Scoliosis is an abnormal sideways curvature of the spine, often resembling an “S” or “C” shape. While natural curves exist, scoliosis involves an excessive curve in the coronal plane, the side-to-side view. It affects individuals of all ages but is most commonly diagnosed during childhood or early adolescence, particularly during growth spurts. Accurate diagnosis and effective management require proper medical evaluation.
Your Initial Doctor for Scoliosis Concerns
When concerns about scoliosis first arise, a primary care physician (PCP) or pediatrician is the initial point of contact. These healthcare providers perform routine scoliosis screenings during well-child visits, starting around age 10, during rapid growth. During a screening, the doctor conducts a physical examination, including the Adams forward bend test, where the child bends forward at the waist with straight knees for observation.
The physician looks for signs of spinal asymmetry, such as uneven shoulders, one shoulder blade appearing more prominent, uneven hips, or the body leaning to one side. They also check for an unequal distance between the arms and body, or uneven skin folds at the waist. If these visual cues suggest a possible spinal curvature, the PCP or pediatrician will recommend further evaluation by a specialist to confirm diagnosis and determine severity.
Orthopedic Specialists in Scoliosis Treatment
An orthopedic surgeon specializing in spinal conditions serves as the primary medical specialist for individuals diagnosed with scoliosis. Their role begins with confirming the diagnosis through X-rays, the gold standard for measuring the Cobb angle. A Cobb angle of 10 degrees or more confirms a scoliosis diagnosis. An MRI or CT scan may also be used to evaluate nerves, discs, or underlying structural abnormalities.
Following diagnosis, the orthopedic specialist monitors the curve’s progression, especially in growing children, as curves can worsen during growth spurts. Monitoring involves regular check-ups and repeat imaging to track changes in the Cobb angle.
Based on the curve’s severity, the patient’s age, and skeletal maturity, the orthopedic surgeon determines the appropriate course of treatment. For mild curves (10-24 degrees), observation with periodic monitoring is sufficient. Moderate curves (25-39 degrees) in adolescents may be treated with custom back braces to prevent further progression. For severe curves (exceeding 40-50 degrees), or curves worsening despite bracing, surgical intervention like spinal fusion may be considered to straighten and stabilize the spine.
Other Professionals Supporting Scoliosis Management
Scoliosis management often involves a team of healthcare providers working with the orthopedic specialist. Physical therapists offer non-invasive treatment focused on improving postural alignment, functional abilities, and pain alleviation. They design customized exercise programs to strengthen core muscles, improve flexibility, and restore muscular symmetry, often incorporating techniques like the Schroth Method for spinal de-rotation, elongation, and stabilization. While physical therapy alone may not reverse a structural curve, it can help prevent further progression and manage symptoms.
Pain management specialists are involved if scoliosis causes significant discomfort. They offer various treatments, including medication, manual therapy, or injection-based procedures, to control pain symptoms, particularly in adults with degenerative scoliosis. Their goal is to alleviate pain and improve the patient’s ability to participate in daily activities.
Neurologists are consulted if there are concerns about nerve involvement or underlying neurological conditions contributing to scoliosis. Conditions like cerebral palsy or muscular dystrophy can cause neuromuscular scoliosis, often presenting with a large C-shaped curve and affecting nerve and muscle function. Neurologists assess for issues such as numbness, weakness, or changes in reflexes that may indicate nerve compression or damage.
Chiropractors are sometimes sought for scoliosis management, primarily for pain relief. While chiropractic spinal manipulation may offer short-term relief from back pain, most experts agree it is not effective in correcting the structural spinal curvature. Current research indicates limited evidence to support chiropractic adjustments in reducing or slowing the progression of scoliosis curves. Therefore, chiropractors are considered for managing pain symptoms rather than for curve correction, and their role remains a subject of ongoing study.