Seen from behind a healthy spine is straight; with scoliosis it forms a C or an S, often with rotation that makes one side of the ribs or waist more prominent. About three in a hundred children develop a scoliosis during growth, most of them idiopathic, meaning no clear cause. In adults we see two groups: those who have had a curve since adolescence, and those who develop a degenerative scoliosis after fifty, when osteoarthritis and disc wear change the alignment of the lower back.
We distinguish structural scoliosis, where the curve is a permanent shape, from functional scoliosis, an apparent curve caused by muscle tension, a leg length difference or a postural habit, which is often reversible. In both cases the number of degrees on an X ray says less about your complaints than how you move, where you are stiff and where you lack strength and control. That is what we examine and treat. Scoliosis is not broken; it is a different shape that moves differently and needs its own plan.
