Lumbar scoliosis is the abnormal lateral curvature of the spine, seen in the frontal/coronal plane. This anatomical plane devices the body in a front and back half. Scoliosis is a malalignment of the spine seen from the front or back. The curvatures of the spine seen from your side profile are normal and necessary for shock absorption, like when you land from a jump. Lumbar scoliosis treatment options include physiotherapy. Mild scoliosis can be corrected with rehabilitation and manual therapy if diagnosed early enough and addressed in childhood. Lower back curvatures affect 6 – 9 million people in the US, with onset between the ages of 10 – 15 years, equally amongst boys and girls. Girls are 8 times more likely to need lumbar scoliosis treatment.

Your spine is the scaffolding of your back. The vertebrae are stacked on each other. You have 24 vertebrae, from your neck down to your tailbone. The vertebral bodies have discs in between them, which are like shock absorbers. The rest of the vertebrae’s structure, the lamina, transverse and spinous processes, fit together snugly, like lego pieces stacked on top of each other to create a tower. These “snug fits” are the facet joints or zygapophyseal joints. You have one on each side of a vertebra, where the one on the top slides on the one below. This forms four facet joints per vertebra or 12 articulations. Ligaments connect the different vertebrae together and provide extra static stability. Between each vertebra, a nerve root exits on each side, branching out to connect to other nerves.

Your back muscles provide dynamic stability and allow movement in all three planes.

• Extensor muscles make it possible for you to straighten up and lift objects.
• Flexor muscles allow you to bend forward and reach your toes.
• Lateral flexor and rotator muscles rotate your spine and bend sideways to lift and load luggage.

Your spine is like scaffolding. The vertebrae provide structural stability, protection for your nerves, attachment for muscles and a leverage system for movement. Like for any building you want equal weight and force distribution, right? This ensures the safety and longevity of the structure. This enables all the team members to play their roles and share the work. When your wheel alignment is out you will get more wear and tear on a specific surface of your tyres. The same is true for your spine. If you are tilted and rotated towards one side, it automatically causes more weight and force transmission on that side.

With a curved lower back you have unequal load distribution through your spine. This malalignment causes more wear and tear on certain segments, depending on the angle and rotation of your lumbar curvature. Early degeneration of the vertebral bodies, facet joint arthrosis, disc space narrowing or osteophyte formation increases your risk of experiencing back pain from these structures. Spinal stenosis, disc herniation and nerve root compression can develop because of neglect of your spinal curvature.

Mild spinal curvatures can cause frequent back muscle spasm symptoms. The longer the lever over which the muscle has to contract is altered the higher the risk of permanent change in the muscle physiology. This can lead to an inability to contract, delayed contraction, increased tone and weakness.

Severely neglected curvatures can cause cardiac and pulmonary complications because of changing the pressure system balance between the abdomen and thoracic cavities.

Even though we define and measure scoliosis in the frontal plane, the effects of malalignment will be felt in all three dimensions.

Scoliosis is diagnosed by measuring the Cobb angle on PA X-rays. This method was invented by Dr John Cobb in 1948. It is calculated by measuring the angle/angles between the upper and lower vertebra of the structural curve. Where the lines perpendicular the to curve intersect the angle is determined. This angle can diagnose and track the regression of your curve and determine treatment options and outcomes.

• 10 – 20 degrees is mild scoliosis
• 20 – 40 degrees is moderate scoliosis where a brace is recommended
• 40 – 50 degrees or more is severe scoliosis where surgical fusion recommended

The Raimondi method is used to determine the vertebral rotational on the same PA X-rays. These calculations can be made by your Orthopod or Radiologist.

This combination of side bending and rotation malalignment can cause a C or S curve scoliosis.

• Idiopathic Scoliosis

80% of all scoliosis cases are defined as idiopathic or spontaneous, without obvious reason. Read on to acquired scoliosis; it may not seem as spontaneous as we thought.

• Congenital Scoliosis

Newborns may be born with a spinal curvature due to embryological malformation in utero. This can also happen if the baby doesn’t have enough space to move and grow, like with multiple pregnancies.

• Degenerative Scoliosis

Normal, age-related changes of the spine, spondylosis, increases the risk of developing scoliosis for people above the age of 60 years.

• Infantile Scoliosis

Babies to a year of age may outgrow spinal curvatures. They may develop scoliosis because of developmental delays.

• Juvenile Scoliosis

Children from the age of 1 – 10 years may develop scoliosis because of developmental delays, lack of movement or diseases like muscular dystrophy. This is the opportune age to delay or change mild curvature caused by scoliosis, as your child’s body is still developing.

• Adolescent Scoliosis

From age 11 – 19 years you are more aware of the differences between your own and your friends’ bodies. You may notice a difference in alignment, now that you understand the possible consequences of not addressing your spinal curvature you are motivated to exercise and delay the worsening of your lower back curvature.

• Acquired Scoliosis

Certain diseases, like spina bifida, muscular dystrophy and cerebral palsy or spinal cord injuries can cause spinal malalignment that can lead to scoliosis. Surgical procedures, like pleurectomy or lobectomy or kidney donation or transplant, can cause scoliosis due to adaptive behaviour due to pain. Neglected rib fractures can cause scoliosis too.

Scoliosis curvatures are defined as S or C curves depending on the shape and direction of the curve. The Cobb angle measurement determines the severity and treatment options to explore.

• 10 – 20 degrees as mild needing only exercise therapy,
• 20 – 40 degrees as moderate and the use of a brace is recommended in combination with rehabilitation,
• 40 – 50 degrees or more as severe and spinal fusion surgery is recommended to maintain ribcage mobility for lung and heart function.

With mild scoliosis, you may never need a formal Cobb angle diagnosis. Your diagnosis may be clinical (only with physical testing) when you experienced mild, intermittent symptoms of back pain. If you don’t address the alignment issues you may experience frequent bursts of the exact same symptoms on a regular basis.

Moderate scoliosis is visible to the untrained eye, where a hip or shoulder height difference is usually the giveaway. Now it is better to get a formal measurement of your curvature to monitor your scoliosis. You probably sought medical care because of chronic symptoms, including pain, loss of movement and even fear of injury.

Severe curvatures are seen in neglected cases, where medical care isn’t available, the patient or family didn’t have access to information and treatment options or in cases where the progression was very fast an underlying bone or other systemic disease may have caused the curvature to progress rapidly. Heart and lung function can be limited because of the severity and space constraints with these cases.

We understand structural integrity and how this translates to functionality. Our physiotherapists are experts in anatomy and have clinical experience and expertise to test and identify the cause of your symptoms. We understand the implications of your problem and can offer you guidance and structure for your recovery.

By knowing what is causing your pain you can be proactive in your decisions. Getting the right diagnosis is crucial to avoid premature degeneration of specific spinal segments due to your curvature.

We will also test other structures like discs, nerves and muscles in the area, to ensure a comprehensive diagnosis. That’s why our physiotherapists are the best at diagnosing lumbar scoliosis. Even though your primary diagnosis is something completely different, we’ll identify the priority and hierarchy that needs to be treated.

An X-ray viewing the entire spine front to back (AP) is necessary to determine the Cobb angle. These are special order views that your GP, orthopod or physiotherapist can refer you for. If you get regular check-up views on a yearly basis and experience acute onset pain in a specific area of your back lateral and stress views of only that segment can be used to confirm or exclude instability, facet joint arthrosis, stenosis or space-occupying osteophytes.

Diagnostic ultrasound is used to diagnose soft tissue injuries, like muscle tears or ligament sprains, and is not indicated for scoliosis diagnosis.

An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves and bones. If your physiotherapist suspects specific pathology due to your scoliosis curvature, you will be referred to the right specialist to order this image.

Symptoms like pain, stiffness, not trusting your back and fear of injury are common among people with lumbar curvature. But this thought pattern and avoidance of movement and exercise are more harmful in the long run. Deconditioning, where your body loses physical function, happens quicker than you anticipate. If you don’t use it, or in this case move it, you’ll lose it. This increases the risk of getting stuck in a cycle of pain where the lightest load, like carrying groceries may cause symptoms, leading to even less functional capability if you avoid this in future too.

Rehabilitation focuses on distributing the load more evenly and preventing early degeneration of joint surfaces and disc space narrowing. If neglected you risk accelerated change causing irreversible damage. 

Scoliosis is a structural change in the alignment of your spine, it cannot resolve spontaneously. You need a knowledgeable, professional team in your corner to prevent the worsening of your curvature through collaborative goal setting. Patience and perseverance is the only option.

Patients only pay attention to their symptoms when they are in pain or unable to perform specific movements. Pain isn’t a measure of your curvature. You need to train extra hard when your back feels great, as this is the time when the most gains will be achieved. Gains mean improving your stability, strength and endurance. This will automatically increase your freedom of movement.

Medication, braces and rest will not solve your problem, only hard work can make a change or delay the worsening of your curvature. Medication masks the symptoms, braces are only suitable for specific Cobb angle measurements and ages and prolonged rest with complete inactivity will decrease muscle tone and endurance, increasing your risk to develop pain.

Our physiotherapists have years of experience in recognising symptom patterns. We know anatomy and understand how biomechanics influence local structures but also the repercussions certain movements can have on other structures further away. Our aim is to help you understand your problem and empower you to prevent this from happening again in the future.

We pride ourselves in our work and offer the best treatment for scoliosis by providing guidance and answers and implementing an effective and structured plan of action. Movement is medicine, we want you to feel confident in the dosage you take. We will also look at muscle strength, joint range of motion, flexibility, ligament stability & nerve control.

If you come to us with symptoms of pain, we aim to identify the structure causing your symptoms and treat the issue. We know that lumbar scoliosis will influence your biomechanics in general. To decrease the risk of recurrence we want to avoid your curvature from worsening. With supple, developing bodies of children aged 8 – 15 years, we have a greater probability of lessening the curvature. The older you are when starting your rehabilitation program the less likely that we will change the angle of your curve, but we can delay it from worsening.

How often you need to come in for treatment will depend on what structures are causing your symptoms. We will probably need to treat your symptoms twice a week in the acute phase and then decrease your sessions to once per month. How fast you recover will greatly be up to you.

• Your doctor (GP) will probably prescribe oral analgesics or anti-inflammatories to relieve your symptoms. These medications should be taken with caution as they will decrease symptoms but not address the cause of your pain.
• Occupational therapists can take you through a back care program to educate you on ergonomics for work or school.
• Getting your back or neck ‘aligned’ or ‘clicked’ in the hopes of improving the pain will not fix your curvature. It could even worsen or trigger a muscle spasm. You need to look at the bigger picture.
• A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.

Surgery to treat lumbar scoliosis is only considered for curvatures with a Cobb angle measuring more than 40 degrees. A lumbar fusion is done to correct the curvature and align the spine by placing rods and screws along the vertebrae. This intervention is only the halfway mark, extensive rehabilitation is required to ensure a successful outcome.

All patients are unique and every surgery will be different, depending on your curvature and the extent of the fusion you may need to use a brace for 6 weeks after the procedure, avoid sitting for prolonged periods of time and mostly keep a regular maintenance training program. Surgery alone will not fix your problem.

• Lumbar disc herniation

Discogenic lower back pain with nerve root impingement is intense, acute pain that radiates down one leg. A lumbar disc herniation can also cause pins & needles, numbness and weakness.

• Lower back muscle spasm

Muscle pain causes limited movement and is mainly felt after doing something that you are unaccustomed to.

• Spondylosis

This refers to the general age-related changes the vertebrae in the spine are subjected to. It is felt like a general limitation and aching, worse in the mornings and better on gentle movement.

• Spondylolisthesis

This instability of the spine due to a fracture of the pars interarticularis causes short bursts of intense pain on specific movements.

• Leg length discrepancy

Difference in leg length of greater than 2 cm should be corrected with orthotics. Standing on a book with your shorter leg will even our your hip height if you have a leg length discrepancy.

• Curvature of the spine
• Lumbar scoliosis
• Mild scoliosis
• Lower back curve
• Postural deformity