Do I Have Scoliosis

Mark: Hi, it's Mark from Remarkable Speaking here. I'm with Wil Seto of Insync Physio in Vancouver. One of Vancouver's best physiotherapy clinics, many time winners of best physios in Vancouver and we're going to talk about scoliosis. How you doing Wil? 

Wil: Hey, Mark. I'm doing well thanks. How about you?

Mark: Good. So scoliosis, now we were talking ahead of time and you mentioned a couple of things. Functional versus structural scoliosis. What's the difference? 

Wil: Yeah. So structural scoliosis is usually a type of scoliosis where the bones and the spine form unevenly. And that usually happens earlier on in childhood. And so it's something that you develop and as you become an adult, it kind of sticks with you. And so there's very noticeable curvatures that when you do certain tests, you look at whether it is a functional or a structural scoliosis. You can determine pretty quickly from that. And if you get to be more specific, then you can actually measure like, you know, technically the curvature in terms of how badly it is.

Versus a functional scoliosis, really is a deviation or a normal sort of curvature in the spine, this lateral curvature. And that can be a result of like an injury that you have, and then you have like muscle spasms and you can have things that are pulling on the spine, in the bony segments and it rotates it. And then in that rotation or in that process of the injury that you're going through in the healing process, then that can look like you have the scoliosis, but then when you do certain tests that evens it out and you can see that it's less structural and functional.

Mark: So how often do you see the difference, those specific differences when someone comes in with scoliosis? 

Wil: Yeah. I see a lot of the second part, which is the functional, where it's sort of this like the nerve muscle stuff going on, where it's just an imbalance. And those things are quite common especially if you've undergone an injury.

And I think that's really the hard thing to really understand from most people is when, you know, they may have seen another healthcare professional or someone else that's looking after them. Or they may have heard the term scoliosis. Or they may have a neighbour or friend that has had scoliosis and they've talked about it.

And then, you know, they feel like, Oh man, is that what I have? I feel like I'm crooked. And then they automatically think about, oh, maybe I have scoliosis. And without even really, you know, thinking more deeply or really trying to understand what that is, then, you know, that sticks in your head. And that functional part of the scoliosis, is definitely more common in an adult. Because like I was saying before with the structural scoliosis, you usually get it developed as a child and it becomes sort of a congenital thing where you're born with. And then you have that throughout your whole life.

Whereas if not just like, as an adult, one day you wake up and you're like, oh, I got this structural scoliosis. Unless you go through you know, a major accident where things happen and then you get some of the major degenerative changes happening in the spine as it ages, but it's actually quite less prevalent.

Mark: So you can treat both as a physio who specializes in some of these things, you can treat both of these to make them, less painful. Is that a good assumption? 

Wil: Yes. Yes, for sure. So essentially, you're looking at obviously localizing the pain and trying to manage that for both scenarios. Now, when it's something that's more structural, you want to really look at increasing the blood flow and blood supply to certain areas and getting the muscle strength where it's really imbalanced, when it's a structural thing going on. A lot more success, obviously, you know, when you it's functional. And you really correct those imbalances and you do things to facilitate the healing process of whatever's going on in there.

Mark: So you mentioned you had a client that came in that had a structural, but that you actually helped. Walk us through that, please. 

Wil: Yeah. So you know, with this specific client, I mean this person had actually an issue in childhood, something surgical procedure done. And basically as a result, as they got older, you know, like it caused a deformity into the lower segments of the spine, where it was more than a certain amount of degrees that you can still physically see. Caused a lot of muscle imbalance as a result of the surgical procedure. And to be more specific, it was like basically removal of a kidney.

And, and then over the years, this person's been really active, and really managing, you know, their problem but has had some back issues, now and again, but still being really active, like skier and runner and cyclist and all that stuff. So still able to do all those things at a very high recreational level. And at a level that the person really wants to enjoy. 

And so, you know, things that can happen over the course of the period, actually we've treated this person for all those things, is basically pinched nerve. Basically a strained back and then just like a shifting of the pelvis. And then pinching in the hip flexers and then sort of issues relating from the back that basically refer around in the hip. 

And so we want to just correct as much of the things that are going on that are really imbalance and pinching because we can still really unload a lot of those specific segments at the middle back or sort of the middle to lower back and the whole lower back area. Because that way it helps with more general movement mobility into those areas, which will allow more freer movement throughout the whole spinal segment, like basically from the neck all the way down to the pelvis and then even in the hips.

And as a result, then this person actually successfully has been able to get normalization and optimization of muscle control and muscle activation patterns to to be able to function, get back on his bike and to be able to work out and do CrossFit. And instead of like being able to just do like a burpee that looks really like what's going on in that burpee to like being able to actually do a full on range with the burpee, because now they've got more mobility and things aren't pinching anymore.

Mark: So other than accidents or a childhood illness or malformation of the spine, are there other possible causes of scoliosis? 

Wil: Yeah, and I think I talked about basically age related things. That's another factor and that's actually a huge part of it. And then like between in the growing years, you know, of like 11 to 18, even up to 20 years old, that can account up to 9% of the cases of scoliosis because they're still growing, then there may be sort of some of the scoliosis happening, but then it resolves after they finish growing. So then that is very treatable. 

I think in those growing years, that's also where we work with athletes, you know, where they're doing competitive sports, that we want to be a lot more cognizant of what they're doing to be able to maintain mobility and do recovery stuff, to be able to make sure that they're not imbalanced.

 I'll just giving you an example, a 16 year old and he was competitive rower and he was getting back pain. Had a little bit of scoliosis and we started to look at the imbalances. And over time we treated him for a couple years where he's like 19 now and he no longer has any more back pain.

Mark: So what can be the kind of course of treatment. The diagnosis sounds pretty complicated. You're looking at muscle function throughout all parts of the back, I'm sure and into extremities. Once you've diagnosed, whether it's functional or structural, what actions do you actually start getting people to do? And how long is it going to take? 

Wil: Yeah. So timeframe wise, it's a little bit harder to really say, you know, this is exactly when this is gonna get better. It's sort of a range. And then that's also considering that it's under a physical therapy or physiotherapy management sort of perspective. And in a physiotherapy perspective, you're also considering the possibility of using bracing. If it's a milder form of scoliosis with respect to the structural. And there's still things that you can do manually, you know, like segments that maybe are stuck and you need to do adjustment and manipulations to kinda get those moving. And that's important too. 

And then not just the joints, but manipulation of the soft tissue. Looking at what is tight and what's not. What's not moving properly. And then proper movement reeducation or proper muscle activation patterning, which is through exercise prescription. And that's really important. And then through that training, maybe using other modalities, like some muscle stimulation and to get these muscles going. Some taping to facilitate the activation of this, and then maybe like, I don't know, maybe like some insoles or whatnot to support the arches. Those are some things that we can do to influence the healing process and the rehab process of a person that is experiencing back pain. Upper, middle, or lower back pain because of scoliosis. 

Mark: And is it fair to say like, always, if you're feeling the pain don't rest and just wait for it to go away, get in, to see a physio sooner rather than later, because that will really accelerate your healing process.

Wil: Yeah, for sure, because there's other specific techniques and methods that can be used to help with the scoliosis. There's certain breathing exercises because we all know that in the mid back, if you breathe, then your rib cage expands and then it moves the vertebrae in certain ways.

And so just things that we can do, there's a lot of things that we can help with that will either, you know, lengthen the spine or get certain muscles moving and get certain joint facilitate a lot better. And then just having that education for you, having you become more aware of what things you can do at home.

Mark: If you've got some back pain and you're suspecting this, or you don't know, and you wanna find out, or you've been diagnosed and you wanna actually take some active participation in healing your back to the best that's possible. Get into see Insync Physio. You can reach them at, book online for either the Vancouver address or in North Burnaby. You can reach the Vancouver office at (604) 566-9716. Or you can book in Burnaby at (604) 298-4878. Thanks Wil. 

Wil: You're welcome Mark.