Curvatures of the spine are generally primary, as in the case of the thoracic and sacral regions, or secondary, as in the cervical and lumbar regions. The primary and secondary curvatures are important, critically so, to our ability to stand upright, hold our heads up, and even walk on two legs. When the spine curves in other ways, in ways that are counter to proper biomechanics, then we have a problem. We will discuss some of the pathological expressions of these curvatures in this article. We will be primarily interested in two, scoliosis and what is referred to as a list, a minor form or scoliosis caused by a breakdown in structure or function. Both scoliosis and list will cause varying degrees of pain, ranging from mild to severe and affecting the neck, back, and legs. Neck pain, back pain, and sciatic nerve pain or sciatica may be alleviated or even eliminated, depending on the severity of the curvature and the measures used to offset it. We will discuss treatment through exercise as an offset strategy below.

Scoliosis is a lateral curvature of the spine, often causing severe neck pain, back pain, and even sciatica in adults and adolescents. In most cases, scoliosis is idiopathic in nature, meaning it has an unknown cause or a cause that is not readily apparent. Interestingly, recent estimates maintain that more than one million individuals in the United States alone have the disorder, eight times as many women as men. Scoliosis is classified in one of two ways, structural or functional. Within the classifications, scoliosis may take on either a primary or compensatory role depending on the level, the severity, and other abnormalities present. In any case, and in all of its various manifestations, scoliosis can be a debilitating, even disabling condition with considerable neck pain, back pain, and sciatica associated with it. However, the affects of scoliosis, even in its most severe manifestations, may be alleviated by engaging in an intelligent, individualized, and medically supervised exercise program.

Scoliosis is most prevalent and generally appears most frequently in adolescence and, at this stage, is called adolescent idiopathic scoliosis. While many causes have been suggested, there is no consensus within the medical community, hence the idiopathic designation. As with classification and manifestations, scoliosis may present itself in one way if an individual has cerebral palsy or spina bifida and quite another way if these conditions are not present. The variable nature of the condition is part of the reason why there is no real consensus concerning etiology or cause. Scoliosis often worsens during the adolescent growth phase and, once again, depending on the manifestation and classification, neck pain, back pain, and sciatica are often present in varying degrees.

The curvatures of the spine associated with scoliosis are classified according to their location on the spine and consist of a primary, fixed curvature with compensatory curvatures above and below the primary location. Generally, the deformity will present slowly, growing increasingly severe with the adolescent growth phase or growth spurt. As scoliosis progresses, the hips will become unequal and the iliac crest, the blades of the pelvis on each side of the lower back, will be elevated, higher on one side than the other. Coincidentally, the shoulder blades will become more obvious, protruding on one side or the other, and upon bending over, the curvature itself will appear to be much worse, even exaggerated, compared to what is viewed when the individual is standing erect. In most cases, the earlier the manifestation in childhood and the higher up on the spine the primary, fixed curvature is found, the worst the potential outcome or prognosis may be. This is not to say that there is no hope, there certainly is. It's just that in such cases, without surgical intervention, the outlook may not be very good. In worst cases, scoliosis will even affect the heart and lungs due to the restrictions placed on them for space in the thoracic cavity. Once again, this can and should be surgically corrected if at all possible.

Once again, the most common type of scoliosis curvature entails a primary, fixed curvature with a secondary compensatory curvature. In other words, the spine attempts to re-establish a center of balance, if you will, by curving in the opposite direction from the first or primary curvature. The body will attempt to correct itself and the results, particularly if the fixed, primary curvature is dramatic, may be drastic. The combination of curvatures may impact the vertebrae, the core musculature, and even the internal organs. Scoliosis may be structural, as in the case above and, if that is the case, the vertebrae may rotate on each other and the rib cage may become deformed. If the scoliosis is functional, as in the case of a curvature compensating for one leg being shorter than the other, the condition can and should be corrected as soon as it presents itself. Neck pain, back pain, and sciatica may be considerable in both types, structural and functional, particularly if the curvature is allowed to worsen over time.

While there are many presentations and manifestations of abnormal spinal curvatures, we will describe only a couple of additional examples, one is what is referred to as a list. A list is a lateral tilt beginning at T-1, the first thoracic vertebra. The first thoracic vertebra is situated high on the back or spine just below the prominent "bump" you may feel at the base of your neck called the vertebral prominens, the seventh thoracic vertebra's spinous process (C-7). If you were to drop a plumb line, a string with a weight at the end of it, from T-1 it will fall to one side of the spine or the other at what is called the gluteal cleft. A list may be caused by a herniated disc or it may be due to severe muscle spasms, particularly those affecting the para-vertebral muscles. A list is generally the least severe and easiest to correct manifestation of a kind of scoliosis, one in which no compensatory curvature is present. In other words, the spine doesn't attempt to offset the curvature with another in the opposite direction. A list is also the type of curvature most amenable to correction through exercise, although it may still be extremely painful, causing neck, back, and sciatic nerve pain (sciatica), it is not as structurally devastating as the more severe manifestations of spinal curvature may be. However, even the most severe categories individuals can and do benefit from an individually designed, medically supervised exercise program. Neck pain, back pain, and sciatica may be alleviated or eliminated entirely if the right procedures are followed properly and consistently.

Another condition worth noting is what is referred to as a "razor back." The "razor back" is evident when a rotary deformity of scoliosis causes a hump, particularly apparent when the individual bends over. The last manifestation of an abnormal curvature we will discuss is the flattening of the lumbar spine or lumbar curve. The flattening out of the secondary curvature of the lumbar spine, one vitally important in weight bearing, is suggestive of either a herniated disc or ankylosing spondylitis. Both of these may cause considerable pain and, while medical supervision is absolutely crucial, an exercise program to strengthen the para-vertebral muscles and the rest of the core muscles should be pursued vigorously. The results should be immediately apparent with a significant reduction in neck pain, back pain, and sciatica.

The curvatures of the spine have developed over millions of years and they are crucial to our ability to hold our heads upright and to walk on two legs. However, once in a while nature goes a little off kilter and the results can be catastrophic. Abnormal curvatures of the spine, particularly scoliosis and what is referred to as a list, or the list, are only two of many. Whenever an abnormal curvature is present or begins to present itself, medical assistance should be sought out immediately. Once a diagnosis has been established, or even while you are waiting for a diagnosis, an exercise program should be considered. Once you are cleared medically, an intelligent, individualized, and supervised program of stretching and exercise should be integrated into your daily routine. Not only will you feel better, you may in fact offset some of the structural damage and significantly reduce the neck pain, back pain, and sciatica you are undoubtedly experiencing, as well.