Parent`s Guide Latest Scoliosis - Scoliosis Treatment Alternatives

Introduction:
If you’ve come upon this report then chances are you’re looking for answers to questions
about scoliosis but you may not even be certain what you want or need to ask. You may
have just been recently told your child has scoliosis or maybe you are the parent of a
child with rapidly progressing scoliosis and you have recently been told that surgery is
your only option. Perhaps you are an adult who has pain related to a long standing
scoliosis.
While the limited options in conventional medicine for scoliosis are still rooted in a
static model that are frequently based on antiquated 20th century thinking in scoliosis
there are many new and innovative dynamic approaches that are now available for the
treatment of scoliosis for both children and adults.
Before you decide on a course of care for your scoliosis be sure to read this entire
report. It is important to understand the theories and science behind each approach as
well as the pros and cons of each type of treatment so that you can make a more
informed choice as to which type of treatment is right for you. Knowing what each type
of treatment entails gives you the vital information you need to make an intelligent
decision about your medical care. This comparative review is the key unlocking the
secret to which treatment option is best for you or your child.
Information used is power. Taking the time to do your homework can make all the
difference in the world for you or your child. Learning the benefits and drawbacks of
each of the types of treatment that are available will have a positive impact on your
health and can significantly reduce the chances of having increased pain and
disfigurement now and later that can significantly impact your overall health and quality
of life.
The devil is in the details
There are some very important details your doctors may not have told you about the
types of treatment that have been recommended at this juncture. There may also be other
types of treatment that are available to you that you may not even be aware even existed.
The problem is if you don’t know what you don’t know you won’t be able to ask the right
questions at this critical juncture so you might not find out about them, until it’s too late.
2
Learn about all of your options so that you can have an intelligent conversation with
your doctor about the risks and benefits when choosing one that is right for you. That
way you can move forward with the utmost certainty that you’ve made the best possible
decision based on comparing each of the currently available scoliosis treatments.
1. Understanding Adolescent Idiopathic Scoliosis (AIS)………………….. 4
Symptoms
5
Signs
6
Imaging of the Spine
7
Measurements
8
Structural vs. Functional Scoliosis and Curvature Patterns
9
Genetic Links
10
Systems of the Body Affected by Scoliosis
10
Current Treatment Options – Conventional vs. Alternative
11
Tiers of Scoliosis Treatment Options
12
2. Conventional Medical Treatments in Scoliosis
13 - 23
Watch and Wait
Physical Therapy
Static (Hard) Bracing
Medication and Pain Management
Scoliosis Surgery
3. Alternative Treatment Options in Scoliosis
Option #1 - Chiropractic Care
Atlas Orthogonal
Option #2 - Yoga, Pilates or Other Exercises
Option #3 – Acupuncture
Option #4 - Manual Muscle Therapies
Option # 5 – Specialized Scoliosis Traction
Option #6 - Vibrational Therapy
Option #7 - SpineCor Dynamic Bracing
Option #8 - Scoliosis Specific Exercise
Schroth Method
SEAS
Option #9 - Gyrotonics
Option #10 – Vestibular Rehabilitation
4. Combination Therapies
Clear
Scoliosis Specialist
Scoliosis Systems
Research
4. Summary
3
13
14
16
18
20
24 - 42
24
26
27
29
30
32
33
35
37
37
38
40
41
44 – 45
44
45
46
45 - 51
52 –53
Understanding Adolescent Idiopathic
Scoliosis (AIS)
The most common type of scoliosis is by far is Adolescent Idiopathic Scoliosis, which
accounts for about 80% of scoliosis, in both children and adults that have carried it over.
The term Adolescent Idiopathic Scoliosis means that there is an abnormal curvature of
the spine by an unknown cause.
While the exact cause of the triggering factor in the onset of scoliosis remains somewhat
of a mystery, a lot is known about the initiating factors. In most cases of scoliosis there is
a genetic link that is caused the onset due to an aberration in the portion of the HOX
gene that controls bony growth. When the abnormality in this gene can triggered it
results in a temporary delay in the growth plate on one side of the vertebra. This delay
initiates an uneven growth from one side of a vertebra causing a slight wedging at that
level, which leads to an imbalance of the spine causing that vertebra to be shifted
laterally while also rotating away from the side of the defect.
Scoliosis in general affects about 4- 5 percent of the population. Scoliosis affects
females over males by 9:1. It occurs most commonly in pre-adolescent teenage girls
between the ages of 9 and 15 just before puberty at a time when the hormonal changes of
the body are beginning. The changing in hormones is what seems to temporarily trigger
this gene to temporarily turn off on one side of a particular vertebra, which is critical
since this is a time of significant growth spurts.
Debate on Nature vs. Nurture in Scoliosis
While recent research in scoliosis has shown that there is a strong genetic predisposition
for the development of scoliosis, it is not a direct 1:1 correlation. Sometimes this gene is
expressed, while other times it is not. This point is most strongly illustrated when noting
that there have been cases of identical twins that both have the abnormal Hox gene but
only one of them actually develops scoliosis.
Also, of note is that in certain sub-populations, like dancers and gymnasts, the incidents
of scoliosis can upwards of 10 times higher than in the rest of the population! If the
expression of the Hox gene were the only thing responsible in initiating scoliosis then the
percentages of people who developed it would not change from group to group.
So clearly there are other factors that are responsible for the onset of the expression of
the gene. Scientific theorists call these the epigenetic factors for scoliosis. In other
words these are factors that are responsible for turning on the expression of the gene that
initiates the onset of scoliosis. Controlling these factors holds the greatest potential for
helping stopping the progression and in many cases even improving the scoliosis
curvatures.
4
Some of the types of scoliosis treatment available today seek to control these factors to
help reduce the chances of the initiating factors from developing in segments above or
below the scoliosis by reducing their contribution towards the overall postural off loading
that is resulting in the progression.
The nervous system has a righting mechanism that demands the eyes stay at a horizontal
level at all times. The postural muscles at the base of the skull will involuntarily move
your head into position to maintain that horizontal balance. When something causes a
disturbance of that balance they nervous system will make adjustments in the posture of
the spine to accommodate the imbalances. This adaptation process by itself can cause the
onset of a scoliosis.
Some of the promising area of treatment includes Stereotactic Cervical Alignment
SCALE Method (aka – Altas Orthogonal), Vestibular Rehabilitation and Craniofacial
Dentistry are all treatments that can have a beneficial effect on these types of maladaptations and thus, help reduce the neurological contribution to a scoliosis.
Other types of treatment are focused primarily on the secondary musculoskeletal
component of scoliosis. These treatments include: Scoliosis Specific Exercises such as
Schroth or SEAS, Yoga, Pilates, Physical Therapy, Chiropractic, Acupuncture, Manual
Muscle Therapies like A.R.T. or Rolfing, Scoliosis Specific Traction, Vibration Therapy
and Gyrotonics.
Symptoms
The majority of adolescent idiopathic scoliosis patient’s generally do not have pain
in their youth. A minority may experience some transient back pain but for the most part
the neurological postural systems of the body are able to adapt to the changes in the
curvature. While most adolescents have no pain, there is still cause for concern,
especially for later in life. There is a tipping point when gravity begins to take advantage
of the curvatures. Once a scoliosis curvature goes past 20 – 25 degrees it tends to
continue to worsen as a result of gravitational forces to the imbalanced spine.
Although the most dangerous time for progression of scoliosis is during the years of
rapid growth spurts surrounding puberty, contrary to conventional belief, scoliosis can
and does continue to progress into adulthood, if nothing is done to stabilize the spine the
forces of gravity will tend to continue to slowly exacerbate the imbalances of the spine at
that will cause a progression of the scoliosis curves of about one degree per year even
into adulthood.
While most adolescent patients with scoliosis have no pain related to their scoliosis many
adults do. Statistic on adults with scoliosis show that up to 40% of adults with
5
scoliosis have related pain and the percentage having pain with advancing age are
undoubtedly even higher.
Interestingly, the scoliosis itself is usually not the cause of the pain; it’s often the
secondary degenerative changes in the body that develop as a result of the postural
changes that result in pain.
While most adolescent cases of scoliosis the curves have not progressed far enough yet to
crush the internal organs such as the heart and lungs, adult cases that have remained
unchecked for years can often develop significant abnormalities that affect the internal
organs of the body. This causes diminishment of vital lung capacity and symptoms such
as shortness of breath. Long term research studies suggest that whether scoliosis develops
early in life or as an adult, it will most likely progress further as time goes on.
In fact, the National Scoliosis Foundation has associated scoliosis changes with a
decreased life expectancy of approximately 14 years. This appears to be due to the
progression of the curves causing chronic headaches, shortness of breath, digestive
problems and other chronic diseases involving the internal organs. The likelihood of
developing chronic musculoskeletal and joint pains (such as the hips, knees and feet)
rises dramatically with an uncorrected scoliosis. In fact, idiopathic scoliosis affects many
other systems of the body. One of these epigenetic links can be seen in the strong
correlation between scoliosis and the need for dental braces.
Signs of Scoliosis
Although pain is not a hallmark in Idiopathic Scoliosis there are many visible signs
associated with it. The most noticeable sign is often one of the shoulder blades sticks out
more than the other and an uneven shoulder height, with one shoulder being higher than
the other, as well as a shift of the hanging to one side.
Another commonly noticed abnormality is when one hip appears to be higher than the
other resulting in what is called an apparent short leg.
The rotation of the spine in scoliosis also causes the torso to appear slightly rotated to
one side or the other when compared to the hips and legs. A prominent rib hump on one
side of the back is another visible feature commonly found secondary to the rotational
aspect of the scoliosis.
6
The easiest way to check is to have the person bend
forward and look at the back from behind. If scoliosis is
present a rib hump will be visible on one side and one side
of the back will be higher than the other.
If idiopathic scoliosis is suspected then usually full spine
x-rays are taken to assess the degrees of curvature of the
spine. A normal spine seen from the front straight will
have no curves at all. Curves that measure between 0º and
10º are considered just mild curvatures, not true scoliosis.
Any curves greater than 10º is considered to be scoliosis.
A scoliosis curvature is considered mild from 10 to 20
degrees, moderate 20 – 40 degrees and severe 40 +
degrees.
Imaging of the Spine
X-ray Analysis
X-rays are used for the confirmation of the diagnosis of scoliosis. The preferred method
is the uses of a full spine x-rays from the front and side to be able to evaluate the entire
curve pattern throughout the spine. Sometimes segmental shots are taken and pieced
together.
Although an x-ray is a relatively in expensive and convenient method of evaluating
curvatures of the spine, consideration must be given to limiting exposure to harmful
radiation. This is especially true when considering a young scoliosis patient with
progressive curvatures who will likely be monitored every 4 -6 months until they stop
growing. For a 10 year old child that could mean up to 14 separate sets of x-rays taken
over the course of 7 years.
Rastersterography
A harmless form of imaging for
the spine that does not use any
x-rays called Rastersterography
has been used at major scoliosis
hospitals in Europe but at only a
handful of scoliosis treatment
centers in the United States. It
uses a special digital camera
camera technology to capture an
image of the back of lines of
light that are projected onto the
back at a 45 degree angle, which
7
allows for triagulation of the surface of the back. This image relayed to a specialized
computer program that creates a 3 dimensional topographical image of the back that
can be imaged at all angles and give a detailed representation of the patients spine and rib
cage.
This information is stored can be used to compared to future images to monitor the
patients treatment progress without the risk of harmful radiation. Using
Rastersteography can reduce radiation exposure to a patient over the course of their
care up to 75%!
Standing MRI
Standing MRI imaging has become more common over the years and can be used as a
substitute for x-ray imaging. There are also a few facilities (San Jose California and New
York) where a specialized cervical coil can be used with the standing MRI that can
evaluate the cerebral spinal fluid flow from the brain to the spinal cord. This is
especially helpful in evaluating the atlas -occiput junction which can be problematic in
scoliosis. (See Atlas Orthogonal Below)
Measurements
The most common measurement of the severity of the scoliosis
curves is called a Cobb Angle Measurement. Lines are drawn
at the top and bottom of the vertebra of each curve and the
resultant angle is measured.
Most Orthopedic Surgeons will say that observation instead of
aggressive intervention (such treatments as bracing or surgery) is
the best option for patients whose curves measure less than 25 º
but who are still growing.
However, new evidence is suggesting that the best time for conservative intervention
to scoliosis of the spine is early on, before it progresses further, as that is when it is
most correctable. Even a mild scoliosis carries a significant risk of progression (up to
22%) but once the scoliosis curvature passes 25°, the risk of progression more than
triples to 68%! By stopping the progression early, we can prevent a severe health crisis.
Research has shown that, the younger the patient, the greater the amount of growth
remaining, the more serious the scoliosis can become in adulthood. In one study, 56% of
patients with juvenile scoliosis (4-10 years of age) eventually required spinal surgery.
Scoliosis curves tend to gets larger during periods of rapid growth so the potential for
growth must be determined by looking to see if growth plates in the hips have fused yet.
The height will also be assessed each visit to look at growth patterns and with females, if
8
she has had her first menstrual period. (While not an exact science, in general skeletal
growth for a female will generally cease within a year or two following onset of
menstruation.)
Large curvatures are more likely to progress or worsen than smaller ones. While most
conventional specialist concur that curves greater than 45º in patients who are still
growing, or curves that measure greater than 50º in patients who have stopped growing,
will continue to get progressively worse over time, recent scoliosis studies have shown
that even mild to moderate curvatures of 20 – 25 degrees may continue to progress at a
slower rate of a degree per year, if they are not stabilized.
Structural vs Functional Scoliosis
Scoliosis can be considered structural if caused by an abnormally shaped vertebra, such
as a wedges shaped instead of square. One of the halmarks of a structural scoliosis is the
appearance of a rib hump deformity. A functional scoliosis is one that is secondary to an
abnormality away from the spine, such as a leg length descrepency. The reality is that
most cases of scoliosis will be a mixture of structural and functional scoliosis.
Curve Patterns
Each scoliosis pattern is unique in the number of curvatures in the (1-4) spine, the degree
and location of the curvatures and the primary and location of the primary vertebral
deformity (if any), thus requires treatment that is peecific to counteract that particular
pattern. Here are some generalized types of scoliosis curvature patterns. A singular
curvature will appear as “C” pattern because it is shaped like the letter C, while a double
curvature is called an “S” pattern because the spine curves back in the other direction. A
double curvature is often difficult to detect due to the relative balancing out of the two
curvatures. The direction of the curvature is defined by the outside of the curvature called
the convex side. The majority of idiopathic scoliosis curvatures (90%) will be a right
thoracic and/or a left lumbar pattern or “Reverse S” pattern while only 10% will be a
left thoracic and/or right lumbar pattern or “true S” curvature.
Common Scoliosis Curvature Patterns
9
Genetic Component of Scoliosis
Often there is a genetic link found in scoliosis. The recessive portion of the HOX gene
are thought to be involved in the development of the initiating factor in scoliosis by
resulting in the asymmetrical growth of the sides of the vertebra at one or more levels
causing the onset of the scoliosis curvatures. If a genetic link is suspected then a
specialized saliva test called the ScoliScore Test can be performed to evaluate the
likihood of rapid progression of the curvatures. This test is painless and test kits can be
provided by your specialist. This test is not inexpensive but is covered by most insurance
companies.
Scoliosis Is Not Just a Condition That Affects the Bones
Current research in the U.S. and Britain is showing that idiopathic scoliosis is a
multifaceted disease that compromises all six of the body’s systems:
• Neurological
• Muscular
• Digestive
• Hormonal
• Osseous (bone)
• Psychological
While it is easy to see how the bones of the spine are affected in scoliosis the other less
obvious components must also be addressed.
The neurologic component is affected in a multitude of ways, everything from
compression of nerve roots in the spine to abnormalities in the vestibular portion of the
brain that adds to the abnormal muscle patterning seen in scoliosis.
The muscular systems of the body will also adapt to the scoliosis and if left unchecked
can play a part in worsening of the curvatures as the muscles on the inside of the scoliosis
curvature are shorter and weaker compared to the muscles on the outside of the curve,
which are strained by trying to hold the body up. The spiral lines (kinestic chains) of the
body are particular affected by scoliosis as this muscle group’s act to rotate the body
along its spinal axis.
The digestive component can also be adversely affected by compression on the internal
organs by a collapsing rib cage. Hormones are also adversely impacted by scoliosis due
to organ pressure and nerve alteration.
The psychological impact scoliosis can have on a child is profound, especially at a tender
pre-teen age when being different than their peers can be so devastating to their self
esteem. What is even worse is the sense of utter defeat and depression that can occur if
10
they begin perception that this “disease” is totally out of their control and that there is
nothing they can do to make a difference.
While the older 20th century based philosophy about scoliosis treatment considered only
the osseous part of the equation, with the focus of treatment being just on stopping
skeletal curvature from progressing by immobilizing it. The attention was on supporting
the spine, while ignoring the body’s four other systems. Newer insights about the impact
of the disease of scoliosis on a patient recognize that the body’s systems work together in
an integrated fashion. When one of the body’s systems suffers a malady it can create
problems with one or more of the body’s other systems.
Current Treatment Options - Conventional vs. Alternative
List of Conventional Medical Treatment for Scoliosis
•
Watch and Wait
•
Physical Therapy
•
Hard Bracing
•
Medications and Pain Management
•
Surgical Fusion of Vertebra with Instrumentation
List of Alternative Treatment Options for Scoliosis
1.
Chiropractic Care
2.
Yoga, Pilates or Other Exercises
3.
Acupuncture
4.
Manual Muscle Therapies
5.
Specialized Scoliosis Traction
6.
Vibration Therapy
7.
SpineCor Dynamic Scoliosis Brace
8.
Scoliosis Specific Exercise (Schroth and SEAS Method)
9.
Gyrotonics for Scoliosis
10. Vestibular Retraining
While some of these treatment options are used in combination with each other we will examine each of
them options separately so that you can compare them side-by-side.
11
Tiers of Scoliosis Treatment Options
Depending on the type of scoliosis, the initial discovery of the curvature, the degrees and
the location of the curvatures, any progression of the curvatures, the amount of
degeneration or pain a person is suffering will dictate the type of treatment that a doctor
will recommend for your treatment, if any.
Here is a “generalized” list of the tiers of scoliosis related treatments that starts from the
least to most aggressive or invasive. Some treatments are more recommended than
others. (Refer to the reviews of the types of treatments listed below)
This list is not intended to be a recommendation for your care, rather only a generalized
guideline of the order of treatment options you may want to consider. For specific
recommendations regarding your case of scoliosis, ask your doctor or consult a specialist
in the conservative treatment of scoliosis.
Each of these treatments can be used as stand alone treatments but depending on your
scoliosis it may be recommended that they be used in combination with others.
1. Watch and Wait
2. Generalized Exercise Programs such as Yoga, Pilates or other Exercise
Therapy
3. Chiropractic, Physical Therapy, Manual Muscle Therapy or Traction and
Acupuncture
4. SpineCor Dynamic Bracing, Schroth Method, SEAS Method, Vestibular
Retraining and Gyrotonics
5. Hard Bracing (Not Recommended)
6. Pain Management with Pharmaceuticals and Injections (Not Recommended)
7. Surgical Intervention (Last Resort)
12
Conventional Medical Scoliosis Treatment
Conventional Option #1
Watch and Wait
“Watch and Wait” for the scoliosis to get worse is by far the most common
recommendation made today by doctors when scoliosis is first detected. The attitude is
one of let’s wait and see what happens.
It’s usually recommended that x-rays be retaken of your child’s spine every 4 - 6 months
to check to see if your child’s scoliosis has progressed. Nothing is done at that point to
prevent the progression. This has become the standard of care in the orthopedic world.
“Would You Watch and Wait For A Tsunami To Hit?”
The concept behind the approach is to see if the abnormal curvatures in the spine
stabilize on its own. If they do then there is no need to consider further treatment. If they
don’t stabilize THEN they’ll explore further treatment options like hard bracing or
surgical intervention.
A large part of the reason that most orthopedic specialist
will take a wait and see attitude is that the other most
commonly recommended treatments are highly invasive
(such as rigid bracing or surgical fusion) to the child and
therefore should be avoided if possible.
Watching and waiting may seem like a really good idea
on the surface, but isn’t the best option if the scoliosis
tends toward progression. It is obviously the least
invasive to your child at the time and of course you don’t
want to start a course of care that isn’t necessary to begin
with; however, the drawback to this approach is that it is
like being told that a Tsunami is coming and then being
asked to stand on the shore, watching the tide recede
way back, just before the Tidal Wave hits with
devastating consequences.
It does nothing to halt or reverse this potentially devastating disease during the
early stages, when it is most correctable. The fact is that gravity is the force that has
already caused these abnormal curvatures to begin with and it will continue its pull on
these imbalanced structures. The truth is that smaller curves left uncorrected can
progress into bigger, more aggressive curves with the potential to make the need for
surgery a self fulfilling prophecy.
13
In fact, in a comprehensive scientific literature review for the Scoliosis Journal titled The
Transformation of Spinal Curvature into Spinal Deformity: Pathological Processes
and Implications for Treatment researchers Martha C. Hawes and Joseph P. O’Brien
conclude the following:
“A significant body of research now has demonstrated that, whatever the initial
trigger that induces a spinal curvature, asymmetric loading of the spinal axis
produces biomechanical forces that can account for most, if not all,
progression of the spinal deformity (9-17, 57-62,80) The data, taken together,
suggests that there is an threshold for continuous asymmetrical loading that must
be reached before vertebral changes occur, and that transient loading will not
foster asymmetric growth leading to deformity… Structural damage to bone and
disc can occur very early in the development of even minor curves (49). Yet the
damage can be reversed entirely if steps are taken to reverse the loading
imbalance while significant growth potential remains (19,40,58) These data
suggests that preventing a state of continuous asymmetric loading in an early
stage of scoliosis will prevent the development of spinal deformities.”
www.scoliosishournal.com/content/1/1/3
A watching and waiting approach only delays treatment and reduces the opportunity for
stopping the asymmetric loading that causes curve progression early on, when they are
the most manageable. Waiting only allows for the curves to progress to the point that
bony changes occur that make the correction of the curvature more difficult to treat
conservatively. Missing this crucial window of opportunity by doing nothing to
correct the asymmetric balance in the spine increases the likelihood of surgical
intervention becoming a self fulfilled prophecy.
Conventional Option #2
Physical Therapy
Many orthopedic surgeons believe the popular medical dogma that exercise therapy isn't
effective for scoliosis, yet they will often provide a prescription for Physical Therapy it if
you ask for one. You’ve probably wondered “what’s up with that?” Why then would a
medical doctor turn around and recommend Physical Therapy treatment if he believes
that it is not going to be effect?
Often, the reason they make the referral anyway is that it is
considered as the “Standard of Care” and insurance companies
like to see that someone has exhausted all other less expensive
forms of treatment BEFORE they are willing to pay for a very
expensive options like hard braces or Harrington Rod
implantation. If the Physical Therapy doesn’t work then the
surgeon is now justified in saying that surgery is now the only
way because we’ve tried the conservative approach and it
doesn’t work.
14
Most Physical Therapists will apply some type of exercise therapy to treat the muscular
component of scoliosis. Although movement IS an essential element to help correct
scoliosis, it is essential they be the right movements to counteract the particular curve
pattern.
Success depends on doing the RIGHT KIND of movements or exercises. Doing the
wrong exercises can actually make a scoliosis worse. Because scoliosis has a
unidirectional rotational dysfunction at its heart, certain exercises in one direction can be
helpful in correcting that dysfunction, while the same exercise done in the wrong
direction will actually worsen it. Because of this, most bilateral exercises (meaning
exercises that are performed the same on the right and left sides of the body) are
contra-indicated for scoliosis.
Unfortunately, many physical therapists will not provide specialized “scoliosis specific”
exercises and as a result may unwittingly cause an exacerbation of the scoliosis. If
scoliosis specific exercises are performed by a physical therapist they are frequently ones
are two dimensional and are designed to merely straighten the concave side of the
curve and reduce the Cobb angle by lengthening the shortened muscles and
strengthening the muscles on the convex curve.
Typically, in scoliosis the muscles on the concave side (or inside) of the curvature are
shortened and weakened and connective tissue surrounding them has adaptively
shortened around them which contributes to the decreased range of motion, fixation of
the joints and overall hypo-mobility. If the muscles and surrounding connective tissues
are left untreated the resultant postural abnormality will eventually lead to chronic pain.
The structures found on the convex side (open side) of the curve are alternatively hypermobile as the muscle and connective tissue fibers are overstretched and strained trying to
hold up the body, thus are often the painful structures in a scoliosis.
The problem with this type of two dimensional treatment is that it does not address all of
the crucial issues in a three dimensional condition like scoliosis.
Unfortunately, these types of exercises tend to fall short of providing much lasting
correction or stabilization because they apply a two dimensional
solution to a three dimensional problem. Although they do
address the lateral aspect of the curvature, they fail to address the
rotational component of scoliosis.
The rotation of the spine in scoliosis is one of the key elements of
its formation. While a scoliosis appears to be a side to side
curvature on x-ray, in reality it is much more like the helix of a
spring. (See Illustration)
Most scoliosis curvatures are a manifestation of a rotational dysfunction of the spine
and this element must also be addressed to succeed in halting the progression of the
abnormal curves.
To illustrate the inadequacy of this approach an analogy of trying to straight the
curvatures of a metal spring by simply bending it to the side. Much like a spring, the
spine in scoliosis is in a coil formation that not only curves side to side but also twists
15
forward and back. Simply bending a spring from side to side does nothing to correct the
spiral in the coil.
The same thing is true in a spine with scoliosis. The curvatures of the spine are always
three dimensional so any exercises provided need to take this into account. Think of the
scoliosis spine like a washcloth that is being wrung out. In order to straighten it out you
first have to un-wring it.
Common physical therapy modalities such as interferential current, diathermy, moist heat
packs, ice or ultrasound may also be utilized by a P.T. in the treatment of scoliosis.
Although the application of these therapies may be good for temporary pain relief when
applied, they are nothing more than “warm fuzzies” designed to give the patient a sense
that something is being done. None of these P.T. modalities when used on their own have
any documented therapeutic benefit for correcting scoliotic curvatures.
Conventional Option #3
Static (Hard) Bracing
Despite the fact that the current standard of care in the medical
field for progressive curves above 25% is hard bracing there is
still a lot of controversy surround the effectiveness of such
treatment. Often a rigid plastic brace that is molded from hard
plastic to the body and is designed to treat the bony component
of the disease by immobilizing the spine in an attempt to stop
the progression of the scoliosis curvature.
The types of rigid scoliosis braces are the Milwaukee brace
(shown here), the Charleston brace, the Boston brace, the
Cheneau brace, the Providence brace and the Lyonnaise brace.
Studies have shown rigid bracing may be effective in halting the progression of a
scoliosis curvature, but often, the benefits are temporary. Compliance in wearing the
brace is kept up, which is not an easy task with such an intrusive device.
In a study performed by the American Journal of Orthopedics, 60% of the patients
surveyed felt that rigid bracing had handicapped their lives. Another 14% had actually
felt that their experience with bracing had left them with psychological scars. This can be
especially detrimental to the teen psyche at a time in life when no teenager wants to
appear different than their peers. It is next to impossible not to stick out in a crowd while
wearing a hard scoliosis brace.
Although rigid brace technology and design has improved immensely over the past 30
years (The old style Milwaukee Scoliosis brace was extremely scary looking and greatly
16
stigmatized the child because of it.) since the newer hard braces are far more form fitted
to the patient’s body even these devices are still cumbersome and not easily concealed.
The long term outcomes associated with rigid bracing is even more frightening. Studies
have demonstrated that after skeletal growth has concluded and the brace is removed, the
curvature is expected to return.
This is due to the fact that these devices immobilize the spine which causes muscle
atrophy, especially of the shortened and weakened muscles found on the inside of the
scoliosis curvature. These muscles become even shorter and weaker during the
bracing process compared to the other side so that when the brace is removed the
imbalance is even greater and as a result the curvatures progressively worsen.
The appliance not only immobilizes the spine but also the entire torso so when a rigid
brace is worn for an extended period of time it tends to cause atrophy of related muscles
in the torso as well as the spine. Additionally, since these braces are all based on a 3 point
pressure system they can often result in the development of pressure sores on the torso
from the brace rubbing on the body.
Because of these side effects most doctors actually delayed bracing because most patients
found the long course of treatment too difficult to endure. The problem is that without
proper intervention there is a significant chance of the abnormal curves worsening as
gravity continues its pull on the imbalanced spine.
From a practical daily activity standpoint rigid bracing tends to cause the child to behave
more like a statue than a fully functioning dynamic individual as the rigidity of the brace
frequently interferes with or inhibits many of a child’s daily activities.
In the Spine Journal, September 2001 an article entitled 'Effectiveness of Bracing Male
Patients with Idiopathic Scoliosis’ indicated that in many cases hard bracing actually
worsened the curvatures following removal of the brace. The article stated:
"Progression of 6 degrees occurred in 74% of boys and 46% reached surgical thresholds.
Bracing of male patients with Idiopathic Scoliosis is ineffective."
The mechanism that causes this is likely the fact that the spine and rib cages were
immobilized by the braces for prolonged periods of time causing the atrophy of related
muscles of the spine and rib cage. Once released from the brace the muscles stayed
weakened and caused further spiraling deterioration from a lack of muscular support.
In other countries the efficacy of this “standard of care” has come into serious question.
For instance an article from the Children’s Research Center in Dublin, Ireland states
"Since 1991 (hard) bracing has not been recommended for children with AIS
(Adolescent Idiopathic Scoliosis) at this center. It cannot be said to provide meaningful
advantage to the patient or the community."
Although rigid bracing, if used as prescribed, can help temporarily halt the progression
of the curvatures in idiopathic scoliosis, it does nothing to address the other systems of
17
the body that are affected (Neurological, muscular, digestive or hormonal or
psychological components). In fact, some of these systems can be adversely affected by
the immobilization of the torso. For instance, the atrophy to the deep spinal muscles
caused by hard bracing actually worsens the imbalances in the muscular system and
often causes further postural disorganization due to the deterioration of coordination of
the various kinesthetic chains in the body.
The fact that hard bracing only addresses the bony component means that it falls far
short of being an effective solution for the long term management of scoliosis. Also, the
drawbacks to rigid bracing in terms of the mental health of your child clearly outweigh
the benefits.
Conventional Option #4
Pain Management with Pharmaceuticals &
Injections
While most adolescent patients with scoliosis have no pain related to
their scoliosis many adults do. Statistic show that up to 40% of
adults with scoliosis have related pain and the percentage having
pain with advancing scoliosis are undoubtedly even higher.
Usually, the scoliosis itself does not cause pain. It is most often the
secondary degenerative changes in the body that develop as a result
of the postural changes that cause chronic pain.
Because of this conventional medical treatment often recommends seeing a Pain
Management Specialist to oversee the prescribed medications when other more
conservative solutions such as exercise, physical therapy and chiropractic no longer
work.
A Pain Management Specialist is a medical doctor with specialized training in managing
pharmaceuticals for chronic pain. They also provide other treatment such as TENS units,
trigger point injections, intra-articular joint injections, cortisone injections, nerve blocks,
epidural injections, implanted drug delivery systems and even spinal cord stimulators.
This extra training is necessary since prescribing heavy duty pain medications for long
term use can itself result in addiction and adverse pain behaviors that must be monitored
closely.
Here is a list of complications that can take place as a result of some of the types of pain
management tools used today to treat scoliosis related symptoms.(1)
For a more comprehensive list or the specific risks and side effects from any Pain
Management Technique, ask your doctor.
Over the Counter Medications (OTC’s)
Long term use of non-steroidal anti-inflammatory drugs (NSAIDS) are thought to be
relatively safe to use and can often be obtained over the counter in lower dosages but
18
even these medications have the potential risks of reduced kidney function, increased
bleeding times due to inhibition of platelet aggregation, impairment of healing of
intestinal anastomoses, increased asthmatic episodes in susceptible patients, increased GI
complications, increased GI mucosal lesions that can aggravate a pre-existing ulcer
resulting in a bleeding ulcer.
Acetaminophen in large doses or chronic use of smaller does can cause severe liver
damage and death.
Prescription Pain Medications
Pain medications are often prescribed for adult scoliosis patients to mask their symptoms.
Complications that can occur from long term use of prescription pain medications are
addiction, tissue toxicity or systemic toxicity that causes central nervous system or
cardiovascular problems such as sedation, constipation, nausea and vomiting, dry mouth,
sleep disturbances, hallucinations, mood changes and respiratory depression that has the
potential to even cause death.
Local Anesthetics and Corticosteroids
Local anesthetics or corticosteroids are increasingly being recommended as an alternative
in the form of trigger point injections or intra-articular injections. Potential complications
of using local anesthetics for pain relief can result in unintended anesthesia of nearby
sensory or motor nerves.
The complications of corticosteroid treatment may include temporary hypertension,
hyperglycemia, gastrointestinal bleeds, glaucoma, alkalosis, mood disorders, psychic
reactions, pancreatic, proximal myopathy and water retention. The long term effects
include amenorrhea, aseptic necrosis of bone, cataracts, hyperlipidemia, hypertension,
muscle weakness and osteoporosis.
Pain Injections
The physical risks of injections from pain management range from soft tissue swelling at
the site of injection, cellulites, abscess formation, nerve damage, vascular injury,
puncture of the dura surrounding central nervous system causing leakage of cerebral
spinal fluid causing severe headaches, pulmonary complications such as pneumothorax
causing respiratory compromise and on rare occasions organ puncture, With the use of
neurolytic agents there is a risk of local loss of sensation, motor function loss locally, low
of bowel or bladder function and even death.
All of these Pain Management Techniques are designed for blocking of pain sensation for
the part of the body that is under strain and causing either degenerative changes or nerve
irritation. None of these treatments are designed to correct the underlying cause of the
pain, which is the progressive postural disorganization causing abnormal spinal loading.
(1) http://www.helpforpain.com/articles/complications/complications.htm
19
Conventional Option #5
Scoliosis Surgery
While most people reading this review are not likely to want to consider surgery as an
option for treatment it is still necessary to discuss the details of surgery as it is still an
option that must be discussed in any intelligent conversation about scoliosis treatment
options, but since scoliosis is rarely a life threatening condition, as with any surgery, it
should always be considered the treatment option of last resort.
Most surgeons will evaluate your indications and contra-indications for surgery to see if
you might be considered a candidate for surgery or not. (Information Obtained from
Scoliosis Surgery – Definitive Patient Reference – This is an excellent book for anyone
seriously considering scoliosis surgery and should be a must read for them)
Indications for Surgery
1. A curvature 50° or greater curvature, (some surgeons may use a 40° curvature as
the threshold mark for surgery)
2. A history of progressing curvatures, especially if the patient is young and the
curvature is rapidly progressing with no end it sight.
3. Severe Chronic Unremitting back pain that unresponsive to all conservative
measures.
Contraindications for Surgery
1. You are too old. Surgeons vary on their opinions of who is too old but usually
considered somewhere between 60 – 70 years old. The spine of an older person is
more rigid and bones are more brittle than in a younger patient making the
surgical correction less obtainable and the risks of complications greater,
especially with the extended anesthesia needed for this lengthy surgery. The risk
Post operative Cognitive Dysfunction is significantly higher in older patients and
some studies have shown the effects can be long lasting, even permanent for some
patients.
2. Poor Health – The risks of this extensive type of orthopedic surgery precludes
someone who is not in good health.
3. Smoking is a major risk factor as a chronic smoker has a significantly greater risk
of fusion failure over a non-smoker because nicotine interferes with the body’s
ability to form new bone. It also diminishes the body’s immune function which
results in an increased risk of postoperative infection.
4. Your primary objective is to improve your cosmetic appearance. While reducing a
scoliosis deformity such as a rib hump, uneven shoulder or poor posture is
desirable and can be improved with surgery they do not outweigh the risks and
20
painful recovery associated with a lengthy scoliosis surgery so most surgeons will
not consider you a candidate if cosmetics are your only reason.
5. Lack of post operative support system. Since scoliosis surgery is extensive it also
requires a lengthy period of post operative recover period. Unless friends, family
members or hired home care nurses are available to help you following the
surgery it is not recommended to undergo surgery until you can make such
arrangements.
Surgical Goals
1. Stop the Progression of the scoliosis curvatures.
2. Reduce the rotation component of the scoliosis. Rarely is a scoliosis ever
completely corrected with surgery, rather it is usually reduced by 50- 60% for
adolescents and younger adults and less than 40% for older adults. This is because
the muscle and connective tissue surrounding the spine in scoliosis have
adaptively shortened and are often stiff, so too much rotation force by the surgeon
could cause fracture of the vertebra resulting major neurological complications.
3. Relieve Pain caused by the advancing scoliosis or as “preventative maintenance”
for those without pain. Scoliosis curvatures by themselves rarely cause pain. It is
usually the chronic postural imbalances that cause secondary degenerative
changes that cause the pain, so secondary therapies to reduce the postural
distortion and relieve the pain should be exhausted before surgery is considered.
Surgical Approaches
The surgical approach describes the side of the body that the surgeon will access your
spine to perform the surgery. The most common approaches, the posterior approach
(through your back muscles) is the most common and the anterior approach (through
your abdominal cavity) or a combined approach for severe cases (both front and back).
Most scoliosis surgeries are “open” surgeries meaning they cut open the skin in the
midline of your spine and reflect back the structures to get to the bone. In the posterior
approach anywhere from 1 – 4 inches of back muscles are dissected away from the
vertebra in the back to get access to the bone underneath. In the posterior approach often
the posterior joints of the spine are removed to make the spine more flexible and are able
to move the spine into the desired position.
In the anterior approach the spine is accessed deep through the abdominal cavity. They
may need to move your internal organs, detach your diaphragm or deflate one of your
lungs to access the spine or rib cage. Once the approach has been cleared then dissection
of the intervertebral discs may be performed and then packed with harvested bone from
your ribs, pelvis or with cadaver bones.
Fusion of spinal segments into a single immobile block is usually performed by cutting
away the posterior elements of the body and grafting the vertebra together using
21
harvested bone from your body or cadaver bone that is crushed and mixed to help
provide a more solid bony fusion. Although the risk of rejection of the bone is decreased
with bone harvested from the individual rather than cadaver bone the harvesting process
itself can cause its own problems. Studies have shown that upwards of 31% of patients
who have had bone harvested from their iliac crest have reported significant pain at the
site of extraction for months to years after the surgery and sometimes it is even
permanent. The incidents of pain or rib harvests is less but some report residual pain for
up to two years.
In most cases a spinal fusion alone will not hold a scoliotic curvature. In most cases
fusion is not enough to hold a scoliosis curvature so internal “instrumentation” must also
be used. This is usually in the form of hooks, pedicle screws, wires or rods, which are left
inside your body to hold the vertebra in place. The metal rods are bent to match the
contour of the spine from front to back then the surgeon will crank the rods with a special
instrument to de-rotate and pull the spine straighter from side to side.
Other more recent surgical procedures include “B-on-B” or bone on bone surgeries where
the discs are removed and segments are pushed together and the bones fuse to each other,
rather than using bone grafts. This procedure requires fewer segments be fused but is still
considered somewhat experimental and long term results have not been established.
The need for improved spinal mobility post operatively has been recognized in the
orthopedic community. So other types of surgical interventions are in the experimental
surgeries that allow for improved mobility having been developed. Such procedures as
surgical stapling of vertebra where staples are placed into once side of the vertebral
bodies a several levels of flexible moderate curvatures in an attempt to arrest the
progression of the curves. Another is called a wedged osteotomy where a wedged shaped
piece of bone is removed from one side of the vertebra and temporary rods are placed in
an attempt to reduce the curvatures in skeletal maturity adolescents.
Length of Surgery and Post Operative Period
Scoliosis surgery is generally a lengthy surgery (4 – 12 hours) depending on the number
of levels, approaches and complications. This means that the risks related to anesthesia
are increased because patient is under anesthesia for an extended period of time.
The fusion process generally takes 6 months to a year before the fusion is solid. During
that time your spine has the potential to move so there is no guarantee that your spine
heal in a straightened position.
22
Impairment of Flexibility Following Surgery
There is no doubt that your ability to bend over, to bend to the side or bend back will be
negatively impacted by the surgically fusing your vertebra together. What degree of
limitation you can expect to have will depend on the type and location of the surgery.
Although your body will adapt to this loss of motion at the fused segments by forcing the
segments above and below the fused area to move more you should be aware that this
increased movement to those segments will put a constant additional strain to them
resulting in a higher probability of problems developing at those joints causing pain in
the future.
23
Alternative Treatment Options for Scoliosis
Alternative Option #1
Chiropractic Care
Chiropractic care for the treatment of scoliosis holds a
great deal of promise because it deals with more than just
the osseous (bone) component of the disease. It also
addresses the neurologic and muscular elements of the
disease.
In fact, a recent retrospective study in the Journal of
Chiropractic Medicine in January 2011 reports that the
effectiveness of chiropractic care with scoliosis revealed
that a multi- dimensional chiropractic treatment program
can significantly ease the pain and disability of adult
scoliosis.
Chiropractic treatment is based on the principle that health is determined largely by the
nervous system since it is the master control system of the body. Interference with this
system impairs normal functions which lead to dysfunction in the body which eventually
leads to disease, like scoliosis.
Most chiropractors treat patients primarily by manual adjustments of joints of the body,
especially the spinal column. Because of the emphasis on the spine and its position, most
chiropractors are very apt at determining the nature and degree of abnormal spinal
curvatures by using X-rays.
In addition, many chiropractors use supplementary measures such as ultrasound,
electrical stimulation, heat, ice therapy, prescribed diet, nutritional supplements, and
supports, heal lifts and exercise therapy.
Because the central component of scoliosis is the malformation of the spine,
Chiropractic care is a natural match for helping treating abnormal curvatures of
the spine. Postural abnormalities of scoliosis curvatures can cause the vertebra of the
spine to become misaligned or deviated from their normal position or vica-versa. This is
especially true when it comes to the atlas vertebrae at the base of the skull, which can be
a major contributor to the neurologic reinforcement of scoliosis curvatures.
Such misalignments are apt to cause pressure or pinching on a spinal nerve root, which
can cause irritation of the motor nerves that cause limitation of movement. It can also
cause impingement of the sensory nerves that causes localized and/or radiating pain. It
24
can also diminish autonomic nerves impulses that cause internal organ malfunction
which in turn leads to hormonal and digestive problems that are frequently experienced
in large curvatures often found in chronic scoliosis in adults.
A subluxation (misalignment) can usually be corrected by adjustments or realignment
whereby the disjointed member is restored to its proper position, thereby alleviating or
eliminating the pressure or irritation to the nerve that is the source of discomfort.
A basic tenet of chiropractic is that the elimination of nerve interference allows the
body to be restored to its normal function and the inherent recuperative powers of
the body to return to good health. Nerve interference is one of the central problems in
scoliosis.
Another benefit of chiropractic care is that because it is a holistic form of treatment they
tend to view the body as a whole and unlike the approaches mentioned so far they
provide correction to all portions of the spine that are in need of correction.
Although many children with scoliosis have never had complaints of pain due to their
body’s tremendous ability to adapt to a problem, the fact that their curvatures are so out
of alignment means that they are highly likely to also have some degree of nerve
irritation. If left uncorrected into adulthood the chances of the developing spinal
joint and disc degeneration increases exponentially. Over time the chances of this
causing permanent nerve damage rise considerably.
There are however, limitations to the average chiropractic approach. The type of analysis
often used to assess scoliosis is a two dimensional x-ray. Thus, the treatment in this case
is focused on correcting the convex and concave sides of the lateral curves and does little
to address the rotation component. Since scoliosis is a three dimensional problem this
approach alone is often insufficient to correct abnormal spinal curves.
Not All Adjustments Work The Same. Just like with exercises, some adjustments can
help correct scoliosis while others can actually worsen the condition. Chiropractic
techniques may vary considerably between practitioners. Not all adjustments will help
properly correct the curvatures in the spine.
In fact, generalized, non-specific adjustments performed in the wrong direction can
actually accelerate degeneration of the curves by increasing the mobility of the spine
in the wrong direction. If you utilize chiropractic care as part of your overall scoliosis
solution be sure that the doctor is specifically trained in the proper type of adjusting
techniques to help correct scoliosis.
25
Atlas Orthogonal Chiropractic and Scoliosis
One of the most promising types of chiropractic
care to aid in the correction of scoliosis is a
highly specific upper cervical technique called
Atlas Orthogonal. This technique uses a highly
sophisticated analysis of the position of the atlas
in relationship to the skull above and the axis
vertebra below. Position of this bone can affect
the entire alignment of the spine. In the normal
position (shown on the right) the head is
centered squarely on top of the spine and the
remainder of the vertebra are stacked properly
in alignment underneath.
The human body is balanced when the head sitting evenly over the shoulder, spine, hips,
knees and ankles. When the atlas gets misaligns it causes the head to tilt. The spine then
shifts in order to support the weight of the head and keep the eyes level with the horizon.
The spine is like a chain and when one segment gets twisted the adjacent ones are forced
to twist as well. That means when the atlas misaligns the rest of the spine has to
compensate in an attempt to re-balance the structure. The muscles of the spine and pelvis
adapt to this mal-position in order to keep the eyes at a horizontal level.
Often musculature of the pelvis will also shorten on one side as an adaptation to try and
keep the eyes at the horizon, causing what is called an “apparent short leg.”
Although an atlas misalignment can be a primary cause of a functional scoliosis it can
also occur as a consequence of a vertebral growth fault from a structural scoliosis at one
of the vertebra in the spinal column down below.
An Atlas Orthogonal chiropractor uses special
instrumentation to painlessly reposition the
atlas back into its proper alignment. If the
scoliosis is functional and secondary to this
mal-position then restoring the atlas to its
proper position will allow for the body’s own
postural righting mechanisms to reduce or
eliminate the scoliosis.
If the scoliosis is structural or a combination of structural an functional scoliosis and an
atlas that has moved out of it’s orthogonal position as a result of the body’s own postural
compensatory mechanisms then Atlas Orthogonal treatment may still be beneficial but
other types of treatment to address the structural components will be needed to further
correct the scoliosis.
26
Alternative Option #2
Yoga, Pilates or Other Non-Specific Scoliosis
Exercises
The concept of exercise therapy as a treatment for scoliosis is sound, when it specifically
focuses on correcting the person’s particular curvature pattern. Specific therapies like
Pilates and Yoga are excellent for maintaining freedom of movement and overall balance
and stability to a healthy spine. Yet, while generalized movement based therapies are
good for in increased range of motion, reduction of muscular tension and improvement in
strength and co-ordination for most types of back pain caution should be taken when
applied to a scoliosis spine.
The generalized application of these types of exercises (such as taught in a group
class) are not generally recommended for the correction of idiopathic scoliosis, since
most classes are not individualized to address the specific needs of the individual
scoliosis patients, so they are not recommended. This is because the unique and complex
3 dimensional postural disorganization of muscles and bones is different in every case of
scoliosis. This makes it necessary to carefully consider all the potential ramifications of
each exercise, to achieve its intended effect and create no unwanted secondary problems.
Some of the popular exercises in yoga are often very positive for normal bodies;
however, certain exercises can be harmful to scoliosis patients because they
unwittingly exaggerate the dysfunction.
For instance, since the precipitating event in the
formation of scoliosis is the delayed growth of one side
of the posterior elements tends to cause an abnormal
extension, lateral bend and rotation of the surrounding
segments. Doing exercises like these on the side of this
bony abnormality, will only serve to further the body’s
rotation into the scoliosis curve pattern and potentially
worsen the curvature.
In some cases patients had performed exercises that
were bad for their condition for many years before
coming to one of our clinics, and as a result their condition was far worse making it more
difficult and time-consuming to correct, than if they had done no exercises at all.
For the treatment of scoliosis it is very important not simply to do a series of non
specific exercises, but instead to only focus on doing corrective exercises that are
designed to accomplish a specific, rehabilitative correctional goals. As was mentioned
earlier, one of the primary components of idiopathic scoliosis that must be addressed is
the rotation component that causes torque to the spine like a wrung out wash cloth.
Exercises used to correct scoliosis must address this component in order to be effective.
27
While some of the exercises found in Yoga, Pilates and other types of movement
based therapies have the potential of helping correct the rotation dysfunction of
scoliosis of the spine, they are usually applied bilaterally and are rarely applied by
an instructor in a manner necessary to make a specific correction for the individuals
scoliosis.
A spine with scoliosis has a shortened and
weakened side and the muscles on the other side is
overly strained. When it comes to exercise therapy
for correction of scoliosis curvatures it is the
muscles on the shortened and weakened side of the
spine that need to be lengthened and strengthened,
while the other side should be left alone, except for
occasional palliative treatment.
Generally speaking most exercises classes are
taught to help maintain balance and bifunctionality
(being able to do the same thing on both the right
and left sides of your body) but they are not specifically taught for correction of a
scoliosis spine that has lost its right to left balance in the first place.
For instance, a rib hump is often found on one side of the body in moderate to severe
cases of a thoracic scoliosis due to the severe rotation of the vertebra in the thoracic spine
that push the ribs out on that side of the curvature., Conversely, the rib cage on the
opposite side of the spine is flattened and the muscles between the ribs have weakened
and shortened. Doing the same exercise to strengthen both sides of the spine does
nothing to help restore the balance. What is needed instead is to strengthen only the
weakened side to help restore symmetry to the body.
Unless the exercises are specifically applied to the unique curvature of each
individual there is little hope for correction of the scoliosis. The unfortunate reality is
that the application of these exercises are usually provided in a “one size fits all” manner.
28
Alternative Option #3
Acupuncture & Acupressure
Acupuncture and Acupressure are both ancient healing
techniques developed in China based on the theory of
releasing blocked energy (Chi) flow in the body. Over
thousands of year’s acupuncturists have mapped out
channels of energy that flow in the body. These “energy
channels” are called Meridian’s and at times correlate
with Western knowledge of anatomy (ie: nerve flow) in
some areas of the body but deviates in others.
The central concept in acupuncture is that there is a
blockage of energy flow somewhere in the body that
must be unblocked for the life force or Chi energy to
flow properly and allow the body to return to its natural
homeostasis state of health. Thin acupuncture needles
or manual pressure to the area of blockage are used by
the practitioner to stimulate and unblock the flow of
energy in that area.
Acupuncture and acupressure can be excellent natural alternative for pain relief by
tapping into and releasing the body’s own endorphins (natural opiod’s produced in the
body), so it is often used for palliative relief of scoliosis related pain, especially with
adults.
Neither Acupuncture or Acupressure do anything to affect the structural component of
scoliosis, as such, they should be considered as only temporary relief of pain symptoms.
29
Alternative Option #4
Manual Muscle Therapies
There are many types of manual therapies that are directed at restoring muscle tissue
function. They range from basic massage that are primarily used for relaxation and
increase circulation to very specific myofascial techniques such as Active Release
Techniques. Others would include Rolfing, soft tissue mobilization or strain/ counter
strain.
The benefit of these types of techniques is that they are profoundly helpful in relieving
shortened muscular and connective tissue adhesions that are very commonly found in
idiopathic scoliosis.
Scoliosis is a rotation dysfunction that causes the spine to be wrung out like a wash
cloth. The resultant torque leads to an imbalance that result in muscles on one side
of the body to be chronically abnormally contracted and shortened while the muscles
on the opposite side become over stretched and weak.
Because the muscles on the tight side have been chronically shortened, weak and nonfunctional so the surrounding connective tissues tends to shorten around them, much like
shrink wrap. This lack of movement causes the body to produce tough, dense scar-like
tissue in the affected area. This scar tissue binds up and ties down tissues to each other
that ordinarily would move freely. As scar tissue builds up, muscles become shorter and
weaker, tension on tendons causes pain and nerves can become entrapped in the web of
shortened connective tissues. This can cause reduced range of motion, loss of strength,
pain, numbness, tingling and weakness and even reduced vital lung capacity.
Generalized massage therapy can be helpful for providing temporary relief of the strained
muscles in the spine. They can provide relief of pain and relaxation for hours to days but
unless the movement patterns of these muscles are retrained there will be a tendency
towards a recurrence of the symptoms.
As with any type of treatment for scoliosis, it is
important to find a massage therapist who has training
with scoliosis specific massage and who has
experience working with scoliosis patients.
This tightened connective tissue must be corrected
if there is any hope of lengthening the muscles on
that side to restore proper spinal balance. Without
it correcting these soft tissue adhesions the body will continue to return to its prior
abnormal position.
30
Special manual therapy techniques, like Rolfing or Active Release Technique work to
first identify the specific structures that are shortened. Then with a series of applied
manual therapy sessions it lengthens the contracted tissues to allow the proper
biomechanics of the body to be restored. The provider must be specifically trained to
uses his or her hands to evaluate the texture, tightness and movement of muscles, fascia,
tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely
directed tension with very specific patient movements.
Most manual therapy practitioner’s have not been trained thoroughly enough to provide
the level of specificity needed to correct the tissues in scoliosis. The human body is a
very complex machine so the practitioner must have a working knowledge of several
hundred specific protocols to identify and correct the specific problems that are affecting
each individual patient. In the case of treatment of scoliosis a cookie-cutter approach will
not suffice. Again, specificity is the key to success.
One of the factors that are predictive of the outcome for scoliosis treatment is the
flexibility of the tissues surrounding the spine. The more flexible these tissues are
the greater the likelihood of a positive treatment outcome. The best and most direct
way to help the shortened tissues lengthen is to apply specific soft tissue techniques
the affected structures. Although manual muscle therapy alone is not the answer, it
should be an integral part of any scoliosis rehabilitation program; for without it the
chronic adhesions and shortened muscles may not release enough to allow for a
solid correction.
When looking for a manual therapist make sure you find someone who not only has the
experience and skill to accurately assess and treat specific tightened structures in the
body but also make sure they have an intricate understanding of the unique challenges of
a rotation dysfunction and a loss of bifunctionality with a person who has scoliosis.
31
Alternative Option #5
Specialized Traction for Scoliosis
A number of very prominent physicians of their time have used traction therapy used for
the treatment of scoliosis over the past 3000 years or so, with varying degrees of success.
Its fundamental concept of axially stretching spinal structures seems to intuitively make
sense but if it worked by itself then Hippocrates the ancient Greek physician and the
“father of Modern Medicine”, would have been given credit for solving the scoliosis
puzzle with the device he invented called the Scamnum. (See Below)
This device was the
precursor to the “Rack”
used in the Dark Ages
both for the treatment of
scoliosis and the torture of
prisoners.
Today, traction therapy is
rarely used as a stand
alone therapy. In more
modern times traction devices have been refined to allow for therapeutic isolation of the
traction forces to treat specific areas of the spine but the success of axial traction as a
stand alone therapy has not been proven.
Axial traction can relieve pressure on spinal nerves and elongating of shortened postural
muscles of the spine that can contribute to progression of related structures and this can
be beneficial in relieving pain and improving range of motion of the spine.
The types of specialized traction therapies that are most commonly used for scoliosis
treatment are Rack Ladders, Flexion Distraction tables, inversion units and in some cases
Spinal Decompression Machines.
Rack Ladders, Flexion Distraction tables and Inversion tripod units can be quite helpful
in allowing the practitioner to provide specific and discrete isolated movements to a
restricted area of the spine in a way which is not easily performed otherwise. These
treatment modalities are quite useful for helping improve mobility of the spine and its
related structures and they should be used as part of a comprehensive scoliosis treatment
program but they should not be used as stand alone therapies.
Unless the fundamental neurologic component of the scoliosis is addressed and the
abnormal movement patterns found in a scoliosis spine are addressed the spine will
return to its prior configuration due to the ingrained muscular patterns of the postural
muscles of the spine.
32
Alternative Option # 6
Vibration Therapy
Vibration therapy is rarely used alone for treatment of
scoliosis but rather as an adjunct to other types of corrective
care exercises but it can greatly enhance the results of such
exercises by enhancing the results of the workout.
There are two types of vibrational therapy applications that are
used in the treatment of scoliosis. The first being a localized
application of vibrational therapy such as a Percussion
instrument being used on a particular body part. The other
being whole body vibration therapy that utilizes a vibrational
platform to affect changes in the body.
The concept for using vibrational therapy in the treatment of scoliosis is the same as
using other types of corrective exercises; only the vibrational therapy tends to turbo
charge the effects of the exercises.
In scoliosis typically the concave side (closed side) of the abnormal curve presents itself
with shortened muscles and connective tissue that contribute to the decreased range of
motion, fixation of the joints and overall hypo-mobility. Conversely, the structures found
on the convex side (open side) of the curve are hyper-mobile as the muscle and
connective tissue fibers are overstretched and lack integrity or strength, often causing
acute pain. The primary goal of treatment is to simply increase motion first in the fixated
areas and stabilize the hyper mobile areas.
Whole Body Vibration (WBV) utilizes mechanical stimulation provided by an
oscillatory motion of a platform that the patient is placed on the platform. The
motion of the platform creates a rapid acceleration/deceleration motion of any body part
aligned with the stroke motion of the platform. The tissues that are directly in line with
the motion of the platform are now exposed to a rapid loading and unloading, which
creates a physiologic response in those tissues equivalent to exercising.
Applied correctly, this allows the body to more rapidly adapt to
corrective changes in to its proprioception (body awareness).
These adaptive responses can be utilized to either provide
enhancement of the bodies proprioceptive reflexes, loosen tissues
by lengthening muscle fibers or to strengthen muscles.
A proper whole body vibration can dramatically reduce the time
required to achieve these physiological outcomes; with work out
routines that require as little as 12-15 minutes training per session,
at intervals of 2 to 3 times per week.
33
The application of WBV in the treatment of scoliosis is usually found in specialized
protocols incorporating combinations of WBV, traction, and rehab exercises to improve
the pliability of rigid structures in the body so that flexibility can be restored where
needed. It is also used to increase muscular strengthening of the corresponding weakened
tissues, often with counterbalance weighting. The idea is that it can help more rapidly
strengthened to help strengthen the weakened muscles in the muscles on the opposite side
of the spine.
Research studies have shown that whole body vibration increases the number of muscle
fibers firing when used in combination with exercise. Body builders have used this
technique to enhance the effectiveness of their workouts and reduce the amount of time
they need to spend in the gym. It also helps improve the patient's proprioception (ability
to recognize where the body is in space).
The mechanism at work in WBV in helping limber and loosening taut tissues is the when
the vibration stimulates the Golgi tendon apparatus in muscles that have become tight
and constricted through a stretch and release reflex similar to the mechanisms used in
Proprioceptive Neuromuscular Facilitation Technique (PNF), resulting in a high measure
of muscular relaxation.
Vibration stimulation helps strengthen muscles by initiating muscle spindle activation by
placing a continual rapid increased load on the tissue which causes continual muscle
firing is known as the Tonic Vibratory Reflex, similar to that found in the Knee Jerk
Reflex resulting in overall improvements in static and dynamic strength.
Increasing proprioception (balance) occurs in WBV by activating involuntary
postural muscles and increasing proprioceptive (balance) input into the brain when
performing specific range of motion and neuromuscular reeducation exercises while
on a vibrational platform. This increases function of the spinal stabilization muscles
by improving postural and spatial awareness. This mechanism is enhanced by the fact
that the vibration is equally perceived by skin, joints and others secondary endings,
which results in rapid improvements in flexibility, joint stabilization, and proprioception
and body awareness.
Although there are many studies that show the effectiveness of whole body vibration
therapy with a healthy neuromuscular system, little, if any, research has been done on the
effects of whole body vibration with weighting on scoliosis. As such, is should still be
considered experimental. None the less, Whole Body Vibration Therapy holds promise as
a potentially useful adjunctive therapy to help restore the body’s ability to body move
more freely without pain or restrictions and it may also have some value in helping
improve postural muscular strength but further research is needed.
34
Alternative Option # 7
SpineCor Dynamic Scoliosis Brace
SpineCor is a revolutionary, non-rigid brace that is the first ever
dynamic scoliosis bracing that is supported by unique guiding
edge technology. Unlike a traditional scoliosis brace made of a
rigid plastic jacket that restricts movement, the elastic
components of this dynamic brace are designed to stretch when
the body bends, thus it encourages movement. This eliminates
the problems associated with hard bracing such as decreased
body awareness, lack of muscle control and resultant atrophy of
related spinal muscles due to immobilization of the torso.
Because rigid bracing is so difficult to endure many doctors
delay bracing until the problem has progressed beyond a 25
degree curvature. Now, with dynamic bracing doctors can
intervene earlier when the problem is more correctable and it’s easier on the patient.
Based on a revolutionary scientific approach this dynamic flexible brace was developed
by a team of Dr. Charles Hilaire Rivard and Dr. Christine Coillard, orthopedic
surgeons at St. Justine’s Hospital in Montreal for the treatment of idiopathic
scoliosis. The development of this device was one of three revolutionary advances for
the treatment of scoliosis that resulted from a $12 Million Dollar grant by the Canadian
Government to study scoliosis.
Although this dynamic brace moves with the body it still applies corrective forces three
dimensionally where they are needed while still allowing freedom of movement. The
dynamic brace consists of corrective and adjustable elastic bands which are
interconnected to three static components that create a modular system. This allows
physicians to customize treatment and it can be worn beneath the patients clothing.
35
Unlike a rigid brace, SpineCor allows for a child to be treated without interfering
with or preventing their normal daily activities. This innovative approach allows the
child a dynamic range of activities while still correcting the curvatures.
The dynamic elastic tension brace allows the body's natural reflexes to improve muscle
recruitment patterns, which can help to alleviate scoliosis. Muscle control and
recruitment are keys in correcting a curved spine, and by using SpineCor, both children
and adults experience spinal offloading and postural correction, which enables them to
re-train their muscles without a cumbersome and restrictive appliance.
The moderate tension in the elastic bands allows the repetition and amplification of
the corrective movement as the child undertakes everyday activities. This results in
a progressive curve reduction.
SpineCor also improves one's quality of social life, as it allows a child or an adult to
discretely treat their spinal condition while continuing to work and play without
being obtrusive or embarrassed as the brace can be easily and comfortably worn
and hidden under cloths. They dynamic tensions acts to help create appropriate
movement patterns, rather than inhibit them.
A rigid brace simply applies a passive force that presses the torso over and holding it but
it does not allow the body to move so it just goes right back to its abnormal shape. The
SpineCor brace is working with the body, instead of against it because it places dynamic
forces on the body that work to help re-educate the spinal musculature to allow for a
more natural correction over time.
This breakthrough approach looks at young patients, not as statues, but as functioning
human beings whose bodies are designed to be constant movement machines. What is
amazing with this revolutionary approach is that curves can be corrected with relatively
minimal forces being applied by the elastic bands of the brace while still allowing
freedom of movement. While the rigid bracing uses large forces to constrain and often
traumatizing the body by causing lesions on the skin. Dynamic bracing allows for
treatment of a much wider array of curvatures than had been able to treat before
with static braces.
Now, rather than just “watch and waiting” for the curves to progressively worsen, the
earlier this treatment is started the better the chances are for correction. The fundamental
shift in thinking between the rigid brace and a dynamic brace is that with the dynamic
brace you are using a more natural approach that allows the spine to help correct
itself with dynamic movements rather than the traditional, antiquated way of the rigid
brace that placed an outside stress on the body to force it into correction.
The flexibility of the dynamic brace and its ability to be easily concealed by clothing is
more easily accepted by patients. They can play with their friends without being
36
perceived as being different, something that is very important in the psyche of an
adolescent.
SpineCor meets the needs of a child who needs to stay active to be healthy by SpineCor
is much less intrusive and painful than the previous by rigid braces. There is no need to
take away a child’s sporting activities or alter their everyday life. As a result the
compliance with treatment goes up providing a better long term outcome.
Alternative Option #8
Scoliosis Specific Exercises
Unlike generalized exercises that are used for the treatment of scoliosis, Scoliosis
Specific Exercises are designed specifically to help stabilize and correct scoliosis
curvatures. Here are a couple of the most commonly used methods from around the
world that have been researched extensively in the scientific literature.
The Schroth Method
The Schroth Method of three dimensional scoliosis
therapies has been the cornerstone of conservative
management in Germany since 1927. Initially
developed by the pioneer physiotherapist Katharina
Schroth for treatment of her own scoliosis condition,
it became widely adopted as the treatment of choice
for both mild and severe cases of scoliosis. She was
awarded the “Federal Cross of Merit” by the Federal
Republic of Germany for the introduction and
development of her treatment for scoliosis, which is
unique in its intensity, effect and results. It has
become the premier treatment of scoliosis in
Germany.
This method is a conservative method of treatment
that works with exercises that elongate the trunk,
correct the imbalances of the body and use a special
breathing technique to change the shape of the rib cage that has been affected by
scoliosis.
It recognizes that scoliosis is a three dimensional problem that requires a three
dimensional solution.
It not only takes into account the rotation component of scoliosis but also the affects of
the rib cage and helps the patient develop specific breathing exercises designed to correct
the biomechanical faults by re-educating the patient’s neuromuscular system to new
movement patterns that correct the underlying faults.
37
The method develops the inner muscles of the rib cage to change the shape of the
thorax allowing for a correction of spinal deformity, slowing or halting of
progression, improve cardiopulmonary function, improving mobility and postural
stability as well as diminishing pain.
The patient is taught to put their bodies in certain positions that enable an expansion of
the flattened portion of their rib cage on the concave (inside) of the thoracic curve in the
back and chest areas. Through many repetitions in the proper positions the patient
develops a new awareness of their posture and alignment. Many scoliosis patients also
have a flattening of their back as a result of the curvature. The Schroth exercises
encourage restoration of the proper curvature of the rib cage on that side.
The exercises are performed in many postures, sitting on a physioball, lying face down,
and face up or on the side. The method also utilizes many standing postures as well as
utilization of other simple tools to assist in regaining and maintaining the proper
positioning. The exact combination of exercises is determined by curve pattern and
severity.
After completing an intensive training in the Schroth exercises the patient is able to do
them at home. Repeat training is recommended as these exercises will be utilized as a
lifetime management tool for Scoliosis.
One of the most important aspects of this method is the perceptual changes of the
body during and after the exercises. The patient is instructed to keep this new body
awareness in their mind. This is enhanced further by receiving visual feed back by
looking in the mirror while doing the exercises. By recognizing the differences in their
postural alignment and continually readjusting their body mechanics to the ideal
positioning, they increasingly develop a better sense of postural awareness and
correction.
By recognizing their body in the corrected posture and then expanding their breath into
the breathing places enhances the realization of a new way of breathing and results in a
reorganization of the motor patterns of respiration and movement. The emphasis is for
the patient to keep the conscious posture not only while they use the exercise program
but during the entire course of their daily activities, from the time they get up in the
morning to the time they go to bed. This is intended to become their new habitual
posture forever.
SEAS Method
The Scientific Exercise Approach to Scoliosis (SEAS) Method of scoliosis exercise is
another scoliosis specific form of exercise that was developed in Italy over 30 years ago.
The SEAS approach has evolved over time with the changes in the scientific literature on
scoliosis. The primary distinguishing factor of SEAS is that it is a team approach and
38
cognitive-behavioral approach because in our view these are two indispensable elements
in chronic disease rehabilitation.
SEAS is used in a variety of ways depending on the Therapeutic goals for the patient. It
is used for prevention of bracing for smaller curvatures (under 20 degrees), to use as part
of a comprehensive movement therapy program in conjunction with a SpineCor Dynamic
scoliosis orthosis, or as a preparatory therapy for hard bracing, or as a therapy to combat
the adverse effects (stiffening, increased rigidity and diminished of muscular control) of
hard bracing and as a therapy for the preparation for spinal surgery.
Like Schroth, SEAS also works to provide active self correction
of the posture of 3 different body parts of the trunk (shoulder
girdle, rib cage and pelvis) in the three planes of movement but
the focus of the exercises with more emphasis on active
movements to facilitate neuromotor learning rather than static
isometric postural posing. The idea teach the patient corrective
movements of the trunk to improve the scoliosis and have them
hold those movements while they are exercising in a variety of
distracting situations so as to strengthen the neuromotor
behavior.
Part of the therapeutic goal for the patient is to move them from a passive postural autocorrection provided by the therapist to an active self correction initiated and held by the
patient without the assistance of the therapist or a device. The use of the active
movements helps more fully integrate the use of sensory-motor component of the body
which is more fully activated with movement to allow for better motor adaptation and
axial motor control.
Like Schroth it also focuses on the respiratory function with an emphasis on increasing
the vital lung capacity to help better oxygenate the body overall. This plays a part in the
mood of the patient as chronically diminished oxygen intake can adversely affect the
mood of the patient.
Another component of the SEAS method is the cognitive-behavioral approach to
counseling to assist with the psychological aspect of the scoliosis. Since they deal with
hard bracing which is most often considered during adolescences (a tender heart time of a
patients life where they are grappling with a growing number of physical and emotional
changes) it is important to help copy with some of the struggles related to standing out in
the crowd because they are wearing a hard brace by providing professional support and
guidance through this often difficult time. When pain is a factor related to the scoliosis
therapy is needed to combat the development of chronic pain behaviors.
Recreational sports activities are highly encouraged to keep the body moving and to
assist in the development of a positive body image.
39
Alternative Option #9
Gyrotonics
Gyrotonics was created by Juliu Horvath in the late 1970s. He
developed the equipment and exercises using a unique method
that offers the benefits of increased mobility, fluidity of
movement and functional strength that are also acquired by
practicing yoga, dance, gymnastics, swimming and tai chi. It was
initially adopted by many dancers to help improve their mobility
and fluidity of movement.
When the Gyrotonic methodology is applied to the treatment of
scoliosis it allows the user of the equipment to stretch and
strengthen muscles, while simultaneously elongating the spine
and stimulating and strengthening connective tissues in and around the joints of the body.
When these exercises are synchronized with specialized breathing patterns it can help
restore proper muscle balance by promoting neuro-muscular rejuvenation and enhance
aerobic capacity.
The biggest advantage of gyrotonic exercises over other forms of exercise therapies is
that it offers complete freedom of movement while the spine is in an elongated position
which helps with the de-rotation of the scoliosis of the spine.
The majority of exercises are performed on a piece of equipment called a Pulley Tower.
The system utilizes a triple reduction system that provided an even pull and resistance in
the handles and pulley tower that eliminates the jarring that takes place at the beginning
and end of conventional exercise equipment. It is also fully adjustable to for varying
body types and levels of strength.
Known as the Gyrotonic Expansion System the smooth circular, spiraling and undulating
movements help to increase the functional capacity of the spine, contributing to a
spherical and three-dimensional awareness, resulting in increased equilibrium. This type
of movement specifically to the treatment of scoliosis can help correct the muscular
imbalances, IF APPLIED PROPERLY.
The proper use of the equipment is paramount to the success. The biggest challenge with
Gyrotonics is finding an instructor who is not only highly qualified to teach Grontonics
but also finding one who has the training and background knowledge of how to apply the
system to scoliosis. For instance, with scoliosis doing rotation exercises to one side is
going to be essential to the correction of the curvatures; however, doing them to the
other side will actually aggravate the curvature.
40
Option #10
Vestibular Rehabilitation
Scoliosis is far more than just some bones being out of alignment. One of the most
frequently overlooked aspects of scoliosis treatment in the neurological connections
between the eyes and the spine have long been neglected in non-surgical treatment of
scoliosis. Despite the many studies which identify vestibular and oculomotor dysfunction
in the majority of patients with Scoliosis the link between the two has long been
neglected.
Often abnormal neurological patterning in the brain can then translate into
abnormal spinal muscle patterning that further exacerbates the curvatures in
scoliosis. Identifying the dysfunction and rehabilitating proper function of the brain is
crucial for success in correcting one of the major potential underlying contributing
factors of scoliosis.
The ability to maintain balance and proper postural support depends on information that
the brain receives from three different sources: the eyes, the muscles and joints, and the
vestibular (position sensing) organs in the inner ears. All three of these sources send
information in the form of nerve impulses from sensory receptors, special nerve endings,
to your brain. Balance and proper postural patterning is highly dependent on the interrelating actions of each of these systems.
•
Input from the eyes
Input from the eyes is an important component of your balance. Nerve impulses
go from the brain to aid in balance and body positioning.
•
Input from the muscles and
joints
The input on positioning muscles
and joints in the body is know as
proprioception. Sensory receptors
in the neck, trunk, legs, arms, or
other parts of the body move, the
receptors respond to the stretch of
the muscles surrounding them and
send impulses to your brain about
the position of your body.
Especially important are the
impulses that come from your neck, which indicate the direction the head is
turned.
41
•
Input from the vestibular system
The inner ear labyrinth has a complex series of components, one of which is
called the vestibular apparatus. It helps your brain recognize where your head is
in relationship to your body. The proper functioning of this system allows for
head movement to automatically adjust to keep your eyes on the horizon by
intricately controlling small postural muscles in the neck.
When this system is functioning properly both the right and left sides send
symmetrical impulses to the brain that allows you to keep your head positioned
properly.
Integration of Sensory Input
The sensory input coming from all three of these systems, (eyes, muscles and joints and
inner ear is sent to the brain stem, where it is sorted out and integrated with contributions
from other parts of the brain that coordinate movement as well as higher functions like
thinking and memory.
As the brain stem integrates all the input concerning balance, the cerebellum may
contribute information about automatic movements that have been learned through
constant practice, such as the adjustments in balance needed to serve a tennis ball. The
cerebral cortex contributes previously learned information; for example, that a recently
mopped floor is slippery and requires you to walk on them with a different movement
pattern to maintain your balance.
Conflicting sensory input
There are times that the sensory input that we receive from one of the sources conflicts
with the input from the other sources. For instance, when standing close to a bus as it is
pulling away from the curb, your visual input from the large rolling bus indicates that
you are moving even though you are standing still. You may lean forward a little to
compensate for that sensation, initially as a reflex you lean forward or feel dizzy but the
muscles and joints send input that you are not moving. Other visual input finally
indicates that other objects are stationary and your brain makes the correction.
As integration of all the sensory input takes place, the brain stem sends out impulses to
the muscles in your head and neck, eyes, legs and the rest of your body move and this
allows you to maintain your balance and have clear vision while you are moving.
Motor Output
Eye movement is intimately connected to head motion and is controlled automatically by
the vestibular system. Motor impulses to your eyes coordinate their movement to produce
clear vision during active head movements (such as in running or watching a tennis
match) or passive head movements (like tracking birds flying overhead).
42
When the head is not moving, the number of impulses from the right side should equal to
the number of impulses coming from the left side. When the head turns toward the right
the number of impulses from the right semicircular canals increases and the number from
the left decreases. This difference controls eye movements and allows for clear vision as
the head is turning.
At the same time motor output also goes to the muscles that control the head movement
and affect the joints in the spine at the base of the skull. In fact, you can feel this
phenomenon by placing your fingers over these muscles and then while you keep your
head still alternately turn your eye gaze sharply from right to left and left to right. You
will feel these muscles involuntarily contract underneath your fingers as your eyes are
tracking back and forth.
In
Scoliosis, many times there is an abnormality on one side in the vestibular system
that allows for tracking. Because the eyes are not tracking properly on one side this
causes an imbalance in the impulses going to the muscles at the base of the skull.
The muscles on one side are contracting while the muscles on the other side are not
firing as frequently.
Although this may not seem like a big deal at first, it’s kind of like a constant drip of
water on the ground. Over time, that drip will eventually carve a stream in the ground
that over time will develop into a river. The same thing is true in Scoliosis. This
constant imbalance of firing creates a strong motor pattern that sets up a rotation
dysfunction that starts at the top of the spine and works its way down the postural
muscles. If this pattern stays uncorrected then it will eventually lead to the creation of
abnormal curvatures found in scoliosis.
Identifying if there is a dysfunction of the patterning of the brain in relation to the
postural muscles of the spine is necessary for proper correction. If this tracking
problem exists then it must be corrected in order to stop the vestibular contribution
to the scoliosis. Specialized equipment is needed to detect the problem and provide
specific correction eye exercises.
Habituation training and vestibular enhancement exercises may be appropriate in patients
with vestibular involvement in their Scoliosis. Therapies and exercises to improve the
central neurological controls of posture may include home, computer or in office
procedures. Following a functional neurological evaluation, including the use of state-ofthe-art diagnostic equipment to evaluate vestibular function, a neurological retraining
program is designed for patients individually.
43
Combination Therapies
In the Alternative Scoliosis Treatment world there are a variety of programs that use a
combination of the above mentioned alternative treatments. Here is a review of some of
the most commonly used combination scoliosis treatment programs.
Clear Method Therapy
The Clear Method is a chiropractic based treatment methodology that promotes a
combination of non-surgical, often brace-less solutions for the treatment of scoliosis.
It operates on a treatment processed it calls “Mix, Fix and Set”.
The “Mix” phase of care is used to warm up the tissues through the use of devices like
wobble chairs, specially designed flexion distraction tables that are equipped with
specialized straps that de-rotates the spine and pull the scoliosis toward better alignment
and vibration traction to help “unwind” the spine and reduce curvatures by loosening
connective tissues for the next phase for treatment.
The “Fix” portion of the treatment is specific instrument adjusting for the upper cervical
spine and drop tables for the thoracic and lumbar spine based on specific x-rays taken of
the spine.
The “Set” is the rehabilitative portion of the care that uses a variety of methods that
include body weighting protocols and scoliosis traction chairs. The weighting protocols
place weights on the head & hips while the patient stands on a whole-body vibration
platform, while the Scoliosis Traction Chair is designed to passively de-rotate the spine
in a non-weight bearing position while the spine is in axial traction. This is followed by
weighted gait therapy which is used to re-trains the movement patterns during walking.
Additional home exercises are given as well. The Clear Institute states that if the “Set”
protocols are not followed that corrections achieved in reducing the scoliosis curvatures
will be temporary in nature.
This device tractions the spine and then strategically placed straps that are ratcheted into
place to reduce the abnormal curves are of the spine. (See below) High frequency
vibration is then applied to the body while in this corrected position to allow for passive
neuromuscular re-education of the deep spinal musculature.
The Clear Method’s provide an intensive and specifically directed therapy to loosen
the structures holding the spine which can dramatically reduce scoliosis curvatures
in scoliosis over the course of the treatment, but the long term benefits of these
44
reductions have not been demonstrated in the scientific literature. Based on
numerous posts in various scoliosis blogs by parents of scoliosis patients who have
undergone the Clear Method treatment is telling of the challenge for the for the Clear
Method by itself in holding the reductions made after the intensive treatment has been
completed.
Also problematic is that the Clear Method’s
lack a foundation in the research literature for
scoliosis. While doing exercise with vibration has
been well documented in providing increased
strength of skeletal muscles during body building
types of exercise programs, their program of
applying body weights to provide “specific”
neuromuscular rehabilitation for scoliosis lacks
documentation in the research literature.
What is known in the literature about scoliosis neuromuscular rehabilitation and bony
changes is that it take time and repetition in order to have lasting effects (18 months to 2
years). As appealing as a short “boot camp” style treatment program sounds, if it is not
followed up by a regimented program that lasts for a 1 ½ to 2 years the reductions in the
curvatures made by loosening the spinal structures simply will not hold long term.
This is because the overall neurologic patterning has not been addressed or corrected.
The abnormal pattern remains and continues to cause input from the body to the brain
which results in a return of the muscular patterns that caused the curvatures in the first
place. Without a solid supporting program of corrective movement re-patterning the
dramatic gains that were made by this specialized type of scoliosis treatment are often
lost.
Scoliosis Specialists
Scoliosis Specialists are a group of chiropractors who are all Certified SpineCor
Providers with varying degrees of experience that are Certified SpineCor Providers
located across the United States and some parts of Canada.
They all provide SpineCor dynamic bracing in their facilities, chiropractic care and some
provide scoliosis specific exercise therapy, some do not.
45
Scoliosis Systems
Scoliosis Systems are a group of doctors that’s sole focus is the conservative treatment of
scoliosis using Evidenced Based therapies for the treatment of both children and adults.
These therapies are based around Corrective Movement Principles and are provided by
highly trained and dedicated doctors who are the most experienced group of Certified
SpineCor Providers in the United States. They have 15 offices located around the
country.
The types of treatment modalities they use includes the use of the SpineCor Dynamic
Scoliosis brace, a Scoliosis Specific Exercise program called the Nu- Schroth Method
(that incorporates the best of the static method such as the Schroth Method and more
dynamic approaches such as the SEAS approach and others), Vestibular evaluation and
testing, Rasterstereography (harmless non-radiation imaging for scoliosis) and Active
Release Technique.
Although this approach provides slower results (usually provided over the course of 18
months to 2 years), the results are found to be permanent because the body has adopted
new, more normalized movement patterns.
Scoliosis Systems doctors also co-manage cases with other local doctors including Atlas
Orthogonal doctors, ART providers, Clear Method practitioners, physical therapists and
orthopedic surgeons to help provide their patients with the most complete and
comprehensive scoliosis care available.
Scoliosis Research Studies have shown the long term results of
the SpineCor brace to be quite effective.
1. A study entitled SpineCor – A Non-Rigid Brace for the Treatment of AIS: Post
Treatment Results was performed at the Medical School of the University of Montreal in
2002 and was reported in the European Spine Journal in 2003. The results of this study
showed that of the patients that the probability of success (stabilization or correction of
the curvature or minimal progression to avoiding surgery) was greater for those patients
the longer they stayed in the program. It also showed continued improvement in many of
the curvatures even after 2 years of completion of the SpineCor program. Of those
patients who reached the 2 year mark 93% of the patients had stabilization or correction
of their scoliosis curvatures.
The Scoliosis Research Society (SRS) published their guidelines for all future studies of
Idiopathic Scoliosis treatments in 2006 that standardized the outcome measurements so
that different scoliosis treatments could be analyzed and compared side by side. These
46
Guidelines also have strict inclusion and exclusion criteria that only allow the study of
the group of patients with the highest progression risk.
2. A long term outcome study entitled Effectiveness of the SpineCor Brace Based on the
New Standardized Criteria Proposed by the Scoliosis Research Society for Adolescent
Idiopathic Scoliosis. (of 171 of these patients who fit the study criteria was performed
and the preliminary results in 2007 showed great promise for the SpineCor braces long
term effectiveness with the majority of patients (59%) showing that they had either
correction or stabilization of their curvatures. In this study, of the 47 patients that had
completed their SpineCor treatment and had been out of the brace for 2 years 98% of
them were able to avoid surgery.
3. Using the results in the above mentioned study the first study comparing the results
from the dynamic SpineCor scoliosis brace with two other Static scoliosis braces was
done that followed the SRS Guidelines. It compared the 3 popular scoliosis brace
treatments. The results published in the Journal of Pediatric Orthopedics in 2007 shows
a very clear difference in outcome for three different treatment methods.
The results of this study showed a dramatic difference in treatment outcomes for each of
the brace treatments. The SpineCor brace was found to be 76.5% effective in avoiding
surgery, while the Providence brace was found to be only 40% effective and the TLSO
brace was only15% success (by SRS definitions) This meant that the SpineCor brace was
found to be 4 times more effective than TLSO in stopping progression of the curve.
4. A study entitled: A New Concept for the Non-Invasive Treatment of Adolescent
Idiopathic Scoliosis: The Corrective Movement Principle Integrated in the SpineCor
System. Disability and Rehabilitation: Assistive Technology. 2008. 3:3, 112-119) This
study showed that of the 349 patients that were treated at the research hospital in
Montreal Canada 248 of them fit into the research criteria. Of those 74.2 % had either
stabilization or correction of their curvatures. Only 2.7 % required surgery at the
conclusion of their treatment. Of the 248 patients that continued in the study to reach
follow up visit at the 2 Year post treatment mark 89.1% of them had sustained
positive results (52% Correction and 37.1% Stabilization) Of that group 14.5% had
continued improvement of their scoliosis curvatures after stopping the use of the brace,
while only 10.9% of the patients had worsening of their curves.
Of the 117 patients that reached the 5 Year post treatment mark in the Study 91.5% of
patients had a positive outcome. (58.2% Correction and 33.3% Stabilization)
47
Of this group 33.3%* of the patients had their curvatures improve beyond what they
had achieved after stopping the use of the brace. (*This shows that the positive effects
of the SpineCor brace’s changing of the neuromuscular re-patterning continue long
after the cessation of wearing the brace.)
The commitment to research in the effectiveness of the SpineCor brace continues. As of
2010 over 950 patients have gone through treatment at the research center in Montreal
and their results have been cataloged.
Additional Studies of the effectiveness of the SpineCor brace have been done by
independent scoliosis researchers from around the world. They have come to similar
conclusions about the effectiveness of the SpineCor brace. Here is a list of these studies:
•
•
•
•
•
A Retrospective Analysis of the SpineCor Brace Treatment at the Sheffield
Children’s Hospital, United Kingdom Reported in the Journal of Bone and Joint
Surgery in 2006.
Preliminary Results of the Use of the SpineCor Brace in Katowice (Poland) in
the Annals of Academic Medicine Siles in 2007.
The Early Results of the Treatment of Idiopathic Scoliosis Using the Dynamic
SpineCor Brace. In Medical Rehabilitation in 2008.
Initial Results of SpineCor Treatment of Adolescent Idiopathic Scoliosis in
Seville Spain. In Scoliosis in 2009.
Use of the SpineCor Dynamic Corrective Brace in Greece: A Preliminary
Report in Scoliosis 2009.
Recent studies have shown that Complete (Combined SpineCor Dynamic Bracing and
Scoliosis Specific Exercises) have been the most effective form of non-surgical scoliosis
treatment available.
An international study done at the Italian Scientific Spine Institute in Milan Italy in 2009
titled “Effectiveness of Complete Conservative Treatment for Adolescent Idiopathic
Scoliosis (bracing and exercises) based on SOSORT Management Criteria: Results
According to SRS Criteria for Bracing Studies” by scoliosis researchers Stefano
Negrini, Salvato Atanasio, Claudia Fusco and Fabio Zaina was the SOSORT 2009 Award
Winner for scoliosis research.
In this retrospective study they examined the benefits on stabilization or reduction of
scoliosis curvatures with a comprehensive program conservative scoliosis treatment that
included the use of scoliosis bracing and scoliosis exercises. This was the first study to
examine treatment protocols based on the Society on Scoliosis Orthopedic and
Rehabilitation Treatment (SOSORT)1. Criteria for appropriate scoliosis treatment and
the results were expressed by methodology set forth by the Scoliosis Research Society
(SRS)2.
This scoliosis treatment research study was the 2009 SOSORT Award Winner at their
annual conference.
What the results of this study on comprehensive scoliosis treatment that includes
simultaneously using both scoliosis bracing and scoliosis exercises was that when there
48
was a high level of treatment compliance 96% of the scoliosis patient’s curvatures did
not progress and many had a statistically significant reduction in their Cobb angles,
ATR and aesthetics.
What is also interesting in this study is the graphs on page 4 of the research paper show
that at the start of the study they used a step by step approach that included exercise and
only static bracing but by the end of the study researchers were recommending the
inclusion of the SpineCor dynamic brace before considering the use of a hard brace.
(See Graph Below)
49
Conclusion:
This is a very exciting scoliosis treatment research study that confirmed that when a
patient is compliant with a SOSORT criteria treatment program (one that combines
the use of scoliosis bracing and specific scoliosis exercises) research demonstrates
that there is a very high likelihood of success in stopping the progression of their
scoliosis. 3.
It is also very important to seek providers that follow these guidelines and also work
to insure your compliance with this very specific type of scoliosis treatment program
in order to obtain these types of results.
Footnotes:
1. The Society of Scoliosis Orthopedic and Rehabilitation Treatment known as
SOSORT is an international organization that was formed in 2004, (Both Doctor
Deutchman and Dr. Lamantia were founding member) whose members are a
group of 100 physicians, physical therapists and other providers who’s focus is on
providing evidence based conservative treatment for scoliosis. They hold annual
conventions to review the best evidence based conservative scoliosis treatment
research to help improve doctor’s knowledge and ability to provide effective
conservative scoliosis treatment.
2. The Scoliosis Research Society (SRS) is an international organization of
orthopedic and neurosurgeon’s that are dedicated to the education, research and
treatment of spinal deformities, like scoliosis. The organization had set forth a
specific framework for presenting research results so that studies could be better
evaluated and compared.
3. Scoliosis Systems treatment protocols follow this SOSORT criteria.
Scoliosis Specific Exercises
The Schroth Method and other scoliosis specific exercises have also been shown to be
quite effective in the scoliosis literature as well.
Efficacy of Scoliosis Specific Rehabilitation after Schroth (Method) Weiss HR.
Arzt für Orthopädie, Chirotherapie u. Physikalische Therapie Katharina-Schroth-Klinik,
Sobernheim.
Abstract
The prospective study reported here was instituted in 1987 to obtain more detailed data
on the efficacy of scoliosis-specific spinal rehabilitation after Schroth. Inclusion criteria
were 1) idiopathic scoliosis, 2) Risser stage < 4, 3) no treatment with corset or electrical
stimulation, 4) first examination between 1 and 3 years postoperatively, 5) usable total Xrays taken with the patient standing not more than 6 months prior to admission. A total of
181 scoliosis patients with an average age of 12.76 years and an average Cobb angle of
27 degrees were included in the study. The average Risser's sign was 1.4 and the average
50
follow-up period was 33 months. No cases of relative progression (annual increase in
curvature of 5 degrees or more) were observed. For the purpose of comparison with the
spontaneous course, the patients were grouped by age and severity of scoliosis. Both the
absence of any relative progression as well as direct comparison of the development of
scoliosis under therapy with the spontaneous course confirmed the efficacy of the
stationary rehabilitation program notably in cases with poor prognosis, i.e. with large
scoliosis angles and unfavorable curvatures.
Although these methods are relatively new in the United States they have been
extensively studied by doctors around the world.
The efficacy of Schroth s 3-dimensional exercise therapy in the treatment of
adolescent idiopathic scoliosis in Turkey
Otman S, Kose N, Yakut Y.Professor, School of Physical Therapy and Rehabilitation,
Hacettepe University, Samanpazari 06100, Ankara, Turkey.
.
Abstract
.
OBJECTIVE: To determine the effectiveness of 3-dimensional therapy in the treatment
of adolescent idiopathic scoliosis.
.
METHODS: We carried out this study with 50 patients whose average age was 14.15 +/1.69 years at the Physical Therapy and Rehabilitation School, Hacettepe University,
Ankara, Turkey, from 1999 to 2004. We treated them as outpatients, 5 days a week, in a
4-hour program for the first 6 weeks. After that, they continued with the same program at
home. We evaluated the Cobb angle, vital capacity and muscle strength of the patients
before treatment, and after 6 weeks, 6 months and one year, and compared all the results.
RESULTS: The average Cobb angle, which was 26.1 degrees on average before
treatment, was 23.45 degrees after 6 weeks, 19.25 degrees after 6 months and 17.85
degrees after one year (p<0.01). The vital capacities, which were on average 2795 ml
before treatment, reached 2956 ml after 6 weeks, 3125 ml after 6 months and 3215 ml
after one year (p<0.01). Similarly, according to the results of evaluations after 6 weeks, 6
months and one year, we observed an increase in muscle strength and recovery of the
postural defects in all patients (p<0.01).
.
CONCLUSION: Schroth s technique positively influenced the Cobb angle, vital capacity,
strength and postural defects in outpatient adolescents.
51
Summary
For those of you who are already questioning the limited conventional treatment options
then exploring other more advanced alternative treatment options is a must.
Conventional treatments are still based on trying to solve a three dimensional problem
with two dimensional solutions. The focus of this treatment oscillates between the
extremes of doing nothing on one end to the other end of the spectrum being
surgery to fuse the spine to stop the skeletal curvature from progressing. Both
approaches represent a potentially high cost to the long term health of the individual.
The watch and wait approach commonly suggested today is a recipe for disaster,
especially when there are excellent viable alternatives that have been highly effective at
“nipping in the bud”. The current medical evidence suggests that early intervention in the
treatment of scoliosis provides the best outcome, because it is most easily treated at the
beginning stages of the disease. A watch and wait approach is an invitation to disaster
that does nothing to mitigate the damage coming from the impending storm.
There are currently many different high quality alternative treatment options available for
treating scoliosis. Some are better than others but none hold a complete solution by
themselves. Because of this our offices prefer to take a proactive approach and provide
early intervention, whenever possible. We evaluate each case individually to determine if
they are a candidate for alternative scoliosis treatments and if they are accepted as a
patient we have an arsenal of different techniques to choose from.
There is no one size fits all. Each scoliosis is unique and requires a treatment approach
that address the specific underlying causes, so depending on the needs of the individual
patient we select the treatment options that best fit their particular condition.
The combination of alternative treatment options and the specific types of treatment we
find the most beneficial includes the following:
•
•
•
•
•
•
Dynamic Scoliosis Bracing – (SpineCor)
Scoliosis Specific Exercises – (ie: Schroth and SEAS Methods)
Manual Muscle Therapies – (A.R.T.)
Chiropractic Care – (Atlas Orthogonal)
Traction – (Flexion-Distraction and Inversion)
Vestibular Retraining - (Eye Tracking Movements)
Using a combination of soft bracing and Scoliosis Specific type of exercises allows for a
dynamic type of rehabilitation to the muscles of the spine that allow for the patient to
take control of their condition. It also helps them reestablish the necessary neuromuscular
patterns in specific weakened muscles involved in the rotation dysfunction of the spine so
as to counter the forces of the rotating spine.
52
A combination of manual muscle therapies and specific chiropractic adjustments allows
for restoration of normal spinal movement and function. Manual therapies like Active
Release Techniques are highly effective in relieving adhesions of the fascia surrounding
the muscles and joints that have occurred as a result of collapsing rotation of the spine.
Specific chiropractic adjustments are beneficial in providing inter-segmental mobility of
the vertebra in the spine and rib cage that will aid in restoring a more normal spinal
function and in the body overall.
Traction and vibrational therapy can also be very effective in helping accelerate the
reductions of curvatures. If used in conjunction with Scoliosis Specific Exercises
programs much of the corrective gains made can be retained.
Finding a practitioner who is proficient in such a wide variety of these forms of treatment
may be difficult but necessary so you can utilize the best of each to stop the progression
of the curvatures and possibly even reverse some of the curves.
To find a practitioner who is highly experienced in alternative treatment options in
scoliosis, feel free to contact me directly at
[email protected]
Dr. Brett Diaz, D.C.
Scoliosis Treatment Alternatives
(800) 943-1254
53