MakatiMed’s Department of Orthopedics answers the question
In track-and-field, Usain Bolt is the most famous in the world, with his charismatic personality and undoubted talent. Despite having a slow start to his career, Bolt has become the greatest of all time. He is an eight-time Olympic gold winner, and the current world record holder for the 100 meter dash, the 200 meter dash and the 4 x 100 meters relay. He is the fastest, most decorated sprinter in history. And what’s most remarkable about Usain Bolt is the fact that he’s accomplished all of this with scoliosis. That’s right — the world’s fastest human has a spinal curvature greater than 40 degrees, and has refused to let it slow him down. The condition made his spine curve to the right, making his right leg half an inch shorter than his left. According to research at Southern Methodist University, his right leg exerts more force to the track than his longer left leg. The ability to run at a pace like that with this condition is unimaginable, and he did it with ease.
What is scoliosis? “Scoliosis is a three-dimensional growth abnormality that occurs when the spine becomes rotated and curved sideways.” says Bruce Canto, MD, from the Department of Orthopedics of top hospital in the Philippines, Makati Medical Center (MakatiMed). “Any sideways spinal curvature of at least 10 degrees, as measured on an X-ray of the spine, is considered scoliosis. As the curve progresses to 20 degrees or beyond, there is an increased chance that the person or an observer, such as a parent or teacher, might notice abnormalities such as clothes hanging unevenly or the body tilting to one side. Most often this condition has no known cause, in which case it is called idiopathic scoliosis. While the cause is unknown, idiopathic scoliosis does tend to run in families. The specific genes involved have not all been identified yet, and there could be factors beyond genetics as well. Some people mistakenly think that carrying heavy backpacks or sleeping on the side could cause scoliosis, but that is really not the case. Scoliosis in and of itself is generally not thought to cause significant pain, especially in adolescents and young adults. However, a scoliosis curve can cause trunk imbalances and other issues that increase the likelihood for muscle spasms and other issues, which can in turn lead to pain.”
“There are also other types of scoliosis such as congenital scoliosis, neuromuscular scoliosis, and even degenerative scoliosis, however the most common type is the idiopathic type, specifically the adolescent idiopathic type.”
How do you determine if you or your family member has scoliosis? According to Dr. Canto:
You can see it. Scoliosis is usually first identified during a regular checkup with a pediatrician or a routine screening at school. An official diagnosis of idiopathic scoliosis requires X-ray confirmation of the abnormal lateral curvature and spinal rotation, as well as ruling out other possible causes for the deformity.
Adam’s Forward Bending Test. This test involves a healthcare professional observing the patient bending forward at the waist 90 degrees with arms stretched toward the floor and knees straight. From this position, most scoliosis signs that present as asymmetry are clearly visible in the spine and/or trunk of the body, such as:
- One shoulder or shoulder blade is higher than the other
- Rib cage appears higher on one side (also called a rib hump)
- One hip appears higher or more prominent than the other
- The waist appears uneven
- The body tilts to one side
- One leg may appear shorter than the other
The Adam’s forward bend test can be useful in detecting scoliosis located in the upper or mid back, which is where idiopathic scoliosis usually occurs. However, the forward bend test is not as effective at detecting scoliosis in the low back because it does not involve rib rotation.
Scoliogram. Taking X-rays of the whole spine is the next step in confirming the diagnosis of scoliosis. Using an Xray of the full spine, the physician can measure the degree of the lateral curve known as the Cobb Angle. A Cobb angle of at least 10 degrees is typically considered the borderline for a scoliosis diagnosis.
So, I have scoliosis. What now? A confirmed diagnosis of scoliosis doesn’t always spell doom and gloom. Depending on how mild or severe it is, doctors will recommend the following treatments:
Bracing. About 90% of idiopathic scoliosis cases are mild and only require observation. Typically, observation is done by a doctor every 4 to 6 months until the adolescent has reached full skeletal maturity. However, a brace for scoliosis will generally be considered if either of the following occurs to the curve’s Cobb angle:
- Progresses past 25 or 30 degrees with significant skeletal growth remaining
- Progresses at least 5 degrees during any 4- to 6-month period
Physical therapy. Usain Bolt managed his scoliosis through core-strengthening exercises, physiotherapy stretches, and sessions with a masseuse to help improve his posture. “Increasing core muscle strength helps support your lower back,” he says. While this is true, claims that treatments such as physical therapy and manual manipulation can help stop the progression of scoliosis have very little scientific evidence to support them. Bracing is currently the only nonsurgical treatment that has been proven to reduce the natural progression of idiopathic scoliosis curves. However, exercise is still healthy and strongly encouraged for people with scoliosis which helps keep the back strong and flexible.
Surgery. Sometimes an idiopathic scoliosis curve continues to progress despite bracing. If this happens and the curve progresses past 40 or 50 degrees, spinal fusion surgery is recommended.
The good news: Scoliosis shouldn’t prevent you from engaging in activities you enjoy. Usain Bolt is a perfect case in point. He worked around it and went on to break records and cement his place in sports history. The key is to take a proactive — not reactive — approach to your condition. The traditional approach to scoliosis is a passive, reactive one that asks patients to “wait and see” what happens. Usain Bolt has proven that scoliosis can be treated in a way that doesn’t just reactively manage the condition. His example shows us that the spine can be strengthened and made more functional. He also demonstrates that with hard work and dedication, just about any goal is attainable.
For more information, please contact MakatiMed On-Call at +632.88888 999, email mmc@makatimed.net.ph, or visit www.makatimed.net.ph.
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