Scoliosis and Chiropractic

This section was compiled by Frank M. Painter, D.C.
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Chapter 13 from:   Clinical Biomechanics

By Richard C. Schafer, D.C., FICC
In traditional medicine, scoliosis is commonly ignored until gross cosmetic effects or signs of structural destruction are witnessed. In chiropractic, however, even minor degrees of distortion should be considered at the time of spinal analysis because of their subtle biomechanical and neurologic consequences, and to halt potential progression at an early stage. To give a better appreciation of these points, this chapter describes the general structural, examination, and biomechanical concerns that should be considered, along with the highlights of conservative therapy.

Physical Examination of the Lungs and Thorax
Chapter 3 from:   Physical Diagnosis: Methodology in Chiropractic Practice

By Richard C. Schafer, D.C., FICC
The term scoliosis refers to any combination of lateral curvature from a straight line with twisting of the spine when viewed from the front or the back. What is grossly viewed in the typical scoliosis from the posterior are the typical spinal curves normally seen from the lateral. That is, the curves are situated in the wrong plane, frontal rather than sagittal, and the vertical axis rotation is usually in the wrong direction and often exaggerated. Simply, it is often as if the spine were fixed in space and the head and pelvis were rotated +/- several degrees in the same direction. Thus, the majority of the distortion seen in scoliosis is the result of rotation. This is the gross effect of scoliosis. The segmental effect is abnormal focal motion-unit disrelationship where normal rotation, lateral tilting, and A–P facet slip has become fixed, functionally and/or structurally. Scoliosis is a mechanical disorder when gross, but there are always many biologic influences operating as well as purely mechanical forces.

The Role of Vitamin D in the Pathogenesis
of Adolescent Idiopathic Scoliosis

Asian Spine J. 2018 (Dec); 12 (6): 1127–1145 ~ FULL TEXT

Our literature review demonstrated an association be­tween vitamin D status and BMD, menarche, and other hormones. Although lower vitamin D levels are correlated with the Cobb angle, the relationship between vitamin D and AIS may not be casual. Further studies are required to determine whether vitamin D definitely plays a casual role in the etiopathogenesis of AIS and whether vitamin D deficiency is related to the tethering of the nerve roots and postural control dysfunctions observed in some AIS subjects. Longitudinal studies may also be required to ex­amine the effects of fat-restricted diets as well as vitamin D and K2 supplementation on the progression and man­agement of the scoliosis curves.

Spinal Manipulative Therapy for Adolescent Idiopathic
Scoliosis: A Systematic Review

J Manipulative Physiol Ther. 2017 (Jul); 40 (6): 452–458 ~ FULL TEXT

Four studies satisfied the inclusion criteria and were critically appraised. The findings of the included studies indicated that spinal manipulative therapy might be effective for preventing curve progression or reducing Cobb angle. However, the lack of controls and small sample sizes precluded robust estimation of the interventions' effect sizes.

Prevalence of Low Back Pain in Adolescents with
Idiopathic Scoliosis: A Systematic Review

Chiropractic & Manual Therapies 2017 (Apr 20); 25: 10 ~ FULL TEXT

The electronic search strategies yielded 1811 unique studies. Only two studies fulfilled the eligibility criteria. The prevalence of low back pain in adolescents with idiopathic scoliosis ranged from 34.7 to 42.0%. However, these prevalence estimates should be viewed cautiously as the included studies were at high risk of bias.   The results of this systematic review indicate that adolescents with idiopathic scoliosis frequently experience low back pain. However, there was insufficient evidence to confidently estimate low back pain prevalence in adolescents with idiopathic scoliosis and further studies are needed in this area.

Chiropractic Treatments for Idiopathic Scoliosis:
A Narrative Review Based on SOSORT Outcome Criteria

J Chiropractic Medicine 2017 (Mar); 16 (1): 64–71 ~ FULL TEXT

The 2014 SOSORT and SRS Non-Operative Committee consensus paper details the format and types of outcomes they collectively believe are the most important and relevant to the patient. Among the chiropractic studies located in this review, 2 described outcomes consistent with how SOSORT recommends they be reported. Given that these consensus papers form the basis for nonoperative treatment recommendations and outcome reporting, future chiropractic studies should seek to report their outcomes as recommended by these papers. This will allow for better interprofessional collaboration and methodologic comparison.

Chiropractic Rehabilitation of a Scoliosis Family:
Results from a 9–Year Follow-Up

Open Journal of Therapy and Rehab 2017 (Jan); 5 (1): 29–35 ~ FULL TEXT

A mother and her 2 daughters reported to a private medical clinic for treatment of idiopathic scoliosis. All 3 patients had differing curve patterns. Following the completion of a prescribed chiropractic rehabilitation treatment, and after 9 years of intermittent follow-up, all 3 patients demonstrated a correction of at least 6° in their respective scoliosis.

The Effect of Chiropractic Techniques on the Cobb Angle
in Idiopathic Scoliosis Arising in Adolescence

J Phys Ther Sci. 2016 (Apr); 28 (4): 106–1110 ~ FULL TEXT

It was established that the Cobb angle was noticeably decreased after 4 weeks of the intervention. Post Hoc analysis revealed that the Cobb angle noticeably decreased after 4 weeks compared with the Cobb angle before the chiropractic techniques were applied. However, no significant difference in Cobb angle was evident after the fourth week.

Results of Chiropractic Scoliosis Rehabilitation Treatment at
Two Years Post-skeletal Maturity in Identical Female Twins

J Bodyw Mov Ther. 2015 (Oct); 19 (4): 592–596

The twins participated in a treatment lasting two weeks, followed by home care maintenance and periodic follow-ups for they reached skeletal maturity. Two year follow up showed reduced Cobb angles of 19° and 15°, respectively.

Can Neurotransmitter Status Affect the Results of Exercise-Based
Scoliosis Treatment? Results of a Controlled
Comparative Chart Review

Alternative & Integrative Medicine 2014 (Nov 20); 3: 177

Two groups of idiopathic scoliosis patients received the same chiropractic rehabilitation treatment, including a baseline neurotransmitter panel. However, one group received treatment for abnormal neurotransmitter status while the other did not. The group that complied with supplement recommendations for their specific neurotransmitter imbalances demonstrated better Cobb angle correction at 6 months post-treatment as compared to the second group, who declined to follow the supplement recommendations. The results of this study suggest that neurotransmitter status needs to be more thoroughly explored in its potential relation to changes in the magnitude of scoliosis. Follow-up studies that substantiate our clinical observations during and after intervention are warranted.

Knowledge and Management of Adolescent Idiopathic Scoliosis
Among Family Physicians, Pediatricians, Chiropractors
and Physiotherapists in Québec, Canada:
An Exploratory Study

J Can Chiropr Assoc. 2013 (Sep); 57 (3): 251–259 ~ FULL TEXT

Health professionals (HPs) are likely to encounter adolescent idiopathic scoliosis (AIS) patients. Best practice dictates that early detection leads to better decision making regarding optimal management. The aim of our study was to appraise the basic knowledge, evaluation and management skills concerning AIS care among family physicians, pediatricians, chiropractors, and physiotherapists. The majority of HPs (70–90%) would refer the patient who required prompt referral, but only 38–60% actually rated the case as requiring prompt referral. Forty percent of HPs (predominantly physiotherapists and family physicians) stated that they would not be comfortable providing AIS patient follow-up.

The Role of Forward Head Correction in Management of
Adolescent Idiopathic Scoliotic Patients:
A Randomized Controlled Trial

Clin Rehabil. 2012 (Dec); 26 (12): 1123–1132 ~ FULL TEXT

A forward head corrective exercise programme combined with conventional rehabilitation improved three-dimensional scoliotic posture and functional status in patients with adolescent idiopathic scoliosis.

Manipulative and Rehabilitative Therapy as a Treatment of
Idiopathic Scoliosis Without Psychological Sequelae:
A Case Report

J Chiropractic Medicine 2012 (Jun); 11 (2): 109–114 ~ FULL TEXT

Physiotherapy treatment with a combination of manipulative and rehabilitation techniques was used. After finishing the treatment, the patient had Cobb angles of 7° and 11°, an improvement of 55% and 54%, respectively. After 6 months, these effects were maintained, as the patient had Cobb angles of 11° and 11°. The clinical appearance of the patient improved after the course of care. The patient was evaluated for psychological outcomes by applying the following tests: Scoliosis Research Society 22, Bad Sobernheim Stress, and the Brace Questionnaire The patient had the maximum score in all tests at the conclusion of therapy.

The Use of Spinal Manipulative Therapy For Pediatric
Health Conditions: A Systematic Review of the Literature

J Can Chiropr Assoc. 2012 (Jun); 56 (2): 128–141 ~ FULL TEXT

Six clinical trials investigated the effectiveness of SMT on colic, two each on asthma and enuresis, and one each on hip extension, otitis media, suboptimal breastfeeding, autism, idiopathic scoliosis and jet lag. None investigated the effectiveness of SMT on spinal pain.

Outcomes For Adult Scoliosis Patients Receiving Chiropractic
Rehabilitation: A 24–month Retrospective Analysis

J Chiropractic Medicine 2011 (Sep); 10 (3): 179–184 ~ FULL TEXT

This report is among the first to demonstrate sustained radiographic, self-rated, and physiologic benefits after treatment ceased. After completion of a multimodal chiropractic rehabilitation treatment, a retrospective cohort of 28 adult scoliosis patients reported improvements in pain, Cobb angle, and disability immediately following the conclusion of treatment and 24 months later.

Four-Year Follow-Up of a Patient Undergoing Chiropractic
Rehabilitation for Adolescent Idiopathic Scoliosis

J Pediatric, Maternal & Family Health 2011 (May); 2: 54-58 ~ FULL TEXT

A 14 year old female with adolescent idiopathic scoliosis presented to a private chiropractic rehabilitation clinic for care. She had complaints of mild thoracic and right sacroiliac pain which worsened during prolonged sitting or while running long distances. Her scoliosis measured 24° in the thoracic spine and 17° in the lumbar spine. Abnormalities in chest expansion and axial trunk rotation were also observed and recorded. Patient participated in a multimodal chiropractic rehabilitation program consisting of 28 clinic visits over 17 months. She also committed to a specific home exercise program. After 17 months, her curvatures decreased to 15°/6°, while showing concomitant improvements in peak expiratory flow, axial trunk rotation, and chest expansion. These outcome measures further improved at follow-up after 4 years with the Cobb angles reducing to 12°/4° respectively.

Back Pain in Adolescents With Idiopathic Scoliosis:
Epidemiological Study for 43,630 Pupils
in Niigata City, Japan

European Jpine Journal 2011 (Feb); 20 (2): 274–279 ~ FULL TEXT

Scoliosis group experienced significantly more severe pain, and of a significantly longer duration with more frequent recurrences in comparison to No scoliosis group. Scoliosis group showed significantly more back pain in the upper and middle right back in comparison to No scoliosis group. These findings suggest that there is a relationship between pain around the right scapula in Scoliosis group and the right rib hump that is common in IS.

Adolescent Idiopathic Scoliosis Treated by Spinal Manipulation:
A Case Study

J Altern Complement Med. 2008 (Jul); 14 (6): 749–751

This report of one case illustrates the potential effect of chiropractic manipulative therapy on back pain and curve progression in the at-risk, skeletally immature patient with adolescent idiopathic scoliosis. Chiropractic treatment was associated with a reduction in the degree of curvature of adolescent idiopathic scoliosis in this case, after half a year of conventional medical treatment had failed to stop curve progression. This suggests that in at least some severe and progressive cases of scoliosis, chiropractic treatment including spinal manipulation may decrease the need for surgery.

Chiropractic Manipulation in Adolescent Idiopathic Scoliosis:
A Pilot Study

Chiropractic & Osteopathy 2006 (Aug 21); 14: 15 ~ FULL TEXT

Adolescent idiopathic scoliosis (AIS) remains the most common deforming orthopedic condition in children. Increasingly, both adults and children are seeking complementary and alternative therapy, including chiropractic treatment, for a wide variety of health concerns.

Scoliosis Treatment Using Spinal Manipulation and the Pettibon
Weighting System: A Summary of 3 Atypical Presentations

Chiropractic & Osteopathy 2006 (Jan 12); 14: 1 ~ FULL TEXT

Each patient was treated with a novel active rehabilitation program for varying lengths of time, including spinal manipulation and a patented external head and body weighting system. Following a course of treatment, consisting of clinic and home care treatments, post-treatment radiographs and examinations were conducted. Improvement in symptoms and daily function was obtained in all 3 cases. Concerning Cobb angle measurements, there was an apparent reduction in Cobb angle of 13 degrees , 8 degrees , and 16 degrees over a maximum of 12 weeks of treatment.

Adolescent Idiopathic Scoliosis Screening For School, Community,
and Clinical Health Promotion Practice Utilizing

Chiropractic & Osteopathy 2005 (Nov 30); 13: 25 ~ FULL TEXT

The social assessment of quality of life is limited with few studies approaching the long-term effects of AIS. Epidemiologically, AIS is the most common form of scoliosis and leading orthopedic problem in children. Behavioral/environmental studies focus on discovering etiologic relationships yet this data is confounded because AIS is not a behavioral. Illness and parenting health behaviors can be appreciated. The educational diagnosis is confounded because AIS is an orthopedic disorder and not behavioral. The administration/policy diagnosis is hindered in that scoliosis screening programs are not considered cost-effective. Policies are determined in some schools because 26 states mandate school scoliosis screening. There exists potential error with the Adam's test. The most widely used measure in the PP model, the Health Belief Model, has not been utilized in any AIS research.

Scoliosis Treatment Using a Combination of Manipulative and
Rehabilitative Therapy: A Retrospective Case Series

BMC Musculoskeletal Disorders 2004 (Sep 14); 5: 32 ~ FULL TEXT

The combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. These results warrant further testing of this protocol.

Effect of Chiropractic Intervention on Small Scoliotic Curves
in Younger Subjects: A Time-series Cohort Design

J Manipulative Physiol Ther. 2001 (Jul); 24 (6): 385–393 ~ FULL TEXT

Forty-two subjects completed the program of chiropractic intervention. Age range at entry was 6 to 12 years, and patients were included if their entry-level x-ray films revealed curves of 6 degrees to 20 degrees. Participants had adjustments performed for 1 year before follow-up. Full-spine osseous adjustments were the major form of intervention, but heel lifts and postural and lifestyle counseling were used as well.   There was no discernable effect on the severity of the curves as a function of age, initial curve severity, frequency of care, or attending physician.

Children and Scoliosis
By Kim Christensen, DC, DACRB, CCSP, CSCS
Dynamic Chiropractic (February 12, 2001)

Successful treatment is dependent upon differentiating the underlying cause of the spinal curvature. In most children, the scoliotic spine is not symptomatic; the spinal curvature is first noticed either by a parent who becomes concerned about a child's posture, or during a screening examination, usually at school. The importance of a good evaluation and early treatment is to prevent progression and worsening of the curvature. Children with all three major causes of scoliosis should have a careful evaluation of the lower extremities as part of their spinal examination to determine associated or contributing components to the spinal deviation.

A New Look at Adolescent Idiopathic Scoliosis
By Mark Sanna, D.C.

My patients with AIS consistently experienced positive outcomes when, in conjunction with chiropractic adjustments, they were placed on the program of proprioceptive training that I will outline later in this article. While it is most likely that the etiology of AIS is multifactorial, I have been pleased to note that recent efforts in scoliosis research have been concentrating on seeking defects in proprioceptive mechanisms, substantiating my long held hypothesis of proprioceptive involvement. Let’s begin our AIS research review with a study performed by W. Keesen in the Netherlands. [1]

Adolescent Idiopathic Scoliosis
By Dr. Diane Benizzi DiMarco

A lateral bending of the spine, adolescent idiopathic scoliosis can present with a lateral and rotary deformity. Spinal curvatures can be the result of varied factors including; muscle diseases or spasms, neurological disease, diseases of the CNS or PNS, congenital vertebral deformities, leg length inequalities, tumors, pain, injury and degenerative spinal arthrosis. The most common cause of scoliosis, adolescent idiopathic scoliosis, accounts for approximately 80% of all diagnosed scoliosis cases. [1] Females are affected at a rate of 9:1. Idiopathic scoliosis, juvenile and adolescent affect females ages three to ten years of age and ten years to skeletal maturity, respectively. [2, 3]

Manipulation for the Control of Back Pain and Curve Progression
in Patients with Skeletally Mature Idiopathic Scoliosis:
Two Cases

J Manipulative Physiol Ther 1994 (May); 17 (4): 253–257

Diversified-type CMT has a favorable effect on acute back pain when used palliatively. The procedure may also have a favorable long term effect of preventing recurrence of back pain and on retarding curve progression when used routinely 1–2 times per month.

Anatomical Leg Length Inequality, Scoliosis and
Lordotic Curve in Unselected Clinic Patients

J Manipulative Physiol Ther 1991 (Jul); 14 (6): 368–375

The results of this study indicate that while there is no strong correlation between any one of the particular postural adaptations to anatomic leg length deficiency, nevertheless at least one abnormal spinal adaptation (scoliosis or hypo-hyperlordosis) occurs in over half of subjects who have LLI greater than 6 mm.

Scoliosis: Biomechanics and Rationale for Manipulative Treatment
J Manipulative Physiol Ther 1989 (Feb); 12 (1): 38–45

Since scoliosis is a lordotic problem, associating lateral curvatures with gender, age, and attitude of the thoracics during growth spurt may answer questions of a female disposition and a male tendency to Scheuermann's disease. Further, this paper evaluates the lateral curvatures of the spine concerning normal curve mechanics and idiopathic scoliosis. Mechanical stability is considered, applying engineering principals to understand buckling and critical loading. By examining the factors of spine slenderness, flexibility and strengths of the trunk muscles, and applying this understanding to curve mechanics-biomechanics of scoliosis, the chiropractor has a rationale for the treatment of mild lateral curves.

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