Back pain is a common issue that affects a significant portion of the adult population. However, the experience of pain can vary greatly depending on whether or not an individual has scoliosis. Understanding the differences between pain in adults with scoliosis and those without the condition is key to effective treatment and management. Here, we delve into the nuances of pain for both groups and the approaches to managing it.

Prevalence of Back Pain: A Comparative Look

For adults without scoliosis, the statistics on back pain are concerning. It’s estimated that 60% to 80% of adults will experience back pain at some point in their lives. Of this group, approximately 20% to 30% will suffer from chronic back pain that lasts longer than three months[i]. This chronic pain often becomes a persistent issue that impacts daily life.

However, for adults with scoliosis, the prevalence of chronic back pain is even higher. Between 50% to 80% of adults with scoliosis will experience chronic pain at some stage. This increased rate is largely due to the long-term effects of scoliosis, which can lead to accelerated degenerative changes in the spine[ii]. Factors such as posture, activity levels, and the curvature itself contribute to the symptoms. Conditions like disc wear, arthritis, and nerve compression may also worsen the pain they experience.

Scoliosis and Asymmetrical Pain: The Key Difference

One of the defining features of scoliosis-related pain is its asymmetry. In individuals with scoliosis, pain is often localized at the apex of the curve in the spine. This is typically on the outer (convex) side of the spinal curve, where the muscles and ligaments are under increased tension. Over time, this tension can cause discomfort that may radiate to one leg, often localized to the front of the thigh. This particular pattern of pain is associated with rotational olisthesis—a condition where a vertebra slips or slides out of place.

In contrast, adults without scoliosis are more likely to experience sciatica, where the pain radiates down the back of the leg. The difference in pain location is notable: scoliosis patients tend to have pain localized to the anterior thigh, while non-scoliosis sufferers typically report pain running down the back of the leg[iii].

The location and type of scoliosis curve also play a role in the severity of the pain. Curves found in the lumbar and thoraco-lumbar regions of the spine tend to cause more intense discomfort than curves in the thoracic (mid-back) spine.

Managing Pain in Adults with scoliosis:

For adults with scoliosis, managing pain requires a personalized approach. Simply focusing on core strength exercises may not be enough to alleviate the discomfort caused by scoliosis. This is where scoliosis-specific therapeutic exercises—such as the SEAS (Scientific Exercise Approach to Scoliosis) method—can make a significant difference. These exercises are designed to specifically address the unique challenges of scoliosis and improve postural balance, function, and cosmetic appearance, all while reducing pain.

In contrast to traditional core strengthening routines, SEAS exercises are tailored to the specific imbalances caused by scoliosis, targeting areas of the spine asymmetrically. The goal is not necessarily to improve the Cobb angle (the angle of curvature in the spine) in adult, but to restore sagittal and coronal imbalance—two key factors that affect pain and quality of life in scoliosis patients.

Sagittal imbalance, in particular, is a critical aspect of pain management. This imbalance occurs when the natural curve of the spine is disrupted, often leading to hyperkyphosis (excessive forward curvature) and increased pain. In fact, a positive anterior sagittal imbalance is closely correlated with significant pain, reduced physical function, and a lower quality of life. The greater the sagittal imbalance, the more predictable the pain and disability become.

For many adults with scoliosis, bracing can also be a useful tool. While bracing adult doesn’t necessarily correct the curvature of the spine, it can help to reduce pain and improve overall posture, leading to better outcomes in the long run.

The Importance of Raising Awareness

Scoliosis is often overlooked in discussions of chronic back pain, yet it plays a significant role in the pain experienced by many adults. It’s important to raise awareness of how scoliosis can impact pain and to ensure that individuals with this condition receive the care they need. Whether through scoliosis-specific exercises, bracing, or other therapeutic approaches, the goal should always be to restore balance, reduce pain, and improve the quality of life for individuals living with scoliosis.

The Need for Tailored Approaches

While back pain is a common issue for many adults, the experience is markedly different for those with scoliosis. The asymmetrical pain, often accompanied by anterior thigh pain, and the increased likelihood of degenerative changes in the spine, make managing scoliosis-related pain a unique challenge. However, with the right interventions—ranging from therapeutic exercises to bracing—adults with scoliosis can experience relief and improve their quality of life.

[i] Hoy, D., Bain, C., Williams, G., et al. (2012). “A systematic review of the global prevalence of low back pain.” Arthritis & Rheumatism, 64(6), 2028-2037.

[ii] Weinstein, S. L., Dolan, L. A., Wright, J. G., et al. (2003). “Effects of scoliosis and its treatment on the health of adults.” JAMA, 289(5), 615-622.

[iii] Zaina, Fabio, Rosemary Marchese, Sabrina Donzelli, Claudio Cordani, Carmelo Pulici, Jeb McAviney, and Stefano Negrini. 2023. “Current Knowledge on the Different Characteristics of Back Pain in Adults with and without Scoliosis: A Systematic Review” Journal of Clinical Medicine 12, no. 16: 5182. https://doi.org/10.3390/jcm12165182