Recognizing the Subtle Signs of Scoliosis, Even As An Adult

There isn't always an obvious moment when scoliosis shows up. A child doesn't necessarily complain that their back hurts. An adult may not realize their spine has curved at all. Sometimes the first clue is something as ordinary as noticing that one shoulder looks higher than the other.

That's part of the problem. Human bodies aren't perfectly even, so small differences are easy to dismiss.

Scoliosis causes the spine to curve from side to side and rotate. The curve can form a shape resembling a C or an S. It's most often diagnosed in children beginning around age 11, but adults can have scoliosis as well. What makes it especially easy to miss is that pain isn't a requirement.

A 2024 study found that only 48% of adolescents with scoliosis reported back pain. That means plenty of kids with a spinal curve aren't walking around complaining that their back hurts.

Parents may notice something else first. Maybe one shoulder suddenly seems higher. Maybe one shoulder blade sticks out more. The waistline doesn't look quite even, or one crease sits higher than the other.

Dr. Archie C. Perry Jr., a board-certified orthopedic surgeon at Spine Institute of Nevada, said those are some of the things caregivers can look for.

There's an important caveat here: an uneven appearance doesn't automatically mean scoliosis. Some people are naturally asymmetrical. In fact, someone can look uneven even when an X-ray doesn't show much of a spinal curve. So it's not about standing behind a child and trying to diagnose them.

Doctors Have A Much Better Way To Check

During what's known as the forward-bend test, the person bends forward, usually toward their toes. The doctor watches the back as they do it. A spinal rotation can make one side of the ribs or back appear higher than the other.

Dr. Paul R. Gause, a board-certified orthopedic and fellowship-trained spine surgeon at Spine Institute of Arizona, said it's a classic screening maneuver.

It's also not unusual for scoliosis to be discovered when nobody was specifically looking for it. A child might have it picked up during a routine physical, school screening or sports physical. A parent may notice something at home. An athletic trainer may see it.

The child, meanwhile, may feel completely normal.

Adults Can Have A Somewhat Different Experience

Some don't find out they have scoliosis until they have an X-ray for another reason, including an evaluation for back pain. Adults can also develop scoliosis gradually as the discs and joints of the spine change with age.

That's where symptoms such as back pain, leg pain, numbness or weakness can enter the picture. Some people may eventually have trouble standing or walking, particularly when the spine or surrounding structures put pressure on nerves.

And there's another little clue that can be easy to brush off: clothes. An adult might notice that a shirt hangs differently on one side or that clothing doesn't seem to fit quite the same way it used to. They may feel like they're standing differently without being able to explain why.

Obviously, a shirt fitting strangely isn't proof of scoliosis. Bodies change, clothes shrink and sometimes the shirt is simply the problem. But when that change happens along with a noticeable difference in posture, shoulders or waist, it's worth mentioning.

The age of the person matters, too. With children, doctors are concerned about whether a curve will continue getting worse while the child is still growing. With adults, the issues are more often tied to pain, loss of function or nerves being affected.

There are also people who have significant scoliosis and very few symptoms. That's particularly common with adolescent idiopathic scoliosis. A teenager can have a substantial curve and still go through the day without back pain or any obvious physical limitation.

Someone Else May Be The One Who Spots It

None of this means every uneven shoulder needs to become a medical emergency. It means persistent changes are worth bringing up rather than assuming they're just part of growing up. The same goes for adults who develop unexplained or ongoing back pain, changes in posture, or symptoms such as numbness or weakness.

There isn't one standard version of scoliosis, and there isn't one treatment that applies to everyone. Doctors look at the person's age, the shape and size of the curve and whether it's changing over time before deciding what comes next.

Sometimes the first sign is pain. Sometimes it's a parent saying, “Why does one shoulder look higher?” And sometimes, the person has no idea anything is going on until someone happens to notice.

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