Most cases of scoliosis begin between the ages of 9 and 13. However, scoliosis can also arise in adults as a consequence of trauma or degeneration of the spinal discs. Left undiagnosed, scoliosis has the potential to cause problems later in life. For this reason, CLEAR recommends being screened for scoliosis and other postural abnormalities at least once a year.
Adam’s Forward Bending Test
Despite increasing evidence of its shortcomings, the Adam’s Forward Bending Test has been the gold standard for scoliosis screening since its introduction in 1865. Most experts recommend using a scoliometer (a simple device that measures rotation of the torso) to enhance the effectiveness of scoliosis screening. However, even when performed with a scoliometer, the Adam’s Test can only detect a pre-existing case of scoliosis. It cannot determine whether scoliosis will develop, or if an existing case will worsen.
Screening for Problems with Balance and Proprioception
Proprioception is defined as the body’s ability to orient itself and to identify its position without using the eyes. For instance, if you close your eyes, you still know the position of your arms. This is because of your body’s proprioceptive system. In some people with scoliosis, the communication between the body and the brain is impaired. There are several simple proprioceptive tests:
- Jump Test
- Marching Test
- One-Legged Stork Test (sometimes called the Unipedal Stance Test, or UPST)
- Modified Clinical Test for Sensory Integration and Balance (m-CTSIB)
These tests require very little training, and can be done by parents at home. When evaluating proprioception, be aware of the risk of falls and be sure to take appropriate precautions to prevent injury.
The Jump Test and Marching Test
In a soundless room with bare feet, the patient closes their eyes, and either jumps straight up and down or marches in place with the arms held straight out from the body for 30 to 60 seconds.
Individuals with altered proprioceptive function will unconsciously rotate from their starting position. The more the patient deviates from their original orientation, the more severe the proprioceptive defects are likely to be, and the greater the risk for the development of scoliosis.
The One-Legged Stork Test
The individual crosses their arms in front of their chest and stands on one leg for 30 seconds. Inability to maintain this one-legged stance for 30 seconds indicates a positive result.
This should be performed first with the eyes open, testing the patient’s ability to balance when visual cues are present. Research suggests that people with scoliosis have a tendency to rely more upon visual cues than people without, so most times this test will be normal even in individuals with scoliosis.
When the test is performed again with the eyes closed, proprioceptive abnormalities will become apparent. Most people with scoliosis (or those at risk for developing scoliosis) cannot hold this position with their eyes closed. Both the left and the right one-legged stance should be evaluated. Often, it’s more difficult on one side than the other.
The m-CTSIB Test
This clinically-validated test requires an unstable surface, such as a foam pad or air disc. The patient stands first on a stable surface with their eyes open, then closed, and is observed for signs of swaying or an inability to balance. This is repeated on an unstable surface.
An individual with normal balance and proprioception should be able to balance on the unstable surface with their eyes closed for 30 seconds. If they cannot, it is indicative of proprioceptive dysfunction.
Screening for Spinal Cord Tension
There are numerous tests for measuring spinal cord tension. The most useful include:
- Spinal Meningeal Tension Test
- Cervical Flexion Test
- Superficial Abdominal Reflex (SAR) testing
- Modified Cox Leg Raise Test
Spinal Meningeal Tension Test
This test requires a barefoot patient to bend forward at the waist with locked knees and arms dangling in front of the body. The doctor then stabilizes the tailbone with one hand, and places the other on the back of the patient’s head to bring the neck into flexion. An individual with spinal cord tension will find this position extremely uncomfortable. The presence of a sharp, localized pain along the spinal cord could be indicative of a spinal cord lesion, which is worth investigating.
Cervical Flexion Test
This test is based on research that many patients with scoliosis have a difficult time touching their chins to their chest. In this test, the physician simply asks the patient to perform this maneuver. If the patient is incapable of doing so, the distance between the chin and chest is measured and used to express the possible severity of the cord tension.
Superficial Abdominal Reflexes (SAR) Testing
For this test, the patient lies on their back and exposes their stomach. The doctor then draws an object (such as the blunt end of a pen) across each quadrant of the abdomen. With a normal result, the navel will “twitch” slightly and reflexively, without conscious effort. If the result is abnormal, there will be no noticeable movement, which suggests the spinal cord is being stretched.
The Modified Cox Leg Raise Test
Clinical experience suggests this test is effective in identifying children, between the ages of 6 and 10, who are at risk for developing scoliosis. The Cox test is performed by lying the patient on their back, and using a large pillow or foam wedge to place their neck into flexion. The doctor then slowly lifts one leg, feeling for a sudden “lock”, and observes the pelvis. If the leg locks suddenly and the opposite side of the pelvis lifts up from the table, this is a sign of underlying nerve tension. If it occurs early on, with less than 50 degrees of hip flexion, this is evidence of higher levels of spinal cord tension.
The proprioceptive tests above, combined with Adam’s Forward Bending Test, can be useful in detecting existing cases of scoliosis in adolescents, ages 10 to 16, or for identifying at-risk cases in younger children. However, the tests for spinal cord tension may be less useful in diagnosing existing cases, as scoliosis can develop specifically to adapt for and to relieve this tension.
Here is a video of Dr. Matt Janzen introducing the scoliosis Cox test:
CLEAR Scoliosis Screenings
Enhancing the Early Detection of Spinal Deformity
Due to their familiarity with the nervous system and spine, CLEAR chiropractors have the potential to recognize abnormalities that could cause a specific case of scoliosis to worsen over time. While further research is necessary, the cumulative clinical experience of the CLEAR doctors has led to the development of new tests that may be able to identify individuals who are at-risk for developing scoliosis, as well as more accurately gauge the risk for an existing case to worsen.
The first step of a CLEAR scoliosis screening is to interview the patient and their family to determine if known cases of scoliosis exist in the patient’s family. While it is highly unlikely that the cause of scoliosis is purely genetic, scoliosis has a tendency to run in families. Therefore, if one person in a family is known to have scoliosis, it is very important to screen every family member.
Evaluations and Screenings
Many CLEAR doctors will provide postural evaluations and scoliosis screenings free of charge. For more information, please contact the CLEAR doctor closest to you.
CLEAR and its Certified Doctors are also happy to support local communities, athletic organizations, and school systems (both private and public) by conducting scoliosis screenings for their members and students. For more information on how CLEAR can help support scoliosis screening in your community, please contact [email protected] or call us at (866) 520-4270.
How to Interpret Positive Results
If the results of a scoliosis screening suggest the individual may have scoliosis, the next step is to schedule an x-ray examination. Only an x-ray can confirm or deny the presence of scoliosis.
If you or a loved one have concerns about scoliosis, the most appropriate course of action is to schedule an in-person consultation with a CLEAR Certified Doctor or another scoliosis specialist in your area.