the rotation of vertebrae does not become fixed, and the curvature is usually non-progressive. There are two types of functional scoliosis: Postural and Compensatory. The spine is structurally normal, but looks curved because of another condition such as a leg length discrepancy or muscle spasm in the back muscles. The curve is usually mild and it reduces when the person bends sideways or forwards. The use of a heel or foot lift on the shortened leg may reduce the scoliosis that has been produced.
This is the type of Scoliosis most commonly associated with Podiatry Assessment. A structural leg length discrepancy is very likely to cause a compensatory scoliosis. This has been debated by many, and in fact if we are not seeing a true scoliosis we certainly see a compensatory spinal curvature. Conversely a patient with a scoliosis will generally function with some degree of leg length discrepancy, due to the associated pelvic tilt. This will vary depending on the presence of a second (compensatory) curve of the spine.
To check for functional or structural scoliosis, sit the person down and look from behind. When it is a postural scoliosis, the curve disappears when the person sits down as the pelvis automatically becomes level. If it is a structural scoliosis, sitting will not make any difference to the visible curve.
The management of a scoliosis is determined by the extent of the scoliosis. In most cases a mild scoliosis requires no intervention. Podiatry assessment will reveal type and extent of the scoliosis, with referral to your doctor for further investigation where necessary.
The presence of a scoliosis will be considered during biomechanical assessment and treatment by your Podiatrist.
Scoliosis remains a much debated topic. It is the subject of many research projects. A clear diagnosis of scoliosis type is required so that a patient may be directed to the appropriate health practitioner for treatment.