2. What is scoliosis?

Episode 2: What is Scoliosis?

Scoliosis can feel confusing, overwhelming, and even scary when you first hear the diagnosis — but it doesn’t have to be. In this episode of ScoliPod, Dr. Laura and Dr. Beth break down the basics of scoliosis: what it is, how it’s measured, and what treatment options are available today.

Whether you’re newly diagnosed, supporting a loved one, or a clinician who treats scoliosis, this episode will give you clarity, evidence-based insight, and encouragement.

In this episode you will learn:

• What scoliosis actually is (it’s more than just a “sideways curve”)
• How scoliosis is measured (Adams Forward Bend Test, Cobb angle, X-ray)
• Different curve types (S-curve vs. C-curve) and why no two spines look alike
• The difference between adolescent vs. adult-onset scoliosis
• Risk factors for curve progression & the latest research on genetics, vitamin D, and activity level
• The role of scoliosis-specific exercise (PSSE/Schroth) and why specialized training matters
• Why having scoliosis or spinal fusion doesn’t mean you can’t live a long, active, healthy life

✨ Key takeaway: Scoliosis is highly individual — but with early detection, the right treatment, and the right support, you can take control of your spine health and thrive.

Resources & Links Mentioned:

• Directories for certified scoliosis-specific exercise practitioners: 
  • Rigo Concept - Spanish school of scoliosis
  • ISICO - Italian school of scoliosis
  • SSOL - Scoliosis and Spine Online Learning
  • PSSE-Schroth - Greek based training
• Follow us on Instagram: 
  • @strengthandspine
  • @laura.g.dpt
• Learn more about our services:
  • https://www.strengthandspine.com/
  • https://www.drlauraglazebrook.com/
• Read some blogs with more on scoliosis and scoliosis exercise:
  • https://www.drlauraglazebrook.com/blog/what-is-scoliosis
  • https://strengthandspine.com/blog/b/UnderstandingtheSchrothMethod

 If this episode helped you, share it with a friend, parent, or healthcare provider who wants to better understand scoliosis.

From our curvy (and one fused) spines to yours, thanks for listening — and stay tuned for upcoming episodes on treatments, exercise, and living well with scoliosis and spinal fusion.

Finally, don't forget to subscribe to ScoliPod on your favorite pod catcher so you never miss an episode!

• Listen on Apple Podcasts
• Listen on Spotify

Transcript

Hello everyone and welcome back to Scolipod. And today we're talking about what is scoliosis. So I'm Dr. Beth, I'm Dr. Laura. And if you're here, you might have a little bit knowledge of what scoliosis is. Maybe you have scoliosis yourself, or you're listening in for a family member, or you're a healthcare provider that treats people with scoliosis. But today we're going to talk a lot about what is scoliosis, how do we measure it, what things are we looking at for people with scoliosis, and what treatments that potentially we use in people with scoliosis as well. Because I think there's a lot of confusion as to where does scoliosis come from How do we measure it and aspects like that? So Laura, why don't you kick us off a little bit on what is scoliosis? How do we define it? And then we'll go from there. Absolutely. So scoliosis, it's relatively common. I think the current research is that about 1 to 2 of any given population has scoliosis. So scoliosis is basically defined as it used to be called just a lateral curvature, but now we know it's a rotation or a twisting of the For the majority of people, when it develops, we actually don't know what causes it. There are different types of scoliosis, but for most people that are listening or are familiar with it, you may know. It, as idiopathic scoliosis, basically means we don't know exactly where it's coming from. There's different types. We can talk about that a little bit more, a little bit later in the episode, but I think for now we're probably gonna focus on the most common, like that idiopathic scoliosis. Right? A lot of people I speak to get a little bit frustrated with the idiopathic nomenclature to say like, well, scoliosis has been around for such a long time. Why isn't there research to really explain how scoliosis develops or where it comes from? And I think part of the challenges is that there are many factors that are contributing. And we have an idea of— we think it starts with bone growth, some sort of change in bone growth, but we're not sure then kind of how it goes from there. We know, like, does that change how the muscles interact? Is the brain more involved than we think? So, research has been going towards that genetic route, not so much the— but lately more so some proteins that are coming up for people with scoliosis. So, you could have a genetic predisposition, but maybe not necessarily develop the scoliosis depending on that protein cascade, let's say. And I think that's where the research is going a bit more now. Yeah, exactly, I actually—when—so, sort last year. There's Dr. Beth and I are going to this amazing scoliosis congress next month. Actually, this month, it is officially April. You're right! But one of my favorite parts of the same conference last year was all of the different research that was on the theories of where the scoliosis is coming from. There's a lot of research also about vitamin D deficiency and how certain nutritional deficits can perpetuate or worsen somebody's progression of scoliosis, obviously gene considerations. So, a lot of it, just like any scientific research, we can't really say definitively unless we have a lot of research. But it's really exciting. because there is a lot of really awesome research that's going on right now. Absolutely, absolutely. And we're going to find out more at the end of this month what's new and exciting coming up. So that's awesome! Yeah, stay tuned everyone. So a lot of times parents will ask me, oh well, if I have scoliosis, is my child definitely going to have scoliosis? And of course, there is some likelihood of developing it, but it's not guaranteed. So I think the incidence is somewhere between three and 20 if a parent has it. And if both parents have it might be a little bit higher, but that's something that we don't know for sure, right? We're still studying. that genetic part of it too. Yeah, for sure. There's also there is a bit of a misconception as well that girls are the only ones that can develop scoliosis. But actually, it does tend to be, you see it more frequently in girls, and I think it tends to be more progressive in. I also believe that because of the time that a lot of at least public schools are screening, they're actually missing a lot of the boys because they haven't hit their growth spurt yet. It does occur in boys and girls. It can develop in younger children. And in fact, the earlier it starts developing, the more chance there is of it to progress if left untreated, which there's. A lot of amazing treatment options out there now, which I'm sure we'll talk about in a future episode. And then, of course, if there's a lot of growth left, then there's a lot of likelihood that that curve can get worse. Right, right, I think the research does show us that girls are more likely to progress to where they would need some sort of And in terms of when to screen, I think that's a good question for us to talk about because early detection is so important. So if you are a person with scoliosis and you have a you want to start screening that child definitely even before that growth spurt to see if you notice any asymmetries. So how do we do that? We use that Adams forward bend test. So that's one way that we diagnose scoliosis. We have the person bend forward and we look for an asymmetry of their back, meaning one side is maybe sticking up higher than the other side. And then, as practitioners, we can actually measure that rotation, get an idea of what that is. Now, we're not 100% sure how that correlates to another way we measure scoliosis, which is the Cobb angle. So the Cobb angle is what we measure on the X-ray. And that's looking a little bit more about the lateral curvature of the So you'll have the doctor say to you, you have a 40 degree curve. And that's something. that they measure on the X-ray. So it's a degree, because it's an. Sometimes people confuse it with a percentage. It's not a, it's a degree of how much bend do we see in that spine. But we have to remember too that it's not just one or two dimensional. That we talked about earlier, Laura said that rotation aspect can change a little bit what the curve might look like for the person's, or how progressive that curve may be. Absolutely. And I think it's also important to point out here that even if you have three or four people with scoliosis in front of you, scoliosis is highly individualized. So you could technically have the same Cobb angle. when you measure it on the X-ray, but depending on other things, like if we have a big pelvic shift or if we have a lot of rotation in the trunk, someone can technically have the same Cobb angle as someone else, but how their scoliosis presents for them or how it impacts them can look completely different, which is why it's important to have a specialist that can help you walk through what that's going to look like as far as just treatment. Absolutely. Yeah, so not every S curve or not every C curve is the same, right? So most commonly, people refer to scoliosis as an S curve because usually there's some sort of compensatory curve to help. try to balance out the body. That's the way that your body tries to balance itself out, so you don't just fall over because of your curve. Your body does a really good job of trying to keep your vision level, so you can walk and do all these things right. And there's also a C curve type, which might just be one bigger curve. Depending where that curve is, it's a little bit different than where the S curves may be. But even if you have an S curve or a C curve with the same degrees as, let's say, your friend, you might not need the same exercise program. There might be some similarities; there might be some overlap. And this is why you have to be a little bit careful when you're looking for like scoliosis YouTube workout type thing because what works for someone with, let's say, a thoracic curve, might be a little bit different than someone whose curve is bigger in their lumbar, in their low back, right? And not everyone is differentiating. Absolutely, there's also it's important to know even with the same curve type how somebody, like what we call compensations, or how somebody tends to move, might be very different. So for instance, if you have, you might have the same S curve as somebody else, but you may use a different movement strategy. That means that you may be more prone to Injury or just issues with certain areas, which is different than somebody else with the same type of. Yes, absolutely, and I find that that becomes more of a challenge in adults. Right? So, we were talking a little bit about the adolescent type of scoliosis, and many people have that as a teenager, and then they grow up. Right? So, they are adults with scoliosis. So, if you're someone who had scoliosis as a teenager and now are an we call that an adolescent onset, but you're now an adult with scoliosis. That's one type. We also see scoliosis appear for adults who maybe had a milder curve that wasn't diagnosed as a teen or started to develop some asymmetry. over time because of asymmetrical changes of the And this is what we call an adult onset scoliosis. There's also a group of people who say, oh, all of a sudden, I have scoliosis; I didn't have it before. And the figures can go up to an adult, up to 60% of people having some degree of especially as we age and get older; it becomes much more prevalent. So, I find that especially in adults, we see a little bit more uniqueness of the curve pattern or of those compensations. Absolutely, and I think also it's important to point out that the severity changes. So, the degree of Cobb angle for an I've heard that 60 degrees is technically still a mild curve for adults. Based on our current literature, which for an adolescent or a 60 degrees is a really large angle. And I think just because of the changes that we can see for adults, this is just something to be aware of that you can't necessarily compare adult scoliosis with adolescent scoliosis. They can be very different in how somebody feels with them and then how the exercise would look for them too. Right, and with adolescents, we see less incidence of, although some of them do have pain, but less incidence of pain. I think that kind of makes it a little bit trickier to diagnose scoliosis, because unless your teen is complaining to you of something. then it may be missed. But, as adults, we do tend to see more incidence of pain in adults with scoliosis. And I think there was a misconception at one point, and many, many people were told especially when we were younger that scoliosis stops progressing after you're finished growing. And we know now that is not the that scoliosis can progress after you're finished growing. Of course, when you're still growing is the biggest chance of a large progression because if you can grow really fast, that curve can pop up super quick. But, as adults, there is still a chance of which can vary depending on how big your curve was when you finished. growing Yes, for sure. There are a lot of factors that go into whether somebody's curve can progress or not. The cob angle is one of those factors. So, a larger cob angle over 30 degrees, there's more of a chance that that curve will continue to progress a little bit. But also, how balanced the spine is plays a So if somebody has a big trunk shift or a big shift of their pelvis, or if somebody has a lot of changes in that side plane, so that they call it the sagittal plane. So there's a lot of factors. Also, of course, how strong we're able to keep our bodies, how we choose to use our time, how we nourish our that all can play a role as well. But I think it's also important to know as scary as it sounds, there are a lot of amazing treatment options now for scoliosis, including scoliosis-specific exercise and strength resistance training to make sure that we're keeping our bodies nice and strong. And absolutely, I always say, I think that's one of the flaws in that research that looked at progression, right? They had done a study a while ago where they just followed people over time to see what happened to their scoliosis as they got older. They didn't have any intervention; they just monitored them. And that's how they developed these figures to say, okay, if your curve is between 30 and 50 degrees. When you stop growing, it's going to progress maybe half a degree per year on average. But if it's more than 50 degrees, it might progress one degree per year on average. And I think one of the flaws there was that they didn't look at how active these people were. And I think we're learning more and more that the person's activity level, their muscle mass, and also their bone density is important to whether they'll have potential progression. There are many factors that contribute to that. And of course, we do have treatments for people with scoliosis that were not as readily available in the past, including scoliosis. specific exercise as well as strength training. So maybe we'll give just an to scoliosis exercise. I'm sure we're probably going to have more episodes on it in the future, but yes. So there's this type of exercise that it used to be known only as the Shroff method. It's now we tend to call it PSSE, or for short, scoliosis-specific exercise. It's a very individualized like treatment method where we figure out what type of scoliosis that somebody has. We learn how to teach them to strengthen their muscles— the right muscles— to stabilize that spine in three dimensions and be able to hold that best, most optimal position. And those can help to make sure we're keeping those muscles balanced, working on the endurance of those muscles, also helping that mobility of the spine and the rib cage, making sure we can still breathe really nicely. The scoliosis, sometimes with thoracic scoliosis in the upper spine, we can have issues with breathing later. It is incredibly effective at keeping a curve stable, reducing the risk of it getting worse over time, eliminating pain, and most definitely improving someone's posture and muscle balance. And there's even some research that says that in adults we can even see decrease in that cob angle as well. Of course, that's individualized but you can see some really amazing things and really improve somebody's quality of life by making sure they know these exercises and are doing them regularly. Yes, and I wanna clarify with scoliosis-specific exercise that this is an additional training that the physical therapist or practitioner has to take in order to be familiar with these exercises because I think there's many practitioners that say I treat scoliosis. Like if you call up the clinic, they say yes we treat scoliosis. Yes, we show people with scoliosis exercises but those exercises are not the scoliosis-specific exercises unless someone has that training and you have to have that training. Many people say, oh well, I read the The book is not really enough to be able to understand the and to be able to build the training exercises for the person. We have to analyze the. We have to be able to identify it. We have to prescribe the specifically for that curve type. So I always like to make that distinction because sometimes I speak to people, they say, oh I already did PT for scoliosis. And you may have, but you didn't do this PT for scoliosis. Yes, I think it's also just out of curiosity, Dr. Beth, if you had to guess how many courses or how much time you've during these specific. courses training about scoliosis what would you say is a good estimate? Oh my gosh, I mean I've taken the Schroth course I think at least two or three times, and I've gone as a patient myself several times. So that's, I mean yeah, it has to be at this point probably hundreds of hours training that I've done between all the coursework, going to the conferences. You know, it's not just like a oh I go for a few hours and I learn about scoliosis six or seven days that you have to do multiple trainings; you have to pass tests that you are efficient and that you are doing the exercises properly with the patients. So yeah, it's not something that you like do a weekend and you've got it down. It's much more training than I think what people realize. Right, I think that is a really important distinction. I mean, I just for myself I've done five courses now, specifically week-long courses plus these, plus I'm probably like you, I'm always trying to keep up with the current research and figure out how things are. Because as science does, it is constantly evolving a little bit over time, which definitely changes every time I go to a conference or every time I go to a learn something new that I immediately take back with me help the people in front of me. And I think that is definitely. Very different than having a baseline understanding of what scoliosis is, but not that specialized awareness. Yes, yes. And I think there's other schools of exercise that claim to treat scoliosis, but it's the system wasn't built for scoliosis. They think, okay, well, we've had some success with people with scoliosis, so we are good at that. But really, the Schroth and all of the scoliosis-specific exercises is developed for people with scoliosis. And I think that's a distinction to make as well because I noticed more training programs for personal trainers and things popping up to say like, oh, this type of exercise treats scoliosis. And I don't think that it was developed for scoliosis. I think that they're trying to apply it, but we don't have the research to say that some of those methods are effective just yet. So Schroth and scoliosis-specific exercises are really the only ones that have research showing their effectiveness in teens. Correct. And I think we'll put this in the show notes as well, but there are some directories where you can try to find somebody locally who is trained in this method. So there's a school out of Italy that's called SEAS, there's one out of Barcelona, there's a French school, there's a German school, and there's SSOL, which Dr. Beth is very familiar with, but they're based here in New York City. So, there's multiple directories where you can find someone that has been certified in this method. If you were trying to find someone locally, of course, both Dr. Beth and I have abilities to work with people virtually. But if you're looking for someone that's more local, there's definitely, it's growing in. And I think that it's going to be more available as time goes on, but a lot of people just don't really have access yet. So, that's why the virtual option can be really helpful. Yes, absolutely. We can probably even do a whole episode about the virtual and how we approach. that Yeah because I'm sure there's people listening that say well how could you do this virtually It seems like something that's so hands-on and you need all this specialized equipment And I think that the pandemic really taught us how we could change it and transpose it And I find that because we're working in the person's home or their environment sometimes it's even a little bit easier to set up their exercises because we see exactly what they have available and exactly where they're exercising whereas in the clinic we have this perfect scenario to create the exercise program but it's not always something the person can recreate at home. So I think there's benefits for both. We can probably do an episode comparing and contrasting of virtual and in person. But of course, if you don't have access, having a virtual option is still gonna be more specific and potentially more helpful than going to a local PT clinic that just doesn't have that expertise. Yeah, PT is a giant umbrella that for most of us, at least here in the States, which is where we are based, you have to be familiar with a little bit of everything. And there's really not the opportunity to specialize in something as complex as scoliosis. So that's not to say that the PT in front of you is not incredibly skilled. They just don't have the specific knowledge to really give you that exercise specific to your spine. And I think that's the distinction. And they'll give you whatever is at the best of their knowledge, but that's probably gonna be something that's more general in most cases. So that's just to clarify and make that distinction for people because I think people sometimes don't understand the difference of like, well, this person says they treat scoliosis, but do they treat it in the way that is so specialized? For example, I can work with people who have had neurological conditions like strokes. and other conditions, but that is not my specialty, right? So if that is somebody's primary challenge, it would be in their best interest that I send them to someone who specializes in that type of physical therapy. And we're seeing more and more that physical therapy is allowing for more specialization, of course. That's a whole nother conversation in our field that is changing, but is a good distinction to be aware of. Absolutely, yeah. So I think this was probably a pretty good overview. I think we can certainly talk in future episodes about different parts of it, but do you have anything else you wanted to say about scoliosis? In general, I think those were the big things we wanted to talk about just to have a basic understanding of what it is, especially for someone who's just been diagnosed. It may sound like a scary thing. Something also I mentioned to people, and because when you're diagnosed with any medical condition, and even scoliosis, like there's always this fear of can this condition kill me, right? Any medical condition, we always have that. And the good news is with scoliosis, it has a pretty low mortality rate. So people don't necessarily die from having scoliosis. Many people live very long lives, very normal lives with scoliosis and people. can have a great quality of life with scoliosis. So if you're new to this diagnosis and you're listening to this and seeing all the negative and all the red flags, we want you to know that having this understanding that it is something treatable, it is something that you can work on, and it's not something that has that as much that scary risk. Long, absolutely. And I hope that after listening, if there's anything you can take away, it's that you are definitely not alone. There are a lot of people that have scoliosis, and there are so many resources out there and a treatment and an entire community of people can lift you up and walk alongside you. So if this is something that was helpful, maybe share this episode with another person who has scoliosis or a family member who maybe doesn't understand scoliosis, and let us know what questions you have. Absolutely! We'll be having some new episodes coming up after this one, of course on treatments, on other conversations. But if you have any questions, you could always email us. We'll put our information in the show notes and let us know other things that you want to hear more about as well, so we can really tailor this to get the clearest information out there for everyone. So, from our curvy spines to yours. Thanks for tuning in today, and we'll see you on the next episode. Bye bye.