June is National Scoliosis Awareness Month, a time to spread awareness about this condition and the strategies to prevent it from progressing. Early diagnosis and the right treatment plan can help manage scoliosis and reduce the risk of further curvature. 

Scoliosis, an abnormal sideways curvature of the spine often occurring in a “C” or “S” shape, is estimated to affect 2-3% (6-9 million) of the population. It can emerge during infancy or childhood, but the primary onset is between ages 10 and 15, affecting both genders equally.

The development of scoliosis can be categorized as either idiopathic—meaning the cause is unknown—or neuromuscular, meaning that it’s caused by disorders such as cerebral palsy or muscular dystrophy.

Although scoliosis is a lifelong condition, several strategies based on spinal maturity, degree of curvature, and location of the curve can help prevent progression. Monitoring, bracing, and surgery are common interventions to prevent, reduce, or correct scoliosis.

Over-the-counter pain relievers such as ibuprofen and prescription drugs like NSAIDs can help relieve the excruciating pain associated with scoliosis. Read on for a detailed guide on how these strategies can help prevent scoliosis from progressing.

What are the causes, signs, and symptoms of scoliosis?

Scoliosis remains largely idiopathic, meaning there is no clear or single cause. Medical experts theorize that genetic predispositions, certain neuromuscular conditions, spinal cord abnormalities, embryological malformation, or traumatic injury to the spine can contribute to scoliosis. Age, gender, and family history may also increase the risk of developing the condition.

The most common signs and symptoms of scoliosis include:

• A visible curvature of the torso when viewed from the side
• Uneven shoulders and hips, either in height or prominence
• Uneven waistline or rib cage
• One shoulder blade appears “stuck out” or more prominent than the other.
• Rib cage deformity where one side “sticks out” more when bending forward

Doctors diagnose scoliosis using X-rays, spinal radiographs, CT scans, or MRI scans. A physical examination also checks for asymmetrical shoulder blades, ribs, legs, and hips. The Cobb angle method is used to measure the degree of curvature, which determines the severity of the condition. A coronal curvature of more than 10 degrees on a posterior-anterior radiograph confirms the presence of scoliosis.

• Below 20 degrees is mild scoliosis
• 20-40 degrees indicates scoliosis
• More than 40 degrees is considered severe scoliosis

Severe scoliosis causes chronic pain, breathing problems, and poor posture, affecting quality of life. That’s why preventing scoliosis from progressing and worsening is important.

5 effective strategies for managing scoliosis

There are several strategies to prevent scoliosis from progressing depending on the degree of curvature, spinal maturity, and curve location.

Regular monitoring

Mild scoliosis with a curvature of less than 20 degrees doesn’t require any treatment. Instead, doctors recommend regular monitoring every 4-6 months to assess the curve and prevent further progression. Your doctor will perform a physical examination and use X-rays, CT scans, or MRI to track the degree of curvature. Adults with scoliosis generally have follow-up visits every 5 years, or more frequently if symptoms worsen.

Bracing

Bracing is a common, non-invasive treatment for scoliosis. It works by providing external support to the curved spine and preventing the curve’s progression by limiting movement. It can only be used in children and adolescents whose spines are still growing and who have a curvature between 25 and 40 degrees.

Braces are categorized into two major types depending on their level of support.

• A thoracic-lumbar-sacral orthosis (TLSO) brace runs from the upper back to the buttocks. This is the most common type of brace used in scoliosis treatment.
• A cervical-thoracic-lumbar-sacral orthosis (CTLSO) brace extends from the neck down to the buttocks.

Your doctor can prescribe any of the following braces based on your condition:

• Milwaukee brace: This is a CTLSO with a rigid metal superstructure, contoured plastic pelvic girdle, and neck ring. There are metal bars connecting the front and back of the brace, which help the torso extend and keep the head centered over the pelvis. Pressure pads are placed at strategic points to help redirect the growth of the spine. The brace is rarely used nowadays due to its bulkiness and discomfort.
• Boston brace: This is the most commonly prescribed TLSO brace. It’s made of a sturdy, lightweight plastic shell that fits snugly around the torso, held in place by straps. It’s unnoticeable under clothing and customized according to the patient’s body shape. The brace applies pressure to the ribs and encourages the spine to curve naturally.
• Wilmington brace: This is similar to a Boston brace but closes at the front. It fits like a jacket and applies pressure to the thoracic and lumbar spine to correct the deformity. It also helps maintain posture by preventing slouching.
• Charleston bending brace: This TLSO is prescribed for night-time wear. It’s made of a light, rigid material molded to the patient’s body shape. The brace applies pressure to your spine, bending it in the opposite direction of the curve.

In general, braces must be worn for 18-20 hours daily to be effective. They can be taken off for sports, swimming, or showering.

Exercise

Regular, low-impact exercises like stretching, swimming, and yoga can help strengthen the muscles around the spine, improve mobility and flexibility, and prevent further curvature. Exercise helps reduce the stiffness, pain, and fatigue associated with scoliosis. 

A daily 30-minute exercise routine promotes a healthy weight, which reduces strain on the spine. Your doctor may also recommend physical therapy to improve your posture and gait, reduce muscular spasms, and maintain the spine in its corrected position.

Surgery

Severe scoliosis with a curvature of more than 40 degrees may require spinal fusion surgery. This involves inserting metal rods and screws to straighten the spine and prevent further progression. The orthopedic surgeon will then use bone grafts to join the spinal bones and form a solid mass. Fusion happens within a year after the surgery, and the metal rods remain in place.

Pain management

Over-the-counter medications like ibuprofen and acetaminophen can help relieve pain and discomfort associated with scoliosis. Your doctor may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants to reduce spasms, pain, and inflammation. It’s important to note, however, that medications can only be used in the short term and should never replace exercise or other treatments.

Your doctor will assess the severity of your condition and recommend the best treatment options. Follow your doctor’s instructions, keep regular appointments, and maintain a healthy diet and lifestyle for positive results.

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