Left-sided scoliosis: types of disease and exercises for therapy

16 September 2020

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S-shaped scoliosis is the second most severe type of spinal curvature in the direct projection. It is characterized by the formation of two differently directed bending arcs, one of which is the main one, and the second is compensatory, i.e., formed in response to the formation of the first. Thus, S-shaped scoliosis differs from C-shaped scoliosis, in which the main curve is located in the thoracic spine. In an effort to restore stability and the vertical axis of the body, compensatory mechanisms are activated, resulting in the formation of a second arch with a bend in the opposite direction.

The pathology develops slowly, without pronounced symptoms, so it is most often discovered during a preventive medical examination. At the same time, S-shaped scoliosis can cause significant harm to the body and cause displacement of internal organs, which will be accompanied by severe pain and the inability to remain in an upright position for a long time. Therefore, the disease must be detected as early as possible and measures taken immediately to eliminate it.

Most often, S-shaped scoliosis is found in children and adolescents 8-16 years old and in older people who already had minor spinal deformities.

Reasons for development

The main reason for the development of S-shaped scoliosis is genetic predisposition. And its formation can be determined by a lot of different factors, each of which boils down to the fact that too much or uneven load is placed on the spine. Therefore, with the initial formation of a scoliotic arch in the lumbar region as a result of the action of compensatory mechanisms, over time a second arch will form in the thoracic spine or even invade the cervical spine.

Such processes pose a rather serious threat, as they entail a change in the position of all surrounding anatomical structures, including the ribs. Therefore, if left untreated, S-shaped scoliosis can easily provoke disturbances in the functioning of the heart, lungs and other internal organs, as well as a decrease in the quality of blood circulation. And if, as a result of curvature of the spine, the spinal roots passing through the natural openings of the vertebrae are also pinched, this will also lead to the addition of radicular syndrome. It is manifested by severe pain, disturbances in sensitivity and mobility of the corresponding parts of the body, as well as disruption of the innervation of certain organs, which will also lead to the development of unfavorable organic changes in them.

Most often, pathology occurs in children and adolescents precisely because the spine continues to form until about 20 years of age, i.e., until this age it remains quite plastic. Therefore, various types of influences can lead to its curvature, which in itself is initially completely asymptomatic.

So, the main reasons for the development of S-shaped scoliosis are the same factors, in particular:

• lack of habit of keeping your back straight when walking and working at a desk, computer, etc.;
• low level of physical activity, which leads to weakness of the muscle corset and lack of adequate support for the spine;
• lifting and carrying heavy objects;
• carrying a bag or school backpack on one shoulder.

Still, the main reason for the development of scoliosis at school age is the improper organization of the workplace, i.e., the height of the table and chair does not correspond to the height of the child.

However, S-shaped scoliosis can also develop in adults. More often, the pathology is diagnosed in older people who have had a slight curvature of the spine since adolescence. Since with age, degenerative changes inevitably occur in the intervertebral discs that separate the vertebrae, they become thinner and can no longer cope with the load. This is usually aggravated by a decrease in the tone of the back muscles, which leads to the existing scoliosis progressing and developing into an S-shape.

At the same time, the risk of spinal deformity increases in the presence of predisposing factors, which include:

• The need to remain in one position for a long time, for example, sitting at a table. Static positions negatively affect the functioning of the entire body, provoking the development of stagnation, but the spine suffers no less from them, especially if a person does not monitor his posture.
• Overweight and obesity. Every extra kilogram negatively affects the condition of the spine, increasing the load on it when moving, standing or sitting. At the same time, the type of obesity, i.e. the most problematic areas in which the bulk of adipose tissue accumulates, determines which part of the spine will suffer the most.
• Incorrect selection of intensity of power loads. Often the cause of the development of S-shaped scoliosis is not only a sedentary lifestyle, which results in a weakening of the muscle corset and a decrease in the quality of support for the spine, as well as obesity, but also excessive strength exercises. If the training regimen is incorrectly selected, especially those involving heavy lifting, the load will fall only on a certain muscle group, which will create the preconditions for spinal curvature.
• Getting a spinal injury. Compression fractures, whiplash injuries and other types of injuries to the spine are fraught with its deformation, especially if the patient neglects the need to wear an orthopedic bandage or corset. In such situations, the injured spine does not receive the support it needs, and due to a gentle lifestyle and the inevitable decrease in muscle tone, it becomes completely unprotected and begins to bend.

Prevention

The development of left-sided curvature of the spinal column can be prevented by knowing the simple rules of prevention that should be followed from childhood.

It is important for children to choose the right orthopedic furniture. To prevent scoliosis you need to:

• choose furniture for the child in accordance with age, height and other physiological parameters;
• relax and sleep on an orthopedic mattress;
• use a backpack for studying with two soft straps;
• control posture when walking and sitting;
• take breaks during sedentary work;
• avoid excessive physical activity;
• exercise regularly and lead an active lifestyle;
• eat properly and balanced;
• periodically examine your health status.

For the treatment and prevention of scoliotic disease, it is necessary to consume foods containing:

If there is curvature of the vertebrae, you should also include fruits, vegetables, grains, seafood, and seaweed in your diet - the composition of these products includes many vitamins and elements that are beneficial for bone tissue.

Degrees and symptoms of S-shaped scoliosis

Scoliosis develops and progresses slowly. Therefore, it is easy to distinguish 4 stages in its course:

1. At the 1st stage, the angle of curvature does not exceed 10°. In this case, only one arch can be detected, since the second one still remains completely invisible, although initial compensatory changes in the part of the spine adjacent to the affected one are already occurring. This is the most favorable stage of disease development from the point of view of conservative treatment, but also the most difficult to diagnose, since the patient does not notice any disturbances in his well-being, and it is still impossible to outwardly notice a deviation from the norm.
2. At the 2nd stage, the bend increases to 10-25°, which is already accompanied by the formation of the 2nd arc, although it is still extremely difficult to detect it visually. At this stage, the first arch attracts attention to a greater extent, so the patient’s tendency to slouch, as well as a mild asymmetry of the shoulder blades, can already be noticed. This can only be noticed when the torso is tilted forward.
3. At the 3rd stage, the degree of curvature of the first arch reaches 25-50°, and the second can already increase to 25°. At this stage, significant asymmetry in the chest and the formation of a noticeable hump in the ribs are easily detected. In this case, S-shaped scoliosis is already considered advanced and is difficult to treat conservatively. Therefore, in most situations, patients are recommended to undergo surgery. After all, the formation of two pronounced arches leads to progressive disturbances in the functioning of internal organs, among which the heart and blood vessels suffer the most, since the curvature of the spine provokes circulatory disorders in the small circle.
4. At the 4th stage, the inclination of the main arc already noticeably exceeds 50°. At this stage, external changes are no longer just noticeable, but striking. Severe deformation of the spine provokes changes in position and disturbances in the functioning of almost all internal organs, and also significantly limits the patient’s mobility and leaves him practically no chance to remain in an upright position for a long time. As a result, patients with stage 4 S-shaped scoliosis often become disabled. If surgery is not performed at this stage, the result will be multiple organ failure.

Thus, when changes occur only in the vertebrae and adjacent tissues, it is impossible to detect S-shaped scoliosis without the use of instrumental diagnostic methods. In such situations, one can only suspect something is wrong based on the results of x-rays. An orthopedist or neurologist is able to notice external signs of deformation only when the bend of the main arch reaches 7-10°.

Therefore, it is important not to neglect preventive examinations, and also to independently monitor the condition of the spine of a child or elderly relatives. Warning signs that it’s time to see a doctor are the following:

• stooping, which is accompanied by the fact that a person not only hunches over, but also involuntarily stretches his neck forward, and also keeps his head down while walking;
• asymmetry of the position of the blades;
• the presence of slight muscle tightening in the ribs on one side.

Subsequently, as the degree of spinal curvature progresses, other manifestations of the disease appear:

• asymmetry of shoulder position;
• pelvic distortion;
• change in gait;
• the formation of a hump in the area of ​​the ribs, shifted to one side or another;
• compaction and increase in the formed muscle shaft;
• increased fatigue after physical activity;
• aching dull pain in the side, resulting from muscle spasms.

When the degree of curvature increases to 40° or more, negative changes occur in the chest and circulatory organs. Since spinal deformation leads to a change in the position of the muscles and a decrease in the supporting function of the spine, this can provoke compression of the blood vessels. The consequence of such changes will be a violation of blood circulation, and therefore the course of metabolic processes.

Since the formation of a scoliotic arch in the thoracic spine is associated with a decrease in the chest, this, with an increase in the angle of curvature, provokes a change in the position of the lungs and heart, resulting in the occurrence of shortness of breath and arrhythmia, i.e., heart rhythm disturbances. Over time, these symptoms are accompanied by disturbances in the functioning of the gastrointestinal tract and kidneys.

Symptoms

1st degree – angle of curvature from 1-10°. Symptoms of the first degree are practically invisible. These include small visual discrepancies, such as one shoulder being slightly higher than the other. After prolonged physical activity, you may experience back pain. 2nd degree – deviation angle from 11 to 25°. In the second degree, symptoms become more noticeable. Regular back pain appears, shoulders and shoulder blades acquire a visually asymmetrical arrangement. 3rd degree – deflection angle from 26 to 50°. Painful sensations become more frequent and worse. A pronounced deformation of the back appears and a rib hump appears. 4th degree - deviation angle from 50° and above. The body is deformed, a bulge on one side of the ribs and a depression on the other become clearly visible.

Diagnostics

Diagnosis and treatment of S-shaped scoliosis is the task of an orthopedist. The doctor will initially collect anamnesis, i.e. data about the patient’s lifestyle, the nature of existing health complaints, and then conduct an examination. Initially, he will examine the patient’s back, and then be sure to ask him to lean forward as much as possible so that his fingertips reach his toes or at least strive for this position. In this position, changes in the spine are best visible.

Thanks to this simple test, you can already detect changes characteristic of S-shaped scoliosis of the 2nd degree:

• the position of one shoulder is higher than the other;
• formation of a hump in the spine;
• the presence of spaces between the ribs, their incomplete retraction;
• approaching the costal arch closer to the spine;
• asymmetrical arrangement of the blades;
• asymmetrical position of the waist triangles;
• shortening of legs or arms.

Also, S-shaped scoliosis is characterized by a decrease in muscle tone, in particular the abdominal muscles.

To confirm the diagnosis and accurately determine the degree of scoliosis, an X-ray examination of the spine in several projections is prescribed. Thanks to the obtained images, it is possible to make accurate measurements and calculate the angle of curvature of each arch, which will allow you to make the correct diagnosis, as well as understand whether you can try to correct the situation using conservative methods or whether surgical intervention is already required.

If necessary, the doctor may also recommend a CT or MRI. These are more modern and expensive research methods, but with their help you can collect maximum information about all the anatomical structures that form the spine and detect the slightest pathological changes in them.

Elderly patients may additionally be prescribed densitometry, i.e., an examination designed to determine bone density. This is important for detecting osteoporosis and determining the risk of developing complications associated with it.

Treatment of S-shaped scoliosis

The nature of what treatment will be prescribed to the patient directly depends on the degree of S-shaped scoliosis that was detected. Conservative methods, including drug therapy, physiotherapy, exercise therapy, manual therapy and lifestyle changes, are effective only in the initial stages of scoliosis development. In case of 3rd or 4th degree, the only way out of the situation is to perform an operation.

But in some cases, surgical intervention is also prescribed for stage 2 S-shaped scoliosis. Most often in such situations it is required for children who have a tendency to rapidly progress the disease and have additional hemivertebrae or fusion of ribs. Surgery may also be prescribed in the early stages of S-shaped scoliosis if it:

• caused the development of cardiac or respiratory failure;
• causes severe compression of blood vessels or spinal roots;
• carries a high risk of spinal cord injury.

Thus, for each patient, treatment is developed strictly on an individual basis, taking into account not only his age, but also the presence of concomitant diseases, the risk of developing complications of S-shaped scoliosis and other factors.

Drug therapy

Drug therapy is far from the main method of treating S-shaped scoliosis. It can only temporarily improve the patient’s condition, as well as increase the effectiveness of other measures taken, but in no way affects the nature of the disease and is not able to restore the normal anatomy of the spine.

Therefore, as part of drug treatment, patients are mainly prescribed only muscle relaxants and anti-inflammatory drugs. The first ones are designed to reduce the tone of overly tense muscles, i.e., relieve spasm. This will reduce the severity of pain and reduce the risk of injury.

Anti-inflammatory drugs are indicated for faster resolution of the inflammatory process, which invariably occurs with spinal deformity. This also helps to reduce pain, both due to the mild analgesic effect of the most drugs in this group, and due to the reduction in the intensity of inflammation. While taking anti-inflammatory drugs, there is an additional decrease in soft tissue swelling.

Sometimes patients are additionally prescribed thyroid hormones. This is only possible with a comprehensive examination and the absence of concomitant diseases, metabolic disorders and other changes in which hormonal therapy can cause more harm than good. In S-shaped scoliosis, thyroid hormones are prescribed to increase bone plasticity, which will allow the normal position of the spine to be restored more quickly and effectively through other components of conservative therapy.

Physiotherapy

Physiotherapeutic procedures are designed to increase the effectiveness of other therapeutic interventions. As a rule, when treating S-shaped scoliosis, the following are prescribed:

• electrophoresis;
• magnetic therapy;
• ultrasound therapy.

Thanks to gentle physical effects, it is possible to increase blood circulation, increase metabolic rate, normalize muscle tone and have a general strengthening effect on the body. In most cases, for S-shaped scoliosis, courses of procedures of 8-15 sessions are prescribed, performed at a certain interval.

Sometimes patients may be offered traction therapy, i.e., spinal traction. The procedure is carried out using a special apparatus and involves carefully stretching the body in opposite directions along the central axis, which helps to normalize the position of the vertebrae and eliminate pathological bends of the ridge.

Exercise therapy

Physical therapy is one of the main methods of conservative treatment of S-shaped scoliosis. It involves daily performance of a special set of exercises, which is developed for each patient individually in accordance with the severity of his disease, level of physical fitness and age. The shape of the S-shaped scoliosis is also taken into account, or more precisely, in which direction the main arch is formed. It is recommended to conduct the first classes under the guidance of a specialist, and only after you have fully mastered the program and methods of performing each exercise, you can start practicing at home on your own.

The goals of exercise therapy are:

• strengthening the muscle corset, which can create adequate support for the spine;
• improved posture;
• activation of blood circulation and metabolic processes;
• correction of spinal deformity.

In addition to daily exercise therapy, patients are recommended to take up swimming, certain types of dancing, or some other sports disciplines that help strengthen all muscle groups of the upper half of the body.

Classes begin with light loads and a small number of repetitions. As the muscles strengthen, the load is increased, reaching the optimal level. Exercises on the Swedish wall have a good effect on the condition of the spine: hanging, pull-ups, etc.

Manual therapy

With S-shaped scoliosis, all patients, provided there are no contraindications, are prescribed manual therapy. It involves a deep massage, which not only works the back muscles, but also has a positive effect on the spine and restores the correct position of the vertebrae. A chiropractor can tone overly relaxed muscles and at the same time eliminate muscle spasms on the opposite side, which very often accompanies S-shaped scoliosis. Thanks to manual therapy sessions, it is often possible to release pinched nerve roots and blood vessels, which has a beneficial effect on a person’s well-being.

But the method cannot be used when:

• acute infectious diseases;
• skin rashes in the affected area;
• severe pathologies of the cardiovascular system, etc.

Lifestyle correction

When diagnosing S-shaped scoliosis, it is very important to create conditions so that the pathology does not worsen. Therefore, patients are recommended:

• provide a balanced diet;
• devote sufficient time to rational physical activity;
• watch your posture;
• avoid maintaining a static body position for a long time (when performing sedentary work, you must take regular breaks, get up and move, not forgetting about your posture);
• do not lift heavy objects;
• change the mattress to an orthopedic one;
• Avoid making sharp body turns.

Patients are often prescribed to wear orthopedic bandages or corsets. For mild forms of S-shaped scoliosis, soft bandages are sufficient, but for curvature of 3, not to mention 4 degrees, you will need to individually make and constantly wear a hard corset. Such designs are designed to reduce the load on the spine and minimize the risk of further curvature.

Preventive measures

Scoliosis is quite problematic to treat, so many experts advise preventing it, that is, ensuring your life activities in such a way as to eliminate the factors that provoke it.

Preventive measures are considered:

• Regular exercise while controlling the load on the spine.
• Selection of the right bedding (preferably orthopedic).
• Selecting a table and chair according to a person’s height, with the ability to change the position of the backrest.
• Frequent walks in the fresh air, with active games or jogging.
• Carrying an orthopedic backpack instead of a heavy bag on one side only.
• To avoid staying in an uncomfortable position for a long time, it is advisable to take a break for 5 minutes every 2 hours in the form of a light warm-up.

Left-sided thoracolumbar scoliosis is not a death sentence at an early stage if you take all the necessary measures to slow down the progression of the curvature, change your lifestyle and move more. Treatment should be prescribed and monitored by a specialist after a comprehensive diagnosis. Compliance with all doctor’s instructions is the key to a positive prognosis and improved patient well-being.