Scoliosis: Why Parents Should Screen their Children, and How to Properly do so

As parents, we tend to be vigilant in our efforts to watch out for and protect our children from physical injury, as well as other potential risks to their wellbeing. It is just what we do. We mostly tend to weigh in on the side of caution in the activities we may choose for our young children, and we are mindful of risk factors for injury. We consider many elements and try to make wise judgments when assessing the risks vs rewards potential. 

Some potential risks to our children’s musculoskeletal (and emotional) health can be more insidious and become somewhat advanced before even noticed, especially when the condition is asymptomatic. Scoliosis is a musculoskeletal disorder in which the spine curves to the side and rotates, with the vertebral bodies rotating toward the convex side of the curve and the spinous processes rotating toward the concave side of the curve. A scoliosis may only have one curve, called a simple “C” curve or it may develop two curves, referred to as compound “S”. Nearly 80% of scoliotic conditions are idiopathic; meaning the cause of the condition is unknown. There are 3 million new cases of scoliosis diagnosed each year in the United States with the vast majority found in females.

Healthy Normal Alignment       Scoliotic Spinal Curve with Spinal Rotation

Why Should Parents Screen their Children for Scoliosis?

Scoliosis is considered an “insidious” and “asymptomatic” disease; meaning that it develops gradually and that there are usually no aches and pains or other warning signs that the curve is developing. Consequently, in many if not most cases, the scoliosis is not detected until after the curve has moderately progressed. At this point, the ability to prevent further progression of the curve(s) is more difficult. 

Scoliotic screening of our children at our public schools has ceased in most states due to budgetary constraints. Even when school-based scoliotic screening is provided, it is usually only performed one time during the school year. Some scoliosis conditions will progress slowly with only a few degrees curvature developing over a year’s time. However, some scoliotic conditions progress more rapidly, with some curves increasing 3 to 6 degrees per month. A one-time a year school-based screen would not detect this type of rapid progressing scoliotic curve. Moreover, when detected, the intervention goal in the treatment of scoliosis is to stop or slow the curve from progressing. It is impossible to cure scoliosis, and it is very rare to substantially reduce the degree of the curve or curves once developed. Therefore, early detection and early intervention must fall to the parents

How Parents Can Screen their Children for Scoliosis

The most common and effective field screen for scoliosis is the Adam’s Forward Bend Test. You the parent are positioned behind your child so you can view the horizon of their back when they bend forward. Instruct your child to slowly bend forward allowing their arms to naturally move forward and toward the ground. You will make two specific observations.

First Observation Point – Thoracic Region of the Spine: When the thoracic section of the spine (rib case level) is viewed on the horizon. At this point, check to see if there is asymmetry across the back. It should be perfectly symmetrical one side to the other. If, however, there is an asymmetry manifested as a “rib eminence” on one side of the back, then a scoliosis curve is present in the thoracic region of the spine. 

Right Thoracic Scoliotic Curve – Asymmetry 

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Second Observation Point – Lumbar Region of the Spine: This observation is made as the child further bends forward to when the lumbar section of the spine (low back level) is viewed on the horizon. It too should be perfectly symmetrical one side to the other. If, however, there is an asymmetry manifested as a “lumbar muscular eminence” on one side of the back, then a scoliosis curve is present in the lumbar region of the spine.

Lumbar Scoliotic Curve Not Present – Symmetry

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Note: The reference curve for properly naming a scoliotic condition is the “convex” side of the curve, as compared to the concave side of the curve. If the person has two curves, one in the lumbar section of the spine and another in the thoracic section of the spine, they will be in opposite directions, i.e., if the lumbar curve is to the right then the thoracic curve will be to the left, and vice versa. 

Other Signs of Scoliosis to Look For

While the Adam’s Forward Bend Test is a specific test for scoliosis, there are other signs that one can look for that also can indicate that a scoliosis may be present. These include:

  • Asymmetry in the distance between the arms and sides of the body
  • One shoulder is higher than the other
  • Asymmetry between the scapula (shoulder blade) 
  • Eyes may be tilted, asymmetrical
  • Uneven hip height or pant leg length – scoliosis can be caused by a leg length discrepancy and this may be able to be seen as asymmetry between hip height and pant leg length
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When Should Parents Begin Screening their Children for Scoliosis?

Data shows that most scoliosis conditions begin to develop just before and at the onset of puberty. Girls are approximately 8 times more likely to develop scoliosis than boys, and taller thinner kids are more likely to develop to scoliosis than their shorter counterparts. As such, around the time of puberty onset, parents should begin looking for signs of scoliosis and perform an Adam’s Forward Bend Test about every month or two. Remember, some scoliotic conditions can progress at a rate of 3 to 6 degrees per month and early detection and intervention is the key to preventing the progression of the curve.

Take Action

If you detect an asymmetry of the body or a positive Adam’s Forward Bend Test, you should have your child examined by a specialist to verify (or not) your findings and so that an appropriate plan of treatment can be determined based on a variety of factors specific to the individual person. 

Lynn Perkes is a full-time faculty member at Brigham Young University-Idaho teaching courses in Kinesiology and Biomechanics, Applied Kinesiology and Assessment, Therapeutic Exercise, and other Physical Therapist Assistant classes. He writes part-time for, who sells healthcare, medical, therapy, fitness, and personal protective equipment and supplies.