"Research is to see what everybody else has seen, and to think what no one else has thought."

-Albert Szent-Gyorgi, Nobel Prize Winner & Discoverer of Vitamin C

The role that genetics plays in the development of scoliosis remains controversial. While it cannot be disputed that scoliosis does have a familial component (people who have a family member with scoliosis are more likely to have it themselves), the fact that identical twins do not always share the disease of scoliosis emphasizes the role that other, non-genetic factors play in the development of scoliosis.

This topic was recently explored in detail by four of the most highly respected researchers in the field of scoliosis, including the foremost experts on the etiology (cause) of scoliosis, Burwell & Dangerfield, and the current editor-in-chief of the Scoliosis journal, Theodoros Grivas. The article, entitled Adolescent idiopathic scoliosis (AIS), environment, exposome, and epigenetics: a molecular perspective of postnatal normal spinal growth and the etiopathogenesis of AIS with consideration of a network approach and possible implications for medical therapy, was recently published in the journal Scoliosis, and is the first research endeavor to explore the role of epigenetics in scoliosis.

Epigenetics, while as complex as genetics if not moreso, can be summarized simply as the study of the environmental factors which regulate genetic expression. Through the process of methylation, genes can be "turned on" or "turned off" in response to these factors. Thus, an individual with a family history of cancer and who is at high risk for developing cancer themselves can modify their diet & lifestyle, which will actually re-write their genetic code to reduce their chances of developing cancer.

Due to the gaps in our understanding of what causes scoliosis, the traditional approaches of bracing & surgery can only aim at treating the effects of scoliosis; most notably, Cobb angle. Bracing & scoliosis surgery are mechanical in nature; they do not involve rehabilitation of the neurological systems of the body, and they do not claim to address what caused the scoliosis to develop in the first place. They merely respond to the presence of a lateral curvature of the spine by attempting to force it back into place.

The lack of research on the causes of scoliosis is, in part, driven by the sociopolitical forces which prevail and continue to promote bracing & surgery as the only solutions. In the last decade, epigenetics has revolutionized the way in which we understand many diseases. Unfortunately, this has not been the case for scoliosis, where "there are only sporadic reports suggesting that environmental factors are at work in etiology. [E]pigenetics does not figure in any causal analysis of postnatal normal spinal growth, or in the etiopathogenesis of AIS. This reflects current scientific opinion that genetic rather than environmental factors determine the etiology of AIS in accordance with the genetic variant hypothesis of disease."

In short, there is a very real possibility that environmental forces may play a larger role in the development and progression of scoliosis than genetic factors, but due to the current dogma, this possibility is simply not being explored in the United States.

One of the possible environmental factors which could play a role in scoliosis is "environmental effects induced in the spine by physical exercises." Unfortunately, this was not explored in this paper, and remains unknown and unresearched.

It is not unreasonable, in the face of evidence proving that an individual's genetic risk for cancer can be reduced through diet & lifestyle changes, to propose that an individual could affect their spinal health in the same manner through chiropractic, physical therapy, and other modalities. With the lack of evidence supporting the current mechanical-based therapies, this new hypothesis - based around epigenetics and its potential to empower the patient by emphasizing how what you do affects your health - has no more or less validity than the old, conventional way of thinking.

"The etiologic, and potentially therapeutic, problem is to establish in each AIS [patient], which process(es), in what pathway(s), is/are abnormal or exacerbating the deformity." It is highly unlikely that the cause of scoliosis is the absence of rods in the spine, or the patient's clothing is not rigid or constricting enough. Although it may mean swimming against the current and going against popular belief, advancing our understanding of the cause of scoliosis can only help us to develop better clinical rehabilitation strategies. Despite the past inattention, it is hoped that this new article by Burwell et al will be the first of many to explore scoliosis in a new light, and that the promise offered by epigenetics to revolutionize scoliosis treatment will be realized in the decade to come.