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Scoliosis
is from the Greek word "skoliosis" which
means “crookedness”. According to Taber’s
Cyclopedic Medical Dictionary, 18th ed. [F.A. Davis
Co.: Philadelphia, PA, 1997; p.1727], scoliosis
is a lateral curvature of the spine. It usually
consists of two curves: a primary abnormal
curve, and a compensatory curve
in the opposite direction. Some chiropractors
tend to use the term “scoliosis” to
describe the presence of any, if even slight, lateral
curvature of the spine. However, such a loose definition
is a common misconception. Peter Fysh, author of
“Scoliosis and the Child’s Spine”
[Dynamic Chiropractic. 1994 Oct; 21 (12)] offers
a more specific definition of scoliosis: “[an]
abnormal curvature of the spine greater than 10
degrees in the sideways or coronal plane.”
This lateral curvature is measured by a Cobb angle.
Typically, the spine looks more like an “S”
or “C” than a straight line, and many
cases include a rotational component. Often, the
patient’s shoulders and/or waist appear uneven.Dennis
Woggon, D.C. of Scoliosis Correction Seminars
– C.L.E.A.R. Institute describes
several categories of scoliosis which are based
on age of onset.
- Infantile scoliosis occurs before
the age of 3.
- Juvenile scoliosis describes prepuberty
which ranges from ages 4 – 12 for girls, and
ages 4–14 for boys.
- Adolescent scoliosis occurs from
puberty to maturity.
- Finally, adult scoliosis occurs
after maturity. Scoliosis is prevalent in 4.5% of
the general population.
Although the cause of scoliosis remains
unknown, there are contributing factors universal
to scoliosis. Ahn [et al] of the New Hampshire Spine
Institute [“The etiology of Adolescent Idiopathic
Scoliosis” The American Journal of Orthopedics
2002 Jul;31 (7): 387-95 studied scoliosis patients
and contributing factors: genetics, growth
hormone secretion, connective tissue structure, vestibular
dysfunction, melatonin secretion, and platelet microstructure.
Ahn [et al] found that brain stem or equilibrium
abnormality may exist in scoliosis patients
leading to proprioceptive mechanism defects that affect
vestibular function and joint proprioception. They
also found stimulation of the leg and tibial nerve
was abnormal. Pathologies associated with scoliosis
also included neurohormonal disorders, and genetic
connective tissue disorders. Further, above 30 degrees
EMG amplitudes were higher on the convex side. Abnormal
changes include bone deformity, neurological, biochemical,
and neuromuscular changes, as well as decreased serum
melatonin levels. Finally, cerebral asymmetry was
found in addition to defects of the motor brain cortex.
Changes in muscle appeared to be secondary to the
CNS disorder. Therefore, Ahn [et al] concluded that
idiopathic scoliosis results from dysfunction in the
CNS. Mental defect and epilepsy are the commonest
findings associated with scoliosis.
Woggon considers scoliosis “a
dis-ease of the neuro-muscular skeletal system. As
Spinal Experts, the Chiropractic profession should
take the lead in the correction and stabilization
of the Scoliotic patient.” The medical correction
methods that patients often turn to are surgery and
braces, yet results are seldom positive. Paul Harrington,
known for inventing the surgery that implants metal
rods in scoliotic spines, stated in 1963, "metal
does not cure the disease of scoliosis, which
is a condition involving much more than the spinal
column”.
Research states, “the
initial average loss of spinal correction post-surgery
is 3.2 degrees in the first year and 6.5 after two
years with continued loss of 1.0 degrees per year
throughout life.” Furthermore, it is
the exception, not the standard, that a Herrington
rod candidate has 100 percent correction. The average
pre-operative curve for scoliosis is 72 degrees while
the average post operative curve still remains an
unimpressive 44 degrees. Scoliosis surgery will only
reduce the curve by 50%, and then it will worsen.
Scoliosis surgery does nothing for the rib hump. The
only indication for surgical intervention is that
the deformity is deemed unacceptable by the patient
and family. Thoracic curves have a much worse prognosis
than thoracolumber curves.
As for bracing, Woggon and Lawrence
conclude that 44 percent of bracing attempts are considered
failures because they do not cease scoliosis progression.
Additionally, many patients feel that bracing handicaps
their lifestyles while others feel that it leaves
psychological scars. Upper-middle-class school children
wore the brace for not much more than 10% of the prescribed
time. Less than 30 degrees of Cobb angle did not indicate
significant differences between braced and un-braced
patients.
Floman of Hadassah University Hospital
conducted a study on six cases of scoliosis and found
that 100 percent of the cases had restriction on cervical
flexion and were unable to touch their chin to their
chest wall [“Thoracic Scoliosis and restricted
neck motion: a new syndrome?” European Spine
Journal (1998) 7: 155-57]. Patients were only able
to flex between 30 to 40 degrees, whereas 65 degrees
of cervical flexion is considered normal. During flexion,
all patients complained of mild thoracic pain. The
patients in the cases ranged in ages from 13 to 17
years old and their scoliosis Cobb angles varied from
10 to 40 degrees. There were no spinal abnormalities
on the x-rays nor the MRI’s. The spinous processes
of scoliosis rotate into the concave, rather than
the biomechanically expected convex angle. According
to Woggon, this rotation “decreases adverse
mechanical tension on the spinal cord, and [it] is
aggravated by adjusting on the ‘high side of
the rainbow.’ Unfortunately, Chiropractic manipulation
frequently makes the condition worse by mobilizing
fixated, compensated vertebra. Adjusting on the “high
side of the rainbow” [in scoliosis] is contraindicated.”
Woggon and Lawrence found that 90
percent of the time, scoliosis patients present with
a standard posture which includes forward head posture,
right head tilt, right high shoulder, right thoracic
Cobb angle, left lumbo-dorsal Cobb angle, right posterior
and left anterior hips seated, and opposite hip displacement
while standing. Additionally, patients exhibit abnormal
subluxation patterns and abnormal spinal biomechanics.
Active scoliosis usually presents with forward head
posture and loss of cervical lordosis. Patients also
have an occiput and atlas extension malposition (which
is ultimately a posterior occiput). Woggon concludes
that the biomechanical abnormalities have “a
subluxation effect on the proprioceptive spinocerebeller
loop resulting in dysponesis in spinal growth torsion
(idiopathic scoliosis).”
Forward head posture and loss of
cervical lordosis always precedes scoliosis. Therefore,
before the A-P dimension of scoliosis can be corrected,
the cervical lordosis must be reestablished first.
Changing this abnormal position is possible by re-training
the nervous system. A retrospective case series, “Scoliosis
treatment using a combination of manipulative and
rehabilitative therapy” by Mark Morningstar,
Dennis Woggon and Gary Lawrence, was published in
BMC Musculoskeletal Disorders on September 14, 2004.
19 patients with scoliosis ranging from 15 to 52 degree
Cobb angles were monitored. After 4 to 6 weeks, patients
exhibited an average reduction of 62% or 17 degree
Cobb angles. 8 of the 19 patients were no longer classified
as scoliotic. These results were achieved when specific
chiropractic adjustments were provided along with
rehabilitative procedures which included specific
spinal isometric exercises, proprioceptive neuromuscular
re-education, cervical and lumbar lordosis restoration,
muscle and ligament rehab and vibration therapy. Because
the scoliotic spine compresses and rotates three-dimensionally,
it must be tractioned and de-rotated in order to correct.
A vibrating platform and a Vibrating
Scoliosis Traction Chair were used to accomplish correction.
The patient was seated on the chair which was then
placed on the vibrating platform. Braces were used
to pull the Cobb angles into the proper alignment.
The patient’s spine was then tractioned while
going through dynamic motion. The vibratory effect
overrides the body’s proprioceptive defenses.
This therapy is done once a day for 20 minutes, compared
to wearing a scoliosis brace for 23 hours. Contrary
to medical misinformation, scoliosis correction is
not age dependant and it does not stop at osseous
maturity. In their clinic, Woggon and Lawrence have
worked with patients ranging in ages from 4 to 73
years old. |