Scoliosis
In all my years as a massage therapist, I have come across many clients that have scoliosis. Scoliosis often begins in childhood, even though it may not be diagnosed until later. It can be symptom free initially, so you may not even be aware your child is starting to have an abnormal curve in his/her back.
Scoliosis is a curvature in the bony spinal column. It can be C-shaped but is more often S-shaped, from side to side. I have sometimes even felt a third curve. It is amazing how our bodies compensate…when the back curves in a C, there will be another curve in the opposite direction to keep the head in the upright position. The large curve is considered the primary curve and the smaller curve the secondary curve – it happens as compensation. Rotation often occurs at the same time and you may hear it called roto-scoliosis. The spinal cord travels down the bony spine through holes in all the vertebrae. When the bones curve, they will also be curving the spinal cord, which is decreased when the vertebrae also rotate, lining up the holes, even when the bone is in an S-shape. This rotation is why you may notice that someone with a scoliosis will also have a side of their rib cage that is more prominent from behind (rib humping). Scoliosis has a huge affect on the body. The ribs on the concave or short side will be compressed; the muscles will shorten, there will be less lung volume on that side, and they can have pain from tightness. The convex or curved side will have muscles that are being stretched beyond their comfort and they will start to splint and spasm against the constant pull. My clients often have more pain on their convex side.
There is a mystery as to why a lot of people have scoliosis. In most cases it is idiopathic, meaning unknown cause. If someone has a condition of the nervous system like spina bifida, muscular dystrophy or cerebral palsy, they may have unilateral spasming or contracture, which can pull the body into a curve. If there is a structural short leg, then the pelvis will be tilted to the short leg side and over time the spine will curve to compensate for the unbalance pelvis. If there is any wedging of the vertebral bodies from trauma or congenital (from birth), the spine will curve towards the short side of the wedge. It could even be from a surgery when s/he is a baby that has affected how flexible the ribs and/or musculature of the thorax are when it is time to go through the large growth spurts.
There can be a large range of how people are affected – some present with a minor curve and few symptoms and some severely curved with a lot of symptoms. In fact, most of us will present with a curve at some point in our life due to muscle tightness and/or trauma, but many of these curves will change or disappear when the muscle tension or trauma heals. These are considered a type of functional scoliosis, which will disappear or change when the person sits or lies down. Up to a 10% curve is considered quite normal; it is when the curves get more pronounced and progressive that they become more of a problem. A structural scoliosis is one where the bones have changed in shape or the ligaments have permanently shortened/lengthened so the curve never decreases. This curve will continue to worsen as the child/teenager is growing, but often slows down its progress in adulthood. When that person becomes older and their muscles and ligaments weaken with age, there may be another progression where the curve begins to get larger again. It is a hard condition to treat because there is often no identified cause and as such nothing to target to change to decrease the curve.
There are some things; however, that you can keep in mind to manage a scoliosis. Pay attention to your child’s posture and appearance of their back as they are growing. Are the shoulders and hips even? Is there a twist to their upper torso? Is the bony ridge on their back curved and do the ribs look uneven from side to side? Listen for a regular complaint of back pain. While a lot of times there are no symptoms, some of the symptoms can be backache in either the upper or lower back, and a tired feeling in the spine after sitting or standing for a long period. This is a test you can do to check for scoliosis: get your child to stand in front of you, facing away, with tight fitting shirt or no shirt and have them bend forward curving their back. You will notice the ribs on one side higher than the other when they are bent forward. By being aware of how your child is growing, you can take them in to get medical attention sooner rather than later.
While there is no research to support my theory, I think another wise thing to do is to encourage our children to be balanced from side to side, so as they grow there won’t be any restrictions on one side that can pull them into a scoliosis. If they have any traumas or muscle shortening, which only occurred on one side of the back, then encourage them to stretch to even out the sides or get them into a massage therapist. If they are involved in a sport that uses one side of the body more than the other (swinging sports like tennis, baseball, hockey, golf, volleyball), then they need to strengthen the other side to match the sport strength. Be sure to stretch the muscles well that are involved in the sport. Be aware of how your child is wearing their backpacks. Often kids put the bag over one shoulder; as they get older their books get heavier, which places a repetitive uneven weight on the back. Finally, watch for any stride changes and possible leg length differences that will lead to a tilted pelvis. These can be dealt with by massage and physiotherapy and, if structural, then orthotics in their shoes.
In many cases, there is no medical intervention to scoliosis. If you are still growing, the MD may prescribe a back brace to prevent further curving. In severe cases, the surgeon can do an operation to put metal rods in the back to decrease the curve and stabilize the back. However, this will also have side effects of limiting movement of the spine and will have effects on the muscles of the back. From my experience with client’s that have the mild to moderate scoliosis, the best results have been when the client has a self-care routine. The self-care routine should include: daily stretching like yoga (with extra focus on opening up the shortened concave side/sections), some cardiovascular exercises to get the ribs moving and blood flowing to all the back muscles, strengthening (with extra focus to the weaker concave side/sections) and using hydrotherapy (ice and heat) to decrease the symptomatic pain/discomfort. Massage can be extremely beneficial for symptom relief. Initially, the client may need more frequent massage until the tissue is healthy and receptive to the self-care routine. Once the client maintains their routine then the massage can be less frequent as their body dictates.
Scoliosis may not be preventable in your child, but you may be able to lessen its impact on his/her life. Some children, unfortunately, will have scoliosis no matter what and it may progress to the point of needing surgery. But if you can catch it early in your child and encourage healthy habits early on, you may be able to slow down the progression and/or decrease some of the symptoms that can present with it.