Is my back pain caused by scoliosis?

[caz]

How severe does scoliosis have to be before it causes back pain? I've read some stuff on the internet which says that scoliosis doesn't cause pain unless the curve is in the 'severe' category - is this right?

I am a 39 year old woman with lower back/right hip pain - I have had this problem for years, getting progressively worse over time. My chiropractor took x-rays and found I have scoliosis and a tilted pelvis - he says this is the cause of my back pain. However the NHS doctor I saw at an Orthopedic Triage Clinic didn't even examine me for scoliosis, just saying that I 'looked quite straight'! He is right that I do appear to be straight, but I also have some of the outward signs of scoliosis - ribs higher and sticking out more on the left side, shoulder blade sticking out more on the right side etc. But because I wasn't obviously crooked, he refused to examine my back without my top on, dismissed my concerns about scoliosis and just referred me to a physio for 'simple back pain'.

So can anyone tell me:

Does mild/moderate scoliosis cause back pain?

And is there any point going back to the doctor and asking him to examine me for scoliosis? (Maybe there is no point since I believe the curves don't tend to progress in adulthood) Or maybe its best to wait and see the physio and see what she says - I think I would have more faith in her than in this doctor, who seemed to be very off-hand!

Thanks for your time :-)

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[Canuck Physio]

Hello Caz,

Unfortunately the Chiropractic world is plagued with creating diagnoses that other health professionals won't necessarily agree with.

Mild amounts of scoliosis are unlikely to cause back pain, but should be confirmed from multiple sources before you label yourself as being affected.

It may be possible that your pain is wholy unrelated, so please consider seeing a physio first.

Regardcs

[caz]

Hi Canuck Physio - thanks for your reply. Yes, I tend to be sceptical of any claim made by someone who is taking my money, so I understand what you mean about chiropractors! I am sure he is right that I have scoliosis, but yes, you may be right that this has nothing to do with my pain. Its just that no-one else has been able to give me a reason for my back pain. As far as I can tell, I am doing everything I can to help - I am not overweight, I try to keep fit, I do stretching and core stability exercises, I take Alexander Technique lessons to make sure my posture is as good as it can be....I don't know what else I can do!

The problem is that I haven't yet found anyone who has helped with my pain long term - I've seen a chiropractor and 2 physios over the past couple of years, and while all have helped a bit in the short term, none have had lasting affect.

Anyway, I have been referred to another physio, who I am seeing in a couple of week's time...so fingers crossed!

[Canuck Physio]

OF course,

Unfortunately back pain comes with more than its fair share of possible sources.

Although I have nothing against, Chiropractic physiotherapists can do the same (as in Grade 5 spinal manipulations ie. "crack of back") Which has its use in certain individuals, but not all.

What I am saying is that the scoliosis may be over-diagnosis, or may simply need confirmation from someone else.

Additionally, I am unaware of the Alexander Technique.

Perhaps you can detail when you first noticed this problem, what exacerbates it, alleviates it. etc.

[caz]

Thanks again for your interest.

I've had lower back pain on and off for as long as I can remember - I used to notice it particularly when standing for long periods. But it was only ever an annoyance, it didn't particularly interfere with my life at that stage. But then it got progressively worse, and really started to interfere with my life a couple of years ago - not being able to sleep etc.

The pain is in my lower back/top of pelvis and is worse on the right side. I also have pain around my right hip - sometimes into the groin and front of my thigh. The pain is a dull ache, apart from an occasional sharp pain on the right side of my back when I'm walking (particularly when going round a corner!)

It is sore all the time, but what makes it worse is sitting or standing still. Moving around helps, so I tend change position as often as I can, and will pace up and down or wiggle my hips from side to side rather than stand still! Sitting is the biggest problem for me as I just can't get comfortable, although I've found that the best position for me is sitting on the very edge of the chair with my legs bent underneath.

The Alexander Technique is to do with your posture - the idea is that you learn to let go of any muscle tension in your body which will then allow your spine to come into a proper alignment. So I am very aware of the importance of posture and make sure I try to move, sit and bend in a way that puts the least amount of strain on my back.

What do you think? Is there any hope for me? Or is it a case of just learn to live with it?

[Canuck Physio]

Of course there is hope,

IT is merely a matter of discovering the root of the problem, you may even derive benefit from spinal corrections.

I would be inclined to suggest getting several alternative opinions, ask your GP for appropriate referral.

Regards

[Yarok]

hi Caz

I can assume Caz looks like a pelvic imbalance with ligament-musular strain of
ilio-lumbar and lumbo-sacral ligaments can be as well as with interspinatous and supraspinatous ligaments ( lower lumgar and sacral spine).

please find those elements and tell what do u think(feel)

all the best

thanks Yaro

[Judith Mollet]

HI there
Alexander Technique is something that can really help postural awareness and more efficient use of "what you have" in body structure. There are also many physios who, after finding out that even "physio" doesn't work for everybody convert to Alexander. I have a contact in the Sheffield area who did that. If you need info about who to go to send me some details by PM and I'll see what I can do for contacts. Having expierienced myself what Alexander can bring I'm sure it's a valid option or addition to your back problem.

[caz]

Thanks for the replies.

Canuck Physio - I did go to my GP about a year ago, and he initially just prescribed anti-inflammatories. When they didn't help, he referred me to a physio, who tried a number of techniques, none of which helped long-term. I was then referred to an orthopediac triage clinic, and the doctor there has referred me to another physio - I'll be seeing her in a couple of weeks. I think I'm starting to run out of hope because its gone on for so long....

Judith - yes, I agree that the Alexander Technique very beneficial, and I'm lucky in having a very good teacher. I think it has helped me in terms of moving around generally, but hasn't really helped with the sitting. Of course it could be that I just need a bit more time - I know its a long process to correct bad habits developed over years, and I've only been taking AT lessons since January.

Thanks again

[caz]

Just thought I'd update you...

I saw the NHS physio last week, and she was much more professional in her approach than that stupid, arrogant doctor I saw (who didn't even examine me properly)

She confirmed that I have scoliosis and a tilted pelvis and that this is the cause of my pain. She is going to start some treatment next week - not exactly sure what she is going to do, but I am willing to try anything because this has gone on for so long....

Thank goodness for sensible physios - I have a lot more faith in you guys than I do in doctors!!

[Canuck Physio]

Just thought I'd update you...

I saw the NHS physio last week, and she was much more professional in her approach than that stupid, arrogant doctor I saw (who didn't even examine me properly)

She confirmed that I have scoliosis and a tilted pelvis and that this is the cause of my pain. She is going to start some treatment next week - not exactly sure what she is going to do, but I am willing to try anything because this has gone on for so long....

Thank goodness for sensible physios - I have a lot more faith in you guys than I do in doctors!!

Great to hear,

Thanks for the update, and please feel free to continue to update on the progress.

Regards

[Yarok]

Hi Caz
How are you now?
all the best

PS what kind of treatment do you receive? does it help?

Yaro

[estherderu]

dear Caz,
I always recommend my patients to read as much about their problems as possible. Here are some sites:

Scoliosis - Have questions about Scoliosis? iScoliosis.com has answers.
National Scoliosis Foundation
Scoliosis World
Scoliosis Association (UK)
http://www.scoliosis-assoc.org/

I am sorry to tell you that research is currently showing that most adult scoliosis curvatures tend to progress with age and that keeping up your exercises and good posture is very important.
For a good review on the pathological process and implications, in early years and in adult life go to Scoliosis | Full text | The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment. I am sorry, this is not an easy article for laymen, maybe your therapist will be interested.

kind regards
Esther de Ru

[caz]

Thanks for your continued interest in my condition

I had a session with the physio a couple of weeks ago and she used various techniques to try to put my pelvis back in the right position. I'm not sure what the technical terms are for the techniques she used, but she put me in different positions, like holding my right leg across my body then applying pressure on my hip. She used another technique of sort of rocking my body while I was in this position. She also got me to lie flat and then pulled my right leg out straight (so I thought she was going to pull me off the bed )

She must have worked with me for about 40 minutes, and at the end of it, she had definitely made a difference to the position of my pelvis - I could see that my hips weren't as badly out of alignment. I was a bit sore that night, but the next day, I felt great - better than I have done for years Unfortunately it didn't last though, and after a couple of days it started to go back to 'normal' - and I can see from the level of my hips that my pelvis is back in the position where it started.

I'm seeing the physio again tomorrow, so I'll be interested to hear what she does this time.

Does the treatment have a cumulative effect - is it more likely to 'hold' once I've had a few of these sessions? Or is my pelvis always going to go back to being twisted after its been 'put right' by the physio?

[estherderu]

dear Caz,

I understand your concern BUT I would trust your physiotherapist.... she/he is the one that will get to know you best and will be able (or at least try) to answer all, or many of, your questions.
The more people you ask ( as in this forum) the more answers you will get.

Can you imagine that, not only because of cultural differences, but also because of differences in basic+ postgraduate education and interests, physiotherapists are not all the same.
It is possibile that they will have very different opinions and give you different advice.

Good luck with your treatment

Esther de Ru

[christieuk]

Hi Caz. I came across your posting by accident when I was surfing for answers regarding my scoliosis.

I will tell you that I was diagnosed at 13 (now 52), did all sorts of stretching, heat therapy and even sleeping with a pillow under my lower back - all of which did nothing.

At 21 I was diagnosed as "stable" and "not bad enough" for surgery which 31 years ago was a whole lot worse than it is nowadays and discharged. However after two children and into my mid-30s the back pain worsened and I asked to be referred back to hospital (RNOH in Central London). My new consultant confirmed that indeed the curves had worsened even though your spine is meant to be fully developed by your early 20s and that I was a candidate for surgery at the age of 39. I had an anterior release performed with implementation from T10-L2 (my main curve). The thoracic spine was not straightened during this procedure.

13 years on, Im wondering now just how much that curve has progressed. The reason for my surfing now is that I have scapula, left shoulder pain and neck pain which with my history Im unclear whether this is referred pain or just independent "old age" pain.

The point of my history and reading your story, if I were you I would very firmly ask to be referred to an orthopaedic consultant who specialises in scoliosis. This may mean travelling and I would highly recommend the RNOH who see hundreds of patients a year with scoliosis. The physio you are doing will help the pain, but it will not change to biomechanics of your spine permanently.

christieuk

[caz]

Christie - many thanks for taking the time to reply. I particularly appreciate it just at the moment as my physio discharged me yesterday because the treatment she has been giving me over the past few months hasn't helped. I'm no better off than I was the first time I went to see her and she has confirmed that because the problem is structural, she can't do anything to help. I have to say though that she was fabulous - very professional and caring and seemed genuinely disappointed that she hadn't been able to help me.

So she told me to go back to my GP and ask to be referred to a pain clinic. I had accepted this and wasn't going to press to get referred to a scoliosis specialist, but after what you have said, maybe I should be more pushy and demand to see a specialist. I suppose I don't want to be seen to be making a fuss, especially since the doctors I've seen to date have been so unsympathetic and unhelpful - I am a bit wary of going to a consultant and him telling me not to be so silly because my scoliosis isn't 'serious'...although it is serious to me because the pain it gives me has a big impact on my life

Maybe I just need to be more assertive and not let these doctors intimidate me!

Thanks again and I hope you get some relief for your symptoms too.

[christieuk]

Hi Caz.

Im sorry to hear that your physio has had to discharge you, but it isnt unsurprising.

As for not wanting to be pushy or worrying that a consultant saying your silly - this shouldnt happen. No self respecting surgeon should make you feel silly for wanting answers. You have pursued other avenues and nothing appears to help, so it is your right to know if there is a surgical option for you.

I have a feeling that you need to get a proper xray done and measured by a specialist scoliosis consultant so that you will have peace of mind at least one way or the other. You would be surprised how little the outside symptoms reflect the interior size of the curve(s). You certainly have all the markers. You may not be a candidate for surgery yet, but will be kept under annual review until they are certain that it has stopped moving. Mine was 14 years ago as I said, so they may have other options for you including a specialist pain clinic if surgery isnt the option.

FYI My youngest son developed a large thoracic curve 6 years ago at 15, it measured somewhere in the 80s which is huge. Needless to say he was escalated to the front of the queue for an operation and his fusion is much longer than mine - T2 or thereabouts down to L4. On xray his spine is now beautifully straight albeit held in place with rods and bolts. He leads an active life (perhaps more than his surgeon would like) and is currently sleeping in a tent for a week for the Reading Festival.

Caz you have nothing to lose and everything to gain by seeing the right person.

All good luck to you

Christieuk

[caz]

Christie - what a lot of sense you talk! You are right, I really have nothing to lose by getting this checked out properly, so I will take your advice and ask my GP to refer me. And if it turns out I'm not a candidate for sugery, then there is the pain clinic option...

Your son sounds like a very plucky and determined young man - great to see he is getting on with his life, despite the rods and bolts holding him together!

Thanks again - you have given me back some hope I'll come back here and let you know how I get on...although I would imagine that the waiting list to see a specialist must be a pretty long one for a non-urgent case like mine, so I don't reckon that it will be any time soon!

[christieuk]

Hi Caz - i am so pleased you felt my advice was helpful. Whereabouts are you in the UK? If you are in London or Home Counties, press for the Royal National Orthopaedic Hospital in Bolsover Street, London. The main hospital is in Stanmore, Middx where I think they also do outpatients. Im aware that patients come from all over the country to attend there and I cant praise them highly enough (my son's was done there too). Kick up a stink if the PCT wont let you go there.

The waiting list isnt too long as I understand it, may be a couple of months. I work in the NHS and there is something called an 18 week pathway which means you should be seen during that period.

So all hope to you and do let me know how you are get on.

Best wishes
christie

[neuromuscular]

Dear caz,

Before you go father, please consider this.

The pelvic bones are the base of the spine as they interact with the sacrum.

Many with scoliosis have greatly differeing pelvic angles which make it impossible for the spine to remains straight.

Find the ASIS landmarks on your pelvic bones. Stand in front of a mirror. Put your right finger on the right ASIS and the left finger on the left ASIS. Next widen your foot postiions to 30 cm, 60 cm, 90 cm, 120 cm or to the extent of your ability. Do the innominate bones of the pelvis (the ASIS landmark) move superior or inferior to each other?

If they do then you may have what I term as APAS, asymmetric pelvic angle syndrome. This is the subject of a new research paper and will be published in about 6 months.

If you can go back to a physio, have them palpate the adductor longus on the left. If it is very tender then it is one of the distorting factors to you pelvis.

Please contact me with how your pelvic bones move in relation to each other.

Best regards,

Neuromuscular

[neuromuscular]

Hi Caz.

Im sorry to hear that your physio has had to discharge you, but it isnt unsurprising.

As for not wanting to be pushy or worrying that a consultant saying your silly - this shouldnt happen. No self respecting surgeon should make you feel silly for wanting answers. You have pursued other avenues and nothing appears to help, so it is your right to know if there is a surgical option for you.

I have a feeling that you need to get a proper xray done and measured by a specialist scoliosis consultant so that you will have peace of mind at least one way or the other. You would be surprised how little the outside symptoms reflect the interior size of the curve(s). You certainly have all the markers. You may not be a candidate for surgery yet, but will be kept under annual review until they are certain that it has stopped moving. Mine was 14 years ago as I said, so they may have other options for you including a specialist pain clinic if surgery isnt the option.

FYI My youngest son developed a large thoracic curve 6 years ago at 15, it measured somewhere in the 80s which is huge. Needless to say he was escalated to the front of the queue for an operation and his fusion is much longer than mine - T2 or thereabouts down to L4. On xray his spine is now beautifully straight albeit held in place with rods and bolts. He leads an active life (perhaps more than his surgeon would like) and is currently sleeping in a tent for a week for the Reading Festival.

Caz you have nothing to lose and everything to gain by seeing the right person.

All good luck to you

Christieuk

Dear Caz:

While this would appear to be a great success report for this operation. Please read the facts on surgery before you conscent.

The success rate for surgery is only 30 to 35 % and pain relief is not always the criteria. Read on the Harrington or other rod implants before you decide. ( Dr. Hamilton Hall lecture 2004, November 12 at U of Alberta Corbett Hall. There are other sources.) As an adult they are usually more cautious.

My cousin had the operation and promptly broke the Harrington rods that were placed in her back.

The reduction of pain by Harrington rod or other rod implants is very poor. The return to structural normal is greater.

Check your pelvic bones by the test I have stated in the other reply. If this is off, then your physio possibly missed the role of the pelvic distortion in your problem and could have tried to treat the effect instead of the cause. Try another practitioner.

Contact me with your assessment of the pelvic bones position.

Best regards,

Neuromuscular

[caz]

neuromuscular - many thanks for your replies. When you say 'ASIS landmarks on your pelvic bones' , can you tell me exactly where these are? Sorry for my ignorance!!

This may well be the problem, because one of my physios did say that my pelvis was 'twisted' - the left side backwards and the right side tilting forwards. She had tried to manipulate my pelvis and gave me exercises to try to get it to 'hold' in place but this didn't work, so I was discharged yet again.

I must say my feeling is that the pain is coming from the pelvis rather than the spine (even though both doctors I've seen seem to think it is caused by a bulging disc!)

Anyway, I have now had an MRI scan and am waiting for the results to come back - maybe (hopefully!) I will have a better idea of what is going on once I get the results.

Thanks for your continued interest and advice.

[Lynz]

Dear Caz:

The success rate for surgery is only 30 to 35 % and pain relief is not always the criteria. Read on the Harrington or other rod implants before you decide. ( Dr. Hamilton Hall lecture 2004, November 12 at U of Alberta Corbett Hall. There are other sources.) As an adult they are usually more cautious.

My cousin had the operation and promptly broke the Harrington rods that were placed in her back.

The reduction of pain by Harrington rod or other rod implants is very poor. The return to structural normal is greater.


Neuromuscular

i'd just like to add my experience of having scoliosis surgery! unfortunately i was one of the unlucky ones who needed surgery in my teens (13 to be precise). My curvature degree was 98 before surgery and was reduced to just 45 after surgery. I no longer have any back pain and look as straight as anyone else! I have also had my rods in for 7 years now with absolutely no problems and i also know plenty of people who haven't had any problems with them!

i have not taken part in things like gymnastics and contact sports as i was advised not to by my consultant, however, i have been on rollercoasters, i own a motorbike and i do part take in activities i shouldn't lol

i think it depends on the individual but my consultant assured me it would be very unlikely that my rods would break or that i would ever need them removed.

i do agree, however, that people have said its not done for pain alone, the surgery is very long and the recovery isnt exactly easy!!!

if you can cope with the pain without resorting to surgery i would, its changed my life but i was told that as my curvature was so bad (had tipped my heart and restricted my breathing) that i probably wouldnt have survived!!

[neuromuscular]

neuromuscular - many thanks for your replies. When you say 'ASIS landmarks on your pelvic bones' , can you tell me exactly where these are? Sorry for my ignorance!!

This may well be the problem, because one of my physios did say that my pelvis was 'twisted' - the left side backwards and the right side tilting forwards. She had tried to manipulate my pelvis and gave me exercises to try to get it to 'hold' in place but this didn't work, so I was discharged yet again.

I must say my feeling is that the pain is coming from the pelvis rather than the spine (even though both doctors I've seen seem to think it is caused by a bulging disc!)

Anyway, I have now had an MRI scan and am waiting for the results to come back - maybe (hopefully!) I will have a better idea of what is going on once I get the results.

Thanks for your continued interest and advice.

Dear Caz

You will have to go to an anatomy chart to see where these are. It is too difficult for me to describe these. There are skeletal and muscular charts which have these shown.

When you can landmark these hold a finger on each, stand in front of a mirror and take a widening stance from closed to 30 cm, 60 cm, 90 cm and wider. Each position must be a complete stop.

Note if one moves inferior to the other.

Then take this information to a practitioner of your choice.
his should proide valuable inforfmation onyour condition.

Usually the right moves inferior to the left, but you could be the one in one thousand that does fit the norm or the one in 11 that had both move equally.

Best regards,

Neuromuscular