Diagnosis and symptoms6 min read
What is scoliosis and how is it noticed?
Scoliosis is a sideways curvature of the spine seen from the front, together with rotation of the vertebrae on their own axis. It differs from poor posture: posture corrects with a change of position, scoliosis does not.
Signs noticeable at home
The most reliable sign is one side of the back standing higher than the other on the forward-bend test. As the person bends forward with straight knees, an observer behind sees an asymmetric prominence at the ribs or waist.
Other signs are one shoulder sitting higher, one shoulder blade more prominent, and waist creases of different depth. Clothing pulling to one side is also commonly reported.
These signs do not make a diagnosis alone. Where there is suspicion, a standing full-spine X-ray measures the Cobb angle, and diagnosis and follow-up decisions rest on that measurement.
What the Cobb angle means
The Cobb angle is the standard measure of curve severity. Curves under ten degrees are not called scoliosis; asymmetry at that level is very common in the population.
Curves between ten and twenty-five degrees are generally managed with exercise and regular monitoring. Above twenty-five degrees, and where a curve is progressing during growth, bracing comes into consideration.
Curves above forty-five degrees fall within the scope of surgical assessment. These thresholds are interpreted differently in adults and in those still growing; once growth is complete, progression slows markedly.
The relationship with pain
Most scoliosis during growth is painless. The picture therefore usually emerges not through pain but through visible asymmetry or school screening.
In adults pain is more common. Its source is usually not the curve itself but the muscles and facet joints strained under asymmetric load.
That distinction sets the treatment target: in adults the aim is not to correct the angle but to balance asymmetric load and build muscular endurance. With this approach pain can recede without the angle changing.
Key points
- Scoliosis is sideways curvature with vertebral rotation; it differs from poor posture.
- The most reliable sign is one side of the back standing higher on forward bending.
- Diagnosis and follow-up rest on the Cobb angle measurement.
- Asymmetry under ten degrees is not classed as scoliosis.
- Scoliosis during growth is mostly painless; pain is more common in adults.
Frequently asked questions
Is scoliosis hereditary?
There is a familial tendency: children with a family history are more likely to develop it. No single inheritance pattern has been defined, however, and it can appear without any family history.
Do backpacks cause scoliosis?
No. A heavy bag can cause muscle tension and temporary pain but is not a cause of structural scoliosis. In most adolescent scoliosis no identifiable cause exists.
How often is monitoring needed?
During growth, six-monthly review is generally advised, with shorter intervals during growth spurts. After growth is complete, the interval lengthens considerably.
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.