Scoliosis is a condition whose course has been widely researched. Nevertheless, the causes that can trigger and condition scoliosis are not currently understood in about 80 percent of all sufferers. Scoliosis is a disease of the bone substance that predominantly affects girls and women.
What is scoliosis?
Infographic on spinal torsion in scoliosis. Click to enlarge. Scoliosis is a condition that particularly affects the skeletal system in a concentrated area. The typical changes characteristic of scoliosis occur exclusively in the spine. Since in the course of scoliosis the spine deforms, that is, its shape is laterally shifted and twisted, scoliosis is called lateral bending of the spine. This condition, accurately referred to in medical circles as lateral bending of the axial skeleton, is permanent and irreversible.
Causes
Three-dimensional bending during scoliosis results from a variety of causes, not all of which are fully understood. Due to the different manifestations of scoliosis, various triggers that cannot be influenced may also be among the causative factors. In principle, scoliosis also occurs without traceable causes. This form of scoliosis is typical for the disease, which can already manifest itself in children and adolescents. It is assumed that twisting of individual vertebral bodies and an overall displacement of the spine occur during the individual growth phases. In adults, scoliosis may be caused by specific pre-existing conditions. In addition to prenatal disorders of bone development, as well as due to irregularities in metabolism or rickets and brittle bone disease, scoliosis can also develop. In addition, accidents and deviantly long lower extremities also lead to scoliosis.
Symptoms, complaints and signs
An incipient scoliosis usually does not cause any symptoms. Often, it is not even noticeable at first. In other cases, a distinct curvature of the spine can be seen, but this is usually only a cosmetic problem. However, if the disease progresses untreated, a number of other symptoms may develop. In many affected individuals, the pathological curvature of the spine is obvious to other people. The shoulders are often at different heights. In addition, there is a characteristic crooked posture of the head. The pelvis of the affected person may also be crooked or protrude significantly on one side. As the disease progresses, a so-called rib hump develops on the back. This is particularly noticeable when the affected person bends forward. While affected children and adolescents usually do not yet experience pain, it becomes more frequent in patients from the third decade of life onwards. Painful tension of the back muscles occurs, especially after prolonged standing and sitting. The pain radiates to the sides. However, it can also affect the neck area or the shoulders. Many sufferers also have headaches. If a particularly pronounced curvature is not treated, symptoms can also occur that affect the internal organs such as the heart, lungs and digestive organs.
Course of the disease
A prognosis of how the disease process of scoliosis will proceed would be beneficial, especially in children and adolescents, in order to be able to intervene in time. Unfortunately, a prediction is not possible due to a lack of knowledge. Scoliosis worsens drastically in terms of progression especially when growth processes are intense. After the onset of menstruation, scoliosis stagnates in the vast majority of cases. In both girls and boys, aggravation of the symptoms of scoliosis no longer occurs due to the completed growth of the skeletal system. Nevertheless, the damage that has occurred up to this point remains. Only in some cases the scoliosis still worsens.
Complications
Scoliosis can result in various consequential damages. These occur mainly after many years of spinal curvature. The most common complications of scoliosis include premature wear and tear caused by the permanent misalignment of the spine.They mainly affect the vertebral bodies and intervertebral discs. As a result, affected individuals often suffer from back pain. In addition, there is a risk of a herniated disc. In addition, the spine can stiffen to an increasing degree. Furthermore, the knee and hip joints are often also affected by the spinal curvature. Another possible complication due to the crooked spine is the shortening of the trunk area. In severe cases, several internal organs decrease in size because of this. These are primarily the lungs, heart, stomach, intestines and kidneys, which lose their functionality. If the scoliosis is severe, it can lead to insufficiency of the right heart, which can be life-threatening. In adulthood, there is a risk that breathing will become increasingly difficult due to severe scoliosis. Thus, the chest can hardly be moved. Furthermore, the volume of the lungs decreases. On the curved side, there is a risk of overinflation of the lungs, which physicians refer to as emphysema. Because the other side of the lung is inadequately ventilated, there is a partial collapse of the lung tissue. As a result, further complications such as chronic bronchitis, pneumonia, or pleurisy (lung pleurisy) may occur.
When should you see a doctor?
Scoliosis is a clinical picture that exists individually in many different forms. Accordingly, the complaints that can lead patients to the doctor are also different. In general, a visit to the doctor makes sense when parents notice a postural abnormality in their children. Often they are also informed of this by teachers or sports instructors, or the scoliosis is already recognized by the pediatrician during the preventive medical checkups. It makes sense to see a doctor early on, as bone growth is not yet complete in children and adolescents, and in many cases a full-blown scoliosis can be prevented by muscle training. The right contact person is initially the family doctor or pediatrician. If necessary, he or she will refer the patient to an orthopedist. Sports therapists or physiotherapists often also help with early treatment. In addition, a visit to the doctor is always important when complaints arise. Back pain or tension are classic in this context, but digestive or respiratory problems can also occur due to the deformity of the spine. Scoliosis can also irritate nerves, which can radiate to different parts of the body and cause problems there. Scoliosis should also be presented to the doctor again if the picture worsens significantly or if gait irregularities and dizziness are added. In children and adolescents, regular monitoring of the clinical picture is important to see if measures to improve posture are successful.
Treatment and therapy
The forms of treatment for scoliosis are manifold and are based on various aspects. Basically, the focus of therapeutic measures is to favorably influence the further development of scoliosis. This mainly refers to an increasing curvature. Depending on the degree of severity, special therapeutic measures are implemented. If the scoliosis is curved up to 20°, physiotherapeutic exercises according to the so-called Lennert-Schroth principle are available. The maintenance of physiotherapeutic methods is necessary until the completion of growth. From a clearly visible curvature of the spine from 20°, the physiotherapeutic expenses are extended by a so-called corset treatment. Corset treatment for scoliosis means that the affected person must wear a specially made support corset. This corset is used to straighten and straighten the spine normally in scoliosis. While wearing the corset, radiological check-ups are performed at regular intervals. Scoliosis is considered severe when the curvature exceeds 40°. In addition to physiotherapeutic and physiotherapeutic exercises in combination with the 22-hour application of the corset, costly and complicated but often very successful surgical interventions represent an alternative therapy option. In most cases, scoliosis entails further complaints that require medical treatment, which can be carried out conservatively mainly in the context of pain management with medication.
Prevention
Basically, it can be assumed that the development of scoliosis cannot be counteracted prophylactically. The only way to be able to perceive scoliosis in time is to have a good perception of one’s own body and to consult a doctor for timely early detection and timely initiation of therapy, both by general practitioners and by specialized medical specialists and surgeons.
Follow-up
Scoliosis is a difficult-to-treat deformity of the back in which the spine may be curved in various directions. Whether there is an outright correction and thus cure of the condition is case-dependent. The aftercare depends on the possibilities and the possibly additionally causing basic disease. For the best possible maintenance of the results, it is essential to be regularly active in sports. Continuous back training and water gymnastics as well as appropriate functional training, for example in a fitness studio, are particularly suitable for improving and maintaining the results. The main focus here is on building up and maintaining the back muscles. A further follow-up point is regular visits to an orthopedist, who checks the progress and can repeatedly assess and evaluate the situation. The orthopedist can also issue appropriate prescriptions for functional training, rehabilitation measures or physiotherapy. What is best for the patient in each individual case and can be considered cannot be determined across the board and depends on the judgment of the specialist. However, it is important in the aftercare to maintain the achieved successes and improvements, here it is necessary to remain active and mobile to avoid muscle degradation and associated pain as best as possible.
What you can do yourself
After treatment by the specialist, the scoliosis patient can do a variety of exercises at home that can curb the further progression of the disease and improve general well-being despite the condition. Most of these exercises are aimed at strengthening the back and abdominal muscles and supporting the spine. The exercises are designed to help return to a natural postural pattern. Good progress can be made here, especially in mild cases of the disease. The basic goal of the exercises is to improve posture. One of the most basic exercises is the “Klapp’sche Krieche”. Here, patients “crawl” in a quadrupedal gait on their hands and knees or slide forward by extending their arms and pull the lower body forward. This exercise primarily strengthens the trunk muscles and makes the spine more flexible. The three-dimensional scoliosis exercise of the therapist Katharina Schroth is also used very often. Here, the patient stands in front of a mirror and corrects the incorrect posture by sight. The patient should consciously perceive and internalize the posture corrected in this way. The patient should also learn to identify and recognize incorrect postures in the mirror image. In this way, he can react in a controlled manner to his incorrect postures in everyday life and take corrective action. In addition to the above-mentioned scoliosis exercises, there are also various approaches of osteopathy as well as chiropractic.