A scoliosis exam allows doctors to see whether the spine has a curve. People with scoliosis can have a single curve, creating a “C” shape, or a double curve, creating an “S” shape.
Scoliosis exams are physical examinations involving exercises that allow a doctor to see the shape of the spine. They are neither painful nor invasive, and they require no preparation.
Scoliosis sometimes appears as a child or teenager grows and develops. Detecting scoliosis at this stage allows a doctor to monitor the curve of the spine and recommend treatment if the curve is severe enough to warrant it.
A scoliosis exam is a type of physical examination that a doctor performs in their office.
There are two types: screening tests, which look for warning signs that a person may have scoliosis, and diagnostic tests, which confirm scoliosis and assess the severity of the curve in the spine. A person with a positive screening test may require diagnostic tests.
Previously, scoliosis screenings were part of routine child health visits. Now, concerns about overdiagnosis and overtreatment mean that many organizations do not recommend this approach.
The Preventive Services Task Force and the American Academy of Family Physicians recommend against routine scoliosis screening exams in people without symptoms.
However, the Scoliosis Research Society, the American Academy of Pediatrics, the Pediatric Orthopaedic Society of North America, and the American Academy of Orthopaedic Surgeons still recommend this screening due to the benefits of being able to monitor the curve of the spine as a child grows.
Those in favor of screening recommend that it take place twice in females aged 10–12 years and once in males aged 13–14 years.
In scoliosis exams, a doctor will look for external signs that can indicate scoliosis. These signs include:
- one shoulder blade being higher or more prominent than the other
- one shoulder being visibly higher than the other, from either the front or the back
- more space between the body and the arm on one side when standing with the arms hanging loosely
- skin creases on one side of the waist
- one hip that is higher than the other
- a head that does not appear centered within the pelvis
The main screening test for scoliosis is the Adam’s test, which doctors may also call a forward bend test.
During this test, a person removes their shirt so that the spine is fully visible. Then, they bend forward with their knees straight and their feet together, allowing the arms to hang freely. This position can allow doctors to see:
- a visible curve in the spine
- asymmetries in the shoulders, shoulder blades, or waistline
- a hump or elevation of the rib cage on one side
If there are signs of scoliosis, a doctor may place a scoliometer on the curved area. This device measures the angle of the curve.
Neither the Adam’s test nor a scoliometer can provide an entirely accurate picture of what the spine looks like and the significance of the curve. If the physical exam indicates scoliosis, a doctor will refer the person for medical imaging to confirm a diagnosis.
If the scoliosis exam suggests that someone has scoliosis, doctors will recommend an X-ray. This imaging test allows them to see the spine clearly and to measure the angle of the curve.
In some situations, doctors may also suggest MRI or CT scans. These can show other structures of the spine, such as the spinal cord. However, a doctor may only order these scans if a person is preparing to undergo surgery or if the person’s symptoms suggest that the bones of the spine are compressing the spinal cord.
A scoliosis exam can estimate whether it is likely someone has scoliosis. An X-ray scan is necessary to help doctors confirm the diagnosis and determine the best course of treatment based on how significant the curve is in the spine.
An X-ray will show the spine from the front and back of the body, clearly revealing its shape and whether there is a curve. This can confirm the presence of scoliosis. A doctor will then use the X-ray to calculate the Cobb angle measurement, which tells whether the curve is mild or severe.
A doctor may also assess whether the curve is structural or functional. Functional curves appear only in certain positions, such as when one knee is bent or a person stands in an asymmetrical position. Structural curves are stiffer and exist regardless of position.
Doctors consider curves of less than 25 degrees to be mild. Curves of more than 25 degrees may require treatment.
The treatment options will primarily depend on the severity of the curve and its likelihood of progressing.
Monitoring
If the curve of the spine is less than 25 degrees, a doctor will typically recommend a monitoring approach rather than treatment. This usually means getting X-rays at regular intervals to check whether the curve in the spine is progressing. If it stays the same, no treatment may be necessary.
Physical therapy
If someone experiences pain due to the curve, a doctor may suggest physical therapy to strengthen the muscles around the spine. There is also some early evidence that specific physical exercises may reduce spinal curvature.
A 2021 nonrandomized controlled trial involving 56 adolescents with scoliosis looked at the effects of performing isometric and yoga-like exercises. The participants who carried out the exercises in a doctor’s office had an average curve reduction of 1.6 degrees per month.
The trial required the participants to hold specific poses for as long as possible at least once per day for 5 months. In total, the exercises took less than 5 minutes each day.
More research is necessary to understand how significant an effect physical therapy might have on scoliosis and whether this approach could work in adults.
Bracing
Doctors consider a curve of more than 25 but less than 40 degrees to be a moderate case. In children and adolescents with such a curve in the spine, they may recommend a brace. This is a device that a person wears under their clothes for most of the day to keep the curve from getting worse. This treatment only works for people who are still growing.
Surgery
A curve of 40 degrees or more is severe. However, the extent to which it affects a person can vary depending on the shape of the curve, whether it causes pain, and whether it affects internal organs.
If the curve is severe and is progressing or having a serious impact on someone, a doctor may recommend surgery to reduce it.
Spinal fusion surgery is a common procedure for reducing scoliosis. It involves a surgeon fusing the bones of the spine into a rigid and straighter position.
However, although this surgery is effective for reducing the appearance and severity of scoliosis, a 2015 Cochrane review notes that no research has compared its long-term effectiveness with that of nonsurgical approaches.
This does not mean that surgery is not helpful but that more studies are necessary to understand how it compares with other options for those with a severe curve.
Scoliosis exams are the first step in diagnosing scoliosis. They involve physical tests that allow a doctor to assess whether someone may have a curved spine. The most well-known test is the Adam’s test, also known as the forward bend test. A scoliosis exam requires no preparation and no invasive procedures.
If someone has signs of a curve, the next step is medical imaging. After assessing the angle of the curve, a doctor can make recommendations for treatment, if any is necessary. Mild curves sometimes only require monitoring to check for progression.