1. What is Scoliosis?
Scoliosis can be defined as the condition where the spine is curved or twisted abnormally. When viewed from the side, the spine should ideally show a mild roundedness in the upper portion of the back and a degree of inward curving in the lower back. In case of a normal spine, it appears to be straight when viewed from the front or the back. In the case of a person with scoliosis, the spine appears to be curved when viewed from front or back.
Some curvature in the spine is normal. But a few people have spines that make a large curve from side to side in the shape of the alphabet "S" or the alphabet "C." If this curve is severe, it can cause pain and make breathing difficult.
2. Types and Causes of Scoliosis
Scoliosis usually starts in childhood, but it can affect children and adolescents of all ages and races. There are several types of scoliosis; in most cases, the cause is unknown. Scoliosis that is severe enough to need treatment is most common in girls than in boys (ratio of 7:1). In Singapore, the occurrence of adolescent idiopathic scoliosis in schoolgirls is 1.4% at 11 – 12 years of age and 2.2% at 13 - 14 years of age.
2.1 Idiopathic Scoliosis
The most common type of scoliosis—adolescent idiopathic scoliosis—has no specific identifiable cause. There are several theories, but none of them has been found to be conclusive. There is strong evidence that idiopathic scoliosis has a genetic predisposition (ie. it is inherited), and tends to affect slimmer girls who are approaching or undergoing their pubertal growth spurt, but the exact cause of this type of scoliosis is yet to be established and research continues worldwide.
2.2 Neuromuscular Scoliosis
Less common, neuromuscular scoliosis is a result of abnormal nerves or muscles. It is frequently associated with conditions like Cerebral Palsy, Spina Bifida, Spinal Muscular Atrophy and Duchenne Muscular Dystrophy. It can also be associated with certain clinical syndromes such as Ehlers-Danlos Syndrome and Marfan Syndrome, or in those with various conditions that are accompanied by, or result in, paralysis.
2.3 Congenital Scoliosis
This is actually explained as a bone abnormality present at birth, when one or more backbones/vertebrae in the spinal column are incorrectly formed.
2.4 Degenerative Scoliosis
This may result from traumatic (from an illness or injury) bone collapse, previous history of a major back surgery, or osteoporosis (thinning of the bones).
3. Diagnosing Scoliosis
Screening scoliosis is most serious and important in young children who are still growing. A curve in the spine may get worse as your child grows—the pubertal growth spurt is the ‘danger period’ during which a child’s scoliosis may progress significantly—so it is important to find any problem early.
The good news is that most cases of scoliosis are mild. Experts believe screening your child for scoliosis is vital so that any curve in the spine can be found early and watched closely—if found early, it can usually be prevented from getting worse.
4. Symptoms of Scoliosis in Adults
In adults, scoliosis may cause back pain and trouble with breathing.
5. Symptoms of Scoliosis in Children
Scoliosis most often causes no symptoms in children until the spinal curve becomes large.
Some early signs of scoliosis:
- one shoulder or hip that looks higher than the other
- head does not look centred over the body
- one shoulder blade that sticks out more than the other
- waistline is flat on one side, or the ribs look higher on one side when bending forward at the waist
Evaluation of a child or teen with scoliosis involves a full clinical examination with specific importance given to examination of the spine. X-rays of the spine allow the severity of the scoliosis to be measured in degrees; successive x-rays allow any development to be detected.
The doctor will check to see if your child's back or ribs are even. In case the doctor finds that one side is higher than the other, your child may need an X-ray so the spinal curve can be measured.
6. Treating Scoliosis
Your doctor will check the curve of your child's spine every 4 to 6 months. Children with more severe form of scoliosis and who have substantial growth remaining may require the use of a back brace or orthosis, until he or she has finished growing. In severe cases, or if bracing doesn't help, the child may need to undergo surgery.
The disorder and its treatment can be a severe strain on your child. Wearing a brace can feel and look strange or weird. It also limits the child's activity. Your child needs your care and support to get through treatments successfully.
We interviewed Dr Kevin Lau of “Health In Your Hands Scoliosis & Spine Correction Clinic”. Dr Lau was awarded Doctor of Chiropractic from RMIT University in Melbourne Australia in 2004. He also has a Masters in Holistic Nutrition from the USA.
The primary goal of treating scoliosis is to prevent its advancement. Dr Lau focuses on also reducing the scoliosis curve.
Mild cases of scoliosis usually do not need treatment. Very mild curvatures require observation only. However, Dr Lau recommends a more proactive approach, rather than wait for the curve to get worse. He believes that patients should act immediately, no matter how small the curve is, in order to control and decrease the abnormality.
GetDoc: Why did you choose to specialise in the field of chiropractic?
Dr Kevin Lau: My brother suffered from scoliosis when he was younger. That motivated me to study chiropractic, and I was able to help him recover.
GetDoc: Why do you recommend non-surgical methods for treating scoliosis?
Dr Kevin Lau: Non-surgical methods are not just quick fixes. I’m interested in the overall well-being of the patient. They need to learn how to take care of themselves and their spine as they age.
GetDoc: It has been said that you are the first doctor in Singapore to provide non-surgical treatment for scoliosis, and/or the first to provide the Schroth Method* of exercises.
Dr Kevin Lau: I’m the first to provide the original Schroth Method of exercises and last year I updated the Schroth Method treatment by going to Germany to train under Schroth’s grandson Dr. Hans-Rudolf Weiss, who is a Chiropractor and Orthopedic Surgeon. So the Schroth Method offered by HIYH is the new, updated method.
GetDoc: Is the Schroth Method the only thing differentiating Health In Your Hands from other non-surgical treatments for scoliosis, e.g. physiotherapy or Pilates?
Dr Kevin Lau: No, we are also the first in Singapore to offer the Clear Method** which is unique for Asia. However, I have moved away from this over the years and developed newer techniques.
GetDoc: People who do not have scoliosis in childhood or adolescence—can they still develop scoliosis as they age?
Dr Kevin Lau: Yes, usually above the age of 40, they can develop adult degenerative scoliosis.
GetDoc: Would doing these exercises—Schroth Method and/or the Clear Method—help prevent against developing scoliosis?
Dr Kevin Lau: Yes, everyone should learn about their spine and learn to take care of their posture.
GetDoc: Is there any other message you would like to tell our readers?
Dr Kevin Lau: An early detection of scoliosis would give the best prognosis.
* The Schroth method, a system of physical treatment to halt and reverse scoliosis and other related spinal deformities, developed by Katharina Schroth and further developed by her daughter Christa Lehnert-Schroth, places great emphasis on conscious correction of posture as a part of the daily life routine, and not only while doing strenuous exercise durations. Each patient gets to learn about her or his own body and what she/he has to do so as to reverse and control anomalous posture so that improved posture becomes a habit. The method is carried forward by a steadily growing number of therapists as well as her grandson, Dr. Hans-Rudolf Weiss, who till date continues to practice and develop Schroth therapy.
** CLEAR Scoliosis Institute is a non-profit organization devoted to refining the quality and effectiveness of scoliosis treatment. Chiropractors specifically trained by CLEAR Institute are committed to accomplishing structural changes to the spine that will permit the body to de-rotate and to correct itself, and they use precise, reproducible precision x-rays that are analysed according to exact guidelines to measure and quantify the change.
1. Schroth Method
2. CLEAR Scoliosis Institute
To know more about Dr Kevin Lau, kindly check here
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Qian's interest in healthcare industry came about after her father was diagnosed with bladder cancer. This experience has led her to become a strong believer in empowering individuals to take charge of their own health. View all articles by Qian.