“How did I get this crooked”?! Have you ever wondered this while looking in a mirror? Maybe you thought you were standing up straight but then notice from photos that you actually lean to one side. Your clothes don’t hang evenly. My mom now wears baggy shirts (stylish ones!) that don’t tuck in because “tighter shirts make me look crooked.” There are many reasons your physique may change with age. Degeneration, fractures, injury, inability to fully straighten a knee, for example, all contribute to uneven weight bearing through the spine.
What if you are young? You just started puberty and notice that you look uneven in a bathing suit. You didn’t have an injury, you don’t slump, you are just being you but can’t stand up straight. Your spine is shaped differently than that of your friends. Being aesthetically unique can be tough during this time in life when body image and self esteem are so fragile.
What does an ideal spine look like?
Textbooks describe ideal posture as a position where the gentle curves of the spine balance the head above the pelvis such that a line dropped from the ceiling would fall through the ear lobe, the tip of the shoulder, center of the hip and knee, and anterior to the ankle joint. From behind, the typical spine is straight. If the structure of your spine is bent or crooked you will not be able to achieve this ideal posture despite your efforts to “stand up straight”!
Scoliosis is a term used to describe an abnormally curved spine. It is not caused by poor postural habits but develops because of a misshapen vertebrae within the spine itself. This deformed vertebra will cause the spine to rotate and bend eventually reshaping the back to appear scoliotic. According to the National Scoliosis Foundation, over 4 million people in the United States have scoliosis and 30,000 surgeries are performed each year to correct this disorder.
Types of scoliosis
There are different types of scoliosis. Idiopathic scoliosis (IS) is a diagnosis given when one or more vertebrae become deformed during growth causing the spine to become curved. A few plausible theories on the etiology of IS can be found through The Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT). Theories point to a series of events that disrupt the process of vertebral growth and symmetry.
Functional scoliosis is another reason for a curved spine. A bend may develop due to leg length differences or significant musculoskeletal imbalance. This type of scoliosis often resolves with lifts, physical adjustments, or stretching.
Other causes of scoliosis mentioned above include significant degenerative changes, injury, fractures, and disease which all contribute to a crooked spine and perhaps the decision to wear baggy shirts. These causes are known and are not considered idiopathic.
For children or adolescents diagnosed with IS, the severity of the curve and the risk of progression will dictate the course of care. In general, the younger the child and the larger the curve (Cobb angle), the more aggressive the treatment. In some cases, a child will simply be monitored. For others, an intense regimen includes full time bracing and exercise. For a few, surgery is necessary.
If you are an adult with scoliosis, you may have had it during adolescence, or you developed a crooked spine for other reasons. Treatment for you will be more conservative. Goals for treatment include adapting lifestyle habits to slow progression, managing pain if present and reducing the curve through appropriate exercise. Scoliosis specific exercise can reduce both the pain and the deformity. Simply treating the symptoms is ineffective.
Scoliosis specific exercises
Scoliosis specific exercises are beneficial at any age. If the forces through your spine are uneven, the exercises you do should effectively address this imbalance. Imagine an S shaped spine from behind (there are many variations of curves according to the Rigo Classification System). The muscles in the concave part of the S will be shortened and weak, and the muscles in the convex portion of the S will be over stretched and weak. Learning how to open the collapsed (concave) areas and strengthen the muscles of your inner rib cage from this optimal posture is one emphasis of physiotherapeutic scoliosis specific exercises (PSSEs). Finding a practitioner in your area knowledgeable in PSSE will help you to better manage your scoliosis.
Below are suggestions for managing your curvy spine:
1) Continue to exercise! Just be smart about the sport you choose. Twisting and overly bending the spine may be contraindicated. Choose exercise that makes you feel good afterwards and promotes balance in body such as recreational swimming, pilates, and tai chi to name a few.
2) Notice if you tend to slump to one side when you sit, if you carry your bag on the same shoulder, or if you always lean on the same hip. These habits won’t cause scoliosis, but may contribute to strain if done repetitively over time. Do your best to stay centered in your daily activities.
3) Practice good body mechanics. If your activities require that you bend to the floor, do so with a straight spine. Bend your knees!
4) Finally, love your body. If you are unsure how to care for your unique spine, seek guidance. Special spines deserve special care!