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Even Kings Can Suffer From Scoliosis

In spite of the amazing advances in modern medicine, scientists have yet to determine the cause of scoliosis. This may surprise laymen because, according to the National Institute of Health, “scoliosis is estimated to affect 4.5% of the general population. In a nation of approximately 273 million people, this means that over 12 million cases of scoliosis exist, and almost 500 more are diagnosed each day – about 173,000 every year.”

The disease has been referenced in medical literature for hundreds of years and has even been alluded to in a Shakespearean play – Richard III. However, when the Bard wrote the description of the king as “that foule hunch-backt toade” he had no idea he was misdiagnosing Richard. New 3D visualization created by researchers and multimedia experts reveals that his scoliosis was the cause of his poor posture. More on this later.

The spine specialists at Texas Back Institute treat many scoliosis patients each year and we asked Doctors Raj Arakal and Isador Lieberman to explain this perplexing and sometimes debilitating spinal disease.

What is Scoliosis?


“Scoliosis is a side to side curve deformity of the spine that is greater than ten degrees,” Noted Dr. Arakal. “Patients can develop misalignment of their spine which can tilt them side-to-side or pitch them forward.”

“Often the mild curvatures are tolerated well, but sometimes the curves continue to worsen and pose risks of significant deformity,” Dr. Arakal said.


“This condition can also cause a loss of height, restriction of rib cage and breathing,” noted Dr. Lieberman. “Compression of the internal organs such as the intestines, lungs and heart, mechanical back pain, muscular back pain, nerve irritation, spinal cord compression, unappealing physical appearance with rib hump, prominent hip, asymmetric shoulders are also possible.”

What Causes Scoliosis?

This is still pretty much a mystery. Scoliosis often occurs during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.

“The cause is multifactorial,” notes Dr. Lieberman. Genetic predisposition, mechanical vulnerability, neurological contribution and asymmetric growth issues playing roles.”

“Trauma might play a role,”notes Dr. Arakal. “And it may be related to physiology of the discs.”

Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.

Did King Richard III Suffer From Scoliosis?


  • According to research published in the scientific journal The Lancet, King Richard’s poor posture and (and perhaps his) unpleasant demeanor seem to be the result of scoliosis.”We wanted to know if Shakespeare’s description was accurate, or an exaggeration to help legitimize the Tudor monarchs on the throne at the time,” study author Piers Mitchell, an anthropologist at the University of Cambridge said “Based on the study of his bones, Richard III would be better described as crook-backed than hunch-backed.
  • In a CBS News report aired in May 2014, it was noted the royal skeleton was discovered under a parking lot in Leicester, England and DNA tests confirmed its identity five months later. In order to figure out the extent of the king’s scoliosis, the researchers created physical and computer-generated models of Richard III’s spine by performing CT scans and then using 3D prints of the bones based on the CT image data.

“The 3D visualization shows that Richard’s spine was curved to the right and it was twisted to a degree, which gave it a “spiral” shape. The researchers also estimated that the king’s Cobb angle — a measure used to determine the extent of spinal deformities — was between 65 and 85 degrees — a curvature that would be considered significant these days. However, he also had a well-balanced curve, which means that his head and neck were straight and not angled to the side.”

“Richard did have a marked  spinal deformity due to scoliosis,” Mitchell said. “However, there was no evidence from his skeleton for his having a withered arm or a limp, as portrayed in Shakespeare’s play.”

Richard’s scoliosis likely started to develop in the last few years of adolescent growth, after he turned 10, the researchers wrote in the study. The monarch’s right shoulder was likely positioned higher than the left one, and his torso was probably relatively short compared with his arms and legs.

The report also noted previous research has already shown that the king would have been about 5 feet 8 inches tall without his scoliosis. But the new study suggests that, because of his spinal condition, he may have appeared shorter than he really was. “This may have made him appear less imposing as a ruler,” Mitchell said.

How Can Scoliosis be Treated?

Texas Back Institute is internationally recognized for effective treatment of scoliosis. “Patients diagnosed with this disease have several options for treatment,” noted Dr. Lieberman. “It’s important to maintain bone health and maintain physical fitness through exercise such as Pilates. We prescribe bracing for those who are in their growth spurt with certain types of progressive curves, medications for those degenerative curves with mechanical or neurological symptoms and as a last resort, surgery for those progressive curves in kids and for the progressive curves with debilitating pain and or neurological issues in adults,” he said.

If you have been diagnosed with scoliosis or have concerns about the possibility of having this disease, contact us for an appointment.

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