Parents should screen their children for scoliosis at least a couple times a year. I recommend putting it on your phone and/or wall calendar (maybe in January and July?). Do it now…. Seriously, right now… mark your calendar now then come back and read about how and why to do it… I’ll wait………………
Don’t just rely on schools or pediatricians to do this screening and, even when they do, don’t rely on them to interpret the results. That’s not a slam but this is important and, as you’ll see, there’s plenty of room for confusion on the subject.
(Before going further, see ATR and Cobb Angle in my post on Scoliosis Terminology)
There are various things to look for, like uneven shoulder height, holding the head to one side, etc, but screening for scoliosis is typically done by schools or pediatricians with the “Adam’s forward bend test” with an ATR Tool (dominant brand is the Scoliometer). A common misconception is that this test is looking for a spinal curve when, in fact, it’s looking for the trunk rotation that accompanies the scoliotic curve. As the spine curves to one side, the vertebrae also rotate in that same direction.
Rotation is most noticeable in the thoracic region because those vertebrae are connected to the ribs which are pushed backward on one side, creating a “rib hump” and also pushing the scapula outward, causing one scapula to be more prominent. If, when bent over, you see that the upper back is higher on the right side, for example, the patient almost certainly has a right convex thoracic scoliotic curve.
The distinction of rotation vs. curve is critical for determining when to just observe vs. when to take further action. There are different guidelines for further treatment based on the degree of rotation (i.e. >7 degrees) vs. the degree of curve (i.e. >20 degrees). Given this, it’s easy to see a potential for confusion if a person thinks an 11 degree Scoliometer reading, for example, means they are well under the 20 degree guideline for a curve requiring treatment… Apples and Oranges.
Say it with me, “trunk rotation is different than curve.” Further, the trunk rotation measure is typically (maybe always?) much lower than the degree of the associated curve. Consider the example of one of my daughters. When her curve (cobb angle) progressed to 29 degrees, her ATR as measured by a Scoliometer (verified by myself and a doctor) was only at 7 to 9 degrees!!
You read that right… If you have a son or daughter with a 7 degree rotation measured by a Scoliometer, they could already have a 29 degree curvature of their spine! See a doctor and get an x-ray!
About Measuring Trunk Rotation…
Degree of Trunk Rotation is typically used for scoliosis screening because it is more easily spotted than the actual curve and can be measured without an x-ray.
Clicking on the above Scoliometer, will take you to the official guidelines for it’s use. As you can see, they say you should seek further evaluation if the scoliometer reading is >7°. I, personally, disagree with waiting that long, particularly for girls (more likely to progress) and particularly for anyone with a family history of scoliosis. Remember my daughter’s Scoliometer reading was still only 7° with a 29° curve. If you consider that many doctors start bracing at >=20° curve, waiting for a 7° rotation could be 9° too late with regard to the actual curvature.
I really don’t know what Scoliometer reading level to recommend as the litmus, but I’d certainly recommend an x-ray to check cobb angle at something less than 7 degrees rotation.
Where to get a scoliometer…
You can buy the physical device at various websites. Expect to pay $45 to $50. I’ve seen some with outrageous prices.
Also, you can find various apps for smartphones that do the same thing (some are free). Two tips regarding using a smart phone app as an ATR. 1) It doesn’t have to be a scoliometer/scoliosis app. Any app that works as a level and gives the variance in degrees of slope would do. 2) a physical ATR, like a Scoliometer, has a gap in the center of the bottom to make room for the areas of the spine where the vertebrae protrude. When using your phone, you need to position your thumbs under the corners in a consistent manner to avoid the protrusions.
See it done…
The Texas Scottish Rite Hospital has an excellent screening summary with a video showing the use of an ATR tool, found here.
Disclaimer: I am not, in any way, medically trained and you should seek professional medical advice before making any decisions based on information found here.