Scoliosis (curvature of the spine)
In scoliosis the spine does not simply lean sideways: it also rotates around its own axis.
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Medicines commonly prescribed for Scoliosis (curvature of the spine)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 1 g / tabletActive substance: paracetamolManufacturer: Apotheke Laboratorios S.L.Prescription not requiredDosage form: TABLET, 650 mgActive substance: paracetamolManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: CAPSULE, 400 mgActive substance: ibuprofenManufacturer: Reckitt Benckiser Healthcare S.A.Prescription not required
In scoliosis the spine does not simply lean sideways: it also rotates around its own axis. That rotation of the vertebrae changes the shape of the ribcage and makes the back look visibly lopsided, which is usually noticed long before the curve itself. Scoliosis is most often picked up in teenagers aged 10 to 15, during the growth spurt, and in eight cases out of ten no cause is ever found. For most people it stays a small curve that does not hurt and needs nothing beyond monitoring. But there are signs that change the picture completely, and they are worth knowing in advance.
How to spot it: the forward bend
Parents rarely see a curve. What they see is a tilt. It is worth taking a closer look if your child has:
- one shoulder sitting higher than the other;
- one shoulder blade sticking out and standing up at an angle;
- an uneven waist, with a deep crease on one side and none on the other;
- a hip that looks higher, as if they were always resting on one leg;
- clothes that hang crookedly, with a strap slipping off the same shoulder every time.
The most useful check at home is the forward bend. Your child stands barefoot with feet together and knees straight, lets their arms hang loose, and bends slowly forwards as if reaching for the floor. Look from behind, crouching down to the level of their back. In scoliosis one half of the back rises higher than the other, forming a ridge of rib and muscle. A straight spine looks symmetrical when bent.
That ridge is not a sign of unevenly built-up muscle. It is the rotated vertebrae, and it stays there however much you correct your child's posture. That is also why posture is not to blame: slouching at a desk, a heavy bag on one shoulder or a soft mattress do not cause scoliosis, and sitting up straight does not undo it.
Why the spine curves
The commonest form by far is adolescent idiopathic scoliosis: the spine starts to curve at the peak of growth with no visible reason. Not from exercise, not from diet, not from sport. Heredity does play a part, because scoliosis often turns up in several members of one family, but there is no single gene that can be tested for.
Less often there is an identifiable cause:
- vertebrae that did not form properly before birth: this is congenital scoliosis, present from the first months of life;
- a nerve or muscle condition that leaves the back supported unevenly, such as cerebral palsy, muscular dystrophy or spinal muscular atrophy;
- age-related wear of the discs and small spinal joints: this is degenerative scoliosis, which appears in adults, usually after sixty, and often goes together with narrowing of the spinal canal.
The distinction is not academic. The cause determines both how fast the curve is likely to progress and what will be offered.
What makes it urgent
Ordinary adolescent scoliosis does not hurt and develops slowly. So anything that does not fit that picture should prompt a closer look:
- back pain that wakes your child at night or does not settle with rest;
- weakness, numbness or pins and needles in the legs, a changed walking pattern, or problems passing urine or opening the bowels;
- a curve that is progressing quickly, with a visible difference over months rather than years;
- scoliosis in a child under ten, and especially in a baby;
- a curve in the upper back that points to the left: in adolescent idiopathic scoliosis it almost always points to the right;
- scoliosis alongside unusually loose joints, coffee-coloured patches on the skin, a very tall build with long fingers, or a dimple or tuft of hair over the tailbone.
Those combinations point to more than a crooked back. Doctors look for a cavity or tumour in the spinal cord, a hidden vertebral abnormality, an inherited connective tissue disorder or neurofibromatosis. All of these are rare, but they are exactly what decides what happens next, so such cases are investigated more thoroughly and usually with an MRI scan rather than an X-ray alone.
There is one more reason not to wait: severe scoliosis in a baby or young child. While the ribcage is still growing, a marked curve can limit the room available to the lungs, so these children are followed more closely than anyone else.
What happens at the appointment
The doctor examines the back standing and bending, compares the height of the shoulders and shoulder blades, checks leg length and tests strength in the legs. An X-ray of the whole spine taken standing up comes next, and the angle of the curve is measured on it. A curve of less than ten degrees is not called scoliosis at all: it is ordinary asymmetry, and plenty of people have it.
The second question decides almost everything: how much growing is left. While a child is growing the curve can increase; once growth has finished, small and moderate curves usually stay much the same for years. Skeletal maturity is judged from the same image, using the bones of the pelvis or the hand. This is why a teenager with a mild curve is usually just reviewed every few months with nothing prescribed. That is not the doctor doing nothing: it is a considered decision, because most mild curves never reach the size at which treatment is needed.
Bracing: what it can and cannot do
This is where disappointment usually sets in, so it is worth saying plainly: a brace does not straighten the spine. Its job is to hold the curve back from getting worse while the child grows. If the angle is unchanged after months of wear, that is not a failure. It is precisely the result the brace was prescribed for.
What is worth knowing before starting:
- the brace is custom-made from a mould and replaced as the child grows;
- it has to be worn for most of the day and comes off for showering, swimming and contact sports; the result depends directly on the number of hours it is worn, and this is the hardest part of the whole thing;
- under loose clothing it is barely visible, but it still weighs on a teenager, and that deserves discussion rather than reassurance;
- it only works on a growing spine. In an adult it will not reduce a curve; it is sometimes used to support the back and ease pain;
- very young children are sometimes put in a plaster cast instead of a removable brace, changed every few months.
When surgery comes up
Surgery is for a minority. It is discussed if the curve keeps progressing despite a brace, if the angle is still large once growth has finished, or, in adults, if there is persistent pain and nerve compression.
Teenagers and adults are usually offered a spinal fusion: the vertebrae are straightened and joined to each other with screws and rods, and that section of the spine stops moving and fuses into a single block. Young children with years of growth ahead of them have growing rod systems fitted, which are lengthened periodically; with some designs this is done by a magnet from outside, with no further incision.
Like any major operation it carries risks: bleeding, wound infection, movement of the metalwork or failure of the fusion and, rarely, nerve damage causing numbness or weakness in the legs. Recovery takes months and the return to sport is gradual. The decision is almost never an urgent one, so there is always time to question the surgeon and seek a second opinion.
Scoliosis in adults: usually a conversation about pain
Adults have scoliosis of two kinds: the long-standing curve left over from adolescence, and the degenerative curve that grows out of spinal wear. In both cases treatment is aimed at pain and movement rather than at degrees: straightening a stable curve for its own sake achieves nothing.
What helps: regular movement, exercises for the back and abdominal muscles, keeping weight steady, and sensible alternation of effort and rest. Painkillers usually start with paracetamol; non-steroidal anti-inflammatories are used in short courses and chosen with an eye on the stomach, kidneys and heart, so they are best agreed with a doctor. If the curve is pressing on nerve roots and the pain runs down the leg, injections of a steroid with local anaesthetic around the spine can help, though the effect lasts weeks or months: they buy time rather than solve the problem.
Sport, activity and how a teenager feels
There is no reason to excuse a child with scoliosis from physical education: strong muscles help the back and inactivity does not. Almost all sports are open to them, and restrictions are set individually and for a specific reason, usually after surgery. Swimming is good for the back but does not correct a curve on its own, and nor do specific exercises: they ease pain and improve how a child feels, but have little effect on the angle. Manual therapy, osteopathy and massage do not straighten a curve either; they do no harm in themselves, but giving up monitoring in favour of a "correction programme" does.
And one thing that is discussed least of all. What weighs on a teenager is rarely the pain. It is how they see themselves: the lopsided back, the brace under their clothes, the conversations about scans. It is worth talking about it directly, without insisting that nobody can tell, and if low mood or withdrawal sets in, asking for help as calmly as you would ask for an X-ray.
Online consultation
An online appointment handles well everything that does not require a doctor's hands on the back. An Oladoctor doctor can help you work out whether what you saw on the forward bend looks like scoliosis and whether an X-ray is needed; explain what the report says and what the measured angle means; advise which specialist to see and how quickly; and go through what to do about back pain in an adult and which painkillers suit you. If your description shows that a face-to-face examination or imaging is needed, you will be told straight away rather than after a long round of questions.
This material is for information only and does not replace medical advice.
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