What causes scoliosis?

Scoliosis has been around for thousands of years, among people of every culture and country.  Yet for all the time we have studied scoliosis, its true causes remain elusive.

Some types of scoliosis have a directly-identifiable cause.  Neuromuscular scoliosis, for example, occurs when a disease such as muscular dystrophy or cerebral palsy causes the spine to develop a scoliosis.  Congenital scoliosis arises due to a failure of the bones to form properly.  Degenerative scoliosis happens in late adulthood due to degeneration of the spinal discs.  Traumatic scoliosis can occur as a result of an accident or surgery.  All of these types of scoliosis, however, comprise less than 20% of the diagnosed cases.  The vast majority of scoliosis cases diagnosed (over 80%) are termed idiopathic.

Idiopathic means, “without known cause.”  It doesn’t mean there is no cause – simply that it is not readily apparent.

We know that scoliosis is not directly caused by problems with the genes.  It is possible for certain genes to predispose an individual to develop scoliosis, but there is no way to tell just by looking at the genes if a person will develop scoliosis or not.  Rather, it appears to be a combination of genetic and environmental factors that influences the development of scoliosis.  Even in identical twins, it is possible for one twin to develop scoliosis but the other does not.

The genetic factors involved with scoliosis appear to revolve around the genes responsible for regulating normal development of the bones and ligaments.  Scoliosis is often associated with low bone density (osteopenia) and joint hypermobility (ligament laxity).

Environmental aspects that influence scoliosis appear to be ectomorphic body types (tall and slender), loss of the normal thoracic kyphosis (flatback syndrome), and abnormal loading of the bones (Heuter-Volkmann’s Law).  One interesting new theory suggests that scoliosis is caused by a sensorimotor re-integration disorder (improper communication between the brain and the  muscles responsible for posture, balance, and coordination).

Scoliosis is not caused by muscle tension.  Studies have found that tension in the muscles arises as a consequence of scoliosis, after it has progressed to a certain point.

CLEAR Insights into the Cause of Scoliosis

One of the fundamental principles of chiropractic is that, in order to successfully treat a disease, you must address the cause, not the symptom.  In other words, when you have a headache, the cause of the headache is not a deficiency of aspirin.  Taking aspirin only blocks the pain signals, much like removing the Check Engine light from your dashboard “fixes” the problem with your car.

Scoliosis is a very complex condition, and it is very rare for a complex condition to arise from one obvious cause.  In most cases, it is probably a combination of factors, and in each individual case, some factors may be more influential than others.  Below is a brief summary of clinical observations and theories put forward by the CLEAR Scoliosis Institute as to how scoliosis might arise in some individuals, and how our treatment aims to address those factors.

Keep in mind that not every one of these potential causes might apply in every case.  In most cases, scoliosis does not develop due to only one cause, but a combination of causes with varying degrees of influence.  Each person must be evaluated on a case-by-case basis to determine which factors are most likely contributing to the development and progression of their scoliosis.

Upper Cervical Injury

Clinical observations suggest that many patients with scoliosis experienced a traumatic birth, such as a Caesarean section or a vaginal birth involving the use of forceps or vacuum extractors.  When the baby is being pulled from the womb or birth canal, its head and neck are very vulnerable to injury.  Excessive force could potentially disrupt the upper cervical spine, creating misalignments in the bones of the neck and leading to injury to the nerves and ligaments.  The nerves and ligaments in the neck have a great deal to do with maintaining posture and balance; it is possible that injuries to this area could interfere with the feedback between the brain and the body, leading to signals being sent and received inappropriately between the two.

A huge part of CLEAR treatment involves screening for and identifying any possible areas of ligament injury.  Patients with scoliosis tend to be more flexible than others, due to changes in the structure of their ligaments.  While this hyper-flexibility can be great for things like dance and gymnastics, it can also lead to problems with instability and excessive motion.  When ligament instability is found, the entire treatment approach is modified to avoid causing additional injury to these ligaments.  For example, CLEAR chiropractors are taught not to adjust the neck by hand using a “twisting”-type motion if the ligaments in the neck are unstable.  Rather, a special mechanical adjusting instrument is used that allows for more precise corrections, without further injuring the ligaments.

Spinal Cord Tension

The Roth-Porter concept, as well as the RASO (Relative Anterior Spinal Overgrowth) concept, revolve around the idea that the nerves (spinal cord) running through the spine (spinal column) are tethered at the top (brain) and the bottom of the spine.  If the elasticity of the nerves is reduced, or the bones of the spine grow faster than the nerves, the end result will be tension upon the nerves.  This tension can have many negative effects.

To understand why, it’s important to look at the characteristics of the spinal cord.  Around the spinal cord is a tough, protective sheath, called the dura mater.  This sheath wraps around the spinal cord in cross-striated fibers, much like the fibers of a Chinese finger trap.  When the spinal cord lengthens, due to the orientation of the fibers of the dura mater, it creates a “pincer”-effect upon the nerves.  This pressure on the nerves can interfere with the health of the body, similar to how blocking off a blood vessel can be harmful to the tissues that were being supplied by that vessel.

Spinal cord tension can be a difficult concept to measure or quantify.  CLEAR Doctors utilize several tests, such as the modified Cox sign developed by Dr. Matt Janzen, that are intended to evaluate how great of a role spinal tethering plays in each individual case.  In some individuals, spinal cord tension plays a very minor role; in others, it could be the primary driving factor behind the scoliosis.  Interestingly, there are two primary genes which influence spinal cord tension; one codes for the elasticity of the spinal cord proper, and the other regulates the elasticity of the spinal nerves that branch out in the lumbar spine.  It’s possible that problems with the first gene lead to more cases of thoracic scoliosis, and problems with the second are more likely to result in a lumbar curvature.

Restoring ideal sagittal balance to the spine reduces the distance that the nerves must travel through the spinal canal, and hence the tension that the nerves are under.  There are also various stretches and therapies that CLEAR prescribes to help improve the flexibility of the nerves themselves.

Sensorimotor Re-integration Disorder

The idea that problems with communication between the brain and the body lies behind the cause of scoliosis has been steadily gaining interest over the last decade.  People with scoliosis often have difficulty balancing with the eyes closed, or balancing on an unstable surface.  What causes this in turn is not known for certain, but it suggests that rehabilitation strategies aimed at improving balance, coordination, and proprioception might help prevent scoliosis from getting worse.

CLEAR uses an advanced system of reactive therapies, including spinal weighting and balance training exercises, to improve balance and coordination.  This approach “re-trains” how the brain activates the postural muscles in response to gravity, helping them to fire in a more balanced fashion.

Posture is an automatic, involuntary system.  It is possible to influence your posture with active conscious effort, but once you stop focusing upon it, your posture will return to its natural state.  In order to make long-term changes to posture, the brain and body must be influenced in a subconscious, reactive manner.  Active exercises are helpful in rehabilitating muscle imbalances, but reactive exercises help to rehabilitate imbalances in the cerebellum and the posture control centers of the brain.  By teaching the brain new ways of activating the muscles in a more balanced fashion, the permanence of the achieved correction is enhanced, leading to much improved long-term outcomes.

Altered Spinal Biomechanics

Many decades ago, scientists observed that people with scoliosis tend to have a flattening of the upper and middle back (thoracic kyphosis).  They theorized that this straightening of the spine and the loss of the normal good curves created a “de-stabilization” effect upon the spine, which rendered it vulnerable to developing scoliosis.  Restoring the good curves of the spine and promoting healthy sagittal balance appears to influence long-term health and quality of life.

CLEAR doctors are trained to analyze the spine in all three dimensions – not just looking at the curves in the spine when viewed from the front, but also the curves when viewed from the side, as well as looking at the rotation from the top-down.  Our protocols are designed to rehabilitate and restore the good, healthy curves of the spine.  With the good curves in place, the scoliosis can more effectively be reduced.  If the scoliosis is straightened without first restoring the good curves, the spine ends up straight and unstable again.  Restoring the good curves is a vital step in ensuring that the spine has the strength and flexibility it needs to function properly.

Chemical Toxicity

Some types of chemicals appear to influence the prevalence of scoliosis.  The chlorine in indoor swimming pools as well as the additives in meat have been found to increase the rate at which scoliosis develops.  Additional ongoing research suggests that certain heavy metals such as mercury may also have a negative effect upon the ligaments, weakening them and encouraging the development of scoliosis.

CLEAR recognizes how food, chemicals, and vitamins can influence the health of the body, and provides its doctors with suggested dietary guidelines and nutritional supplements to give to their patients.  As an example, scoliosis is often associated with low bone density (osteopenia and osteoporosis); however, evidence suggests that calcium and vitamin D alone are insufficient to provide the bones with all of the materials they need to be healthy.  For this reason, CLEAR advocates a more comprehensive approach to bone health, involving a combination of minerals and trace elements.

While there is no evidence that scoliosis is directly linked to any particular deficiency of vitamins and minerals, we believe that it is possible for an individual person to be affected by deficiencies or poor diet, that can in turn have effects upon their musculoskeletal system.  For this reason, CLEAR doctors are taught to provide nutritional and dietary counseling to all of their scoliosis patients.

Muscle Imbalances

As stated earlier, it is unlikely that imbalances in the strength or activity of the muscles are a direct cause of most cases of scoliosis.  It is certainly possible for a slight case of scoliosis to develop this way (mild scoliosis develops in many professional athletes that play sports which focus very heavily on one-sided activities, such as tennis and golf), but in most cases of scoliosis, the muscle imbalances that exist are a result, rather than a cause, of the scoliosis.

Nevertheless, CLEAR recognizes that muscle imbalances do contribute to the worsening of the condition, and must be addressed alongside all the other factors.   CLEAR has developed a program of isometric, asymmetrical spinal exercises that patients perform both in the clinic and at home, to stretch and relax tight muscles while also developing and strengthening the weak ones.

In summary, CLEAR recognizes that scoliosis could arise from a combination of factors, including but not limited to spinal cord injury, upper cervical trauma, spinal cord tension, ligament injury, vestibular/sensorimotor dysfunction, connective tissue disorders, exposure to various toxins, and alterations in spinal biomechanics.  It is also possible that genetic factors may predispose some individuals to be at a higher risk for developing scoliosis than others; however, even genetic factors can potentially be influenced through the science of epigenetics.  The CLEAR Scoliosis Treatment is tailored to identify and treat every aspect of a patient’s health that could be influencing their scoliosis, in order to achieve the best possible long-term outcomes not just in terms of Cobb angle reduction, but also in regards to improvement in quality of life.