Tag: scoliosis pain

5 Tips to Help Reduce Scoliosis Pain

Posted on January 14, 2023 by - Blog

For most of the history of Scoliosis treatment, the widely held view has been that Scoliosis does not cause pain. It’s certainly true that many Scoliosis patients present at our clinic with no pain nor discomfort – but recent research, as well as our experience, has shown that in many cases Scoliosis can be painful.

At least one research study suggests evidence of a possible 35-42% prevalence of lower back pain in adolescents with idiopathic scoliosis[1] (AIS), in another study of 2400 patients with AIS, 23% reported back pain at their initial contact[2]. Chronic non-specific back pain (CNSBP) also seems to be frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[3]  – in addition, patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[4]

In patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[5] and Scoliosis patients have between a 3 and 5-fold increased risk of back pain in the upper and middle right part of the back[6].

While this does not mean that everyone with Scoliosis will experience pain – in fact the numbers roughly support about a 50/50 chance – there are still a significant number of individuals for whom the management of Scoliosis & pain is a factor. At the UK Scoliosis Clinic, we utilise a number of approaches to help manage the pain associated with scoliosis – but there are also some steps you can take yourself.

 

1 – Keep active, Keep fit

Being physically active and reducing the amount of time spent in sedentary positions is very important, not only for pain management but for your overall health and well-being. While it’s true that Scoliosis can make some activities more difficult, and there are some exercises (especially “one-sided” activities, like racket sports) which we might advise against – there’s no reason why Scoliosis should stop you from being as active as possible. If pain is already a significant issue, low-impact activities such as Yoga or Pilates  can be an excellent way to keep moving, and may even provide some additional pain relief. Swimming, once thought to treat Scoliosis (sadly, based on current research, does not[7]) is nonetheless an excellent way to stay fit with almost no risk or injury.

 

2 – Improve your posture.

While it’s not true that poor posture causes Scoliosis – poor posture can cause pain, both for Scoliosis sufferers and those without Scoliosis.

A huge part of Physiotherapy based approaches to Scoliosis is increasing awareness of posture – when sitting and standing and to take note of the position of your spine. Are you collapsed to one side or slouching? Try to straighten & lengthen your spine and keep balanced, avoid leaning to one side as this can aggravate pain – instead, try to remain in a neutral or corrected position. Many people with Scoliosis pain find that regular movement helps to reduce pain too.

 

3 – Avoid extended sitting/extended standing

Where possible, avoid extended sitting when working, studying or at school. Regular postural changes/breaks (every 20-30 minutes) are very important and can be as simple as standing up, walking to the other side of the room, or stretching, before sitting back down.

This is, like most of these tips, a good idea to do regardless of your Scoliosis status as long periods of sitting encourage imbalances in muscles and ligaments – in fact, it’s the cause of a huge percentage of back pain cases treated by Chiropractors every year.

 

4 – Light Stretching or Massage

Stretching or Massage, either as a targeted activity or part of something like Yoga can be highly beneficial for Scoliosis suffers –focussing on elongation and decompression of the spine is likely to help relieve pain for many, and can often be performed at home using a tennis ball, foam roller or massager. That being said it’s best to consult with a Scoliosis expert when it comes to stretching or flexibility routines, for example many people with AIS will have reduced spinal curves or flat backs, so it is important that significant hyper-extension/arching backwards is not performed as it may increase the flattening of the back which may in turn progress the scoliosis.

Repetitive one-sided movements, or exercises & stretches leading to excessive spinal rotation may actually worsen pain – due to the 3D nature of scoliosis. Repetitive twisting or one-sided movements can potentially put your spine into an unfavourable position or even counteract an ongoing treatment program, so use with care.

 

5 – The Best Option, Scoliosis Specific Exercise

The best option to address Scoliosis pain is, of course a professional plan. A Scoliosis professional can design a series of Scoliosis Specific exercises, that will help improve posture, manage pain and slow the progression of your condition. These scoliosis-specific exercises, once mastered, can be incorporated into your day-to-day life or form part of an active treatment program.

In some cases, the part-time use of a Scoliosis brace could also be considered – for example, while bracing in adults is not likely to reduce the Scoliotic curve itself, research does indicate that bracing can be effective in reducing chronic pain.[8]

 

 

 

 

[1] Théroux, J., et al.Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review. Chiropractic & manual therapies, 25(1), 1-6.

[2] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

[3] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[4] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[5] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[6] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

[7] Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al.: Physiotherapy scoliosis-specific exercises—a comprehensive review of seven major schools. Scoliosis Spinal Disord, 2016, 4: 1.

Zaina, F., Donzelli, S., Lusini, M., Minnella, S., and Negrini, S. (2015). Swimming and spinal deformities: A cross-sectional study. The Journal of Pediatrics, 166(1): 163-167.

Gonen Aydin C, Oner A, Hekim HH, Arslan AS, Oztas D, Akman YE. (2020) The prevalence of scoliosis in adolescent swimmers and the effect of swimming on adolescent idiopathic scoliosis. Turk J Sports Med.;55(3):200-6.

[8] Scoliosis bracing and exercise for pain management in adults—a case report Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.

­­­­Scoliosis – some posture tips

Posted on October 26, 2022 by - Blog

Contrary to popular belief, poor posture cannot give you Scoliosis – the known causes of Scoliosis include degenerative changes in the spine (associated with ageing), neurological conditions and some genetic conditions. It’s also possible to end up with Scoliosis as the result of an accident or injury, or perhaps due to complications during surgery for another issue. All other scoliosis cases are considered idiopathic, meaning the exact cause is unknown – however, there is no evidence to suggest that bad posture causes Scoliosis.

 

Nonetheless, posture is an important thing for Scoliosis sufferers to keep in mind – now that it is more widely recognised that scoliosis can cause pain and discomfort, many people naturally wonder if there are ways we can reduce discomfort and support treatment during scoliosis correction. While everyday postural changes designed to correct scoliosis are a critical part of approaches such as Schroth therapy, there are also some small changes which one can make in order to potentially improve their overall quality of life.

 

Sitting and standing

When standing or sitting; good posture uses less energy than poor posture – this is true whether you have scoliosis or not! Some people with scoliosis might find sitting or standing with good posture difficult, either because of the spinal deformity or because of tiredness associated with scoliosis exercise treatment (this is normal!).  Because of this, it’s not uncommon for scoliosis patients to sit or stand with weight shifted more to one side than the other – either trying to overcompensate, or simply leaning on the strong side due to tiredness.

The ideal posture when standing is to have weight evenly spread – the neck should be straight with no tilt, the hips level, and the pelvis neutral (this means not tilting forward or backwards). The knees should be straight or alternatively, one knee straight, the other slightly bent. It can help to check your posture regularly in the mirror or get others to check it for you. Imagine yourself as a puppet with a string attached to the top of your head pulling you straight. The important thing to remember is not to overcompensate – if you lean slightly to one side, try to aim for this neutral posture – but don’t go further the other way!

When sitting, it’s easier to centre yourself correctly – the key is to allow the chair to take your weight evenly, which a normal char will. Try to sit back in a chair with your weight on your buttocks and thighs and your back straight. Try not to sit forward on the edge of your seat and keep the pelvis neutral (not tilting forward or backwards). Try to select a chair that allows your knees to be bent at roughly a 90 – 75 degree angle when sitting so that your knees are level with, or slightly lower than your hips. Keep feet flat on the floor and shoulder-width apart. Try not to sit for too long at any one time. It is best to move every 30 minutes to avoid getting stiff, whether you have Scoliosis or not!  Low soft sofas, chairs without arms, chairs that are too low or too high, bucket chairs and deep chairs can all be especially uncomfortable for those with Scoliosis.

Some patients find that lumbar (lower back) supports, cushions or memory foam can assist with any pain when sitting – for the most part these are safe to use, but t’s worth checking with your scoliosis practitioner if possible.

 

Exercise

Exercise is an essential part of everyday health and may well also form part of your Scoliosis treatment – if you are using an exercise-based approach to Scoliosis you will be well aware of the importance of maintaining a balanced and symmetrical spine unless you are specifically performing a corrective exercise.

It’s easy for people with scoliosis to get sore, stiff or tired when using the gym or exercising due to the additional strain which the spine is already under. Similarly, it’s not always a good idea to perform stressful exercises after a scoliosis specific exercise session, as parts of your back will feel tired.

If you do want to perform any kind of weight-bearing exercise, be sure to discuss the best way to do this with your scoliosis practitioner – and always work within your limits, especially during treatment. Very often, low impact and symmetrical exercises, such as swimming are an excellent way to augment scoliosis treatment while keeping fit and with a very low risk of injury or strain.

 

Beds and sleeping

Choosing the right bed is very important as you spend around 8 hours of the day in it. If you are comfortable you are more likely to sleep well. Getting enough is critical for mental as well as physical health.

As with a chair, it’s recommended to have a bed that allows you to sit on it with your knees at or just below 90 degrees – this should make it easier to lie down and get up.

The mattress should not be too hard or too soft. It needs to support your weight without sagging or giving way at the hips and shoulders – many Scoliosis patients find that a memory foam mattress is more supportive for them – don’t forget that these can be bought separately and added to your bed!

Some patients, especially those with Lumbar curves can experience discomfort when sleeping and laying in bed – this is, in fact, the case for many people, scoliosis sufferer or otherwise, since sleeping flat on your back with your legs straight can put a strain on the lumbar spine. Sleeping on your back, with your knees bent, on your side with your leg bent forward or on your side with a pillow between your legs or under your knees for better support can all help to relieve this discomfort. While not a universal rule, we also find that most scoliosis patients find sleeping on their front somewhat uncomfortable – so you may want to avoid this!

 

Does Degenerative Scoliosis cause pain?

Posted on August 7, 2019 by - Blog

Degenerative, or “De-novo” scoliosis is the name given to a scoliosis case which develops later in life and which has a known cause. Whereas the vast majority of scoliosis cases in younger people are classified as “idiopathic” scoliosis (that is to say, a condition without a clearly defined cause) de-novo scoliosis is understood to be the direct result of spinal degeneration – the term “de-novo” simply means “new”. Usually, de novo scoliosis develops as discs and facet joints (the hinge joints at the back of the spine) start to age – often in the lumbar spine (the lower part of the spine). When discs and facet joints age the vertebrae can slip out of place, which makes the spine curve – weakening of muscles and ligaments can also help to exacerbate the condition. Research suggests that de-novo scoliosis may affect as many as 30% of the over 60’s.[1]

 

Adult, or De-novo scoliosis?

Sometimes naming conventions are less than well thought through and scoliosis in adults is just such an example. There are, in fact, two main types of scoliosis in adults – these are de novo scoliosis and adult scoliosis. Adult scoliosis is the term which refers to a scoliosis case from adolescence, which has been carried into adulthood – and is also sometimes called adolescent scoliosis in adults (ASA). The difference matters since in adult scoliosis cases, curves that are 50 degrees or more in size after a person is fully grown are likely to increase by an average of 1 degree per year, whereas curves of less than 30 degrees rarely get significantly larger. De-novo scoliosis cases tend to increase in magnitude, but the progression is less predictable. Knowing as much as possible about a patients history is therefore critical to making the right diagnosis.

 

Is de-novo scoliosis painful?

There has been a long-running debate in the field of scoliosis treatment and research – does scoliosis cause pain? Since at least the 70’s there have been opposing views on both sides of the argument all of which have presented evidence to support their claims. In many instances, there have been limitations to the studies in both camps (with sample size being the most frequent issue) but it is also the case that adolescent scoliosis often receives more attention in research. In this regard, however, it does seem to be increasingly demonstrated that pain is correlated with scoliosis – and it’s not unreasonable to suggest the same is true in de-novo cases.

In the last 5 years or so, numerous studies have suggested that…

  • Spinal pain is, in fact, a frequent condition in AIS patients, further supporting the need for early detection and screening to minimise potential pain and suffering[2]
  • In patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[3]
  • In one study of 2400 patients with AIS, 23% reported back pain at their initial contact[4]
  • Scoliosis patients have between a 3 and 5 fold increased risk of back pain in the upper and middle right part of the back[5]
  • Chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[6]
  • Patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[7]

In truth, whether or not scoliosis causes pain is less of an issue when it comes to adolescent scoliosis since most cases in young people are noticed either as a result of screening or due to visual symptoms. In adults, however, pain may well be a significant symptom which (since “back pain” is such a common condition today) many older people simply ignore.

Perhaps the link between de-novo scoliosis and pain was best summed up in a comment by Manuel Rigo, a scoliosis clinician with the Institut Elena Salvá in Barcelona, Spain, in a presentation to the 7th international conference on the conservative treatment of spinal deformities – according to Rigo (our emphasis added):

“Adult patients attending our institution – a scoliosis-specific rehabilitation centre – could be divided into two main groups: Group I: Patients attending the clinic with a clear self-conscience of belonging to the scoliosis population because they were mostly diagnosed during childhood or during adolescence – treated or not treated-; Group II: Patients belonging to the back pain population referred to us by their doctors, mostly because they showed a bad response to general rehabilitation and such a bad response was related to a non-previously diagnosed scoliosis condition. Generally speaking, we could identify patients with idiopathic, congenital and secondary scoliosis in Group I while most of the patients in Group II have developed de novo degenerative scoliosis or scoliosis secondary to any pelvic or lower limbs biomechanical disturbance.”

Degenerative or “De-Novo” scoliosis

Therefore, while it is unclear exactly how well de-novo scoliosis and pain are correlated – pain is well worth considering as a possible symptom in older individuals. Indeed, many of our patients presenting with de-novo scoliosis do initially complain of pain. Indeed, the UK Scoliosis association now also recognises that patients with degenerative scoliosis will often also have back pain and muscle fatigue and that people with degenerative scoliosis sometimes also have back stiffness and leg symptoms, including pain, numbness, and weakness.

The positive message overall though, is that research does show that conservative approaches, such as part-time bracing can have a positive effect in reducing it where it does exist.[8] One such approach is our latest generation brace, the ScoliBrace. Unlike many scoliosis braces, ScoliBrace is a fully customised, 3D designed, CAD/CAM manufactured brace which is low profile, comfortable and easy to use, alongside specialist scoliosis exercises, part-time bracing with ScoliBrace can provide a significant improvement in quality of life for those suffering from De-novo scoliosis.

 

 

[1] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

[2] ‘Back Pain and Adolescent Idiopathic Scoliosis: A Descriptive, Correlation Study’,
Theroux Jean, Le May Sylvie, Labelle Hubert [University of Montreal, Quebec, Canada; Murdoch University, Perth, WA, Australia], Spine Society of Australia 27th Annual Scientific Meeting (8-10 April 2016)

[3] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[4] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

[5] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

[6] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[7] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[8] Scoliosis bracing and exercise for pain management in adults—a case report Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.