Wednesday, 2 November 2011

Get Your Scoliosis Facts Straightened Out!


Hello again, friends and followers! Today’s post is going to cover a relatively common spinal deformity called Scoliosis. Chiropractors treat spines – it is what we do! Scoliosis is one of the most common issues seen and treated by Chiropractors, and, as I will discuss further down the page, early diagnosis and treatment can prevent worsening of this condition which can be quite painful, debilitating, and can even decrease your life expectancy!


What Is Scoliosis?

Scoliosis is not a disease – it is a descriptive term. All spines have curves and, being bipedal (we walk on two feet, not four), all human beings need these curves to balance the upper body over the pelvis. Curves become abnormal when they run lateral, or side-to-side, and this is what we term Scoliosis. Although it is a complex, three-dimensional deformity, on an X-ray, the spine may look like a “C” (single curve) or an “S” (double curve). The individual show in the X-ray below has a double “S” curve.


Scoliosis is classified as congenital, idiopathic, or neuromuscular:

Congenital Scoliosis is caused by vertebral anomalies that are present at birth. These anomalies occur in utero as soon as 4-6 weeks gestation. The number of abnormal vertebrae, their location, and the growth potential around these abnormal bones is what determines how severe a congenital curve will become. For very mild, single vertebra anomalies, the deformity may not be readily observable and may be found incidentally on x-ray.

Idiopathic Scoliosis is, by definition, of unknown cause and is the most common of the classifications. This category has subclassifications defined by the time of onset (infantile, juvenile, adolescent, or adult). Adolescent idiopathic scoliosis accounts for 80% of all cases of idiopathic onset.

Neuromuscular Scoliosis develops as a secondary symptom of another condition. Some examples include spina bifida, cerebral palsy, spinal muscular atrophy and physical trauma.

What are the Risk Factors?


Age: Signs and symptoms typically appear during the growth spurt that occurs just prior to puberty.

Gender: Although both boys and girls develop scoliosis at about the same rate, girls have a much higher risk of the curve worsening over time and requiring treatment.

Family History: Scoliosis tends to run in families. If it runs in yours, get yourself screened by your Chiropractor!

Patients having reached skeletal maturity before diagnosis are less likely to have a worsening case. Women reach skeletal maturity at the age of 16-17 and men at 18-20.

Could I Have Scoliosis?

The signs and symptoms of scoliosis vary based on the degree, or severity, of the curve(s). Some of the more common and observable signs include:
·         Uneven musculature on one side of the spine
·         Back pain
·         Loss of motion
·         A rib prominence and/or a prominent shoulder blade – caused by the rotation of the ribcage
·         Uneven hips or a difference in leg length
·         Slow nerve action
·         Uneven waist line
·         Short stature

Some severe cases of scoliosis can lead to diminished lung capacity, pressure on your heart, and restricted physical activities.

What Can I Do About It?

The treatments for scoliosis include observation and chiropractic care, bracing, and surgical procedures.

If the curve is relatively mild (0-20 degrees) observation and chiropractic care are the recommended treatment. I must first and foremost note that chiropractic care does NOT cure scoliosis. Although there have been many cases (and some that I have seen in my own clinic) of curves decreasing in angle, no chiropractor should ever guarantee that they will change your curve!

The basis behind the chiropractic care of scoliosis (the idiopathic kind – congenital and neuromuscular causes are different) lies in the realm of the neurological system. The idea here is that one side of your spine is being over-stimulated, while the other side is under-stimulated. The concave side of the curve has postural muscles that are being over-stimulated and are, thus, very strong. In order to correct this, chiropractors use a variety of techniques that impact the cerebellum and other neurological pathways in order to inhibit the over-stimulated side and excite the under-stimulated side. Spinal manipulation delivers a “fast stretch” and acts to inhibit, as does the application of heat. A type of electrical stimulation known as interferential current (or IFC for short) excites the neurological system. In my personal practice, the utilization of these techniques, coupled with advanced moveable treatment tables to help stretch the spine and the muscles of the back are used to decrease the symptoms associated with scoliosis.  X-rays are used as well to monitor and observe for changes in the curvature. Often postural training and exercises are prescribed to help strengthen weak muscles and stretch tight ones. The National Scoliosis Foundation states that chiropractic care has been instrumental in the treatment of scoliosis for many years. It is a safe and often recommended form of therapy for the care of mild to moderate scoliosis.

A moderate curve is when the angle is between 20 and 40 degrees. At this stage, bracing and chiropractic are the most common mode of care. Bracing is recommended when you are young and still growing. The purpose of wearing the brace is to keep the curve from getting worse as you continue to grow; however, it is not usually intended to reduce the amount of curve you already have. The braces are custom fit by a specialist and are worn for 12 hours a day – usually though the evening and sleeping hours, as they can be quite cumbersome and hard to wear during the day. Because bracing is designed to halt the curve progression, it is generally not recommended for treating scoliosis in people who have reached skeletal maturity. Once skeletal growth has finished, or if the curve has become too severe, bracing is not as effective.

When a curve has reached the 40-60 degree angle, it is considered severe. At this point, surgery is usually recommended by orthopedists for curves that have a high likelihood of progression, curves that would be cosmetically unacceptable as an adult, curves in patients with spina bifida and cerebral palsy that interfere with sitting and care, and curves that affect such physiological functions as breathing. The result of the surgery is rarely a completely straight spine, but in most cases, significant corrections can be achieved. There are two general types of surgery to correct severe scoliosis:

Anterior fusion is accomplished through an incision at the side of the chest wall.

Posterior fusion takes a different approach and an incision is made through the back. This specific type of surgical procedure involves the use of metal implementation to correct the curve. The photos below demonstrate the before and after appearance of the spine on X-ray using this type of surgical technique.


Chiropractic Care for Your Children:

Here is where I make a case I feel very strongly about. Because the majority of curves appear in children and adolescents, it is crucial that you have your child examined early and often. If the curve is managed before your child is skeletally mature, there is a greater chance that the progression can slowed or stopped. Just like you take your child to the dentist every year to have their teeth checked for cavities, so should you take your child to a chiropractor or spinal care expert to have them examined for scoliosis among other things! Research has proven time and time again that chiropractic care is gentle, safe, and effective for children, starting from birth.

Don’t just take MY word for it – Let’s see what the research is saying…

"The effects: Reduced life expectancy, it can stunt growth and decrease pulmonary function. It's associated with headaches, shortness of breath, digestive problems, chronic hip, knee and leg pain."
-National Scoliosis Foundation

“After 4–6 weeks of [chiropractic] treatment, the treatment group averaged a 17° reduction in their Cobb angle measurements. None of the patients' Cobb angles increased.” 
-BMC Musculoskeletal Disorders 2004, 5:32.

"The scoliotic group was characterized by a decrease in standing stability. Center of Mass (COM) and Center of Pressure (COP) were significantly different between the scoliotic group and the norm."
-Spine 27(17):1911-1917; 2002.

”Scoliosis is not only a deformation of the spinal column, it is also a disease of the neuro-musculo-skeletal system. Scoliosis is more than a 3-dimensional deformation of the spine. It also involves postural disorganization, neuro- musculo-skeletal dysfunction and unsynchronized growth patterns. IS (idiopathic scoliosis) could be reinforced by a disrupted integration of vestibular and visual signals at the cortical level".
-Arch Ital Biol 2002 Jan; 140(1) 67-80.






2 comments:

  1. Very informative blog Doc. Looks like you invested a lot of time into it. Nice job.

    I'm not sure how many of you are aware of the recent scientific developments and breakthroughs that have or are recently occurring in the field of scoliosis treatment. Prognostic testing/technology in the way of genetic testing and blood tests are now able to determine which early stage scoliosis patients are most likely to experience severe curve progression. This presents a new and unique opportunity for early stage scoliosis intervention rehab programs to reduce and eliminate many of the "at risk" smaller curve cases before they progress to much more complex and difficult large curvature cases. It’s actually quite revolutionary and amazing.

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  2. Thanks Dr. Callaghan for this balanced article. I particularly appreciate your admonition that chiropractors shouldn't promise to "cure" scoliosis. It's a tricky area to research, particularly since curves sometimes regress without treatment.

    Still, I'm aware that chiropractic offer so much in the realm of spinal care including minimizing the effects of scoliosis.

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