Scoliosis is defined as a lateral or rotary curvature of the spine. Scoliosis is a feature of rickets, a condition in which bones become soft and decalcified. Scoliosis with no known cause is called "idiopathic" scoliosis. The term "idiopathic" scoliosis may be outdated, as recent studies show a clear link between scoliosis and lowered bone densities.
Scoliosis is common in most connective tissue disorders including Marfan syndrome, homocystinuria, Ehlers-Danlos, osteogenesis imperfecta, the MASS phenotype and mitral valve prolapse syndrome.
A large portion of recent scoliosis research has been focused on finding a "scoliosis gene" or a singular cause for the disorder. This may be looking for a too-simple solution for a complex problem. Scoliosis is closely linked to low bone densities, yet we know that bone densities are influenced by a wide variety of overlapping factors that include genes, estrogen levels, nutrition, exercise levels and drugs.
In animal studies, scoliosis is known to be caused by a wide variety of conditions including lack of physical activity, pesticide exposure and nutritional deficiencies. Some of these are the same conditions that are known to lower bone densities in humans, especially the lack of exercise and nutritional deficiencies . Based on these facts, it is illogical to assume that scoliosis in humans would be caused by a single gene, or even by genetic factors alone.
In order to determine what is really causing scoliosis, you have to look at the big picture. What causes scoliosis in animal studies? What causes osteoporosis and osteopenia? Besides osteopenia, what conditions frequently occur along with scoliosis? Are surgery and bracing really the only valid treatments? How do these studies all fit with each other?
If you take a look at the
data with an eye for finding the answers to these questions, then there
are some very logical answers as to what is likely a factor in the
occurrence and logical treatment of scoliosis.
Most studies that have examined bone densities in patients with idiopathic scoliosis found that the subjects often have osteopenia or osteoporosis. Interestingly, studies of bone densities in people with connective tissue disorders, where scoliosis is usually an important feature, also find that they commonly have osteoporosis or osteopenia. Osteopenia is the underlying condition in rickets, another disorder in which scoliosis occurs. Bone density problems are the common link in many different types of scoliosis.
Based on a search of bone density studies on PubMed, one can see that connective tissue disorders with both scoliosis and low bone densities include:
Other chronic or genetic disorders where scoliosis and low bone densities occur together include:
In all of my research of bone densities in people with scoliosis, or in disorders where the people frequently have scoliosis as a feature of the disorder, they almost invariably have low bone densities. I've found only a few studies that showed normal bone densities, and none that ever showed high or even above average bone densities. Low bone densities are the common link. It is not a random coincidence. There are just too many studies on the subject for low bone densities to not be a highly relevant factor in scoliosis.
The chart below notes the
conditions that are linked to both scoliosis and osteoporosis. There have
been thousands upon thousands of studies done on osteoporosis prevention.
Perhaps some of this knowledge could be applied to scoliosis prevention,
too, since the conditions seem so closely linked. Whether curing
the underlying osteoporosis or osteopenia would cure the scoliosis, too,
remains to be proven. However, increasing one's bone densities into
the normal range is a desirable condition in any event, and it may
help the scoliosis, too.
|Low estrogen levels||Low estrogen levels|
|Nutritional deficiencies||Nutritional deficiencies|
|Lack of physical activity||Lack of physical activity|
|Low body weight||Low body weight|
A paper from a researcher at the Women's Medical and Diagnostic Center in Florida reports that among other factors, scoliosis is a known risk factor for osteoporosis.
In a study of women with osteoporosis, 48% had scoliosis, a statistically significant relationship.
Amenorrhoea (a lack of menstruation) in athletes is associated with both scoliosis and fractures. Amenorrhoea is associated with low estrogen levels, which is associated with osteoporosis. (Osteoporosis prevention is the reason many women in the U.S. are prescribed estrogen treatments. Keeping estrogen levels up is a proven way to increase bone densities.)
Osteopenia has been correlated with scoliosis in studies in Hong Kong.
In a study from the Department of Orthopaedic Surgery, Louisiana State University Medical Center, researchers concluded that of the females with scoliosis in their study group, over one half had marked osteoporosis.
A study that appeared in the Journal of Pediatric Orthopedics found that adolescent girls with scoliosis were found to have a generalized state of osteoporosis.
According to a paper that appeared in Spine, persistent osteopenia in adolescent idiopathic scoliosis was found in a scoliosis follow-up study.
Based on a study of elderly patients, it was concluded that factors that can cause a scoliotic curve to increase include degenerative disc disease with lateral disc space narrowing, soft tissue failure, and osteoporosis.
Another paper from researchers in Hong Kong reported that adolescent idiopathic scoliosis (AIS) may be associated with generalized low bone mineral status.
In yet another interesting study from researchers in Hong Kong, bone biopsies from patients with adolescent idiopathic scoliosis showed a disturbance of bone turnover. The study authors concluded that the "abnormal metabolism might contribute to the low bone mineral density and play an important role in the etiology and pathogenesis of adolescent idiopathic scoliosis."
Researchers from the Rheumatology Department, Saint-Etienne Teaching Hospital, found that bone mineral density values were lower in scoliosis patients than in the controls. They reported, "Among the patients, those with osteopenia wore a brace significantly longer and had more severe scoliosis in adulthood than those without osteopenia." The researchers went on to report that their findings "suggest a need for osteopenia screening and prevention in children with scoliosis, for monitoring physical activity and calcium intake during bracing, for preferring braces that allow greater mobility, and for closely monitoring the scoliosis during adulthood if osteopenia is present."
Researchers in Hong Kong found that, "Inadequate calcium intake and weight-bearing physical activity were significantly associated with low bone mass in AIS (adolescent idiopathic scoliosis) girls during the peripubertal period. The importance of preventing generalized osteopenia in the control of AIS progression during the peripubertal period warrants further study." (Italics added for emphasis.)
According to a 2001 report on health care in the U.S. from the Institute of Medicine, it takes, on average, 15 to 20 years for important medical discoveries to be incorporated into routine patient care. Based on this trend, it makes me wonder how long it will be before people with scoliosis are routinely screened for bone density problems. Based on the figures from the Institute of Medicine's report, unfortunately it seems as if it will likely take more than a decade for the link between scoliosis and osteoporosis to filter down to the average orthopedist and become a consideration in the treatment of his or her patients.
In the past, I have been diagnosed with
both scoliosis and Ehlers-Danlos syndrome. Yet, despite the studies
that show that people with EDS often have low bone densities and the studies
that show that people with scoliosis often have low bone densities, my
last two osteoporosis tests, done when I was about 40 and 45, showed my
bone densities to be above normal and normal respectively. My scoliosis
is almost gone now, too. I believe my scoliosis improved and my
bone densities are fine because I pursued very aggressive measures, through
diet and exercise therapy, to increase my bone density and balance my
muscles. Perhaps what
helped me would help other people with scoliosis and/or EDS, too.
As osteopenia and osteoporosis are often
treatable conditions, it would seem to be highly logical to have children
and adults with scoliosis routinely screened for bone density problems
For more information, see my section on: Books for Osteopenia and Osteoporosis Prevention and Treatment.
Scoliosis has been induced in a variety of animals through the creation of nutritional deficits and imbalances. Not surprisingly, many of the nutritional imbalances linked to scoliosis in animals such as deficits of manganese, vitamin B6, and copper have all also been implicated as factors in osteoporosis in humans. As noted above, research shows there are strong links between scoliosis and osteoporosis. Could nutritional deficiencies and diet play a role in scoliosis in humans? That seems quite likely.
Here are some of the animal studies of nutritional imbalances and anomalies known to cause scoliosis:
In chickens susceptible to scoliosis, the severity and incidence of scoliosis was decreased by giving the birds increased dietary copper.
In a different study on humans, teenage
girls with scoliosis were found to have
high copper levels in their hair. The authors of this study
suggested that copper may play a role in idiopathic scoliosis.
In another study on scoliosis in susceptible chickens, vitamin B-6, manganese or copper deficiencies caused an increase in the expression of scoliosis in the majority of the birds.
Rainbow trout fed a diet that was deficient in ascorbic acid developed many adverse health conditions, including scoliosis.
Channel catfish fed diets deficient in Vitamin C developed skeletal malformations.
Trout fed a diet deficient in tryptophan developed severe scoliosis.
Rats fed a diet deficient in vitamin E developed kyphoscoliosis.
Salmon fed a diet deficient in vitamin C developed scoliosis.
Trout fed diets containing excess leucine (an amino acid) developed scoliosis.
In a study of humans with scoliosis,
was higher in idiopathic scoliosis muscles than in other forms of scoliosis
or in normal control muscles. The authors suggested that a calcium-related
neuromuscular defect could be an important factor in the genesis of idiopathic
A study from researchers in Washington, D. C. found that nutrition should logically be considered as a possible factor human scoliosis, based in part by a review of all of the animal studies where nutrition plays a role in the disorder. The study authors concluded that, "There is evidence that poor nutrition may play a role in the etiology of idiopathic scoliosis. This possibility should be examined further in humans."
Drug, pesticide and herbicide exposure has been found to cause scoliosis in studies of animals. Perhaps exposure to toxins is also a factor in human scoliosis. It would be a highly logical area for further research.
Animal studies on scoliosis, drugs, herbicides and pesticides include:
Diquat, an aquatic herbicide, caused scoliosis and other defects in mallard embryos.
High doses of ibutilide fumarate, an antiarrhythmic, caused scoliosis in rats.
Poor posture was thought to be an important contributing factor in the development of scoliosis in the early 19th century in the U.S. Posture training was one of the primary treatments for scoliosis in that era. It fell out of favor in the later years of the 19th century as bracing and surgery became the preferred treatment of orthopedic doctors.
Romans many centuries ago discovered that their slaves who were
employed in rowing, if always kept on the same side of the ship,
developed lateral curvature of the spine. To prevent this they frequently
changed from one side of the boat to the other.
From The Home Physician and Guide to Health, Mountain View. Pacific Press. Pub. Assoc. 1931
Posture correction training did help me personally to improve my scoliotic curves, and a couple of recent papers suggest it has been beneficial in other cases of scoliosis, too. My physical therapist constantly stressed the importance of proper posture and body alignment to me, similar to the methods described in my antique medical books. Today we call it "ergonomics" and "body alignment", but the basic premise of posture training seems to have remained the same for the last 100 years. Perhaps posture training is a lost art. In any case, proper posture is thought to have many benefits besides scoliosis prevention and treatment, and no downside risks of which I am aware. The bottom line is that good posture won't hurt you, by keeping the muscles of the rib cage balanced it may help people to breathe better and reduce muscle tension, and according to a majority of the older medical text books and a couple of more recent studies, it may even help your scoliosis.
Studies that I found relating to scoliosis and posture include:
Tethering the spine to one side causes scoliosis in rabbits.
In a study in Russia, biofeedback was used to correct postural defects and straighten spinal columns.
A 1979 study in Poland found that posture training and exercise therapy had a role in scoliosis prevention and treatment.
A 2001 study from Hong Kong showed promising results in scoliosis treatment using posture training. According to the study authors, "A long-lasting active spinal control could be achieved through the patient's own spinal muscles."
According to a paper in the
medical journal Spine, studies in Japan and in Sweden have suggested
that a disturbance
of postural equilibrium exists in idiopathic scoliosis. With this
in mind, then it is not surprising that the studies listed above from
Russia, Poland and Hong Kong showed positive results on scoliotic curves
from posture correction.
Besides posture training, exercise was also once considered important for scoliosis prevention and treatment in the United States. It is my understanding that it fell out of favor after a single study in the 1940s concluded that exercise was not effective in treating scoliosis - that only bracing and surgery were effective treatments. I disagree that concluding that "exercise" is not an effective treatment for scoliosis is a logically valid conclusion, however, from a single study. All the study authors could have logically concluded was that the type, intensity and duration of the exercises performed in the study did not alter the course of scoliosis in the set of patients they selected for their study.
Different results may have been obtained in further scoliosis and exercise studies by altering the variables of the original study. This would include such factors as using different exercises (such as yoga or Pilates), more frequent exercise sessions, a longer study duration, subjects with more or less severe cases of scoliosis, or more knowledgeable exercise instructors. The possibility of researcher bias in the original study must also be considered, as the study results were reported by the American Orthopedic Research Committee. Bracing and surgery would monetarily benefit orthopedic surgeons, while exercise training would not. It would be naive to think that scoliosis surgeons in the U.S. are going to knock themselves out conducting studies that would prove that there were better ways of treating scoliosis than through bracing and surgery, a big part of their livelihoods.
In the book Backache
Relief by Arthur C. Klein and
Dava Sobel, the authors surveyed patients with different types of back
problems. The authors sent out questionnaires and asked people with back
trouble what treatments worked best for them. Of the people with
scoliosis, the most effective treatment was deemed to be yoga. The
study was small, but this would be my answer, too. I have
found that yoga exercises have helped my back pain from scoliosis, and
I have been able to reduce quite a bit of my curve through the stretching
of the concave side of my body using yoga postures.
While U.S. medical doctors may widely accept the premise that exercise does not have a place in scoliosis treatment, this does not mean it is true. Being widely accepted and being true do not mean the same thing. What is important to ask is, is their belief based on common medical dogma, or on actual scientific studies? When looking through the PubMed database at the website for The National Institute of Health, I found quite a few studies showing positive benefits from exercise for scoliosis patients.
Below are some interesting papers on scoliosis and exercise treatment. Note that these papers are based on actual scoliosis research --not just on common medical dogma.
Sports activities are a recommended treatment for scoliosis in Croatia. Greater occurrences of scoliosis were observed in children with limited physical activity.
Small cage size, which reduced the amount of space the animals had to move around in, caused deformation of the vertebral column in rabbits. Inactivity is a known cause of low bone densities, which, as noted above, are also associated with scoliosis in human studies.
Researchers from The Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand, reported on a case of a young scoliotic boy with progressive juvenile idiopathic scoliosis. They found that there was a rapid improvement in this child's spinal status achieved by physiological traction and specifically designed exercises.
therapy has been used for scoliosis treatment at a back clinic in
Germany with positive results.
Germany the triad of outpatient physiotherapy, intensive inpatient
rehabilitation, and bracing has proven effective in conservative
scoliosis treatment. Indication, content, and results of the
individual treatment procedures are described and discussed. The
positive outcomes of this practice validate a policy of offering
conservative scoliosis treatment as an alternative to patients,
including those for whom surgery is indicated."
From Conservative treatment of idiopathic scoliosis with physical therapy and orthoses by HR Weiss, Katharina-Schroth-Klinik. Orthopade 2003 Feb;32(2):146-56
A paper from researchers in Turkey published in the Saudi Medical Journal on the efficacy of Schroth s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis found that after 6 weeks, 6 months and one year, of therapy, all patients had an an increase in muscle strength and recovery of the postural defects. The researchers concluded that the Schroth technique positively influenced the Cobb angle, vital capacity, strength and postural defects in outpatient adolescents.
Physiatrists in Finland at Helsinki University Central Hospital, found pelvic asymmetry to be an overlooked syndrome manifesting as scoliosis, apparent leg-length difference, and neurologic symptoms. They report symptoms as improving with conservative, nonsurgical, simple and safe treatment.
A friend of mine from Poland tells me that exercise is considered a valid treatment for scoliosis in her home country. She showed me a book, written in Polish, of complete scoliosis exercises. Although I was unable to read the book, I could tell from the pictures that many of the exercises in her book were the same ones that were in my antique U.S. medical books. They were also many of the same exercises my physical therapist gave me to treat my own scoliosis. As noted above, a 1979 study in Poland did find that posture training and exercise therapy had a role in scoliosis prevention and treatment. Another paper from Poland reports positive results from exercises to remove contractures in spinal curvature.
"In summary, statements claiming that scoliosis cannot be stabilized or reversed without bracing or surgery are not, and never have been, supported by scientific data. On the contrary, as detailed in this book, long-standing basic and clinical research results in documented in reputable medical journals are consistent with the hypothesis that scoliosis can be reduced if not eliminated using nonsurgical approaches."
Excerpt from Scoliosis and the Human Spine, by Martha C. Hawes, PhD.
A preliminary report on the effect of measured strength training in adolescent idiopathic scoliosis from a spine clinic in San Diego reports that out of 12 patients treated with strength training, four reduced their curves by 20 - 28 degrees. From the same authors, they report in another study that sixteen of twenty patients demonstrated significant curve reduction due to specialized strength training and no final study participants had an increase in spinal curvature.
A study of 19 patients by a group of chiropractors, found that the combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. It is interesting to note that one of the methods the chiropractors used to treat the patients was traction, a treatment that was popular for spinal curvature in the early 1900's. (See my section on physical therapy for spinal curvature for more on this topic.)
A study from the University
of Athens on aerobic training for patients with idiopathic
scoliosis showed that the ability to perform perform aerobic work increased
48.1% in the training
group, while it decreased 9.2% in the control group.
Click here for my section on Important Clues to Spinal Curvature CausesThis section covers logical possible reasons why scoliosis often occurs with conditions like mitral valve prolapse, hypermobility (double jointedness), pectus excavatum and bleeding tendencies (heavy periods, nosebleeds, easy bruising, etc.). In most cases the common link is nutritional deficiencies.
There is a good paper from the U.S. government on scoliosis screening that includes information on the effectiveness, benefits and risks of scoliosis braces and scoliosis surgery: U.S. Preventive Services Task Force (USPSTF) Guidelines: Screening for Adolescent Idiopathic Scoliosis . Please note this is an older study, but significant findings from the USPSTF were, "The USPSTF found fair evidence that treatment of adolescents with idiopathic scoliosis detected through screening leads to moderate harms, including unnecessary brace wear and unnecessary referral for specialty care. As a result, the USPSTF concluded that the harms of screening adolescents for idiopathic scoliosis exceed the potential benefits.*
A landmark 2003 study from Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, published in the Journal of American Medicine (JAMA), found that "Untreated adults with LIS** are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns."
CBS News reported on their web site that the results of this study meant that "Many adolescents diagnosed with spine curvatures can skip braces, surgery or other treatments without developing debilitating physical impairments later in life, a 50-year study suggests." For more on this read the article Study Reverses Scoliosis Myths .
*Italics and bold letters added for emphasis.
** Late onset idiopathic scoliosis
Click here for my
The single gene theory as
a cause of scoliosis is an illogical conclusion that ignores all of the
important facts we know about the disorder. If scoliosis was really
caused by a single gene, then there would be no logical answer as to why
people with scoliosis frequently have bone density problems, why there
are a wide variety of nutritional and other environmental causes of scoliosis
in animal studies, and why scoliosis so frequently occurs along with conditions
like mitral valve prolapse, a heart condition which studies show most
cases are linked to magnesium deficiencies.
However, if you consider that there may well be multiple factors influencing scoliosis and that a major factor is likely to be a weakened spinal column, then all of the findings from the studies noted above make sense. They fit together like pieces from a puzzle.
Contrary to common medical dogma in the U.S., there actually are a number of studies from a variety of countries around the world that have shown positive results for scoliosis patients from exercise therapy and posture training, as noted in the sections above. In light of the fact that scoliosis is closely linked to inactivity and osteoporosis, the indications would logically be that bone strengthening exercises would be beneficial in the treatment of the disorder.
Nutritional therapy is not standard treatment for scoliosis currently in the U.S, but would seem like a logical area for more research in view of all of the nutritional deficiency links to scoliosis in animal studies. The previously noted recommendation that people with scoliosis be screened for osteopenia seems quite logical, as scoliosis has been noted as a marker for osteoporosis for many years. Osteopenia is known to be heavily influenced by nutrition, so again, diet therapy may be indicated as a treatment in cases of scoliosis where osteopenia is an underlying factor.
In the past
50 years, conventional medical treatment in the U.S. for scoliosis has
consisted mainly in bracing and surgical options. However, it is
time to reconsider the validity of these recommendations in light of recent
scoliosis research, especially the research linking scoliosis to osteoporosis
and osteopenia. A big picture review of the data regarding scoliosis indicate
that exercise therapy, posture training, diet therapy, investigation of
possible toxin exposure, and osteoporosis screening should also be considered
as possible treatment options.
For a list of other books that helped my connective tissue disorder symptoms, including my fibromyalgia, scoliosis, TMJ and MVP, please see my recommended book list.
1. Millner PA, Dickson RA. Idiopathic scoliosis: biomechanics and biology. European Spine Journal 1996;5(6):362-73 [ PubMed Abstract]
2. IllÚs T, Halmai V, Magdics M. Persistent osteopenia in adolescent idiopathic scoliosis: a longitudinal follow-up study. Spine 2000 Jan 15;25(2):273. [ PubMed Abstract]
3. Healey JH, Lane JM. Structural scoliosis in osteoporotic women. Clinical Orthopedic Related Res 1985 May;(195):216-23 [ PubMed Abstract]
4. Gidwani GP. Amenorrhea in the athlete. Adolescent Medicine 1999 Jun;10(2):275-90, vii. [ PubMed Abstract]
5. Cheng JC, Guo X, Sher AH. Persistent osteopenia in adolescent idiopathic scoliosis. A longitudinal follow up study. Spine 1999 Jun 15;24(12):1218-22. [ PubMed Abstract]