Scoliosis-related pain can involve the back muscles, spinal structures, and nerves, leading to radiating pain.
Chest pain is most closely associated with thoracic scoliosis that develops in the middle/upper back. The best way to minimize the potential effects of scoliosis, including chest pain, is to manage the scoliosis with treatment.
Scoliosis involves the development of an unnatural spinal curve with rotation, but it doesn’t just affect the spine. Scoliosis can sometimes cause chest pain due to a muscular imbalance, compression of the rib cage, irritated nerves, and in severe cases, lung impairment (1).
Let’s talk about the different ways scoliosis can cause chest pain from how it affects the spine to its surrounding muscles and nerves.
Thoracic Scoliosis
Scoliosis can develop anywhere in the spine, and curvature location is an important factor when it comes to shaping the type of symptoms a patient is going to experience (1, 2).
The spine can be divided into three main sections: the cervical spine, thoracic spine, and the lumbar spine.
The cervical spine refers to the neck and acts as the bridge between the brain, the spine, and the rest of the body; it also has to support the weight of the head and facilitates the neck’s range of motion.
Scoliosis anywhere in the back can affect neck position.
The lumbar spine refers to the lower back and has to support the weight of the thoracic and cervical sections above, along with the torso, and the vertebrae of the lower back feel the effects of strenuous movement.
So scoliosis that develops in the lumbar spine can affect the position of the entire body and the position of the thoracic and cervical spine in space.
The thoracic spine refers to the middle/upper back and is the largest spinal section; as such, it has some important functions (1).
While all spinal sections protect the spinal cord within, the thoracic spine is the only section that attaches to the rib cage, and it facilitates the upper body’s range of motion, so thoracic scoliosis is the most closely associated with symptoms involving the rib cage and chest (1, 2).
Symptoms of Thoracic Scoliosis
A diagnosis of thoracic scoliosis means an unnatural sideways-bending spinal curve has developed, and the rotational component means the spine also twists.
The thoracic spine is most commonly affected by scoliosis, and a single thoracic curve is the most prone to rapid advancement (3)
It’s therefore also common for thoracic scoliosis to have more rotation: another potential cause of scoliosis pain (3).
As scoliosis is progressive, it’s not going to go away on its own and will require treatment to counteract its progressive nature (3).
Scoliosis ranges widely from mild scoliosis to moderate scoliosis and severe cases, and growth makes it progress (1, 3).
The symptoms of scoliosis are shaped by a number of variables including patient age, condition type, severity, and curvature location, and as progression occurs, the size and rotation of the scoliosis is increasing, making symptoms more noticeable (1, 3).
In mild cases, symptoms are also mild and often unnoticeable, which is a challenge to early detection (1, 4).
In children, the main signs of thoracic scoliosis will be postural changes such as uneven shoulders, shoulder blades, hips, and one side of the rib cage protruding excessively; in adults, there is no more growth in the spine to counteract compression, so pain is the main symptom (4, 5).
So let’s talk about the different ways thoracic scoliosis can cause chest pain, starting with a muscular imbalance and trunk muscle endurance issues (5).
Muscular Imbalance and Chest Pain
A common effect of scoliosis is muscular imbalance. As an asymmetrical condition, scoliosis doesn’t just disrupt the body’s posture, but also the spine’s surrounding muscle balance (5).
If the thoracic spine has an unnatural curve and twist, it can cause uneven and strained muscles as the muscles on one side of the spine work hard to counteract the spine’s unnatural position, and muscles on the opposite side grow weak due to lack of use.
A muscular imbalance in the chest and back can be painful; it can involve muscle tension and muscle spasms, especially when severe (2).
It’s not just the spine and its surrounding muscles that feel the effects of scoliosis, but also the nerves within the spine, and nerve compression can cause a number of symptoms.
Nerve Compression and Chest Pain
The spinal cord contains 31 pairs of spinal nerves, and as a role of every spinal section is to protect the spinal cord within, scoliosis can also expose the spinal nerves to uneven pressure.
Compressed nerves in the thoracic spine can cause related chest pain and a number of unpleasant sensations and this can occur in adult scoliosis too (6). Nerves branch off from the spinal cord carrying both sensory and motor information, so if a nerve is compressed, it can cause a number of sensations felt anywhere along the nerve’s path.
A compressed nerve may also experience functional deficits and not transmit signals as effectively, causing pain and other disruptions.
Rib Cage Compression and Chest Pain
As the thoracic spine is attached to the rib cage, the rib cage can also experience rotation and compression (1).
If the rib cage is being compressed, due to the thoracic spine’s unnatural pull on the rib cage, and develops an arch where one side protrudes more than the other, this can also cause rib pain and chest pain.
As the rib cage and thoracic spine work together to protect the lungs and heart, in severe cases, lung function can be disrupted (1).
Lung Impairment and Chest Pain
While lung impairment and breathing problems aren’t common symptoms of scoliosis, in severe and/or atypical cases, thoracic scoliosis can affect lung function (1).
If the rib cage that protects and surrounds the lungs is being compressed, this can mean less room for the lungs to function within, making it difficult to inhale and exhale fully (1).
In many cases, changes to lung function are difficult to notice, with the exception of scoliosis patients who are particularly athletic and put higher-than-average demands on their respiratory systems.
Addressing Scoliosis Chest Pain with Treatment
For those experiencing scoliosis chest pain, treatment can help achieve long-term pain relief by addressing the underlying cause of the chest pain: the scoliosis itself (4).
When pain is a symptom of scoliosis, for long-term relief, the spine’s healthy curves need to be restored to address the structural nature of scoliosis; this means working towards improving the spine’s alignment, balance, and stability.
The ScoliCare approach is proactive and is started immediately following a diagnosis because as a progressive condition, the timing of treatment is crucial.
Particularly in childhood scoliosis, we want to work towards counteracting progression and preventing increasing condition severity.
Scoliosis becomes compressive once skeletal maturity is reached, and this is a key factor when it comes to scoliosis pain, but pain is also shaped by other factors such as curvature location and angle of rotation.
A single thoracic scoliosis is more prone to rapid advancement, which will further increase compression and potential chest pain, so the goal of a proactive treatment plan is to prevent the thoracic scoliosis from progressing to the point of causing sore muscles from a muscular imbalance, a painful rib hump, and irritated nerves.
A comprehensive initial assessment informs the complete customization of treatment plans that combine the potential of a scoliosis-specific exercise program (ScoliBalance®), and corrective bracing (ScoliBrace®).
Although scoliosis is progressive, it can be highly responsive to proactive customized nonsurgical treatment plans.
Conclusion
While there are never treatment guarantees, addressing scoliosis proactively is the best way to minimize its associated symptoms and manage progression.
As progression makes scoliosis more complex to treat and its effects more severe, the goal is to prevent progression and increasing symptom severity through proactive treatment.
Chest pain isn’t a common symptom of scoliosis but is most likely to affect adults with thoracic scoliosis and is caused by how scoliosis can affect the spine’s surrounding muscles, nerves, and the rib cage.
If the uneven forces of scoliosis cause a muscular imbalance in the chest and back, this can cause chest pain, and the development of a rib cage arch due to compression is also common and capable of causing chest and rib pain.
Compressed nerves can also cause pain and other symptoms in the chest.
So for scoliosis patients suffering from chest pain, this is a sign that progression is occurring and treatment is needed; when it comes to symptom relief and managing progression, the sooner treatment is started, the better.
References:
- Xantus, G., Burke, D. & Kanizsai, P. Previously undiagnosed scoliosis presenting as pleuritic chest pain in the emergency department – a case series and a validating retrospective audit. BMC Emerg Med 21, 62 (2021). https://doi.org/10.1186/s12873-021-00455-x
- Weinstein, S. L. (2019). The natural history of adolescent idiopathic scoliosis. Journal of Pediatric Orthopaedics, 39, S44-S46.
- Lenz, M., Oikonomidis, S., Harland, A. et al. Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression. Eur Spine J 30, 1813–1822 (2021). https://doi.org/10.1007/s00586-021-06817-0
- Negrini, S., Donzelli, S., Aulisa, A. G., Czaprowski, D., Schreiber, S., de Mauroy, J. C., … & Zaina, F. (2018). 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and spinal disorders, 13(1), 3.
- Marchese, R., Du Plessis, J., Pooke, T., & McAviney, J. (2024). The Improvement of Trunk Muscle Endurance in Adolescents with Idiopathic Scoliosis Treated with ScoliBrace® and the ScoliBalance® Exercise Approach. Journal of Clinical Medicine, 13(3), 653. https://doi.org/10.3390/jcm13030653
- Zaina, F., Marchese, R., Donzelli, S., Cordani, C., Pulici, C., McAviney, J., & Negrini, S. (2023). Current Knowledge on the Different Characteristics of Back Pain in Adults with and without Scoliosis: A Systematic Review. Journal of Clinical Medicine, 12(16), 5182. https://doi.org/10.3390/jcm12165182
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