Adolescent Idiopathic Scoliosis and Back Pain

Aims

This article aims to discuss the relationship between adolescent idiopathic scoliosis (AIS) and back pain, and the management plan for it.

Fig. 1 Cobb angle (Greiner, 2002)

Objectives

• To introduce AIS
• To discuss the relationship between AIS and back pain, with considering of dysfunctional breathing
• To discuss the potential treatments for back pain in AIS

Introduction

Scoliosis is where the spine twists and curves to the side (National Health Service (NHS), 2017). See Scoliosis for full details.

The common outcome measure for the curvature of scoliosis is the Cobb angle (Fig.1).

One type of idiopathic scoliosis is AIS.

Prevalence

AIS is a common disease with an overall prevalence of 0.47-5.2 % in the current literature (Konieczny et al., 2013). It develops at the age of 11-18 and takes up 90% of idiopathic scoliosis cases in children (Konieczny et al., 2013). The female to male ratio ranges from 1.5:1 to 3:1 and increases substantially with increasing age (Konieczny et al., 2013). Genetic factors play a role as well (Konieczny et al., 2013).

Back pain in AIS

Back pain is approximately twice as prevalent in patients with AIS compared to non-scoliosis patients (Théroux et al., 2015; Sato et al., 2011; Joncas et al., 1996).

Théroux et al (2015), Sato et al (2011) and Joncas et al (1996) reported that back pain most commonly occurred in the lumbar region followed by the thoracic region in AIS for both sexes. A statistically significant association was found between thoracic pain and thoracic scoliosis in patients with AIS as well (Théroux et al, 2015). Most AIS patients with back pain reported their pain as moderate (Théroux et al., 2015; Joncas et al., 1996) to mild (Sato et al, 2011) intensity. Sato et al. (2011) also reported that back pain in AIS lasted longer and occurred more frequently when compared to patients without scoliosis.

Back pain and Cobb angle

No statistically significant relationship was observed between pain intensity and Cobb angle severity (Théroux et al, 2015; Balagué et al., 2016). Rigo (2010) also suggested the idea that Cobb angle does not correlate with back pain. However, this paper also suggested that patients without pain tend to present smaller curves and the incidence and intensity of back pain was higher in more severe curves (> 40°-45°). The Scoliosis Research Society (SRS) (no date) suggested that the presence of back pain may due to reduced abdominal and back strength or hamstring flexibility. However, no evidence supports this statement.

Back pain and quality of life (QoL)

Makino et al. (2015) reported that low back pain (LBP) in AIS patients can cause deterioration of patients’ quality of life. This can be due to the change of physical appearance due to AIS.

Dysfunctional breathing in AIS and back pain

Dysfunctional and asymmetrical breathing pattern often presents in patients with scoliosis (Weiss et al., 2016). Trunk rotation is increased as a result of breathing forces being directed downwards to the convexity of the spinal curvature (Weiss et al., 2016). There is also a linkage between dysfunctional breathing and LBP (Chaitow, 2014; Kiesel et al., 2017) and neck pain (Kiesel et al., 2017).