EXPERTS DIFFER ON HOW TO TREAT CURVY SPINES

Istill remember grimacing at my back X-ray at age 13. My spine looked like a road curving around an invisible mountain.

The doctor called my condition “scoliosis.” I was among the two to three per cent of people with scoliosis, according to the National Scoliosis Foundation. About three million scoliosis cases are diagnosed in the United States every year, generally in children aged 10 to 12, according to Johns Hopkins Medicine. Girls and women are more likely than boys and men to have scoliosis. It’s not clear why.

While some of us have had curvy spines since childhood, adults can develop scoliosis that gets progressively worse over time from wear and tear on the spine.

“As we have more people that age and become elderly, then adult degenerative scoliosis will absolutely be more common,” said Akhil Chhatre, director of spine rehabilitation at Johns Hopkins Medicine in Baltimore.

What is scoliosis?

Doctors diagnose scoliosis when a spinal curvature “measures 10 degrees or greater on an X-ray,” according to Johns Hopkins Medicine. Scoliosis curves are broadly characterized as S or C shapes, but each person’s spine is unique, as is the way their body compensates.

Often, scoliosis is accompanied by such clues as unevenness in the shoulders, waist or leg length, according to the Cleveland Clinic. Physical trauma such as a fracture or arthritis of the spine can lead to adult scoliosis, Chhatre said.

But experts at the Mayo Clinic and other organizations say the cause of childhood scoliosis is often unknown, though it may run in families.

Adolescents with scoliosis are often most concerned with how it affects their appearance, said Sanja Schreiber, the director of a scoliosis physiotherapy clinic called Curvy Spine Inc. in Edmonton. Many teenagers don’t experience pain because of their scoliosis, Schreiber said, although I have memories of feeling sore from sitting in classroom chairs.

In adulthood, scoliosis can cause pain, arthritis, pinched nerves and even walking or breathing difficulties, Chhatre said.

In severe cases, the spine can twist into one of the lungs, squeezing it “like a towel with water,” said Santhosh Thomas, a staff physician at the Center for Spine Health at the Cleveland Clinic. This can lead to limited capacity for heavy exercise or for standing for long periods, and may require surgery.

Even minimal curvature “can manifest with symptoms such as pain or discomfort,” Chhatre said.

Stiffness and soreness, especially in my neck and around the apex of my curve, creep in periodically, reminding me to stretch and stand up or take a walk.

How is scoliosis treated?

When the angle of the spinal curve is less than 20 degrees, scoliosis is often considered mild enough to go without treatment. Children and adults with curvatures over about 40 to 50 degrees are candidates for surgery, which often involves straightening the spine using steel rods and comes with risks including blood loss, inflammation and nerve injury. Less invasive surgical techniques have been developed involving smaller incisions and faster recovery.

A patient’s age, health and expectations all play into the decision of whether to operate, Thomas said. “If a patient can function without much pain, then there is no reason to operate on or correct the deformity,” he said. It’s hard to put a number on what percentage of patients will need surgery, he said, but some 38,000 undergo spinal fusion surgery each year, according to the American Association of Neurological Surgeons.

For kids in the “moderate” category of curves, as I was, doctors often recommend wearing a back brace until they stop growing to prevent the curve from worsening and possibly slightly improve it.

Physical therapy options

Physical therapists can put together a set of exercises targeting the body’s symmetry, balance and posture.

For example, a specialized scoliosis therapy called the Schroth method uses individually tailored programs targeting breathing, strength training and posture awareness. In general, scoliosis patients should find a specialist with training in managing the complex condition.

Treatment challenges

Yoga became a game changer for me after I found an instructor who understood how to modify poses for scoliosis. I currently don’t go to physical therapy partly because of out-of-pocket costs and conflicting guidance I received from different practitioners.

Even while interviewing experts for this article, I found differences in their general advice. For example, while Schreiber cautions against stretches and exercises that put strain on the spine — such as twisting and prolonged bending — Thomas generally tells his scoliosis patients to do whatever activity they want, as long as it doesn’t cause them pain.

The experts agreed people with scoliosis should work on good posture, take breaks from sitting, exercise moderately and stay fit to improve muscle tone and strength. Also of prime importance: bone health, to prevent a worsening of the spinal curve.