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  • Debora Turczan, PT, CST

The Scoliosis Pain Puzzle - Addressing the Many Pieces

Scoliosis – defined by the Mayo Clinic as “a sideways curvature of the spine” – can be responsible for a broad spectrum of physical complaints, ranging from mild backaches to disabling pain and limited tolerance for physical activity. While many successful treatment options are available that improve dysfunctional curves of the spine, including bracing and surgery, those who undergo these corrective treatments sometimes continue to experience pain even after the spine is brought closer to a normal alignment.

Scoliosis X-Ray

Improving the position of the bones of the spine is only one piece of the scoliosis puzzle. Another critical piece is addressing the motion of the bones. Depending on the type of scoliosis present, this may be an area of great potential for symptomatic improvement. Physical therapy, yoga, and Pilates are all very effective methods that can increase the amount of motion available to the spine, allowing for improved function and decreased pain.

Physical Therapists who specialize in complex orthopedic, spinal, and pelvic dysfunction are well equipped to tease out the many pieces of the scoliosis pain puzzle. Joint restrictions and muscle imbalances can pull the spine further into painful curves, and limit the flexibility through those curves, making movement painful and restricted. Of course, a person with scoliosis will find a way to move in spite of these restrictions, which can create secondary issues. For example, if movement in one part of the spine is limited due to the scoliosis curve, or due to hardware placed in the spine to stabilize it, the areas above and below this restricted area will need to move more to make up for those restrictions. This can create excessive flexibility in the nearby joints, leading to pain and weakness. Excessive curves or limited motion in the spine can also lead to poorly timed weight shifting when walking, which can lead to balance deficits, or pain in other seemingly unrelated joints, like the knee or ankle. Further, pain in the spine can lead one to avoid certain kinds of motion, like overusing the shoulder joint to reach high shelves rather than stretching up through the spine - compensations which the keen eye of a physical therapist can easily identify and help to correct. Finally, bends and twists in the spine can also lead to compression of the organs that reside within the abdomen, causing painful problems with digestion and elimination. Again, the trained eye and hands of a physical therapist can help to determine what organs may be restricted, and what can be done to free them up.

Some therapists - specifically those trained in a technique called craniosacral therapy - are also skilled in addressing the motion within the spine. A membrane sheath inside the bones of the spine - called the dura - envelops and protects the spinal cord, and contains the fluid that nourishes it as well. The dura needs to be free to slide and glide within the spine. Otherwise, the spine would not be able to bend very far. As an example, imagine two “bendy” straws, one inserted fully inside the other. If we wanted to flex the straws at the “bendy” part, the straw on the inside would have to slide a bit along the straw on the outside in order for you to successfully flex them. If, for example, we glued one straw inside the other, we would not be able to bend them as far, and we might even crush them a bit in our attempt, resulting in a pinched fold rather than a rounded bend.

The same principle applies to the dura within the spine. If the dura is stuck to the inside of the bones of the spine, the amount of flexion, extension, side bending and rotation available to the spine would be significantly decreased. Further, the dura would also tug on the nerves that come out from the spinal cord, resulting in pain. In a scoilitic spine, dural adhesions, or places where the dura is stuck to the bones of the spine, the spinal cord, or both, form easily. Even if the position of the spinal bones is corrected with surgery or bracing, the dural restrictions may remain, causing pain and preventing optimized spinal motion. A physical therapist trained in Craniosacral therapy can help free the restrictions of the dura within the spine, therefore allowing the potential for improved mobility and decreased pain.

Is managing scoliosis pain complex? Yes, but with a skilled physical therapist in your corner, the many pieces of this puzzle can come together to form a picture of a person with less pain, better mobility, and (most importantly) an improved quality of life!

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