Most people with scoliosis have more than one lateral curve in their spine. Each curve can be classified as either structural also called primary or major or nonstructural usually called compensatory, though also called secondary or minor. They exhibit some degree of permanent curvature because the curve is rigid. They also tend to be the largest curves. To keep the spine as balanced from side-to-side as possible, other sections of the spine may develop a curve in the opposite direction to the structural deformity.
An individual with a right-bending thoracic curve, for example, may have three curves—a structural curve in the thoracic area, and two compensatory curves, one each in the cervical or upper thoracic area and one in the lumbar region. Most surgeons will only operate on the structural curve because the compensatory curves will generally spontaneously realign once the structural curve is reduced.
Surgically correcting only the structural section of a curve is called a selective fusion. Note that flexible, nonstructural curves can become progressively more rigid as you age. It is thus possible for a flexible compensatory curve to become a rigid structural curve over time, though this curve would still be considered secondary to the primary curve. It is also possible for a primary curve to be nonstructural, if the scoliosis is caused by a neuromuscular disorder, for example.
Location and convexity of the curve. It is helpful to be familiar with three terms commonly used to describe curves: convex, concave, and apex. The convex side of the curve is the outer angle; the concave side is the inner angle. The apex of the curve is the most deviated, or off-center, vertebra. If you consider the curve like a mountain, the apex is the peak. You need to make sure your concave exercises are not also firing your convex muscles. It could take months, or years, depending on how much your discrepancy is.
Thank you! Do I have to make sure my convex side is fully calmed down before I can work on shortening the convex? When will your team offer virtual scoli mat classes again? Will there be one later this month or next?
I feel as if my neck is being pulled toward the right side and also my head rotating To the right side. Is there any way I can reverse this condition or at least fix the balance in my body? And also can u enlighten me what is going on with my body? I also have loss of lordosis on the upper cervical spine and minimal diffuse bulging in c4-c5 and c5-c6 thanks. Technically scoliosis is diagnosed as a lateral bend of the spine of 10 degrees or more.
It is truly almost straight, and depending the time of day that the X-ray was taken, it might be less than 10 degrees. I would look to your jaw and mouth as the possible culprit of this. See if you can find a manual therapist to do inter-mouth release work. Check out the free Starting Point videos on this site on how to start your search for one in your town. I also put up a video of me having this work done on instagram within the last few months so you can see what it looks like.
Great job being proactive. Hi Clarissa, A scoliometer cannot diagnose scoliosis. A 1 degree rotation could simply be from unilateral muscle imbalance right to left. That being said, a few degrees of rotation could be an indication that you need to get an X-ray to see if a scoliosis diagnosis is there.
I have mild lower thoracic scoliosis. Convexity to right side. Kindly guide me whether i have to strengthen left side; the side of concavity or stretch? Hi Fatima, Good question. You need to both stretch and strengthen in an elongated state the left thoracic concave part of your curve. I want to change my brace been using it for 4yrs and months now so I want to know which I can change too.
The person I look to as the gold standard for scoli bracing is Dr. Moramarco in Boston, MA. He makes the Cheneaux Ginsingen brace. Feel free to look him up and call his clinic. I am a 52 year old woman with mild s curve scoliosis, I have a leg discrepancy of half cm , been given a left heel raise by physio, but am really frightened, its cause me to curve more , I have left throsic curve , plz help I am so frightened. Hi Johanna, The purpose of the feeling fear is to help us prepare and plan—when passively left unchecked it turns to anxiety and being overwhelmed.
It sounds like I need to help you get proactive and make a plan so you feel empowered. Your body is worth it. Thank you for reaching out. First off, if you feel the lift is making you curve more, then absolutely take it out.
With almost all scoli cases, there are lots of things going on, and it sounds like that might be the case with you. Is this the best type of padding for stomach and back exercises? One side is thicker if that makes sense. Heavens, sometimes I just use a pair of rolled up socks. I have a free video on padding in the Starting Point Series videos and also talk about padding a lot in my book Analyzing Scoliosis.
Great job asking this question and working on your scoli. My curve is right side lumbar concave 48 degrees and the upper curve is about I have severe hip pain on my right side that sometimes has me screaming and can barely walk.
I have been to several doctors and so far the only thing that has helped was a steroid shot in my hip. What exercises can I do to help? The shot lasted about a year. Should I just go get another? We have many, many clients at Spiral Spine that have curve patterns just like yours that like you have hip pain.
My staff and I would love to work with you virtually, to help you figure out your scoli, start to untwist everything, and start you on the path to pain management for your scoliosis. I have exercises for lumbar scoli in my book Analyzing Scoliosis available on amazon , but having a few virtual lessons with either me or my staff would also be a great option.
Feel free to reach out to us about virtual lesson through the contact page of this site. Hi Erin, can you explain the relationship between degrees of rotation with a scoliometer and the Cobb angle?
I read that with a 20 degree curve, you can often expect 7 degrees of rotation, but not necessarily — that in some cases, a more severe curve might have less rotation, whereas a mild curve might actually have severe rotation? The information available on this is confusing to read about, so wanted to ask you. The Cobb Angle measurement from X-ray and Axial Vertebral Rotation measurement from scoliometer are positively correlated. Vice versa, as one number goes down, so down the other. The particular numbers vary from person to person, but as a pair of measurements, they go up and down together.
I even show a real life client example in the blog post. I hope this helps make sense of this. First off, thank you for all the helpful information you post on your website! My biggest curve is in the left thoracic area where that shoulder blade is. Is this common for people with scoliosis in the thoracic area — to have a shoulder blade in that area not move much, and a rib seeming to be out of place?
This is the case for my scoliosis too. Different forms of massage therapy have been really beneficial for me and many of my clients with similar curve patterns. Great job being a detective with your scoli.
Hi Erin, I have been very proactive with my scoli this past year, including regular schroth PT. My x ray prior to starting schroth showed a 24 degree thoracic curve and a 26 degree lumbar curve from May My pain levels have improved, so I am confused as to why my curve appears to have progressed.
Thank you in advance. Hi Barbara, First off, great job being proactive about your scoli. It might be time to add in a new tool to your tool kit. Sometimes you need a hammer, sometimes a screwdriver, and sometimes a chisel. Also, check this link out. We work with people all over the world on a regular basis. Hello, I AM right now suffering through a great Amount of pain because of scoliosis.
The pain radiates from neck to my scapula, even in whole right arm.. But my question is if u have bend towards left why I am feeling pain on right side..
Which nerves are really getting affected.. Why I am in so much pain. Can you please help me by answering this question. Should I try leaning more to the left side while standing, sitting and sleeping to try to even out my spine? Will that correct it from my spine going to the right so much or should I put even weight on both feet?
Thank you. Hi Amanda, It is always a great choice to have your weight evenly distributed on your feet and to stack your ribcage on top of your pelvis.
Without setting your body, I would have a hard time giving you exercises to strengthen your body into more of a straight line. It would be interesting to find out the root of your ribcage shift. You can email us through the contact page of this site for more info. You can watch the free Starting Point videos on this site to learn how to do that. Good job on wanting to be proactive with your body.
For those with thoracic scoli due to a syrinx in the spine from syringomyelia and Chiari , is there anything special we need to keep in mind? Keep moving and loving on your spine. I have left thoracic, right lumbar scoliosis, with my larger curve being in the left thoracic area degrees depending on the x ray for thoracic, 24 in the lumbar area. My pain is only on my left convex side, especially in the neck area. However — nothing I do seems to really help with the neck pain on my left convex side.
ANy ideas or general comments? Hi Anne, First off, I have to let you know how proud I am of you for being proactive with your scoli. My neck is what causes me to most trouble with my scoli. Try finding a manual therapist who has years of experience with neck and inner mouth work you may have to search for a bit to find a person like this. Often times that will start to release the muscles that are holding your jaw and neck in the scoli position.
This has been a lifesaver for me. Give this a try and keep me posted. Blessings, Erin Myers. Thank you for the info! I will keep you posted on the Intra-oral massage. Have you heard of something like that helping With the neck pain? Hi Anne, Absolutely there are strengthening exercises you can do to help alleviate neck pain. With scoli, strengthening can be a big tricky at times.
If you feel good, then add another exercise. Think of it like a science experiment by not adding too many variables at once. Keep experimenting to get out of pain. Thank you so much! That makes sense to try things out and see what sits well with my body. Fingers crossed it helps!
Thank you again. Hi my scoliosis is getting worse. Are u able to look at my back and give me some tips please?
My right side is more dominant. Hi Zerah, My staff or I would love to work with you virtually. We work with people all over the world on a weekly basis. They can absolutely give you exercises and stretches to help with your scoli. Check this link out to learn more about virtual lessons.
Hi Erin — is a hypermobile neck common with scoliosis? How do you know if you have a hyper mobile neck? The neck is rarely a issue alone, but is oftentimes connected to the thoracic spine or jaw. Check those other areas out. Hi Nishu, You have the same scoliosis as me. Your upper right and lower left are overworked and can be released when they are in pain with a small hard ball.
They on the ball on the floor and put the ball right under the tight muscle and breathe until it releases a bit. Your upper left and lower right need to be lengthened and strengthened. I have exercises specifically to target these areas in my latest book Analyzing Scoliosis available on amazon with pictures and easy to follow descriptions.
Way to go on being proactive with your scoli. Hi — My largest curve is my upper right thoracic. Lately, even if I stretch my arms overhead like a regular good morning stretch , my convex area of the right thoracic curve goes in spasm and pretty bad pain.
It sounds like you need some knowledge on how to release it, how to realign your spine, and some good exercises to start the derogation process of your scoli. A virtual lesson with me or one of my staff would be great to work with. Is this common With your scoliosis patients? Can it ever get better? Yes, this can improve but you need to start to strengthen the other side. Info on all this is on spiralspine.
Your body can improve, yes. Hi Annie, Yep, myofascial adhesions are a really good guess. Unlock that tissue and keep being proactive for your spine. HiI have a couple other questions!
I have done schroth and have pads and know where they go on my body. Im doing mat Pilates. Is it appropriate to pad yourself for all Pilates moves? Thanks a bunch and merry Christmas! Great question about the bilateral work. I would love to talk to you about my scoliosis! I have significant pain only in my right side. Im 24 and I started having pain almost right after high school ended. I currently practice yoga and weight training. I also see a chiropractor about every month which seems to help.
I kind of just do whatever I feel that my body needs in the gym. I focus on a lot of core and back exercises. I work both sides of my body evenly. Can I send you my x ray? Or set up an online consultation. You could also come to a 2-day Scoliosis Intensive workshop at Spiral Spine Pilates in Nashville, where you can work with me and my staff for two days and get tons of at-home exercises. I think mine increased 7 degrees based on x Ray post pregnancy, which I requested due to bad neck and back pain on convex side.
While my previous x Ray prior to pregnancy was 4 years old, my curve had stayed the same for over a decade without much pain. Hi Liana, Yes, absolutely pregnancy can alter scoli.
It went almost straight during my first pregnancy and wound up like a cork screw during my second. Scoli often reacts to hormone changes. I have many, many resources on this website that can help you. If you want more assistance my staff or I would be happy to do a virtual lesson with you. Great job putting the pieces together for your scoliosis. Thank you so much for the info, will def reach out to your team!
Im considering no baby 2 because I think my scoli worsened with my first pregnancy. Plus ligament laxity. Liana, From the bottom of my heart I would say yes, have another child. Seven degrees is a small increase, and it could have increased from your body being tired and you sinking into your scoli from breastfeeding and carrying around your child. I absolutely think you can improve your curve and quality of life, and have a second child.
I look forward to working with you. IS yoga something that someone with scoliosis needs to be wary of? I find my muscles are more relaxed after yoga, but worry I am doing longer term damage by twisting and bending into the curve with some poses.
Rods, screws or other implants may be used to hold the spine in alignment during this period. Once the fusion is complete, these implants no longer serve a function but are left in place to avoid the need for additional surgery. Figures Pre-op images of an adult with thoracic scoliosis.
Figures The same patient after posterior fusion and instrumentation. Depending on the nature of the curve and its location, the orthopedist may need to perform a fusion from both the front and the back of the body, a procedure that may be done as a single operation or in stages. Figures Pre-op images of an adult with lumbar scoliosis.
Adults with very large and rigid curves may also require osteotomies, in which stiff segments of the facet joints are released. Some patients with lumbar and thoracolumbar curves may be candidates for thoracoscopic or lateral assess surgery, in which incisions are made from the side of the torso or flank. As with the posterior and anterior approaches, instrumentation corrects the curve and the rotation of the spine. Adults with scoliosis and spinal stenosis often also require a decompression procedure in which the roof of the vertebral column is removed at the affected area, freeing the nerve from any material that is compressing it, prior to fusion.
Whenever surgery is considered, the orthopedic surgeon reviews the risks and benefits with the patient, taking into account the person's age and medical history. The presence of other conditions can pose additional surgical challenges, including:. Surgical patients are given antibiotics to help guard against infection, and their sensory and motor function is monitored throughout surgery to detect any changes in spinal code integrity during spinal manipulation and curve correction. In appropriately selected and prepared patients, good outcomes from surgery are achieved, according to Dr.
Following surgery, most patients remain in the hospital for three to seven days — or slightly longer for those who undergo combined anterior and posterior front and back surgery. They are usually back on their feet the first day walking with the physical therapists in the hospital.
Pain medication is continued as needed. As recovery progresses, patients are advised to limit their activities to walking and to avoid bending and heavy lifting for the first four weeks. By adhering to these guidelines and with the help of physical therapy, the patient should be able to resume normal activities at home by about four to six weeks. Those with desk jobs may return to work. Adults may take a year or longer to achieve full functional recovery, according to Han Jo Kim, MD, Spine Fellowship Director and Fellowship Committee Chair, and it is rare for adults to require pain medication for ongoing discomfort.
Patients should be aware that spinal fusion does result in some loss in range of motion; however, the degree varies depending on the site and length of the fusion. If the treatment is primarily in the thoracic spine, normal mobility is achieved after the healing process is completed.
If the lumbar spine is the site of treatment, sideways movement will be more restricted, although the patient will still be able to bend forward from the hips.
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