How Can Chiropractors Detect Scoliosis Effectively?
First, it can be done through posture. Ninety percent of Scoliosis patients present with a common posture. The middle back (dorsal) curve deviates to the right, and the curve in the low back (lumbo-dorsal) compensates to the left. In this typical pattern, look for a right head tilt, right high shoulder, a tight right trapezius muscle, and right dorsal curvature. This is an innate response to protect the heart. Any other configuration would mandate an MRI to rule out pathological causations. You can read more on spotting scoliosis through posture in the blog linked HERE.
Next, I have stopped relying upon Adam’s Test which only tells you there is a rib hump which means we haven’t detected scoliosis before it’s reached at least a 30 degree Cobb angle. There are other exams, based upon proprioceptive or mechanical defects, which may suggest the presence of scoliosis long before the rib hump becomes visible.
In the Cervical Flexion Test, Scoliosis patients demonstrated an inability to touch their chin to their chest (8). This may be due to Occiput / Atlas flexion malposition; an uncommon subluxation in the general population, but extremely common in scoliosis patients.
There are five(5) major righting reflexes in the body: the eyes, the ears, the neck and two body receptors. Guyton’s Physiology states that the eyes are the major righting reflex. With the eyes closed, the neck and body have to communicate to tell the head where it is. Scoliosis patients have a very obvious problem with proprioception, and there are physical tests which will detect this. Proprioception is defined as how one orientates in time and space. The Balance Test, performed with the eyes open, will evaluate the patient’s stability, but a better method is the One-Legged Stork Test, which is done with the eyes closed and evaluates proprioception. Normal for this test is standing on one leg with the eyes closed for 30 seconds; anything less than 30 seconds may suggest developing scoliosis.
In the Jump Test (9), the child (or adult) jump up and down for 60 seconds with their eyes closed. If the patient rotates while performing this test, this may be a positive indication for Scoliosis.
These tests above are not just common in scoliosis patients they are standard for scoliosis patients to show positive signs of. These tests are usually done in large group settings for school screenings to reduce time spent on each person. When I find positive results I will then perform individual testing in a clinical setting for those who had positive results for one or more of the above tests.
I use a spirometer due to the dorsal Cobb able. The pulmonary function may be compromised. This is also a necessary part of any re-examination. It allows an objective measure improvement in thoracic volume.
Finally, a Spinal Meningeal Tension Test is performed by having the patient bend over to touch their toes, and then stabilizing the sacrum while putting the head and neck into flexion. Paraspinal pain and tension are prominent. This may be done in conjunction with Adams’ Test.
Patients with scoliosis may also have difficulty sleeping (due to lack of melanin production), digestion problems (constipation), and a decrease in saliva production; these findings help finish up a scoliosis screening on my part.
I don’t always perform all of these exams at screenings due to time constraints but if time allows Adam’s Test is the one I prefer to check. It gives me the opportunity to inform parents of an obvious rib hump. If patients follow up in an office setting and the patient has been clinically evaluated, the next step is to analyze the x-rays. I will follow up with what we’re looking for on x-rays on the next blog.