1.0 Abstract
Background: Scoliosis was traditionally thought to develop mainly during the adolescent phase of life. However, research has been reported on older age groups along with follow up periods that show that scoliosis may develop later in life. The aim of the study was to determine the incidence of scoliosis in female students at Kuwait University Health Sciences Center.
Methods: One hundred and fifty-five female students from the five faculties aged between 18 and 25 were recruited. An intake form was completed then an initial Visual screening (Adam’s Flexion Test) was conducted. If the test was positive, a final visual screening (Side Flexion Test) to determine flexibility of the curve and leg length discrepancy was done.
Results: Scoliosis was detected in 43 (33.3%) of the participants and additional screening was performed. Sixteen participants from the FAHS (15 flexible curves and 1 non-flexible curve), 12 from the FOM (11 flexible curves, 1 non-flexible), 2 from the FOD (2 flexible curves), and 13 from the FOP (12 flexible curves and 1 non-flexible). Of the 43 (33.3%) participants with a visible curve, 36 (83.7%) were right handed.
Most of the participants with scoliosis had a right thoracic spine curve 22 (51.2%) followed by right thoraco-lumbar curve 9 (21%).
Conclusion: The result demonstrate that scoliosis is not limited to the adolescent phase of life. The majority of the curves in this sample were flexible curves indicating a need to Physical Therapy education.
2.0 Introduction:
Scoliosis is a progressive disease that attacks the muscles and ligaments of the spinal column and results in an abnormal curve in the anterior-posterior plane of the body (1). It causes a sideways twisting and rotation of the spine, ribs, and pelvis (2). Scoliosis may be seen as either a C-shaped or S-shaped curve of the spine. Different signs may manifest in scoliotic individuals, including uneven muscle bulk on one side of the spine, rib prominence or a prominent shoulder blade, uneven hips, uneven arm or leg length, and heart and lung problems in severe cases (3). There are several causes of scoliosis. The first is a congenital abnormality, meaning someone is born with an atypical spine. The second, which is the most common type, is called idiopathic or juvenile scoliosis and is first noticed in adolescence. The third is secondary scoliosis due to an earlier condition such as vertebral body fracture that cause the spine to curve abnormally (1). Scoliosis is categorized as either functional or structural. Functional is a temporary form of scoliosis and structural is a permanent form of scoliosis.
Scoliosis was traditionally thought to develop mainly during the adolescent phase of life. However, research has been reported on older age groups along with follow up periods that show that scoliosis may develop later in life (Francis et al, 1988). Therefore, the aim of this study is to determine the incidence of scoliosis in female students of Health Sciences Center at Kuwait University.
2.1 Hypotheses:
There is a high prevalence of functional scoliosis in female students of the Health Sciences Center at Kuwait University.

2.2 Research Question:
What is the prevalence of scoliosis in female Health Sciences Center students at Kuwait University?
3.0 Literature review:
Shohat et al. analyzed the height, weight, and body-mass index of 54,030 male and 38,102 female recruits from the army who all underwent a complete routine health assessment at the age of 17. In total, 6,711 males and 4,864 females were diagnosed as having idiopathic scoliosis and were categorized according to three grades of severity. There was a difference in prevalence in both sexes with parental origin from Iraq and western Europe. The risk of developing more severe grades of scoliosis increases with females as compared to males. Young scoliotic adults were taller, lighter, and thinner than the nonscoliotic controls. These differences in height, weight, and body-mass index correlated with the severity of the scoliosis. Genetic factors and growth pattern are suggested to be of major importance for the prevalence of scoliosis. (Mordechai Shohat, Tami Shohat, Menachem Nitzan, Marc Mimouni, Ron Kedem and Yehuda L. Danon at 1988) (4).
The relationship between functional scoliosis and leg length discrepancy was studied by Raczkowski and her colleagues (2010). They investigated that the leg length discrepancy causes pelvic obliquity in the frontal plane and lumbar scoliosis with convexity towards the shorter extremity, leading to posture deformation, gait asymmetry, low back pain and disc disease. This was done among 369 children. The discrepancy of 0.5 cm was observed in 27, 1 cm in 329, 1.5 cm in 9 and 2 cm in 4 children. During the first follow-up examination, within 2 weeks, the researchers found that the adjustment of the spine to new static conditions was noted and correction to the curve in 316 examined children (83.7%). In 53 children (14.7%) the correction was observed later and was accompanied by slight low back pain. The time needed for real equalization of limbs was 3 to 24 months, and the time needed for real equalization of the discrepancy was 11.3 months. They concluded that leg length discrepancy equalization results in elimination of scoliosis (5).
A study by Darwish et al. investigated the possible role of the radiate ligament in idiopathic scoliosis. The study was a case-control adapted to cadavers. Eighteen human cadavers, 12 males and 6 females of Caucasian race, with a mean age of 55 years. Among the studied subjects, 15 were with normal spines, and 3 were scoliotic. The upper and lower bands of radiate ligaments were identified and measured. All cadavers were examined grossly, and scoliotic cadavers were also examined radiologically. They revealed that the mean of the lengths of the upper bands of radiate ligaments, on the concave side, in each scoliotic cadaver showed a highly significant shortening compared with that of the upper bands of the corresponding segments in cadavers with normal spines, while no significant change was detected when comparing those of the lower bands to normal values. They concluded that a possible relationship will be between radiate ligament shortening and the etiology of idiopathic scoliosis (6).
Breast asymmetry samples between ladies with idiopathic scoliosis was demonstrated by Cruz et.al (2013). Breast asymmetry is seen in females with idiopathic scoliosis. 54 females suffering with idiopathic scoliosis were evaluated. Age, weight, height, scoliosis type, Cobb angle, breast measurements and then attendance of rib cage asymmetry were assessed. Breast quantity used to be deliberated the use of anatomic measurements (anthropomorphic method). The vile youth regarding the group used to be 25 +/- 7 years. An appropriate convex thoracic corner befell within 85%, along a vile Cobb perspective about 32 +/- 15 degrees. The study indicated that women, including idiopathic scoliosis, constantly presented breast asymmetry that accompanied a predictable pattern. The breast concerning the side over the convex thoracic scoliosis curve is constantly smaller between amount (mean difference 59 +/- 39 mi). Additionally, the affected side gives a smaller areola, a greater function concerning the nipple (mean distinction 2.2 +/- 1.3 cm) yet a higher function on the inframammary board (mean difference 2.1 +/- 1.4 cm) in contrast to the opposite breast. However, the asymmetry is predictable and the rate in conformity with the patient provides these adjustment does not correlate along the rapidity on the scoliosis (Cobb angle). We believe that the rapidity of the asymmetry is a result of the difference between the hypo-plastic breast and the normal breasts. In women with very substantially different breasts the asymmetry seems to be worse (7).
A study by Vincenzo et al. in 2017 investigated the factors influencing curve behavior following bracing are half understood then there is no agreement if scoliotic curves stop progressing along skeletal maturity, and the aim concerning that study was once after considering the deprivation about the scoliotic curve correction of patients dealt with along relation at some point of childhood and to examine affected person results of under and over 30 Cobb degrees, 10 years after brace removal. This used to be done with the aid of reviewing 93 (87 female) of 200 and 9 patients along adolescent idiopathic scoliosis (AIS) who have been treated including the Lyon or PASB brace at a mean on 15 years (range 10–35). All patients answered a simple questionnaire (including work status, pregnancy, yet pain) yet underwent scientific and radiological examination, and these populaces was once divided within twin’s groups primarily based on Cobb levels (?30°). Statistical analysis was performed to check the efficacy regarding our hypothesis. They observed that there was no significant distinction of the mean development concerning corner magnitude in the ??30° or >?30° groups at the long-term follow-up. They concluded that scoliotic curves did no longer collapse beyond their original curve size after bracing in both groups at the 15-year follow-ups. These consequences are within contrast together with the history of this pathology so much normally suggests an innovative and lowly increment regarding the curve at skeletal maturity. Bracing is a high-quality cure approach characterized with the aid of positive long-term outcomes, such as because of patients demonstrating reasonable curves (8).
Ferguson (2017) investigated the Adolescent idiopathic scoliosis and its association with The Tethered Spine and fascial spiral. This article reported on an observational and treatment case series involving 22 young people or preadolescents were handled over a 15-year length whoever had or rising idiopathic scoliosis (IS). Common patterns over muscle or fascial asymmetry had been observed and treated. Most of these patients had pain in the spinal area, yet the trigger points were accountable because pain was in the muscles. Asymmetries in tension of these muscle groups show up in accordance with the tethered spine within certain ways to contribute to scoliotic curvatures, and the common asymmetrical pattern located in these individuals who follows a unique spiral fascial plane. Additionally, evaluation showed that 21 regarding 22 of the patients had primary ligamentous laxity, joint dysfunction, muscle weakness, and over pronation of the ankle. Treatment concerning the tethering of the spine from myofascial asymmetries may also result in reduction on scoliotic curvatures and rib humps (9).
Hawes and O’Brien (2009) summarized what is known as the pathological processes (e.g. structural and functional changes), with the aid of which spinal curvatures develop and bring out into spinal deformities. Comprehensive decrial regarding articles (English language only) posted over ‘scoliosis,’ whose content yielded records on the pathological changes related along spinal curvatures. Medline, Science Citation Index and other searches yielded ; 10,000 titles each of who used to be surveyed because content related according to ‘pathology’ then related terms certain so ‘etiology,’ ‘inheritance,’ ‘pathomechanism,’ ‘signs or symptoms.’ Additional resources included all books published about ‘scoliosis’ and reachable through the Arizona Health Sciences Library, Interlibrary Loan, yet through direct consultation including the authors yet publishers. The results confirmed a lateral curvature of the spine–’scoliosis’–could develop in association with postural imbalance due to genetic defects or damage as properly namely penalty then scarring out of trauma then surgery. Irrespective over the factor as triggers its appearance, a sustained postural imbalance may result, on time, among institution concerning an administration on continuous uneven loading friend in accordance with the spinal axis. Their conclusions had been that spinal curvatures could automatically keep recognized between promptly stages, before pathological deformity concerning the vertebral elements is precipitated among rejoinder to asymmetric loading. Current clinical tactics contain ‘watching yet waiting’ while slight reversible spinal curvatures develop within spinal deformities with strong in accordance with reason symptoms all through life. Research after defining patient-specific mechanics about spinal loading may additionally permit quantification about an imperative introduction at who curvature institution yet development turn out to be inevitable, and thereby yield strategies to prevent development regarding spinal deformity (10).
A cross sectional study by Fotrtin and colleagues (2016) about trunk imbalance in adolescent idiopathic scoliosis. Trunk imbalance in which frontal trunk shift measured with a plumb line from C7 to S1, is part of the clinical evaluation in adolescent idiopathic scoliosis (AIS), but its prevalence and relationship with scoliosis, back pain, and health-related factors are not well documented. The principal objectives are to document trunk imbalance prevalence and to explore the association between trunk imbalance and the following factors: Cobb angle, type of scoliosis, back pain, function, mental health, and self-image. The secondary objective is to determine back pain prevalence and the relationship between back pain and each of the following: Cobb angle, function, mental health, and self-image. The study was in a scoliosis clinic of a tertiary university hospital center. The sample includes youth with AIS (N=55). The outcome measures were trunk imbalance prevalence and magnitude, and back pain prevalence and intensity using the Numeric Pain Rating Scale (NPRS) and the Scoliosis Research Society-22 (SRS-22) pain score, and the function, self-image, and mental health domains of the SRS-22. Trunk imbalance and back pain were assessed in 55 patients with AIS (Cobb angle: 10-60°). Patients completed the SRS-22 questionnaire and the NPRS. Correlations were done between trunk imbalance and scoliosis (Cobb angle, type of scoliosis), back pain (NPRS and SRS-22 pain score), and health-related factors using Pearson correlation coefficients (r) and logistic regression models. Results Trunk imbalance prevalence is 85% and back pain prevalence is 73%. They found fair to moderate significant positive correlation between trunk imbalance and Cobb angle (r=0.32-0.66, p