Ed Paget here.
Today I’m going to help you understand your scoliosis
from your X-ray.
Alright the way I’m going to do this is a little bit different from
how I normally do videos. I’m actually going to jump over to the computer
and I’m going to take you through some real-life X-rays
so we can look at them
and help determine what you have
to make sure you do the right rehab
for your particular curve.
So, let’s jump over to the video
and you can see what I’m looking at.
By the end of this video
you will be able to tell what type of curve you have from your X-ray.
Now can also watch this if you just have an X-ray report
as I will help you understand
what the report is telling you,
I’ll help you with some of the language there.
Now I’m going to be discussing the 4 main types of curves
which are the 2 types of C-curve and the 2 types of S-curve.
Now...
These types of scoliosis don’t have any known cause
which is why they are referred to as idiopathic,
which is just a fancy way of saying, no known cause.
They commonly occur during adolescence
or in the case of the C-shape curves in the lower back
that can come in later life.
Alright, so we have
a left C-Curve,
we have a right C-Curve,
essentially the same curve just going in different directions.
We have an S-Shape Curve,
and you can see why it’s called an S-shape curve
simply from its shape
and then a reverse S-curve.
And the most common one is the last one,
a reverse S-shape curve.
And this is what people would refer to as an
adolescent idiopathic scoliosis;
and it most commonly occurs in adolescents or teenagers.
And so they would've been investigated,
but again there is no known cause.
And these curves account for about 80%
of the scoliosis or curves out there.
I’ll also gonna show you
how to test your curves from home
in case you don’t have an X-ray,
but we’ll do that later.
Alright...
If in doubt
you have to ask for an X-ray
because an X-ray is the gold standard.
Now for example,
some people might look like they have an idiopathic scoliosis
but really
it is caused by something
and that’s congenital, it means they were born with it.
For example here
we can see
that there is a hemivertebrae
which means half a vertebrae
or.. some of the vertebrae are stuck together,
now on an X-ray that can look like this.
But your X-ray report will tell you whether or not you have a
hemivertebrae or a failure of segmentation.
But what type of X-ray should you ask for?
A standing X-ray from the front and the back
and the side is the best one to ask for.
Because this lets us know whether
your hips are... in line...
or what hip is higher than the other.
Now we also like to have X-rays with no brace.
The X-rays should include both hips,
the whole pelvis, if possible,
the whole spine definitely
and if possible, the lower half of the skull and the shoulder girdle.
And when should you take an X-ray?
Well...
if the child,
assuming your child has a scoliosis,
is still growing
and their degrees are
more than 30
they should be taken 4 times a year.
Now if the curve is less than 30 degrees
and has not progressed
then the X-rays can be taken just once a year.
And the reason for that is
during the growth spurt of children
the curve can increase rapidly.
Now for adults who have stopped growing
they can have an X-ray just once every 4 years
unless... some sort of rapid change is suspected.
Alright, let’s get to the curves
and see what we can find here.
So, this is a single curve,
we call it a thoracic dextro scoliosis,
dextro meaning right,
and the curve
is referred to by the side of the convexity
or the long side or the apex,
they are all the same thing.
So, when we look at the spine like this, we can divide it into 2 areas.
There is the thoracic
and then there’s the lumbar.
And so the red line here is the thoracic
and the green line is the lumbar.
The thoracic consists of 12 bones
or vertebrae and the lumbar consists of the bottom 5.
As this curve is in the thoracic vertebrae,
we can also call this a thoracic C-shape curve,
or to be more accurate
when we look at it from behind,
we can call it a thoracic reverse C-shape curve.
You can see that there is one major curve here
we can call that the primary curve.
There is a corrective curve below it... here
but that one
is secondary to the primary and were not going to refer to it here.
Now, some X-rays are taken from the front...
and watch out for this because it can be confusing.
Learn how to flip the X-ray.
Now, usually somewhere on the X-ray there will be a little
L or for left or little R for right.
This can help orientate you.
So, you can see here I’ve underlined the R
with that red on the left hand side.
Now if there is no indication of which side is which
you can look at the heart
cause the heart
should always be on the left
if you are looking at someone from behind.
So, you can see here I’ve flipped that X-ray,
circled the heart
and you can see the R
is underlined
and after the R it says PA which stands for
posterior to anterior,
so this is taken
from someone looking at them from behind.
Which is the same way
I like to look at X-rays
when I am looking at someone standing in front of me,
and I compare their X-ray to their spine.
Ok, so let’s look at a different type of curve.
This curve is called
a thoracolumbar levo scoliosis
or, as I like to call it a left C-shape curve
when viewed from behind.
Now you can see the curve starts
at the top of the lumbar vertebra
where the green line is and then extends up
into the thoracic vertebra
where the red line is.
So, that's why it's called
a thoracolumbar levo scoliosis
because the curve
is in two different areas of the spine.
Now, let’s talk about
double curves.
We can call these ones a
dextrothoracic
meaning right thorax
and levolumbar meaning left lumbar.
But most commonly this type of curve
is called a reverse S-shape curve.
So, when you look at someone from behind
this is the shape they will have.
They will have slight rib hump on their
upper right back and a slight thickening
on their left lower back.
You may even see the spine
in this reverse S-Shape.
Now, these curves are actually quite balanced,
meaning the top and the bottom curves are nearly equal.
But it isn’t always like this though, sometimes one curve
can be almost double the other curve.
Which ever is the biggest
is referred to as the primary curve which I mentioned before,
and it's often best to start by treating
the primary curve
with exercises as the secondary curve
or small one will usually decrease
if the one...
is bigger than it's dealt with.
Ok...
So now, you've seen
an S-shape curve,
you've seen a
C-shape curve in both ways
so what we are going to have a look at now is
how
you can actually find these things out
from home without having an X-ray.
So, some people don’t actually want
X-rays or repeated X-rays
and an X-ray doesn’t actually take into account
something called rotation
and that is where
the spine
will bend... rotate or bend
at the same time it bends to the left
or right.
So, in a thoracic curve
with the curve apex on the right-hand side
it will always be accompanied by right rotation.
I’ll explain what I mean by that in a minute.
But first I want to show you the Adam's test.
So, the actual
mechanics of the Adam’s test are quite straight forward.
You simply ask a person to stand in front of you
and, you make sure their legs are straight
and there is no knee bend.
And, you’ll ask them to slowly
bend forward vertebrae by vertebrae.
and as they bend forward,
the flexion,
that’s the movement of the spine that happens,
will increase the rotation
and you will start to see
a rib hump or a thickening
in certain areas of their back.
The reason this happens
is that the flexion of the spine
increases rotation.
Rotation of the spine is increased by side bending.
So, where a person has a side bending or a curve in their spine,
their spine will also rotate.
So, let’s have a look at what the Adam’s test could look like.
So, imagine you are seated or crouched down behind someone
you may see something like this.
Now, my focus here
is on the upper right back where you can see the rib hump.
A rib hump like this on the right
will indicate
that the rotation of the ribs is to the right.
This is because the ribs are attached to the vertebrae.
As they are rotated to the right
you'll also know with some degree of certainty
that the upper spine here
has a thoracic dextro scoliosis,
or a curve with the apex on the right,
or as I call it, a right C-curve.
So, this is how the spine will look
if someone was bending forward in front of you
and had a
rib hump on the right-hand side.
So, let’s have a look at how that looks for something slightly different
so reverse S-shape scoliosis.
Here
you will see a hump on the upper right back
but also a thickening on the lower left back.
And this is the most common type of scoliosis
and, this is the most common type of
presentation you would see.
When this person is standing up
you may notice that their right shoulder blade
sticks out a little bit more
than their left shoulder blade.
Let’s have a look at a C-shape scoliosis here.
So, the apex
will be on the left-hand side.
Which also means
the rib hump will be on the left-hand side.
So, looking at a C-shape curve
you will have a rib hump on the left.
For a regular s-shaped curve
this is less common.
And when we actually see this in children or teens
it's often a sign of something else going on
so, this could be some sort of
cerebral palsy or paralysis or...
some sort of muscular abnormalities,
Duchenne muscular dystrophy
or some other syndromes like Marfan’s
or neurofibromatosis.
So, it’s worth
checking if you have this pattern of scoliosis
if it's anything else going on.
Now... don’t freak out it doesn’t always mean that
but it’s just less common.
So, what would we see here?
We would see that rib hump on the upper left
and we would also see a thickening
on the lower right in the lumbars.
How can we measure this from home?
There is a device
that is very cheap and can be bought online
that measures the rotation of the curve
or you can use this to measure
the rotation of a curve of a family member.
It’s called a scolimeter.
This can be a useful tool
to track changes in curve rotation
without multiple X-rays.
A lot of my older clients
don’t like having multiple X-rays
and are more
focused on the aesthetics of their spine,
so, this is a great tool
to notice any changes in the rotation.
You can even use your smart-phone with these as well.
What you do here is just simply find the most rotated part of the curve,
then you place the scolimeter on it just like in this picture
It will give you the angle of rotation.
As you use exercises to manage your curve
you can then track changes over time.
The key here
is to make sure you are in exactly the same position
every time.
I like to have people measure a mark on their shins
where they are able to put their hands every time.
Maybe that's 6 inches or 15cm from the floor.
Also, it can be helpful to actually
count the vertebrae, either from your pelvis up
or from your neck down
to make sure you get the same one every time.
However you do it make sure it's repeatable.
Ok,
So, what we did here is we covered the 4 main types of curves,
the 2 types of C-curves and the 2 types of S-curves.
We looked at some X-rays,
we looked at how to perform the Adam’s test,
and we looked at the scolimeter,
Ok, so there you have it.
If you like this video
make sure you check out my other videos on scoliosis here.
also you can check out the play-list of scoliosis.
And you can then
watch all my videos on scoliosis
in any order you like.
You can start to manage your scoliosis
from home.