• Medical history: The doctor talks to the patient and the patient's parent or parents and reviews the patient's records to look for medical problems that might be causing the spine to curve; for example, birth defects, trauma, or other disorders that can be associated with scoliosis.
• Physical examination: The doctor looks at the patient's back, chest, pelvis, legs, feet, and skin. The doctor checks if the patient's shoulders are level, whether the head is centered, and whether opposite sides of the body look level. The doctor also examines the back muscles while the patient is bending forward to see if one side of the rib cage is higher than the other. They will be looking for a significant asymmetry (difference between opposite sides of the body). Certain changes in the skin, such as so-called cafe au lait spots, can suggest that the scoliosis is caused by a birth defect.
• X-ray evaluation: Patients with spinal curves, unusual back pain, or signs of involvement of the central nervous system (brain and spinal cord) such as bowel and bladder control problems need to have an X ray. The X ray should be done with the patient standing with his or her back to the x-ray machine. Occasionally, doctors ask for more tests to see if there are other problems.
• Curve measurement: The doctor measures the curve on the x-ray image. He or she finds the vertebrae at the beginning and end of the curve and measures the angle of the curve. The amount of curvature with along with other findings will determine the nature of the recommended treatment. Hopefully with early detection, conservative care can be instituted.

• Location: To identify a curve's location, doctors find the apex of the curve (the vertebra within the curve that is the most off-center); the location of the apex is the "location" of the curve. A thoracic curve has its apex in the thoracic area (the part of the spine to which the ribs attach). A lumbar curve has its apex in the lower back. A thoracolumbar curve has its apex where the thoracic and lumbar vertebrae join.
• Shape: The curve usually is S- or C-shaped.
• Pattern: Curves frequently follow patterns that have been studied in previous patients. The larger the curve is, the more likely it will progress (depending on the amount of growth remaining)

The doctor's at Allied will suggest the best treatment for each patient based on the patient's age, how much more he or she is likely to grow, the degree and pattern of the curve, and the type of scoliosis. The doctor may recommend observation, physical therapy , chiropractic, exercise, bracing, or surgery.

• Observation: Doctors follow patients without treatment and re-examine them every 4 to 6 months when the patient is still growing (is skeletally immature) and has an idiopathic curve of less than 25 degrees.

• Physical Therapy-Chiropractic-Exercise: The staff at Allied Medical & Rehabilitation, PC specializes in the conservative care of mild to moderate scoliosis. The combination of PT, Chiropractic and proper exercises can restore function and mobility to a growing spine.

• Bracing: Doctors may advise patients to wear a brace to stop a curve from getting any worse when the patient:
  
  > is still growing and has an idiopathic curve that is more than 25 to 30 degrees
  
  > has at least 2 years of growth remaining, has an idiopathic curve that is between 20 and 29 degrees, and, if a girl, has not had her first menstrual period or
  
  > is still growing and has an idiopathic curve between 20 and 29 degrees that is getting worse. These guidelines vary depending upon the individual patient.
  
  As a child nears the end of growth, the indications for bracing will depend on how the curve affects the child's appearance, whether the curve is getting worse, and the size of the curve.
   

• Surgery: Doctors advise patients to have surgery to correct a curve or stop it from worsening when the patient is still growing, has a curve that is more than 45 degrees, and has a curve that is getting worse.

• How do I know if I have scoliosis?
• Is scoliosis caused by not drinking enough milk or eating too much junk food?
• Does scoliosis hurt?
• Why do kids get scoliosis?
• Can People with Scoliosis Exercise?

• Scoliosis is typically a painless deforming curvature of the spine with rotation in children. Adults may have significant back pain. This can result in your back looking crooked, your shoulders being uneven, or developing a rib hump. In some cases, people feel that they lean forward or that their body shape is changing. One common way that people will notice they have scoliosis is by their posture changing or their clothes fitting differently.

• Scoliosis is often noticed as a small difference in the shape of your back. The first person to notice this is often a parent, school nurse, or friend. If you think that you might have scoliosis, have it checked out by a qualified professional . A diagnosis of scoliosis is confirmed by a visit to your doctor, who may wish to take an x-ray of your spine.

• Your physician will be able to determine whether you have scoliosis or not based on physical exam and an x-ray of your spine.

• You may not know if you have scoliosis. Scoliosis is a curvature of the spine (the back). Sometimes it can only be seen from behind. Sometimes patient's note that they have a waist asymmetry, or it feels like one hip sticks out more than the other. Usually scoliosis is found in a routine physical in adolescents. When you bend forward your rib cage on one side may look different than the other.

• You may have noted in trying on a skirt that one of your hips seemed to jolt forward or while looking into your mirror that one of your shoulders was higher than the other. A slight hump may have been noted in your back. This may have been noticed by your mother or in school by a nurse or a school physician. Your pediatrician may also have noted any of the above during his evaluation and told your parents and yourself about scoliosis.

• If one hip is higher or the shoulders are not level when standing with equal weight on both feet, or if one side of the waistline is more prominent, or if one side of the rib cage is more prominent, then you may have scoliosis. The only way to know for sure is to check with your physician.

• Scoliosis is not caused by your behavior; it is a genetic condition (in your genes). But drinking more milk and eating less junk food is a very good idea!

• The most common form of scoliosis, idiopathic scoliosis, is an inherited type of scoliosis. The specific genetic cause of the disorder has not been fully elucidated and in some individuals it may be a result of a spontaneous genetic mutation. There are other forms of scoliosis, such as neuromuscular scoliosis that is a result of muscular imbalance such as occurs with cerebral palsy. Nutritional deficiency may cause osteopenia or osteoporosis, loss of bone mineral density, but does not have any direct link to scoliosis.

• In children and adolescents scoliosis usually does not cause pain. However, in adults, particularly when scoliosis is associated with instability of the spine, pain is not uncommon. Even in adolescents who do not have scoliosis, back discomfort may occur from time to time. If back discomfort becomes more serious and really painful then an evaluation by a doctor is important.

• In general, small curves do not cause pain in the back. However, large curves certainly may be associated with some aching and discomfort because not only is the spine curved and rotated, the ribs are oriented abnormally as well as the shoulder blades. Various kinds of activities, then, in the presence of this abnormal alignment may cause aches and pains in the back. Also, in older adolescents and adults, large curves that have been there for awhile will cause arthritic changes in the joints of the spine, which also may hurt.

• There is not an easy answer to this question; however, it is well known that scoliosis is a problem that occurs during growth. There are a number of different causes of abnormal bone growth that can cause scoliosis (and other problems with the skeleton), some of which are well understood by doctors, and some of which are still a mystery. The most common type of scoliosis occurs during the growth spurt of teenagers. We have no real explanation for why this occurs, but many doctors and scientists have been working on an explanation. Once you are done growing (about 14 for girls and 16 for boys) it is very unlikely that you will develop a scoliosis.

• There are different kinds of scoliosis. The most common kind is called idiopathic, and that word idiopathic means that we don't know the cause. There probably is some kind of nervous system abnormality that starts it off, and it probably has something to do with balance and how one's body reacts to changes of position of the body in space, but this theory has not been worked out completely. There may be some other hormonal abnormalities that also are involved with the development of idiopathic scoliosis. However, there are other forms that have other causes; for example, congenital scoliosis is caused by actual abnormalities of the vertebrae which cause them to grow differently one side to the other. Persons who have nervous system diseases that result in weakness of the muscles of the trunk can also develop scoliosis because they just don't have the muscle strength to maintain their body in the proper position.