Idiopathic scoliosis, by far the most common form of scoliosis, affects approximately a half million adolescents in the United States, with girls more likely to be affected than boys.

Scoliosis is defined as a lateral (away from the middle) or sideways curvature of the spine which usually develops in the thoracic spine (upper back) or the thoracolumbar area of the spine between the thoracic spine and lumbar spine (lower back). The curving of the spin from scoliosis may develop as a single curve (shaped like the letter C) or as two curves, shaped like the letter S.

Scoliosis can be caused by congenital, developmental or degenerative problems. However, at present, the vast majority of cases of scoliosis actually have no known cause.

Local physiotherapist Shirlene Dill thinks the lack of good posture amongst young girls may also have something to do with Idiopathic scoliosis, noting how girls tend to stand more on one leg as opposed to standing straight and with their weight evenly distributed on both legs.

"That's my educated guess," she said.

"Plus different structure. And anatomically girls and boys are different anyway. A woman's pelvis and lower spine is designed to have children."

She warned: "If you don't feed symmetry into your body it is going to take the form of what it learns.

"That's one of the things I have to work on with people with scoliosis, or any back problem... 'am I standing on both feet, am I sitting on both cheeks'.

"People very often stand and sit asymmetrically. People just get into habits and form follows function. When you do something all the time your body adapts."

There are four main forms of scoliosis:

Congenital scoliosis: This is a relatively rare form of congenital malformation of the spine. These patients will often develop scoliotic deformities in their infancy.

Juvenile scoliosis: Another uncommon form is the development of scoliosis in childhood.

Idiopathic scoliosis: By far the most common form, also referred to as adolescent scoliosis which develops in adolescents and progresses mostly during the adolescent growth spurt.

Degenerative scoliosis: Scoliosis can also develop later in life, as joints in the spine degenerate and create a bend in the back. This condition is sometimes called adult scoliosis.

Idiopathic scoliosis tends to occur in families and significant curvature of the spine is much more prevalent in girls than in boys. The majority of curves do not require treatment.

Because idiopathic scoliosis is considered a deformity, scoliosis treatment is largely centred on reducing or limiting the progression of the deformity and is not focused on treatment of pain.

"The doctors will send them (to a physiotherapist) if they have pain and the parents have taken them to the doctor for pain, but if pain is not an issue yet, then more often the mother will notice that the child is 'crooked'.

The symptoms include the spine curving abnormally to the side; shoulders and or hips appearing uneven, backache or low back pain or fatigue.

"A couple of my teenagers (patients) are promising (female) soccer players and the parents will say 'she is going away to a soccer camp and she needs to perform but she has this back pain every time she plays and the doctor says she has scoliosis, what can you do?'," said Mrs. Dill. She says scoliosis is more common than people realise.

"A lot of people do have mild scoliosis, but it is not always a problem and does not always need treatment. If it looks deformed, doesn't quite look right, then yes they should seek help before it gets worse."

According to information on a website, routine scoliosis is now done in junior high and middle school and many early cases are detected that previously would have gone unnoticed.

Frequently, the curve of the spin is first diagnosed in school exams or in a regular check up with a paediatrician. It is most commonly noticed with the patient bending forward, when a rib hump can be seen.

If a rib hump is noticed or a fullness in the lumbar spine is noticed, then an x-ray will usually be ordered to both confirm the diagnosis and check on the magnitude of the curvature. The x-ray will also give some indication as to the skeletal maturity of the patient.

Treatment decisions are based on the skeletal maturity of the patient, based on how much growth can be expected as well as the degree of curvature. The younger the patient and the bigger the curve, the more likely the curve is to progress.

"It is only if the scoliosis is bad enough that they need orthopaedic treatment that breathing can be a problem," explained Mrs. Dill.

She explained that treatment would first include making sure all the stabilising muscles of the back are doing their job.

"If they are not, then I will give them the appropriate exercises," she said.

Curves that are less than ten degrees are not considered to even represent scoliosis, but rather spinal asymmetry.

Those types of curves are extremely unlikely to progress and generally do not need any treatment. If the child is very young and physically immature, then the progress of the curve can be followed during the child's regular check-up with his or her paediatrician. If the curve is noticed to progress beyond 20 degrees, then the child should be referred to an orthopaedic surgeon for continued treatment.

Curves that are between 20 and 30 degrees can be observed at four to six month intervals. Any progression that is less than five degrees is not considered significant, but if the curve progresses more than five degrees then the curve will need treatment.