Scoliosis (when it’s not idiopathic) can spring from a number of different conditions, with all kinds of factors potentially contributing to the development of a spinal curvature.
From osteoporosis to Rett syndrome, we’ve discussed many of these underlying conditions here on the Scoliosis SOS blog, and today we’d like to talk about pectus excavatum – another condition that can cause scoliosis to arise.
 

What is pectus excavatum? 

What is pectus excavatum
 
Pectus excavatum (PE) is a congenital chest wall deformity that arises due to the abnormal growth of several ribs and the sternum, giving the chest a caved-in appearance. The condition is more common among men than women; it can be present at birth, but sometimes it doesn’t develop until adolescence.
 
PE typically affects 4-5 ribs on each side of the sternum. The condition’s visibility varies from one case to the next, and there can sometimes be significant asymmetry between the two sides of the chest. 
 

Symptoms of pectus excavatum

PE sufferers may experience chest and back pain (this is usually of musculoskeletal origin). In mild cases of pectus excavatum, the patient’s heart and lung function may be completely normal, although their heart may become displaced and/or rotated. In more severe cases of PE, mitral valve prolapse (click-murmur syndrome) may be present, and the patient’s physical capability may be limited due to decreased lung capacity. 
 

What causes pectus excavatum?

The exact cause of this condition is unknown, although some cases of familial occurrence have been reported (suggesting that PE may be a genetic condition). Pectus excavatum is also a common symptom of Marfan syndrome, and many children with spinal muscular atrophy (SMA) develop PE due to the diaphragmatic breathing that commonly accompanies that disease.   
 

How is pectus excavatum diagnosed?

PE is can be diagnosed via a visual examination of the anterior chest wall. Chest X-rays are also useful in diagnosing the condition. If the patient suffers from PE, their X-ray scan will display an opacity in the right lung area. PE is differentiated from other disorders by eliminating other signs and symptoms.
 

Treating pectus excavatum

Mild cases of pectus excavatum may require no corrective procedures at all. In more severe cases, the patient may require surgery, in which case several tests will be performed (including a CT scan, pulmonary tests, and cardiology exams).
 
Exercise plays an important role in the treatment of pectus excavatum. Exercising can stop or slow the progression of the condition, as well as helping to improve the patient’s posture.
 

Pectus excavatum and scoliosis

Pectus excavatum sufferers are more likely than average to develop scoliosis, a sideways curvature of the spine. This is especially true if PE has arisen as a result of Marfan syndrome or SMA, since both of these conditions can themselves lead to a curvature of the spine.
 
If you suffer from scoliosis or another spinal condition – whether as the result of PE or not – you’ll be happy to know that the Scoliosis SOS Clinic can help! Our ScolioGold programme is an exercise-based treatment regime that we use to help scoliosis sufferers combat their symptoms and achieve a higher quality of life.
 
If you would like more information regarding ScolioGold treatment and how this could help you manage the symptoms of your condition, please get in touch with us today!
Can Scoliosis Be Cured?
One must be careful when using the word ‘cure’ in a medical context. There is a big difference between a ‘cure’ and a ‘treatment’ – an effective treatment might completely eliminate the symptoms of a disease, but if the underlying disease is still present then – strictly speaking – the patient has not been cured.
By the most rigid definition of the word, scoliosis is more or less impossible to outright cure. Even if the patient no longer suffers as a result of their curved spine, their scoliosis is still there; even if the angle of the curve is reduced to the point that it no longer qualifies as a case of scoliosis, the patient has not truly been ‘cured’ because there is a chance that they may relapse and that the curve will begin to progress again.
Don’t worry, however – if you suffer from scoliosis, there are a number of very effective treatment methods that can help you to overcome the symptoms of the condition and achieve a high quality of life.

Common scoliosis treatment methods

When a medical doctor diagnoses you with scoliosis, they will likely recommend one of the following courses of action:
  • Observation. If your spinal curvature is quite mild and/or you haven’t yet finished growing, medical practitioners may recommend forgoing treatment for the time being and simply observing the condition’s progress. Further action can be taken at a later date depending on whether the curve improves, gets worse, or stays the same.
  • Bracing. Some scoliosis patients wear a back brace to halt the progression of their spinal curve. This is effectively a rigid plastic shell that prevents your back from changing shape any more than it already has. Sometimes the brace is only worn at night, but it is more common to keep it on around the clock (except when showering or bathing).
  • Surgery. Spinal fusion surgery is an operation that is commonly used to combat more severe spinal curves. Click here to read about this procedure and what it actually involves.
Remember, none of these approaches – not even surgery – ‘cure’ scoliosis as such. Rather, they aim to relieve the symptoms of scoliosis, straighten up the spine, and stop the curve from progressing any further.

Treating scoliosis with physical therapy

Here at the Scoliosis SOS Clinic, we treat scoliosis patients using a set of non-surgical therapies that we collectively refer to as The ScolioGold Method. This programme is specifically tailored to the needs of scoliosis sufferers, combining numerous treatment strategies in order to effectively combat:
  • Back pain
  • Mobility and flexibility issues
  • Muscle weakness
  • Further progression of the condition
  • The visible symptoms of scoliosis (e.g. uneven shoulders, leaning to one side)
While ScolioGold therapy cannot truly cure scoliosis any more than surgery or bracing can, this has proven to be capable of minimising the symptoms of scoliosis and dramatically improving patient QOL (quality of life). It also has a demonstrable impact on the Cobb angle – click here to see X-ray evidence of this.
We at Scoliosis SOS are currently in the process of applying for NHS funding, which would make ScolioGold treatment far more accessible for UK patients. In the meantime, if you’d like to arrange a consultation at our clinic in London, please get in touch today.

Spina Bifida

Scoliosis can occur as a result of numerous other conditions, such as neurofibromatosis and Rett syndrome. We’ve looked at many of these conditions here on the Scoliosis SOS Clinic blog, and today, we’re going to talk about another underlying condition that can lead to the development scoliosis: spina bifida.  

What is spina bifida?

Spina bifida is a condition that arises when there is an issue with the development of the neural tube, causing a gap in the unborn child’s spine. The neural tube starts to grow during the early stages of human development in the womb; it eventually becomes the spine and nervous system. When something goes wrong during this process and the tube develops incorrectly, the consequence of this is called a neural tube defect. Spina bifida is a type of neural tube defect. Spina bifida is caused when the arches of bone that surround the spinal canal don’t fully close. In most cases of spina bifida there will only be a gap in the bone arch, but in some cases the spinal cord itself does not form correctly either, causing severe repercussions. The exact cause of this condition is unknown, but there are a few things – a lack of folic acid, taking certain medication during pregnancy, genetic conditions like Patau and Down’s syndrome – that do increase the chances of a child being born with spina bifida. There are three types of spina bifida: Spina Bifida Occulta – This is the most common and least severe type of spina bifida. The opening of the gap in the spinal arches is very small and covered in skin, stopping the spinal cord and membranes from pushing out. Cases of spina bifida occulta usually aren’t accompanied by a noticeable bulge in the back. Myelomeningocele – This is the most serious form of spina bifida. Individuals with this type of spina bifida will have a sac in their back; this happens because the spinal cord and the protective membrane surrounding it protrude through the opening in the spinal arches. People that suffer from myelomeningocele spina bifida may be at risk of significant damage to the spinal cord and infections of the nervous system. Although this isn’t the most common type of spina bifida, this is very often the form of the condition that people are referring to when they talk about spina bifida. Meningocele – Similar to the above, except only the protective membranes protrude out of the opening in the spine (not the spinal cord itself). The spinal cord and nervous system are left intact, so this type of spina bifida can usually be corrected via surgery, with no further treatment required.

Types of Spina Bifida

In the majority of cases, surgery can be carried out to close the opening in the spine, but damage to the nervous system may well already have taken place. The damage to the spinal cord can lead to bladder and bowel control problems; leg weakness and paralysis; and scoliosis (a sideways curvature of the spine).  

Treating scoliosis in spina bifida patients

If you or a loved one have developed scoliosis as a result of spina bifida, you’ll be pleased to know that we can treat it without you being required to wear a brace or undergo spinal fusion surgery. Here at Scoliosis SOS, we treat scoliosis sufferers using a treatment programme called ScolioGold. This is a combination of exercise-based techniques that has proven effective in reducing the patient’s Cobb angle, improving mobility, and reducing any pain that the spinal curve may be causing. Click here to find out more about our ScolioGold courses, or get in touch to arrange an initial consultation with our scoliosis specialists.
SIJ joint
 
One of the biggest obstacles for those who treat scoliosis is the number of secondary complaints that can arise as a result of a spinal curve. One such issue is sacroiliac joint (SIJ) pain, which can originate from the joint itself as well as being referred from the lumbar spine in many cases. 
 
The SIJ joins the spine to the pelvis, and is made up of the sacrum along with the right and left ilium (as illustrated in the diagram above). The sacrum is a triangular bone that sits just below the lumbar spine, while the right and left ilium comprise part of the pelvis, more commonly referred to as the hip bones.

What causes pain in the sacroiliac joint?

It can be difficult to differentiate between the kind of SIJ pain that originates in the joint itself and the kind that comes from the lumbar spine – this is simply due to the fact that the patterns of referral are often highly similar to one another. Both forms of pain will often occur over the SIJ, buttocks/posterior, or lateral thigh, making it difficult to identify the root cause. 
 
Pain can also be caused by pelvic dysfunction, which refers to a disturbance in the normal movement of the SIJ during movement. This can occur due to myofascial restrictions, which develop when normal patterns of muscle recruitment are altered, or when a restriction within the SIJ itself is present.

How is this connected to scoliosis?

SIJ pain is often reported in those with scoliosis, and this is likely due to the secondary impact of the spinal curvature on this part of the body. The unnatural curvature of the spine has an impact on the alignment of the joint, which results in pain and movement dysfunction in this area.
 
For this reason, it is highly important to monitor and assess the signs of pelvic dysfunction in scoliosis sufferers in order to ensure that any treatment administered for the spinal condition is also considering the possible impact on the SIJ. By doing this, appropriate manual therapy techniques can be applied in order to restore optimal alignment and movement in this area.
 
therapy for SIJ pain

Can SIJ pain be improved?

In order to effectively treat the pain and discomfort caused by pelvic dysfunction, it is important to begin by conducting a thorough assessment. This can be done by performing a variety of kinetic tests (which assess the movement of the ilium and sacrum) during exercises such as single leg standing, as well as trunk flexion whilst upstanding and sitting. 
 
If positional assessment of the area reveals the cause of the dysfunction, this information should be used to prescribe the correct range of manual therapy techniques, selected based on the type of restriction and presentation. These can then be used to restore the correct muscle recruitment pattern, joint alignment, and normal pelvic movement.
 
Here at the Scoliosis SOS Clinic, our aim is to offer a highly tailored and unique treatment to each of our patients, including a thorough evaluation of each individual’s specific needs and complaints. This means that sources of pain, secondary conditions and other contributing factors are all taken into consideration so as to offer a treatment plan that meets the specific aims of the patient – without causing reactionary damage to other parts of the body.
 
To find out more about our ScolioGold treatment method, please click here.
While scoliosis usually starts to develop during puberty, it is not unheard of for the condition to arise far later in life. We frequently treat elderly scoliosis sufferers here at the Scoliosis SOS Clinic, and whereas our younger patients usually have what’s known as idiopathic scoliosis (a progressive spinal curvature with no apparent cause), scoliosis in older people almost always occurs as the result of another, underlying condition.
Very often, that underlying condition is osteoporosis.
 
Osteoporosis vs. Normal Bone Density

What is osteoporosis?

Osteoporosis is a weakening of the bones that commonly occurs in later life. As we age, our bones naturally lose mass and become more fragile, although this process happens more quickly in some people than others. You are particularly at risk of osteoporosis if:
  • You are going through, or have already experienced, the menopause (reduced oestrogen levels often lead to a rapid decrease in bone mass, particularly when the menopause occurs before the age of 45)
  • You have a very low BMI
  • You drink and/or smoke heavily
  • You don’t get enough calcium and vitamin D in your diet
  • Osteoporosis runs in your family
  • You don’t get enough exercise
  • You have had your ovaries removed (e.g. due to ovarian cancer)
  • You have been taking certain medications (such as corticosteroids) for an extended period of time

Symptoms of osteoporosis

Osteoporosis doesn’t have any symptoms in and of itself, but it is problematic because weak bones are far easier to break. Reduced bone mass can easily be identified via an X-ray or DEXA bone mineral density scan; however, many osteoporosis sufferers remain unaware of their condition until they break a bone (usually a hip, wrist, rib or vertebra).
 
Increased risk of fracture isn’t the only issue that can arise due to osteoporosis. When the bones in the spine lose their strength and density, the spine can begin to slip into a curved position as it becomes too weak to support the weight of your upper body. This is how many osteoporosis sufferers end up suffering from hyperkyphosis (a forward curvature of the spine) or scoliosis (a sideways curvature of the spine).
 
Osteoporosis & Curvature of the Spine

Treating osteoporosis and osteoporosis-related scoliosis

Once osteoporosis has been diagnosed – and again, this often doesn’t happen until after the patient has suffered a fracture – the condition can sometimes be managed using medication that helps to strengthen the patient’s bones. Doctors may also recommend dietary/lifestyle changes to help slow the deterioration of the bones, and certain measures can be taken to reduce the risk of a fracture (e.g. removing household hazards that may result in a fall).
 
When scoliosis arises as the result of osteoporosis, it can be treated in a number of different ways. Some patients will undergo surgery to correct their spinal curvature, but it is usually possible to manage the condition with physical therapy – eliminating the need for surgical intervention.
 
Located in the City of London, the Scoliosis SOS Clinic treats scoliosis and hyperkyphosis sufferers using the ScolioGold method (a combination of specially selected non-surgical treatment techniques). Click here to see the results that this approach can achieve for elderly patients, or contact Scoliosis SOS now to arrange a consultation.