Scoliosis: Causes, Types, Symptoms, and the Role of Physiotherapy

What Is Scoliosis?

Scoliosis is defined as a lateral curvature of the spine greater than 10 degrees, typically measured using the Cobb angle on an X-ray. The condition may be mild, moderate, or severe depending on the degree of curvature and its progression.

Scoliosis is not only a side-to-side curvature; it often involves vertebral rotation, which may cause rib prominence and visible postural asymmetry.

Types of Scoliosis 

Scoliosis is classified into three types based on cause, age of onset, and underlying pathology. Proper classification helps in planning, monitoring and management strategies.

1. Idiopathic Scoliosis

The word "scoliosis" means "of unknown origin."  It is the most common type of scoliosis, in which the spine curves to a sideways or S shape without any known cause. It is most common in children and teenagers. Girls are more affected than boys.

affected age group;

It usually appears between the ages of 10 and 18.

Further subdivision

a. Infantile Idiopathic Scoliosis (0-3 years)

• Occurs from birth to 3 years of age

• More common in males

• Some cases may resolve spontaneously, while others require close observation

b. Juvenile Idiopathic Scoliosis (4-10 years)

• It develops between 4 and 10 years of age

• Higher risk of progression compared to the infantile type

• Regular follow-up is essential due to continued growth

c. Adolescent Idiopathic Scoliosis (11-18 years)

• Appears between 11 and 18 years of age

• Most frequently diagnosed form

• Curve progression is more likely during growth spurts

Genetic and hormonal factors are believed to contribute to idiopathic scoliosis.

2. Congenital Scoliosis

This type of scoliosis is rare. It is present at birth and results from abnormal vertebral development during fetal life.

Common abnormalities include:

• Hemivertebra (incomplete vertebral formation)

• Failure of vertebral segmentation

This type often progresses as the child grows and may be associated with other congenital conditions. Early diagnosis and long-term monitoring are essential.

3. Neuromuscular Scoliosis

Neuromuscular scoliosis develops due to muscle weakness or neurological disorders that affect spinal stability.

Common associated conditions include:

• Cerebral palsy

• Muscular dystrophy

• Spinal cord injury

• Spina bifida

This type of scoliosis often progresses rapidly and may significantly affect the posture and functional ability.

4. Degenerative (Adult-Onset) Scoliosis

Degenerative scoliosis occurs in adults, usually after the age of 40, due to age-related spinal changes such as:

• Intervertebral disc degeneration

• Facet joint arthritis

• Osteoporosis

It commonly presents with back pain, stiffness, and sometimes nerve compression symptoms.

5. Functional (Non-Structural) Scoliosis

Functional scoliosis is a temporary curvature caused by external factors rather than structural spinal changes.

Possible causes include:

• Leg length discrepancy

• Muscle spasm

• Postural imbalance

Correction of the underlying cause may lead to improvement in spinal alignment.

Causes and Risk Factors

Although the exact cause of idiopathic scoliosis is unknown, several factors are associated with its development:

• Genetic predisposition

• Rapid growth during adolescence

• Neuromuscular disorders

• Congenital spinal abnormalities

• Degenerative spinal changes

Poor posture alone does not cause scoliosis but may contribute to discomfort.

Signs and Symptoms

Common signs and symptoms include:

• Uneven shoulders or hips

• Constant leaning to one side

• Prominent shoulder blade

• Visible spinal curvature

• Rib hump during forward bending

• Back pain (more common in adults)

• Fatigue with prolonged standing

• Height loss

• Uneven alignment of pelvis

In severe cases, respiratory function may be affected.

Diagnosis

Diagnosis typically involves:

• Physical examination (including Adam’s forward bend test)

• Radiographic evaluation to measure Cobb angle

• Regular monitoring to assess progression

Early detection plays a key role in effective management.

Role of Physiotherapy in Scoliosis

Physiotherapy is an important conservative management approach, particularly in mild to moderate cases.

Goals of Physiotherapy

• Improve postural alignment

• Enhance core stability

• Reduce pain and discomfort

• Improve breathing mechanics

• Support functional independence

Physiotherapy Interventions

• Postural education and correction

• Scoliosis-specific exercises under professional supervision

• Strengthening and flexibility exercises

• Breathing and chest mobility exercises

• Functional activity training

Physiotherapy does not cure scoliosis but may help improve function and quality of life.

Other Management Options

Depending on curve severity and progression:

• Observation for mild, stable curves

• Bracing for growing adolescents with progressive curves

• Surgical intervention for severe deformities

Management decisions are individualized and guided by healthcare professionals.

Living with Scoliosis

Many individuals with scoliosis live active and productive lives. Regular follow-up, appropriate guidance, and adherence to recommended management strategies are essential for long-term spinal health.

Conclusion

Scoliosis is a complex spinal condition that requires proper assessment and individualized care. Physiotherapy plays a valuable role in improving posture, reducing discomfort, and enhancing functional ability. Early diagnosis and professional management are key to achieving positive outcomes.

Medical Disclaimer

This article is for educational purposes only and does not replace professional medical advice. Always consult a qualified physiotherapist or healthcare provider for diagnosis and treatment.