One of the first questions we hear after someone is diagnosed with scoliosis is:

“What caused this?”

Parents may wonder whether their child carried a backpack that was too heavy. Adults may blame years of poor posture, an old injury or the way they sit at work. Some parents even worry that they somehow missed something or could have prevented their child's scoliosis.

The answer is usually more complicated.

Scoliosis is not one single condition with one single cause. There are several different types of scoliosis in Phoenix AZ, and the underlying cause depends on the type.

The most common form in children and teenagers—adolescent idiopathic scoliosis—does not have one clearly identifiable cause. Other forms can be associated with congenital spinal abnormalities, neuromuscular conditions or age-related degeneration of the spine.

At Barr Chiropractic and Scoliosis Center, we believe understanding the type of scoliosis is an important first step in understanding what treatment or monitoring may be appropriate.

Let's take a closer look at what we know about the causes of scoliosis—and clear up some common misconceptions along the way.

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First, What Exactly Is Scoliosis in Phoenix AZ?

Scoliosis is often described as a sideways curvature of the spine, but that description is incomplete.

Scoliosis is actually a three-dimensional spinal condition.

In addition to curving from side to side, the vertebrae can rotate. These rotational changes can affect the appearance of the ribs, shoulders, waist and pelvis.

A person with scoliosis may have:

• One shoulder higher than the other
• One shoulder blade that appears more prominent
• Uneven hips
• An uneven waist
• A rib prominence on one side
• A shift of the trunk
• An S-shaped or C-shaped spinal curve

Scoliosis is typically evaluated with X-rays and measured using the Cobb angle.

But determining the Cobb angle is only part of the evaluation.

We also want to understand what type of scoliosis the patient has, how much growth remains, whether the curve is progressing and what factors may affect the future of that curve.

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The Most Common Type: Idiopathic Scoliosis

The word idiopathic means that a condition does not have a clearly identifiable single cause.

This surprises many parents.

They may come into our office expecting us to identify exactly why their child's spine developed a curve.

With adolescent idiopathic scoliosis, or AIS, there usually isn't one event that caused it.

Your child didn't suddenly develop scoliosis because of a heavy backpack, bad posture or sleeping in the wrong position.

Researchers have studied scoliosis for many years, and evidence suggests that multiple factors may contribute to the development and progression of idiopathic scoliosis.

These may include genetics, growth, neurological influences, biomechanics and other biological factors.

Rather than thinking of idiopathic scoliosis as having no cause, it may be more helpful to think of it as having no single known cause.

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Does Genetics Play a Role?

Genetics appear to be an important part of the scoliosis story.

Scoliosis can run in families.

We frequently meet parents who tell us that they had scoliosis as teenagers, or that another child, grandparent, aunt or uncle also had a spinal curve.

However, scoliosis is not as simple as inheriting one gene that guarantees the condition.

A parent with scoliosis does not automatically have a child with scoliosis.

Likewise, a child can develop scoliosis even when there is no known family history.

The genetic relationship appears to be complex and likely involves multiple factors.

The practical message for parents is simple:

If scoliosis runs in your family, pay closer attention to your child's spine during the growing years.

Family history doesn't mean scoliosis will occur, but it provides another reason to consider regular screening.

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Why Does Growth Matter?

Growth doesn't necessarily “cause” adolescent idiopathic scoliosis, but it can play an important role in progression.

This is particularly important during puberty.

A child may have a relatively small curve before a major growth spurt and then experience progression as the skeleton grows rapidly.

That is why doctors evaluating childhood scoliosis don't look only at the current Cobb angle.

We also ask:

• How old is the child?
• How much growth remains?
• How skeletally mature is the child?
• Has the curve already been progressing?

A 20-degree curve in a younger child with considerable growth remaining can present a very different situation from the same 20-degree curve in a teenager who has nearly finished growing.

Growth is one reason early detection and appropriate monitoring are so important.

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Is Scoliosis Caused by Poor Posture?

This is one of the biggest misconceptions surrounding scoliosis.

Generally, poor posture does not cause adolescent idiopathic scoliosis.

Slouching over a phone, sitting incorrectly at a desk or spending too much time playing video games may contribute to postural problems or discomfort, but these behaviors are not considered the cause of structural idiopathic scoliosis.

A child with scoliosis may appear to have poor posture because of the spinal curvature.

For example, scoliosis can make one shoulder appear higher or cause the trunk to shift.

In that situation, what looks like poor posture may actually be a visible sign of the scoliosis rather than its cause.

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Can a Heavy Backpack Cause Scoliosis?

Another common concern among parents is backpacks.

A heavy backpack is not considered a cause of structural scoliosis.

An excessively heavy or poorly fitted backpack can certainly contribute to temporary discomfort, muscle fatigue or changes in the way a child carries themselves.

But that is different from causing the structural curvature and rotation associated with scoliosis.

Parents should still make sure backpacks are appropriately fitted and not unnecessarily heavy, but they should not blame themselves—or the backpack—if their child develops scoliosis.

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Does Sleeping Position Cause Scoliosis?

No evidence suggests that simply sleeping on one side, sleeping on the stomach or using the wrong mattress causes adolescent idiopathic scoliosis.

Parents sometimes become concerned after a diagnosis and begin analyzing everything their child has done for years.

• “How does she sleep?”
• “Does he always sit on one side of the couch?”
• “Did we buy the wrong mattress?”

These are understandable questions, but scoliosis is much more complex than a sleeping position.

Changing how a child sleeps is not a substitute for appropriate scoliosis evaluation and monitoring.

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Can Sports Cause Scoliosis?

Sports generally do not cause adolescent idiopathic scoliosis.

Children with scoliosis can often continue participating in athletics, depending on their individual circumstances and their healthcare provider's recommendations.

In fact, many children with scoliosis are highly active athletes.

Gymnasts, dancers, swimmers, runners, soccer players and other athletes can develop scoliosis just as non-athletes can.

A child being strong, flexible and physically fit does not eliminate the possibility of scoliosis.

This is another reason visual screening during the growth years remains important, even in athletic children.

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Congenital Scoliosis

Not all childhood scoliosis is idiopathic.

Congenital scoliosis results from abnormalities in spinal development that occur before birth.

One or more vertebrae may not form normally or may fail to separate properly during fetal development.

These structural differences can cause the spine to grow unevenly, producing a scoliosis curve.

Congenital scoliosis may be identified in infancy or childhood, although some cases become more noticeable as the child grows.

Because congenital scoliosis has a different underlying mechanism from adolescent idiopathic scoliosis, evaluation and treatment considerations may also be different.

These children should be appropriately evaluated and monitored by healthcare professionals experienced in pediatric spinal conditions.

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Neuromuscular Scoliosis

Another category is neuromuscular scoliosis.

This type of scoliosis occurs in association with conditions affecting the nervous system or muscles.

Examples can include certain forms of:

• Cerebral palsy
• Muscular dystrophy
• Spinal muscular atrophy
• Spinal cord disorders
• Other neurological or muscular conditions

When the muscles responsible for supporting and controlling the spine are affected, spinal curvature can develop or progress.

Neuromuscular scoliosis can behave differently from idiopathic scoliosis and often requires coordinated medical management.

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Adult Degenerative Scoliosis

Scoliosis can also develop later in life.

This is commonly called adult degenerative scoliosis or de novo scoliosis.

Unlike adolescent idiopathic scoliosis, which begins during growth, degenerative scoliosis can develop as the discs, joints and other spinal structures change with age.

Over time, uneven degeneration may cause the spine to tilt and curve.

Adults with degenerative scoliosis may also experience other age-related spinal changes such as disc degeneration, arthritis, spinal stenosis or changes in spinal alignment.

Symptoms can include:

• Back pain
• Muscle fatigue
• Reduced mobility
• Difficulty standing for extended periods
• Leg symptoms
• Changes in posture
• Reduced walking tolerance

The goals of conservative care for an adult may therefore be very different from those for a growing teenager.

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Can an Injury Cause Scoliosis?

Most adolescent idiopathic scoliosis is not caused by an injury.

However, injuries or structural changes can sometimes affect spinal alignment.

There is also a difference between structural scoliosis and a temporary or functional curvature.

For example, differences in leg length, muscle spasm or certain postural changes may make the spine appear curved without representing the same structural condition as adolescent idiopathic scoliosis.

A proper examination and imaging can help distinguish between these situations.

This is why simply seeing that someone's spine “looks crooked” isn't enough to determine the cause.

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Why Do Girls Seem to Be More Affected?

Both boys and girls can develop adolescent idiopathic scoliosis.

However, girls are more likely to experience curves that progress to a point where treatment may be considered.

The reasons for this difference are still being investigated and likely involve several biological and growth-related factors.

This is one reason scoliosis screening during the preteen and early teenage years can be especially important for girls.

But boys should absolutely be screened as well.

Scoliosis is not exclusively a female condition.

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If We Don't Know the Exact Cause, Can We Still Treat It?

Yes.

Not knowing one specific cause does not mean there are no options.

Consider how many conditions in healthcare are influenced by multiple factors. Treatment often focuses on understanding the condition as it exists today, determining the risk of progression and deciding what can reasonably be done to manage it.

With scoliosis, we evaluate factors such as:

• Curve magnitude
• Curve pattern
• Spinal rotation
• Age
• Skeletal maturity
• Growth remaining
• Previous progression
• Symptoms and function

These factors can help guide decisions about monitoring and conservative treatment.

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Our Conservative Approach to Scoliosis

At Barr Chiropractic and Scoliosis Center, we take an individualized approach to conservative scoliosis care.

Our goal isn't to claim that we can eliminate the underlying cause of idiopathic scoliosis.

Instead, we focus on the scoliosis that is present and determine what conservative options may be appropriate for that individual patient.

Depending on the patient's age, curve pattern, skeletal maturity and risk of progression, our program may incorporate:

• The Scolio-Trainer®
• Over-corrective nighttime-only bracing
• Scoliosis-specific exercises and rehabilitation
• Periodic examinations and imaging

Not every patient requires every component.

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The Scolio-Trainer®

The Scolio-Trainer® is a patented scoliosis treatment table developed specifically for conservative scoliosis care.

Because scoliosis involves both curvature and rotation, the Scolio-Trainer® is designed around the three-dimensional characteristics of the patient's individual curve.

It allows us to position a patient while applying controlled corrective forces based on the scoliosis pattern.

Depending on the individual curve, treatment may incorporate lateral corrective positioning and rotational components.

The objective is to work with the patient's unique spinal pattern rather than treating scoliosis as simply a general back problem.

Treatment plans vary, and no conservative treatment can guarantee a specific amount of curve correction.

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Over-Corrective Nighttime Bracing

For certain growing children and adolescents, particularly those considered at greater risk of progression, we may recommend an over-corrective nighttime-only scoliosis brace.

Unlike a traditional full-time brace, nighttime braces are designed to provide corrective positioning primarily while the patient sleeps.

For appropriately selected patients, this can allow the child or teenager to attend school, play sports and participate in normal daytime activities without wearing a brace throughout the day.

Nighttime bracing is not appropriate for every curve.

Curve pattern, magnitude, flexibility, skeletal maturity and remaining growth all need to be considered.

When appropriate, however, combining the Scolio-Trainer® with nighttime bracing and scoliosis-specific exercise can provide a comprehensive conservative approach.

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Don't Focus on Blame—Focus on What Comes Next

Perhaps the most important message for parents is this:

Don't blame yourself.

Your child's scoliosis was not caused because you failed to notice something soon enough.

It wasn't caused because your child slouched.

It wasn't caused because you bought the wrong mattress.

And it wasn't caused because your child carried a backpack to school.

For most adolescents with idiopathic scoliosis, there simply isn't one identifiable event that caused the condition.

A much more productive question is:

“Now that we know scoliosis is present, what should we do next?”

Find out the Cobb angle.

Determine where the curve is located.

Understand how much growth remains.

Ask whether previous imaging shows progression.

Learn how frequently the curve should be monitored.

And ask what conservative treatment options may be appropriate.

Understanding Scoliosis Creates Better Decisions

Scoliosis is a complex condition, and there is still much to learn about why idiopathic curves develop.

What we do know is that scoliosis can take several different forms and that the cause—or combination of contributing factors—varies depending on the type.

For children and adolescents, early identification can be particularly valuable because growth may influence progression.

At Barr Chiropractic and Scoliosis Center, our goal is to help patients and parents understand the scoliosis in front of them and determine whether conservative care is appropriate.

For selected patients, that may include the Scolio-Trainer®, scoliosis-specific exercises and over-corrective nighttime-only bracing.

You may not always be able to answer exactly why scoliosis developed.

But you can understand the curve, monitor it appropriately and make informed decisions about what comes next.

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Schedule a Scoliosis Evaluation

If you or your child has recently been diagnosed with scoliosis—or you've noticed uneven shoulders, hips, ribs or posture—we would be happy to evaluate the curve and discuss the available options.

If previous scoliosis X-rays are available, bring them with you. Comparing previous and current imaging can provide valuable information about whether a curve has been stable or progressing.

Barr Chiropractic and Scoliosis Center

Dr. Stephen Barr