The Scoliosis Curve That Gets Missed Because It Doesn’t Hurt Yet
By Dr. Justin Dick
Most adults who come into my clinic with a diagnosed scoliotic curve didn’t get there because of back pain. They got there because someone finally took a full-length standing X-ray. This is usually years after the curve had already progressed past the point where conservative correction is straightforward.
That gap between when a curve starts and when it gets caught is the part of scoliosis care that doesn’t get talked about enough. Adolescent screening exists in some school systems.Adult curve progression has almost no structured screening. People assume scoliosis is something you’re born with or that gets caught in your teens. Curves in adults can progress slowly for decades. We see this especially in degenerative curves that develop alongside disc height loss and facet arthropathy. The person carrying that curve often has no idea it’s happening until something else brings them in.
I had a patient last year, mid-40s, who came in for hip pain. She assumed this was from running. Her hip was fine. Her lumbar curve measured 34 degrees on imaging. By her own account she’d never been told she had scoliosis at any point in her life. She’d compensated for it so gradually that her body had built an entire movement pattern around the asymmetry. The hip pain was downstream of the spine. It was not the source of it.
This pattern is what I see most often in adults. The presenting complaint is rarely “I think my spine is curved.” It’s hip pain, one-sided shoulder tension, a rib that “sticks out” more on one side, or a family member noticing uneven shoulder height in a photo. By the time imaging confirms the curve, the person has usually had it long enough that the correction window has narrowed.
A few things I wish more people understood about this:
Pain is a poor screening tool for scoliosis. Curves under 25 to 30 degrees are frequently painless. By the time discomfort shows up, the curve has often already progressed into a range where treatment takes longer and the outcome ceiling is lower. This means we are past the best window.
Postural asymmetry is visible before it’s painful. Uneven shoulders, one hip riding higher, a rib hump when bending forward, these are observable years before someone feels anything. A fair number of primary care visits don’t screen for them because there’s no complaint driving the exam in that direction.
Adult curves aren’t static. There’s a persistent myth that once skeletal growth stops a scoliotic curve is locked in place. Degenerative changes, disc desiccation, and postural decompensation over decades can all drive continued progression well into adulthood. We see this predominately in the lumbar spine.
This is part of why I’ve made community screening a standing part of my practice. We run a free quarterly screening initiative here in Charlotte specifically because the people who need to be looked at usually aren’t the ones already sitting in a chiropractor’s chair. They’re the ones who assumed a slightly uneven shoulder was just how their body is built.
If there’s one thing worth taking from this: a scoliotic curve doesn’t announce itself with pain until it’s already had years to establish itself. If you’ve ever been told that one shoulder sits higher than the other, uneven hips, or pain in the spine, that’s worth a five-minute look at an actual X-ray. It’s not a wait-and-see approach based on how you feel today.
Dr. Justin Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC, focus in non-surgical structural scoliosis correction. He holds dual imaging credentials (CNMT, ARRT(N)(CT)) and has published peer-reviewed research on spinal mechanics. Learn more at clearlifescoliosis.com.