Scoliosis: Part 1 of 2. Functional Scoliosis.
Scoliosis is a term used to describe a curvature of the spine. This two part series on scoliosis will discuss scoliosis, diagnosis, and treatment at the request of several readers. Scoliosis screening is very important for early intervention and prevention of long term and irreversible problems.
The spine has three regions: the neck, the upper back, and the lower back. Each region normally curves in a particular direction. The neck and lower back curve inward (lordosis). The upper back curves outward (kyphosis). However, with scoliosis, the spine curves abnormally in a sideways direction greater than 10 degrees. This lateral flexion of the spine is also combined with a twisting or rotation of the vertebrae. Scoliosis can affect any of the three spinal regions and any age group.
There are a number of anatomic changes that occur with scoliosis. The sideways curve of the vertebrae produces a concavity (inward curve) on one side of the spine and a convexity (outward curve) on the opposite side. On the concave side of the curve, the ribs approximate, the intervertebral discs are compressed, disc spaces are narrowed, and the trunk muscles are shortened. On the convex side of the curve, the opposite occurs. The twisting of the vertebrae that accompanies the sidebending causes the ribs to deviate. On the concave side, the front ribs are pushed forward and on the convex side, the back ribs are pushed backward. This is responsible for the characteristic rib “hump” on one side of the back. With scoliosis there may be two curves present: one major curve which is usually considered “structural” (i.e. permanent changes in the shape of the bone and/or tone of the muscles) and one minor curve which is a compensatory curve to balance the trunk and allow it to be upright.
In the literature there are two types of scoliosis: functional and structural. A functional scoliosis is not produced by abnormal bone development or muscle tone. The causes are varied and may include:
1. Nerve root irritation (sciatica).
2. Muscle spasm due to spinal injury.
3. Poor posture.
4. Highly repetitive, asymmetric activities related to hand dominance.
5. Leg length discrepancy caused by a true shortening of the limb or compensatory secondary to faulty lower limb alignment.
A functional scoliosis is easily corrected once the cause is determined. Once nerve root irritation and muscle spasm dissipate, the scoliosis will resolve. Poor posture, hand dominance, and leg length discrepancies can lead to muscle imbalances (certain muscles shorten and others lengthen) resulting in a functional scoliosis. Be aware of poor postural habits! If a particular posture is assumed in a variety of positions throughout the day (sitting, standing, laying), you are prone to develop muscle imbalances that may lead to scoliosis. Hand dominance causes an individual to frequently assume certain postures and positions throughout the day. When sitting, there will be more weight on one hip than the other. This individual will lie on one side more often in order to allow use of the dominant hand to turn the pages of a book or to write. Also, objects will be carried on one side more than on the other. An individual with a leg length discrepancy will stand with body weight shifted onto one leg or will stand with one knee bent. If not addressed, a functional scoliosis may produce abnormal permanent changes in the bones and muscles.
Treatment for a functional scoliosis includes exercise to stretch the short muscles and to strengthen the long muscles. This will usually correct the muscle imbalances to prevent further exaggeration of the curve. Exercises are carefully selected on the basis of a thorough examination. Adequate instruction ensures precise performance. Researchers advocate educational programs in public schools for postural awareness due to the high incidence of poor postural habits. Additional supports in the form of orthotics for flat feet and heel lifts for leg length discrepancies can be used to assist in the treatment of scoliosis. The combination of the correct exercises, precise performance, and education on avoiding habitual positions, postures, and activities that may accentuate the curve should remedy the functional scoliosis.
Over the next two weeks, two common types of structural scoliosis will be discussed.
Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, and exercise regularly
Contributor: Janet Caputo, PT, DPT, OCS is clinical director at Mackarey & Mackarey Physical Therapy Consultants, LLC. in downtown Scranton where she specializes in orthopedic and neurological rehab.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune entitled “Scoliosis - Part 2”
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.
