MALADY MAKEOVER

Dangerous Curves

Scoliosis of the spine can throw your back out of balance, resulting in pain.

By Beverly Burmeier

September 2009


Avid tennis player Cathy Battles, 67, of Austin, Texas spent years feeling unbalanced. With one leg slightly shorter than the other, her active lifestyle resulted in back pain. After years of simply icing the aches and moving on, Battles learned that the discrepancy in leg length likely resulted in a curved spine. “Although I had known since my thirties that I was slightly lower on the right side, I never thought much about it until four years ago when I noticed the difference was becoming greater,” she says.

A curvature that exceeds 10 degrees is classified as scoliosis, a condition generally associated with adolescence. However, “aging is rough on the spine,” says John Ratliff, MD, FACS, of the American Association of Neurological Surgeons (AANS). “Even normal wear and tear can create abnormal curvature in some patients.” The spine can shift out of alignment and the spinal canal may narrow, pinching nerves and making normal functioning difficult. Severe cases may even affect lung and heart function. The National Scoliosis Foundation (www.scoliosis.org) says as many as 9 million Americans have scoliosis.


Spines gradually lose calcium with age, and back muscles get weaker. Ligaments that support the spine may not function as well as they once did. “Scoliosis that occurs or is diagnosed in adulthood is distinctive from childhood scoliosis, since the underlying causes and goals of treatment differ in patients who have already reached skeletal maturity,” says Roger Hartl, MD, chief of spinal surgery at Weill Cornell Medical College in New York.

You’re 20% more likely to develop scoliosis if someone in your family suffered from it. People who had mild curvatures that were not treated when they were younger may experience progression to the point of discomfort. In one study, 10% of adult scoliosis patients required aggressive treatment, such as surgery. Fortunately, Hartl says that minimally invasive procedures are now available to correct severe problems.

Degenerative scoliosis, which occurs most frequently in patients over 60, begins slowly. Physically demanding activities, whether for work or play, tend to take a toll over time, resulting in more wear and tear on the spine. As a result, conditions such as stenosis (narrowing of the spinal canal), disc degeneration, compression fracture or a combination of conditions may affect structural integrity of the lumbar spine in the lower back.

Signs of Trouble

Scoliosis testing usually starts with the patient bending forward from the waist while an examiner checks for asymmetry of the trunk or abnormal curvatures. Leg length may be measured and X-rays or other diagnostic images are used to confirm the diagnosis. Scoliosis symptoms include uneven shoulders or a hump on the back, or a head that’s off-center from the pelvis. A raised hip or uneven waist may cause leaning to one side, or the rib cage may be at different heights on each side. The skin over the spine may show dimples or other abnormalities.


Good habits can help forestall or alleviate spinal degeneration. Eating a healthy diet and exercising regularly are important because being overweight promotes scoliosis progression. Make sure your fitness routine includes weight-bearing exercises, such as walking, weight lifting and tai chi, to avoid loss of bone strength. Taking supplemental vitamin D and calcium can also help build bone density; look for products that include magnesium, calcium’s mineral partner in bone formation, and boron, a trace element that helps activate vitamin D.

If you already have scoliosis, don’t rush into aggressive treatment. “Progression in adults is usually slow, so the goal is to make sure patients are pain-free and able to participate in whatever level of activity they desire,” Ratliff says. Hartl recommends cognitive intervention—therapy sessions that help change the way someone reacts to pain—to overcome pain-related fear. Heat or ice can ease discomfort, and massage therapy can help keep muscles loose and pliable.

One way to feel better is to get wet. “Aquatic therapy is one of the healthiest things patients can do to alleviate back pain,” advises Ratliff. Tabitha Chin, 62, of New Jersey, had scoliosis-related problems that made walking very painful. A couple months of water therapy after surgery, though, helped get her back on her feet. “It relaxed my back and made it feel better,” says Chin, who also wears a special girdle for extra support.

Stretch your spine daily to improve mobility. A physical therapist can work on muscles directly or recommend safe stretches to do at home. Yoga and Pilates can help build core strength; find a certified instructor experienced in working with people who suffer from cranky backs. Hartl suggests acupuncture, which he says is highly effective for relieving back pain. And Ratliff recommends wearing orthotics in your shoes to help align your body.

“Older individuals today are less willing to tolerate physical limitations,” Ratliff notes. Battles is a good example: She continues to play tennis, aided by a lift in one shoe that keeps her body in proper position, while physical therapy eases any residual discomfort. “The combination of wearing the lift and doing exercises has lessened my back pain,” she says. “I’ve worked hard to stay fit, so
I’m glad I was proactive in seeking a solution.”

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