Many people when they think of scoliosis think of the standard forward bend test as a kid at annual scoliosis screenings. They think if they passed these screenings earlier in life, scoliosis is something they do not have to worry about. However, there are many individuals with scoliosis who do not display severe spinal curvatures and may never know they have it despite being screened as children. Many people exhibit mild curvatures that do not cause obvious pain or any pain at all. However, if you have pelvic pain and scoliosis, there could be a link with directing parts of physical therapy treatment towards your scoliosis to help optimize outcomes.¹

Scoliosis is a musculoskeletal deformity of the spine that causes it to curve to one side and creates a problem with movement. The curve can appear as a “C” shape or an “S” shape. Scoliosis can be classified as structural or functional. Structural scoliosis is a curvature of the spine that does not go away with position changes. Adolescent idiopathic scoliosis (AIS), a type of structural scoliosis, occurs in patients from 10 years old until they reach skeletal maturity.  In adulthood, AIS can continue to progress or adult degenerative scoliosis may occur.² If you are over 40, increased age has been associated with an increased prevalence of scoliosis.³ ⁴ Functional scoliosis is a curvature of the spine due to elements not involving the spine such as muscle imbalances, leg length discrepancy, or poor postural habits.² ⁵  

Symptoms of scoliosis include:²

• One hip or shoulder higher than the other
• Uneven shoulder blades
• A “rib hump” and feeling like one side of your ribs is sticking out more
• One arm hanging longer than the other
• Legs appear uneven
• The above listed are accompanied by back pain or breathing difficulty/asymmetry

The prevalence of scoliosis in patients referred to a clinic with pelvic pain has been found to be high. Scoliosis may contribute to pelvic pain by influencing the pelvis, muscles, and surrounding joints. Pelvic pain can be highly associated with pain in the hip flexors, quadratus lumborum, abdominals, piriformis, and levator ani. Scoliosis may impact all these muscles negatively secondary to causing pelvic obliquity, leg length discrepancy, muscle imbalances, and postural faults.¹ Additionally, scoliosis may impact the respiratory system secondary to decreased chest mobility and asymmetrical inspiration. Impaired breathing patterns and lack of diaphragm usage can impact the pelvic floor negatively secondary to the pelvic floor and diaphragm’s close relationship.⁶ ⁷ Many studies have found a higher rate of occurrence of back pain and inguinal pain in patients with scoliosis then those without.¹ ⁸

Treating the muscles surrounding the scoliosis and postural retraining exercises may help decrease pelvic pain and back pain, especially in the case of a functional scoliosis. If breathing is asymmetrical or impaired, physical therapists can provide proper resisted breathing and strengthening exercises to improve respiratory function and postural control.⁷ In cases of structural scoliosis, collaboration with physical therapy and a medical team may lead to better outcomes on pelvic pain.

There is a reason why your physical therapist may be focusing treatment at your mid back or lumbar spine in order to help decrease your pelvic pain. Good posture is one of the keystones to optimal musculoskeletal health. The team at New Dimensions Physical Therapy can provide you with a thorough postural assessment when considering causes of your pelvic pain and prescribe the appropriate postural strengthening and breathing corrective exercises. Manual therapy to help decrease symptoms and pain can also be provided as needed. Addressing the body as a whole system is key to helping heal chronic pelvic pain cases.

Lila Abbate PT, DPT, OCS, WCS

Andrea Wood, PT, DPT

References:

1. Tate, L. Prevalence of scoliosis in a pelvic pain cohort. J Womens Health Phys Therap. 2015; 39(1): 3-9.

2. Seattle Children’s. (2015). What Is Scoliosis? Retreived from http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/spinal-conditions-treatment/scoliosis/

3. Kebaish KM, Neubauer PR, Voros GD, et al. Scoliosis in adults aged forty years and older: prevalence and relation-ship to age, race, and gender. Spine. 2011;36(9):731–736.

4. Urrutia J, Diaz-Ledezma C, Espinosa J, Berven SH. Lumbar scoliosis in postmenopausal women: prevalence and relationship with bone density, age, and body mass index. Spine. 2011;36(9):737–740

5. Raczkowski J, Daniszewska B, Zolynski K. Functional scoliosis caused by leg length discrepancy. Arch Med Sci. 2010;6(3):393-398.

6. Mohammadi P, Akbari M, Sarrafzadeh J, et al. Comparison of respiratory muscles activity and exercise capacity in patients with idiopathic scoliosis and healthy individuals. Physiother Theory Pract. 2014;30(8):552-556.

7. Kim JJ, Song GB, Park EC. Effects of swiss ball exercise and resistance exercise on respiratory function and trunk control ability in patients with scoliosis. J Phys Ther Sci. 2015l 27(6):1775-1778.

8. Sato T, Hirano T, Ito T, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan. Eur Spine J. 2010;20(2):274–279