How does scoliosis cause back pain?

From the Guidelines

Scoliosis causes back pain primarily through the abnormal curvature of the spine, which creates uneven pressure on spinal discs, joints, and surrounding muscles. This is evident as the global prevalence of chronic low back pain has been estimated at 4% among adults aged 24-39 years and 20% among adults aged 20-59, with chronic low back pain being the leading cause of disability worldwide 1. When the spine curves sideways, it forces muscles to work harder on one side to maintain posture, leading to muscle fatigue and strain. The misalignment also places asymmetrical stress on vertebral joints and facet joints, causing them to wear down prematurely.

Some key points to consider in the relationship between scoliosis and back pain include:

• The abnormal curvature of the spine creates uneven pressure on spinal discs, joints, and surrounding muscles
• The misalignment places asymmetrical stress on vertebral joints and facet joints, causing them to wear down prematurely
• In more severe cases, the curved spine can compress nerves exiting the spinal column, resulting in radiating pain, numbness, or weakness
• The body's attempt to compensate for the curvature often leads to secondary curves in other parts of the spine, creating further imbalance and strain

As noted in a recent clinical practice guideline published in the BMJ, approximately 85% of patients with chronic spine pain present with non-specific pain, and advanced imaging often reveals incidental findings with low correlation between pathology and symptoms 1. Over time, these mechanical stresses can cause inflammation, degenerative changes in the spine, and chronic pain. The severity of pain typically correlates with the degree of curvature, with mild scoliosis often causing minimal or no pain while severe curves (greater than 40-50 degrees) more frequently resulting in significant discomfort. Pain management typically involves physical therapy, core strengthening exercises, anti-inflammatory medications, and in some cases, bracing or surgery for progressive or severe curves.

From the Research

Scoliosis and Back Pain

• Scoliosis is a common frontal plane spinal deformity with pain as a commonly associated occurrence in approximately 38% of the cases 2.
• The causes of scoliosis vary and are classified broadly as congenital, neuromuscular, syndrome-related, idiopathic and spinal curvature due to secondary reasons 3.
• Patients with scoliosis may experience back pain due to the lateral curvature and rotation of the vertebrae, which can lead to muscle imbalance and strain 3, 4.

Treatment Options for Scoliosis-Related Back Pain

• Corrective treatment with bracing or surgery does not specifically target the pain problem, and other causes of back pain should be considered before or meanwhile treatment is initiated 2.
• Injections with botulinum toxin in the paravertebral muscles do not have any corrective effects but may reduce localized muscle pain 2.
• Other options including peripherally acting pain medication and muscle strengthening by either exercise programmes or physiotherapy should be tried first 2.
• Brace treatment has been shown to be effective in reducing chronic non-specific low back pain in patients with scoliosis 5.
• Physiotherapy scoliosis-specific exercises (PSSE) can also produce benefits in subjects with scoliosis, such as improving back asymmetry, reducing muscle imbalance and related pain, and improving breathing function 6.

Exercise and Physical Therapy for Scoliosis-Related Back Pain

• PSSE is part of a scoliosis care model that includes scoliosis specific education, scoliosis specific physical therapy exercises, observation or surveillance, psychological support and intervention, bracing and surgery 6.
• The standard features of PSSE interventions are: 1) 3-dimension self-correction; 2) Training activities of daily living (ADL); and 3) Stabilization of the corrected posture 6.
• PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, and produce a temporary and significant reduction of the Cobb angle in non-progressive scoliosis 6.