As I speak to more and more patients, I've come to a realization that there is quite a bit of confusion about what scoliosis is, and how it can affect your child's health. Many people remember going into the school nurse's office every so often and get a scoliosis test where they bend down from their waste and touch their toes.

But what is scoliosis? Scoliosis involves a curved deformity in the spine. When you look at someone from front to back, the bones that make up the spine (vertebrae) should stack up nice and straight. When there is a scoliosis present, the vertebrae will deviate to the side and form a curved C or S shape. Now very few people are perfectly straight, but when the curve exceeds 10 degrees, it is usually deemed a scoliosis.

Many people can have a scoliosis and never feel any effects or symptoms from it. Others may experience more common symptoms like back pain, neck / shoulder tension, and posture / cosmetic problems. In rare cases, the curvature can become large enough (50 degrees or more), that it can compress the chest cavity causing respiratory and cardiac problems, and become a surgical issue.

Scoliosis comes in 2 main forms. There are a functional scoliosis which is typically named idiopathic scoliosis, and there is a scoliosis called structural / anatomical scoliosis.

• A structural / anatomical scoliosis is called by a malformed vertebra which can force the spine to a curved position as it seeks to get back to center. This type of scoliosis can not be fully corrected and it can also lead to larger curvatures depending on how malformed the vertebra is.

• A functional / idiopathic scoliosis is named as such because there is typically no medically known cause. This is the most common type of scoliosis. These types of curvatures can be corrected and reduced significantly through conservative means when before a person is fully developed.

The real question is, should you be worried?

The truth is, if you're just worried about pain, then probably not. Many times, scoliosis is asymptomatic, especially in children. In fact, most people will probably go through their childhood with no knowledge that it is even there. For the category of idiopathic scoliosis, it is often the secondary result of a structural shift in one or more bones in the spine or pelvis ..

Most doctors are concerned when the curvature surpasses 20 degrees and begin watching the curve for progression. As the curve approaches 30 degrees, bracing becomes a common recommendation, and cosmetic concerns become more obvious, especially for teenage girls where image is everything. When the curve grows 40 degrees, surgery starts to become a real option for treatment to prevent compression of the heart and lungs.

The key is catching these curves early. Scoliosis is most commonly found in girls during adolescence, which is a great window of opportunity for structural correction, no matter how small the curve may be. Just like how a bent frame of a car can create suspension problems and tire wear / tear, a bent spine can increase the damage the spine experiences through life. I've seen x-rays of people well into their 40's and 50's who have never experienced spinal pain, but will show a scoliotic spine with disc degeneration and bone spurs in the exact pattern that the structural alignment would dictate.

As the spine shows early wear and tear, the nerves can get damaged, and symptoms of damage into the muscles, ligaments, and even the vital organs of the body can start to show.

As a worried parent, what can you do? Here are a few tips:

1. Get a spinal check up by someone who is focused on the health of the spine! Nurses and general practitioners do a great job of identifying major curvatures using basic screening tools, but these will typically identify cases of scoliosis that are excessively large and may be candidates for surgery. A chiropractor focused on structural correction instead of pain relief can recognize smaller deviations and provide tools to correct them if necessary.

2. Avoid the one shoulder back pack routine. It may look cooler and be more comfortable, but extra forces on a spine that is not optimally positioned to increase scoliotic curves.

3. Stay active. Movement is life and a spine that moves early and often has more pliability and flexibility than one that is sedentary and stiff.

4. Keep the weight down. If you had a crooked house and you add more weight to it, what happens to the house? It breaks down faster. The same thing happens to the body. If you build more mass on top of a crooked structure, it will lead to earlier degeneration. Stay fit.

If the scoliosis is large but not correctable, the best thing a parent can do is provide love and emotional support. Although it's not typically cause pain or serious illness, it can be a label that wears on the psyche of a teenager or young adult because other young people and gym class bullies may poke fun of their condition. Adolescence is a psychologically trying period for any young person, and another label is the last thing they need, especially if major surgery may be one of the options on the table. Providing your child with a strong base of confidence and self-esteem, along with proper management of scoliosis can help ensure a happy and healthy school year.