scoliosis

Whilst conducting the objective assessment on a 15yo girl with low back pain recently, I noticed scoliotic features. For example, a thoracic curvature was palpable; in full flexion, the left rib-cage was higher than the right; the arm/waist gaps were asymetrical; one scapula protruded much more than the other and was angled differently. 

She reported never having been diagnosed with a scoliosis, or screened for them at school. She had reached menarche, but has not finished growing. 

I surmised that this factor could be contributing to her back pain, in addition to the loading/motor control disorder apparent from other objective findings.

I looked up our scoliosis notes before I saw her again, and found that after menarche, curve progression is not as much of an issue as the major growth and bony ossification have already occurred. However, as she has never had a diagnosis, and has some growth remaining... I sought confirmation from my supervisor about whether I should suggest further investigation. She agreed but emphasized that I should check for a leg length difference first.

I did this with a tape measure from ASIS to tip of lateral malleolus and found a 2cm difference. This is at the upper end of normal, however, the scoliotic signs disappeared with correction of the LLD. By placing 2cm worth of towel under one foot, the curve straightened and scapulae became symmetrical etc.

Instead of sending her to a doctor, I therefore suggested a podiatrist. I wrote a brief summary of my findings for her to give to the podiatrist as her reason for making the appointment. Hopefully an insert to make her posture symmetrical might assist, (in conjunction with our motor control interventions), to reduce her back pain.

In future if I suspect scoliosis in a patient (that is symptomatic or progressive), I will always remember to check whether LLD is a cause or contributing factor before making further recommendations.