If last year taught us anything, it’s that taking care of ourselves and our health is of the utmost importance. For preteens, at annual check-up visits, it is critical to watch for changes in the spine — especially during puberty. Dr. Lorena Floccari of Akron Children’s Hospital stresses the importance of getting kids checked for scoliosis and how a routine check-up can prevent irreversible changes of the spine.
“The puberty years are the highest risk-time points for when scoliosis can go from a minor curve to a much larger curve,” Floccari says. “It’s critical for early detection, so that nonsurgical treatment can be implemented.”
Scoliosis is defined as a more than 10-degree curve in the frontal plane, causing an ‘S’ shape when seeing someone from the front. During pre adolescent years, before puberty, the back might be completely straight and not change at all. As soon as a child hits a growth spurt, the curve can take off and progress.
“There’s a lot we don’t know about scoliosis and the causes of it,” Floccari says. “Girls are five times more likely to have a curve that progresses. We do think there is a hormone component to it, because of the gender disparity.”
Scoliosis can be tricky to detect, because not all people experience back pain. One sign doctors look for when checking for scoliosis is rib prominence. The Adams Forward Bend test is used to detect if one side of the rib cage is higher than the other. Other signs of scoliosis include if the shoulders are an uneven height, or if one shoulder blade appears more prominent than the other.
“Having a positive family history is a factor that would put us on higher alert,” Floccari says. “It can be difficult to detect it if you are not actively looking for it. That’s where the importance of seeing your primary care doctor for your annual well child check is really critical for detecting it.”
The American Academy of Pediatrics recommends that girls get screened for scoliosis twice, at age 10 and again at age 12, whereas boys should get screened once, either at age 13 or 14.
“It is less common to get diagnosed with scoliosis in your 30s or 40s, unless it was from your teenage years that was missed,” Floccari says. “Scoliosis is present in one to three percent of the population, however 75 percent of people have mild scoliosis that doesn’t cause long-term problems.”
Nonsurgical treatment options are available for smaller curves, with the main treatment option being a brace. A scoliosis brace is designed to slow the progression of the spinal curvature. Doctors begin implementing bracing between 20-40 degree curves and often do not recommend treatment for curves of less than 20 degrees. Physical therapy for scoliosis, known as the Schroth Method, is also effective at preventing curve progression.
“There are different kinds of braces: Some braces are only worn at night, and some are worn throughout the day and night,” Floccari says. “Our recommendation is based on the type of curve the magnitude of the curve, and the age of the patient.”
Doctors recommend wearing a back brace until the patient is done growing. The spine is checked every six months via X-rays to see how the curve is doing and to note when the child is done growing.
Although back braces may appear uncomfortable, doctors do not put many restrictions on what patients can’t do. Preteens may be insecure or self-conscious when wearing their brace, so it is critical to talk to your child about their concerns with treatment options.
“Even when a patient is being treated in a back brace, they can still live a very normal teenage life,” Floccari says. “We encourage patients to take off the brace and do the activities they want to do, such as swimming, gym class or sports. I want parents to know that teens can still live a normal life even with scoliosis.”
The biggest benefit to getting checked for scoliosis is that if the patient does end up having it, nonsurgical treatments can begin right away. Floccari notes that several patients have come in who did not attend annual check-ups and ended up needing surgery right away.
“I would urge parents to get their child checked even if it seems minor,” Floccari says. “We would much rather see you sooner and implement nonsurgical treatments. I would hate for a child to not be seen, thinking it was minor, and then the curve rapidly progresses, and the child has missed that window of opportunity to brace.”