Manipulation Reduces Pain Associated With Scoliosis
OBJECTIVE: This report of two cases illustrates the potential effect of chiropractic manipulative therapy on back pain and curve progression in the at-risk, skeletally mature patient with adolescent idiopathic scoliosis.
CLINICAL FEATURE: Two patients suffering from lumbar scoliosis and chronic back pain. Both had scoliosis that had progressed after skeletal maturity.
INTERVENTION AND OUTCOME: Diversified type chiropractic manipulative therapy was used palliatively for back pain relief in one case, and routinely 1-2 times per month in the other case. The manipulation was applied manually, with the patients in the prone and side-posture positions. Vertebral levels manipulated were identified as fixated/dysfunctional segments based on static and/or motion palpation. They were generally applied to areas above and/or below the curve apex. When applied at the apex, cavitation was more easily achieved when the direction of thrust was into the concave side. This was also tolerated better by the patient. No attempt was made to "straighten the curve" by thrusting into the convex side. Gentle manual intersegmental mobilization, stretching and muscle massage techniques were also applied. The case treated palliatively had curve progression consistent with the literature over an 8-yr period.
The case treated routinely did not. The procedure was effective in both cases for subjective relief of back pain.
CONCLUSIONS: 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.
Tarola GA. Manipulation for the control of back pain and curve progression in patients with skeletally mature idiopathic scoliosis: two cases. J Manipulative Physiol Ther 17 (4): 253-257 (May 1994)
Proprioception Abnormalities Seen In Adolescent Idiopathic Scoliosis
Recent studies in Japan and in Sweden have suggested that a disturbance of postural equilibrium exists in idiopathic scoliosis. Proprioceptive function is one of the factors involved, and therefore a study of proprioception in patients with adolescent idiopathic scoliosis (AIS) was carried out. No difference was noted in joint position sense and in fine motor control between 24 scoliotics and matched controls taken from a group of 70 normal children of the same age group. Blindfold weight discrimination, a test of muscle spindle and tendon stretch receptor function, also showed no abnormality in scoliotic children. The Charpentier test, thought to be a test of control of muscle spindle function, showed a tendency to an infantile response in patients with adolescent idiopathic scoliosis, while the control subjects showed a normal size-weight response.l This suggests that the muscle spindle system may be at fault in AIS and supports the suggestion that postural equilibrium reactions may be abnormal in this disease.
Yekutiel M, Robin GC, Yarom R, Proprioceptive function in children with adolescent idiopathic scoliosis., Spine 6: 6, 560-6, Nov-Dec, 1981.
Understanding Spinal Biomechanics Aids Chiropractors
This paper discusses methods to biomechanically evaluate scoliosis. From a chiropractic point of view, an understanding of the biomechanics of scoliosis is of paramount importance. By understanding the pathogenesis, the chiropractic physician can apply a rational approach to outline a treatment regimen. Spinal curvatures in the median plane change during growth, and in normal children the thoracic kyphosis reduces in size between the ages of 8 to 14. However, the
change occurs at different times for boys and girls. 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.
Danbert RJ. Scoliosis: biomechanics and rationale for manipulative treatment. J Manipulative Physiol Ther 12 (1): 38-45 (Feb 1989)