Posture. Bad sitting habits or scoliosis? What’s the difference?

When a doctor sees a child with a crooked back, he should ask himself, “Is this a disease or is it a case of bad posture?” I wrote about the problem of scoliosis in my previous books, “33 Vertebrae, or I Love My Osteochondrosis”, “Smart Back” and others. But this problem is so urgent that I would like to talk about it again.

What is scoliosis?  It is not just an outward cosmetic defect. Spinal deformities affect the internal organs, self-confidence, and even the inner attitude. It’s sad that scoliosis is a disease that children and adolescents have to suffer with, and so I am asking young parents to read this chapter. 

We’re told in folklore that to meet a hunchback is good luck, and it is even better to touch his crooked back. I’m not sure if the hunchback experiences good feelings when someone is touching him. Just think of Quasimodo from “The Hunchback of Notre Dame” by Victor Hugo. There is also a story called “Hunchback’s Romance” by Russian writer Ivan Bunin. In this tale, a hunchback is looking forward to a date with a girl. But, to his disappointment, the girl appears to be a hunchback as well… 
If you have noticed that your son or daughter is sitting crooked at the table, and you’re wondering if there might be a spinal problem, examine your child! It might happen that you will be the first to sound the alarm. 

The initial diagnosis of scoliosis starts with a simple examination. You can learn how to conduct this test. This is also interesting for the child because as children become independent they start paying attention to their bodies. Ask your child to undress down to their underclothes and stand on the floor barefoot.  Draw an imaginary vertical line in your mind through these checkpoints: through the top of the nose, chin, and navel on the front, and the nape of the neck and sacrum on the back. Evaluate if these checkpoints are symmetric: are they situated on one line or are they off to one side? If a child is thin, the angles of the shoulder-blades are easy to see. They must be at an equal height and distance from the vertical line. If the child’s arms are hanging along the body, there are triangles between the arms and the body. In a child who is healthy, the triangles are symmetric. Gluteal (buttocks) folds should be symmetrical at the same height and have the same size. When you are looking at the child from the side, look for cervical and lumbar lordosis (the curves that dip inward.) The stomach should not stick out, and the deepening in the area of the low back must not be too deep either. A healthy child has moderate thoracic kyphosis. The ears must be on one horizontal plane. So here is our beloved, dear, and healthy child!

If your child’s posture is not right, you can define for yourself what type of disorder you see. This is because, in the previous chapters, we have discussed and have given you some examples of normal and pathologic postures.  However, you need to know that it’s not easy to detect mild scoliosis with this simple examination. To realize what scoliosis is, we have to return to anatomy and biomechanics.
Scoliosis is not just an inclination of the spine to one side. When a person has this disease, the spine is totally curved. A healthy spine is like a symmetrical toy pyramid, the tension and strength of which are evenly distributed. A spine like this grows and develops without abnormal curvatures, gradually and evenly. But this harmony is disrupted if the spine has the wrong shape from birth. This happens for instance in the case of a hemivertebra. A hemivertebra doesn’t have the usual cubic shape, but instead is shaped like a triangle. Before birth, the vertebrae develop from several folds. In some cases, not all the growth points are present, and a wrongly curved vertebra, like a triangle or some other shape, is formed.

It’s easy to understand that a spinal pyramid with such an odd and misshapen vertebra will develop asymmetrically and curvatures will appear. This is the reason for scoliosis in less than 10% of cases. The rest of the 90% of cases are so-called “idiopathic scoliosis” that appears in adolescence. The term “idiopathic” means we don’t know why it happens or there is no cause. Of course, there is some cause, but neither doctors nor scientists can state the exact reason for more than 90% of the cases of scoliosis that strike 2-4% of the population. In the entire whole world, there are millions of these children.
It is significant that girls suffer from scoliosis five times more often than boys. During pubescence, genes that determine skeleton development become more active. Now genetic analysis exists so it is possible to predict by looking at the cells in a child’s saliva if scoliotic spinal curvature will progress. If we compare the spine to a multi-storied building, we will see that in scoliosis, the upper floors start turning in one direction and bending to the side at the same time. These are the displacements that are observed when scoliosis is present: the vertebrae are leaning to one side and turning. If you remember that the ribs are attached to the thoracic vertebrae, it’s easy to understand that the chest is also involved in this turning. As a result, the two sides of the chest become asymmetric. This is the basis for a very sensible inclination test.

This test helps define even the initial stages of scoliosis. Ask the child who is dressed only in underwear to bend forward from the waist and let his or her arms hang down freely. Standing behind the child, look at the body outline, especially at the chest. If you notice that the chest is raised on one side a bit, it means scoliosis is present. To be sure, repeat the test several times.

Now, I guess, you are probably tired of reading descriptions of scoliosis. I will calm you down a bit: only one child in 10 needs to wear a brace to correct the condition. And only one child in 100 requires surgery. To evaluate how fast the disease is progressing, the child will need to be assessed by an orthopedist regularly, once every six months. From the age of 10 until the age of 16 (the end of pubescence) this examination is usually combined with X-rays. Of course, such a large amount of X-rays is excessive, so you will need to follow your specialist’s advice and recommendations.

If you have not detected any chest asymmetry, then there is no spinal rotation or scoliosis. This is the case when only posture defect is present, and this can be eliminated with the help of training, gymnastics and special exercises.

Can gymnastics help if you really have scoliosis? This question is often asked by many patients and doctors. Unfortunately, there is no final answer yet. In the 1920s, Katharina Schroth worked out some exercises for the treatment of scoliosis. Doctors still think this gymnastics program creates and maintains even loading on the spine and perhaps can prevent scoliosis progression.

Summary

• In more than 90% of cases, the reason for scoliosis is unknown; idiopathic.
• Scoliotic deformation can be detected in its initial stage with the help of an inclination test.
• Gymnastics and posture correction are an important part of scoliosis treatment and prevention.