Understanding your spine and the pain that can come from it has long been a study of the medical profession. Add in the complexity of a spinal asymmetry, such as Scoliosis, Scheuermann’s Kyphosis or Flat Back Syndrome and it can all be downright over-whelming. We know that spinal asymmetries can affect people of all ages though seen more in females than males. Despite modern medicine’s best efforts, research shows that, without addressing the underlying muscle imbalances, even the most stable curves can still progress 0.5 to 1 deg per year. This can be frustrating for those who have undergone a spinal fusion and, yet, their pain cycles return without specific treatment to the pull of their underlying curve pattern.

Scoliosis is a condition often initially noticed in girls between 10-12 and boys between 11-13 either by their parents or a pediatrician. Commonly referred to as AIS, or Adolescent Idiopathic Scoliosis, it is defined as a 3-dimensional change in the spine that has no specific cause but can result in physiological changes to the vertebrae and discs. It is defined as a curve that measures greater than a 10-degree Cobb angle identified through x-rays. Early intervention is of paramount importance as these children can be at a higher risk for progression when they are in the year leading up to pubertal changes.

Adults can also present with a scoliosis. In some circumstances, perhaps the scoliosis was just undetected because it was slight. However, in others, it may be an adult onset due to physiological failures of an aging spine (bones, ligaments, discs, trauma, osteoporosis). This is termed De Novo scoliosis.

Hyperkyphosis in children, is a forward bending of the spine that is excessive and does not necessarily have to be present with a scoliosis. It is still considered a spinal deformation but in the sagittal plane (side view of your body) instead of the coronal plane (the back view of your body). It is usually accompanied by “Schmorls nodes” which can be seen on x-ray and are a presentation of physiological changes to the vertebrae themselves.

Hyperkyphosis found in adults can either be genetic or degenerative, often tied to spinal aging changes or osteoporosis which result in asymmetrical loading on the vertebrae/discs from front to back. If left untreated, this can lead to secondary issues such as compression fractures, respiratory difficulties, low back pain and GI issues.

Hypokyphosis, also known as flat back syndrome, is when there is less than normal backward curve found in the upper back. A healthy spine needs to have enough curves and balances between the upper and lower back to ensure that the spine can absorb pressures of our bodies weighted against the ground while we are standing and walking. Without these curves to absorb the force, it will more directly transfer the pressure and wear to the discs/cartilage and joints of our knees, hips and sacrum. These issues are often felt in our distal joints before the back will experience any discomfort.

I often get asked, if I have had surgery or am going to have surgery, are Physiotherapeutic Scoliosis Specific Exercise (PSSE) still beneficial for me? The answer is absolutely! If you are planning to have or have already undergone a spinal or lumbar fusion surgery, the value of PSSE is a critical component to both the pre-hab and post-habilitation of a health spine and recovery. Strengthening your entire body before surgery has shown to minimize recovery time, establish better patterns of posture, movement, and muscle functioning. It is important to not only retrain your body but also to adjust your habits to create safer movement patterns, postural alignment and exercising awareness leading to more effective surgical outcomes.

Treatment after surgery, gives you the advantage of strengthening around your spinal asymmetries while still protecting your recovery and your surgical site. Remember that the surgery has fixated your spine but it has not done anything to change the way the muscles and joints are functioning. The old, dysfunctional cycle of your curve pattern will still try to take over if not given a new and more effective way to move.