Chiropractic Care for Scoliosis
Scoliosis for some is a foreign word. No one really knows what it is until it affects them or someone they care about.
At Corrective Chiropractic we know there is a science to the understanding, evaluating, and management of scoliotic deformities in adolescents and adults. There is a link between genetic triggers, biomechanical growth modulation, environmental risks, and age development that contribute to scoliosis.
Corrective Chiropractic utilizes a number of different treatments when treating scoliosis including but not limited to physical therapy, exercises, adjustments, and spinal remodeling. Chiropractic services for scoliosis are unique to each patient and based on the results of an examination and weight bearing x-rays and digital posture analysis.
We take into consideration all risk factors for curve progression in both adolescent and adult scoliotic deformities before beginning any care.
The first step is to determine whether or not you or your child is a candidate for corrective chiropractic care. Regardless of where you are you need to find a chiropractor that is capable of and has experience with making measurable corrections to the spine. This is only determined via x-ray of the entire spine. If you are looking for a Greenville chiropractor, Corrective Chiropractic is very capable of working with scoliosis. Chiropractic will not be able to help everyone but the only way to determine if we can help is first by doing a full evaluation. Reviewing each case thoroughly to see if any chiropractic treatment would be beneficial. If you are not an ideal candidate for treatment then we can point you in the right direction.
There are risk factors for progression of scoliosis that have to be reviewed in order to manage the scoliotic deformities or to determine the need for a surgical consultation.
These factors are cutoff curve values.
The age of onset of scoliosis
Curve flexibility determined via CPX (corrective potential x-rays) stress films
Curve magnitude (which must be done in office utilizing our Computerized Radiographic Analysis)
Scoliosis curve pattern (Cobb Angles)
Growth plate closure
What is a Cobb Angle?
A Cobb Angle is the measurements of the two most tilted vertebrae found on an Anterior/Posterior X-ray (looking at the front/back). There should be a horizontal line drawn on the top of the superior vertebral body and a horizontal line on the bottom of the inferior vertebral body. A perpendicular line is drawn (90 degrees) inferior and superior on the vertebral body lines. Then the Cobb Angle is measured at the intersection. Any Cobb angle over 10 degrees is medically considered a Scoliosis.
It is important to realize that you can have an abnormal spine that needs corrective chiropractic care even if there isn’t a 10 degree or higher Cobb angle. Ten degrees is an arbitrary number that was chosen at random with no supporting research. There are numerous different ways that the spine can shift and move out of place that results in abnormal biomechanics and unbalanced spinal loading. Only structurally focused chiropractors are trained to analyze and treat these types of subluxations resulting in abnormal spinal and postural alignments.
It is not uncommon for medical and chiropractic doctors to misdiagnose abnormal postural alignment as traditional “scoliosis” or vice versa.
Why Is Age of Onset of Scoliosis Important?
Detecting scoliosis at a younger age the incidence of progression is higher. This means that the younger the child is the more likely their scoliosis will get worse. For example, if an 8-year old has a Cobb Angle of 15 degrees and an 18-year-old has the same Cobb Angle then the 8-year-old is more likely to progress than the 18-year-old.
Once a body hits skeletal maturity scoliosis will continue to progress on average of 1 degree a year.
Scoliosis Curve Flexibility
The more “flexible” a scoliosis curve is the more likely it is going to progress without chiropractic intervention. Higher flexibility towards normal also means that structural chiropractic care has a higher potential for correction.
After the initial chiropractic exam and x-rays, we take additional weight bearing (standing) digital x-rays as well as and laying down. At Corrective Chiropractic, we take CPX (Correction Potential X-ray) stress films to assess the Cobb Angle’s flexibility and response to bending and the potential for correction. In these x-rays, we place you in a ‘mirror’ image of your current spinal position by having you laterally bend into the curve. If indicated we will also take digital x-rays where you will be laying on orthotic devices called Dennerolls™ placed at a specific location on the spine determined via your initial weight bearing x-rays.
Scoliosis Curve Magnitude
The larger the curve or Cobb Angle the more likely it is going to progress.
Research from several sources has shown that adolescent idiopathic curves that exceed a Cobb Angle of 30 degrees by skeletal maturation, still have the capacity to worsen by 1 degree per year.
By proactively taking action at a younger age via chiropractic care, scoliosis is easier to treat and prevent from progressing. It is always better to intervene as soon as possible. However, even geriatric scoliosis patients may have the potential for improvement.
Scoliosis Curve Pattern
What do you mean by curve pattern? Scoliosis can have one to three curves. Very rarely is there more than three scoliotic curves on one person. Double curves are the most common which have a typical pattern and rotation. A double curve scoliosis when viewing an x-ray film from front to back of a spine will have the following traits.
The curve of the low back (lumbo-dorsal) will typically bend with the apex of the curve facing the left with a double scoliosis curve. The middle of the back (thoracic spine) will typically bend with the apex of the curve facing the right. This pattern is believed to be more common because the body innately avoids curving towards the heart. Left thoracic scoliosis curves are potentially dangerous and your chiropractic or medical doctor would likely order an MRI to rule out any pathological causations. Most people with the typical thoracic curve to the right and lumbar curve to the left will present with a high right shoulder, ribs on the right rotating backward and a low left hip posture.
A single curve has a wide range of possibilities but it typically is a C curve. With one continuous bend from thoracic to lumbar. This can also be just in the thoracic or just lumbar spine. The only way to determine the exact pattern and severity of the curve is via full spine weight bearing x-rays.
How Long Will I Need Chiropractic Care for Scoliosis?
This is where I tend to step on toes. I find that once you start down the path of correction with scoliosis then you must remain with that chiropractor for life, depending on the severity. Finding a traditional chiropractor to work with your scoliosis can be detrimental to the progression of your scoliosis. When treating scoliosis there are a number of erroneous and contradicting treatment protocols that can cause poor success, especially when being utilized simultaneously. For this reason, it is not recommended that you work with numerous different doctors while treating scoliosis. This isn’t to suggest that a second or third opinion is bad. Simply, that you don’t want too many “cooks in the kitchen”.
There are situations that may require you to utilize more than one provider. The most common example is when a patient is moving. Regardless of the reason, we will work together to find someone that has the education or training required to manage your scoliosis.
As you see in the picture the patient received care for approximately four months and saw some improvements in the Cobb Angle. However, care is still needed to continue to improve or maintain the correction obtained.
Will I have to brace? There is a possibility of bracing depending upon all of the above factors. Bracing is an option for some moderate to severe cases, especially if they are likely to progress.
Options for Scoliosis Bracing
At Corrective Chiropractic, we recommend a specific brace that is the mirror image of your scoliosis. This is accomplished through x-rays and a 3-D Digital scan of your normal posture. The Scolibrace™ is developed specifically to support the spine and “untwist” and is different from other braces that only utilize two-dimensional x-rays alone to force the spine into position.
The spine is a three-dimensional structure. Any photographer will tell you that the position of their subject during a photograph session can greatly influence how they appear in the photo. I.e. forced perspective is a technique that can make this appear closer or bigger than they are based on their position and distance from the camera. This same kind of phenomenon happens during x-rays causing the spine, ribs, pelvis, etc. to appear bigger, closer, higher, lower, etc. on the x-ray image than it actually is. This is why it is imperative that the x-rays are not the sole diagnostic tool.
This principle is especially important when you consider many medical bracing and surgical options only look at the A-P (front to back) views when treating with a brace or surgery. One of the greatest mistakes is to focus only on the Cobb angle and ignore all dimensions of the spine. This is often seen in post surgery when a patient’s scoliosis is reduced. Looking from the back only via x-ray and ignoring the rotation of the spine completely. The “solution” to this problem is often a second surgery to shave the ribs down that are rotating back on the right. Treating the spine three-dimensionally is of the utmost importance!
What to Expect During Chiropractic Treatment
Chiropractic treatment of scoliosis will require specific chiropractic adjustments for scoliosis along with specific chiropractic therapy and rehab in and out of the office. Patients interested in structural correction are recommended to avoid traditional chiropractic treatment. Traditional chiropractic focuses primarily on the relief of symptoms and cannot make reproducible, objective improvements to the spine.
Structurally Focused Chiropractic Care
Specific spinal adjustments are performed to cause bone or joint repositioning. In effect, the body is positioned in the exact opposite position of the current abnormal alignment found on the x-ray and digital posture analysis. Adjustments may be performed using:
A specially designed instrument
A table with movable parts
Or any combination of the three
Your adjustments will gently shift improperly aligned joints, vertebra, muscles, and ligaments back towards normal. Structural correction with chiropractic will help your body to reset its sense of balance by stimulating the nerves that control posture. This change in posture is typically evaluated each visit after the adjustment to verify improved alignment.
Isometric Stabilization Therapies
These therapies cause soft tissue, ligaments, and muscles to elongate, stretch into the exact opposite position of the already abnormal spinal alignment.
Performing Isometric Stabilization Therapies in the mirror image of the abnormal spine’s incorrect position.
Your therapies will improve overall flexibility, strengthen weakened muscles, and help your body maintain the proper sense of postural balance.
Spinal Remodeling Traction
Placing custom foam mold spinal orthotics at a precise position (determine via digital x-ray) on the spine. This can be done while standing or lying on your side, prone and/or supine to mold the spine into a normal structure. This process is typically done daily for 15-45 minutes, which is the time it takes to reshape the ligaments holding the spine in place. Think of spinal remodeling like braces for your teeth. Straightening your teeth happens over a long period of time. Pulling the teeth into place slowly. Spinal remodeling is similar but does not necessitate constant tension like braces, which are always in place. The spine is remodeled using a specific orthotic in combination with mirror image adjustments and mirror image exercises to move and hold the structure in place and replace the need for constant tension.
Typically non-scoliotic cases take less time to make changes and improvements. Whereas, a scoliosis case may take several corrective treatment plans or consistent stabilization care for several years. This all depends on the severity of your scoliosis.