Rupert Health Centre Blog

Author: Sabrina Tsui

  • Scoliosis – causes, effects, treatment

    What is scoliosis?

    Scoliosis is classified as an abnormal side-to-side curvature of the spine, according to the Cleveland Clinic. It happens when a vertebra is rotated, making the spine appear curved. This condition is found in roughly 2-4% of the world, with a higher prevalence among girls and women (Lee et al., 2022). Furthermore, it is often developed during childhood or adolescence and is usually diagnosed in children with the help of early screening.

    Diagnosis happens when there is a spinal curvature above 10 degrees, with the spine curving to the left and right or to a C or S shape, looking like a person leaning to the side, according to John Hopkins Medicine. Diagnosis is based on the Cobb angle which is used to measure the degree of tilt and is defined as “the angle between the upper border of the uppermost vertebra in the curve and the lower border of the lowermost.” (Goldberg et al., 2007) This angle is used as a measurement tool for diagnosing the severity of a curve, helpful for developing treatment plans.

    Some risk factors of developing scoliosis include genetics/family history of scoliosis, an injury affecting the spine, or weak muscles and nerves (Cleveland Clinic, 2025). Scoliosis mainly affects the thoracic and lumbar spine, as they are more prone to change with aging and growth. Therefore, early detection and intervention are important for treating scoliosis and preventing further development of the curve.

    The exact cause of scoliosis is often, unknown but is generally grouped into three categories.

    Types of scoliosis

    There are three main types of scoliosis: idiopathic, congenital, and neuromuscular.

    Idiopathic scoliosis is most commonly found and diagnosed in adolescence, as growth spurts can affect the spine curvature. The cause of idiopathic scoliosis is unknown despite extensive studies. However, there is a greater risk of developing it if a family member has it (Cleveland Clinic, 2025). Idiopathic scoliosis can also be further classified by age group.

    • Infantile –younger than 3
    • Juvenile –4-10
    • Adolescent –11 – 18
    • Adult –after 18, when skeletal growth is complete

    Congenital scoliosis is rare and can be diagnosed at birth due to vertebrae not being formed during embryonic development, causing a spinal curvature to develop (Cleveland Clinic, 2025). In many cases, congenital scoliosis is diagnosed later in childhood and is usually monitored in case of further curve development.

    Neuromuscular scoliosis is caused by deformities in muscles and nerves that support the spine, which could be due to injury, cerebral palsy, spina bifida, or muscular dystrophy (Cleveland Clinic, 2025). This is due to weak and unbalanced muscles, causing the spine to curve.

    What are the symptoms?

    • Back pain
    • Hard to stand up straight
    • Weak core muscle
    • Leg pain, numbness, or weakness
    • Uneven shoulders
    • Uneven waist
    • Constant leaning to one side
    • Uneven leg length
    • Elevated hips
    • Head not centered above pelvis
    • Different arm lengths

    Symptoms can also be due to other spinal conditions; please consult with a doctor if you experience any of these symptoms.

    Effects of scoliosis

    Scoliosis can result in pain and aching, organ or nerve damage, arthritis, spinal fluid leakage, difficulties breathing, and even deformities in muscles or nerves. However, the effects of scoliosis are not limited to physical effects; it also affects one’s psychological well-being (Lee et al., 2022). This condition can have a negative impact on a person’s mental health, particularly in younger children and adolescents, due to the uncomfortable nature of brace wearing or the feeling of standing out in a crowd.

    Diagnosis and testing

    Screening is done by a family physician via physical exam to assess posture, alignment, and spinal curvatures. For a full diagnosis, your family physician may refer you to get an X-ray, MRI, or CT scan. Based on the degree of the angle, curves are divided into 3 types; mild, moderate, and severe.

    • Null: less than 10 deg
    • Mild: 10-14 deg – does not require therapeutic intervention, only monitoring
    • Moderate: 25-39 deg – recommended to get bracing
    • Severe: more than 40 – requires surgery

    Scoliosis is measured using the Cobb angle which is used to “determine success and effectiveness of orthosis treatment” (Lee et al., 2022). A treatment is deemed successful when there is less than 5 degrees of a Cobb angle progression (Lee et al., 2022).

    What treatment is offered?

    Treatment is focused on relieving symptoms and slowing down curve progression. Some non-invasive treatments include exercising to strengthen core muscles, physical therapy to improve posture, stretching daily, and partaking in physical activity. In addition, regular checkups with a healthcare provider to monitor the curve progression is recommended. Your healthcare provider may suggest wearing a back brace to support your spine and to halt the progression of your curve under 50 degrees (Lee et al., 2022). There are a few different types of braces – Milwaukee, TLSO, Boston, and Charleston.

    The Milwaukee brace is used to treat thoracic curves at or above T8 (Lee et al., 2022). It utilizes passive and active pressure to help in spine alignment. However, many found that wearing the brace was uncomfortable, leading to decreased compliance, as it needed to be worn for 18-23 hours a day for most effectiveness (Lee et al., 2022).

    The thoracic lumbar spinal orthosis (TLSO) brace also used active and passive pressure to prevent the curve from progressing. It was reported to be more comfortable to wear, leading to increased compliance from patients (Lee et al., 2022). This brace was custom-made and fit to each patient. However, to save on cost, John Hall and William Miller developed a new, pre-made brace that could be modified to fit a patient’s needs (Lee et al., 2022).

    The Boston brace is the most commonly used brace in North America and is most effective at a curve between T6 and L4, with a curvature of 20-49 degrees (Lee et al., 2022). Additionally, a study done by Katz et al. found that the Boston brace was more effective for preventing progression of the curve in individuals with a curvature between 25 and 35 degrees. However, this brace also needed to be worn for 18-23 hours per day for increased effectiveness (Lee et al., 2022).

    The Charleston brace was designed to be worn during sleep (8-10 hours), and is most effective for those with a curvature between 25 and 35 degrees at an apex below T8 (Lee et al., 2022). This brace holds a patient in an overcorrected position and is custom molded (Karimi et al., 2018). However, patient compliance did not increase due to the uncomfortable brace structure and material (Lee et al., 2022).

    In severe cases, with a curve 50-degrees and over, your healthcare provider may suggest surgery to treat the curve (Cleveland Clinic, 2025). Some surgeries include

    • Spinal fusion –fuse bones together using metal braces to hold spine in place
    • Expandable rod –insert rod along vertebrae to support growing spine of a child

    However, surgery is used as a last resort and has complications like infection, bleeding, and nerve damage. Therefore, early screening and detection are vital for preventing curve progression.

    Come visit our office for treatment

    • If you notice symptoms
    • If you are experiencing back pain
    • We can help alleviate symptoms of pain and discomfort; however, for improvement of spinal curvature, please see your family physician for more information.

    We offer personalized care to relieve your pain and get you moving comfortably again. Book an appointment today and feel the difference! Call us at 604-435-2285 or visit https://ruperthealth.com for more!

    References

    Goldberg, C. J., Moore, D. P., Fogarty, E. E., & Dowling, F. E. (2007). Scoliosis: a review. Pediatric Surgery International, 24(2), 129–144. https://doi.org/10.1007/s00383-007-2016-5

    Karimi, M., & Rabczuk, T. (2018). Scoliosis conservative treatment: A review of literature. Journal of Craniovertebral Junction and Spine, 9(1), 3. https://doi.org/10.4103/jcvjs.jcvjs_39_17

    Lee, G. B., Priefer, D. T., & Priefer, R. (2022). Scoliosis: causes and treatments. Adolescents, 2(2), 220–234. https://doi.org/10.3390/adolescents2020018

    Scoliosis. (n.d.). John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/scoliosis

    Scoliosis. (2025, June 2). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15837-scoliosis

  • The Importance of Vitamin D

    What is Vitamin D?

    Vitamin D, also known as calciferol, is an essential vitamin that has many functions. It plays a role in absorbing calcium, helps in building and maintaining strong bones, supports the immune system, and improves muscle functions like balancing and reducing the risk of falls and injuries (Mavar et al., 2024).

    There are two types of vitamin D; vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). Vitamin D3 comes from animals and is also synthesized in humans when our skin epidermal cells come in contact with sun rays (Chang & Lee, 2024). Whereas vitamin D2 comes from plants and fungi containing the precursors for vitamin D2 (Mavar et al., 2024). Vitamin D is also a fat-soluble vitamin, meaning that it is stored in the body’s fat cells. Fat in the small intestine also enhances vitamin D absorption (Mavar et al., 2024). This makes sense as most of the naturally occurring vitamin D-rich foods are high in dietary fat.

    Furthermore, sunlight exposure remains the most common intake of vitamin D for humans as there are very few foods that contain vitamin D naturally. Certain food products on the shelves are fortified with vitamin D in regulation with Health Canada to maintain sufficient levels of vitamin D in our diets. Without sufficient levels of vitamin D in our bodies, we may suffer from vitamin D deficiency.

    Vitamin D Deficiency

    Vitamin D deficiency is classified by insufficient serum vitamin D levels and is a rising global public health concern. Vitamin D deficiency can increase the risk of many health conditions. Some of these include our bones becoming brittle and thin due to lack of vitamin D, causing osteoporosis and rickets in children (Chang & Lee, 2024). The global increase in vitamin D deficiency could be due to lifestyle changes, as more people are spending time indoors, limiting sun exposure according to Mavar et al. Aging populations are also more susceptible to vitamin D deficiency as their ability to synthesize vitamin D from sun exposure weakens and becomes less effective (Mavar et al., 2024).

    Furthermore, people residing in the Northern hemisphere of the world are more at risk of vitamin D deficiency, due to a lack of sun exposure (Mavar et al., 2024). There are other risks to our health due to vitamin D deficiency, such as respiratory infections and autoimmune diseases (Mavar et al., 2024). Which is why we need to maintain sufficient levels of vitamin D in our bodies. To do so, we can incorporate more vitamin D into our daily lives. The main sources of vitamin D include: supplements, food, and sunlight exposure.

    Supplements

    Health Link BC recommends that we choose supplements that have a Natural Product Number (NPN) because they meet Health Canada’s safety measures. There are three main kinds of supplements: liquid, chewable, and pill form.

    • Liquid form is recommended for children 4 and under
    • Chewable form is for anyone who can chew and swallow safely
    • Pill form is for anyone who can swallow a pill safely

    Please follow the labels for dosage and instructions on the intake of the supplement. Take caution and speak to your health care provider when incorporating vitamin D into your diet as taking excessive amounts can lead to vitamin D toxicity and detrimental health outcomes (Mavar et al., 2024).

    Health Canada recommends taking daily supplements of vitamin D and incorporating vitamin D rich foods into your daily diet.

    Dosage recommendation:

    Age rangeRecommended dosageUpper intake level
    0-12 months400 IU (10 µg)1000 IU (25 µg)
    1-3 years600 IU (15 µg)2500 IU (63 µg)
    4-8 years600 IU (15 µg)3000 IU (75 µg)
    9-70 years
    (including pregnant and breastfeeding individuals)    		600 IU (15 µg) 4000 IU (100 µg)
    70 and over800 IU (15 µg) 4000 IU (100 µg)
    Courtesy of Health Link BC

    Foods Rich in Vitamin D

    There are very few foods that contain vitamin D naturally. Most of the vitamin D we consume in Canada is from fortified foods – where vitamin D is added. It is recommended by Health Link BC to check the nutrition facts table to see if vitamin D has been added.

    Here are some vitamin D-rich foods to incorporate into your diet:

    • Egg yolks
    • Soft Margarine
    • Fatty fish such as – salmon, artic char, rainbow trout
    • Unsweetened low-fat milk
    • Unsweetened fortified plant-based beverages
    • Mushrooms
    Vitamin D Metabolism and Pathway (Mavar et al., 2024, p. 1176)

    Vitamin D Metabolism

    As vitamin D enters the bloodstream via food or dietary supplements, it is in an inactive state, meaning it is not contributing to the many functions in the body. It is essential for vitamin D to convert to its active form in order to have many functions and carry out positive effects. The vitamin D precursor binds to vitamin D receptors and is transported to the liver to be converted to calcidiol – the main form of vitamin D circulating in the bloodstream. Calcidiol is then transported to the kidneys to be converted to its most active form, calcitriol. From there, vitamin D3 becomes functional throughout the body in places like the immune system, small intestine, pancreas, cell functions, and bones (Mavar et al., 2024).

    Refer to the figure for a detailed visual representation of the vitamin D metabolism and pathway.

    Sunlight

    Our bodies can make vitamin D when our skin is exposed to UV rays from sunlight. This ultraviolet radiation skin exposure is the major source of vitamin D most people get (Chang & Lee, 2024). However, many factors can influence vitamin D synthesis in the skin such as season, time of day, cloud cover, skin pigmentation, smog, and sunscreen use (Health Canada, 2022). Our skin produces vitamin D through a thermal reaction that occurs after UV radiation from the sun enters the skin (Mavar et al., 2024). The vitamin D precursor in our skin epidermal cells converts into pre-vitamin D3. It is then converted to calcidiol in the liver, which converts to its active form (calcitriol) in the kidney (Chang & Lee, 2024). After vitamin D3 is synthesized/activated, it then moves through our bodies to provide various functions as mentioned above.

    However, sun exposure is classified as a Group 1 carcinogen which is known to cause cancer in humans. So, Health Canada recommends incorporating vitamins from foods or supplements as a safer measure of daily vitamin D intake.

    Key Takeaways:

    • Vitamin D is important for our bodies as it provides numerous functions that are both fundamental and beneficial for maintaining our overall health.
    • The main sources of vitamin D include: supplements, food, and sunlight exposure.
    • Our bodies activate vitamin D from its inactive state to perform the many functions it has across our bodies.
    • Health Canada recommends incorporating vitamin D from foods or supplements on a daily basis as sun exposure may be an inconsistent source or may increase the risk of skin cancer.
    • Everyone is different! – Please consult with your health care provider before incorporating vitamin D into your diet or sunbathing

    Visit Health Link BC for more information and resources regarding Vitamin D.

    References

    Chang, S., & Lee, H. (2019). Vitamin D and health – The missing vitamin in humans. Pediatrics & Neonatology, 60(3), 237 – 244. https://doi.org/10.1016/j.pedneo.2019.04.007

    Government of Canada. (2022, May 2). Vitamin D. Canada.Ca, www.canada.ca/en/health-canada/services/nutrients/vitamin-d.html.

    Mavar, M., Sorić, T., Bagarić, E., Sarić, A., & Matek Sarić, M. (2024). The Power of Vitamin D: Is the Future in Precision Nutrition through Personalized Supplementation Plans? Nutrients, 16(8), 1176. https://doi.org/10.3390/nu16081176

    Province of British Columbia. (2021, September 1). Vitamin D and your health. British Columbia | HealthLink BC. https://www.healthlinkbc.ca/healthlinkbc-files/vitamin-d-and-your-health

  • The Benefits of Mobility Stretching

    Maintaining mobility through simple stretches can bring numerous benefits to our daily lives. As we inevitably age, so do our bodies and our muscles. Stretching a muscle enables it to extend to its full length, which in turn increases flexibility as the muscle lengthens. There are different types of stretching which include static stretching and dynamic stretching.

    Static Stretching

    Static stretching is an activity that extends muscles and tissues to their maximum length when held for a period of time in a stationary position. It is known to be a “safe and effective method for improving flexibility and range of motion, preventing muscle atrophy, enhancing physical functioning, and improving quality of life with minimal risk of injury” (Mašić Et al., 2024). Some static stretches include seated shoulder stretch, seated rotation, standing hamstring stretch, floor hip flexor stretch, double-knee torso rotation, and downward dog – refer to Harvard Health for visual and descriptive examples.

    Dynamic Stretching

    Another type of stretching you can do at home is dynamic stretching, which includes active movements where joints and muscles are able to reach their full range of motion. It is known to increase range of motion and joint flexibility, which can play a role in decreased risk of injury (Iwata Et al., 2019). Some dynamic stretches include shoulder rolls, hamstring curls, side-to-side lunges, knee lifts, and arm sweeps – refer to Harvard Health for a video example.

    Helpful Tips and the Benefits of Stretching

    According to Harvard Health, longer muscles and increased flexibility leads to many benefits. Some of which include increased range of motion, improvement of balance and posture, reduced joint and back pain, and decreased risk of injury (Harvard Health Publishing, 2016). However, it is important to keep in mind to stretch properly and safely.

    Here are a few tips to do so:  

    • Warming up with dynamic stretching as mentioned above
    • Aim for smooth, controlled movements and avoid bouncing when stretching as it can lead to injuries
    • Hold your stretch until you feel mild tension, not pain
    • Be consistent with your stretching – allocate 5 minutes of your day to stretch regularly to achieve maximum improvement
    • Speak to a qualified health professional before proceeding to stretch to prevent potential injury and pain

    Stretching can be an easy and effective way to enhance and preserve overall health while also improving comfort during everyday activities. By incorporating regular stretching and movement into your daily routine, you may experience improved flexibility, reduced muscle tension, and a greater sense of physical well-being. Over time, these benefits can contribute to a more active, pain-free lifestyle, ultimately supporting long-term health.

    Visit the BC Chiropractic Association for some helpful stretches to relieve neck and low back pain.

    References

    “Dynamic Stretches.” Harvard Health, 9 Feb. 2015, www.health.harvard.edu/dynamic-stretches.

    Iwata, M., Yamamoto, A., Matsuo, S., Hatano, G., Miyazaki, M., Fukaya, T., Fujiwara, M., Asai, Y., & Suzuki, S. (2019). Dynamic Stretching Has Sustained Effects on Range of Motion and Passive Stiffness of the Hamstring Muscles. Journal of sports science & medicine, 18(1), 13–20. PMID: 30787647 PMCID: PMC6370952

    Mašić, S., Čaušević, D., Čović N., et al. (2024). The benefits of static stretching on health: a systematic review. Journal of Kinesiology and Exercise Sciences, 34(107), 27-39. https://doi.org/10.5604/01.3001.0054.2941.   

    “Stretching: The New Mobility Protection.” Harvard Health, 8 Nov. 2016, www.health.harvard.edu/staying-healthy/stretching-the-new-mobility-protection.