Scoliosis Treatment: Is Chiropractic Management An Effective Solution?
Scoliosis is perhaps the most recognised spinal deformity. Although this is the case, Scoliosis is in fact not a diagnosis but rather a descriptive term for the characteristic curved appearance that is evident in individuals.
Scoliosis presents in the spine as an abnormal S-shaped curve (when viewed from behind). A normal spinal column is straight except for the normal lordotic and kyphotic curvatures when viewed laterally. If the curvature of the spine is directed towards the left, it is referred to as a levoscoliosis. Conversely, if the curvature is directed towards the right, it is referred to as a dextroscoliosis. Scoliosis is most commonly seen in the thoracic and lumbar spines and primarily affects adolescents with various different classifications which are explored below:
- Congenital (caused by abnormalities at present at birth)
- Idiopathic (sub-categories include infantile, juvenile, adolescent and adult)
- Secondary (caused by deformities such as Spina Bifida, Cerebral Palsy or physical trauma)
There are various important warning signs and risk factors to look out for in your children. These warning signs will enable you to detect the early progression of Scoliosis, ensuring you get prompt management before the problem worsens.
- Clothes not sitting correctly
- Abnormal posture – unlevelled shoulders and pelvis
- Abnormal head position
- Asymmetrical muscle development
- Unilateral prominent ribs and chest cavity
- Unequal gaps between arms and torso
- Family history of Scoliosis
- Unequal leg length
Scoliosis screening should be regularly performed by not only parents but trained musculoskeletal professionals to ensure proper development throughout the growth and development years as early detection and treatment leads to better long term results. Two assessments, including the Forward Bend Test (Adam’s position) as well as spinal observation and palpation are the most sensitive testing measures to date.
The Forward Bend test involves having the child bend forward at the hips while keeping their legs straight. The child is instructed to reach towards the floor while the parent / examiner views the child from behind. If a unilateral prominence is evident, this is clinically indicative of Scoliosis. This prominence represents the thoracic rib cage.
Spinal observation and palpation is also of clinical importance. With the child seated and shirt removed observe their posture for the presence of an abnormal curvature. While slowly running your fingers up their spine you may also feel the curvature. Repeat this test in the standing position. If a curvature is observed or detected on palpation it is indicative of Scoliosis.
HOW IS SCOLIOSIS MANAGED?
Generally speaking Scoliosis is managed either conservatively or with the use of surgical intervention in severe cases. Further details can be found below.
If Scoliosis is evident, specific spinal X-ray analysis is warranted to determine the severity which will allow your Chiropractor to advise on appropriate treatment options. The below table highlights the risk of Scoliosis progression (worsening) with the age at which it is initially determined to be present.
|Scoliosis Curvature||Age (10 – 12)||Age (13 – 15)||Age (16+)|
|21 – 30°||60%||40%||10%|
|31 – 60°||90%||70%||30%|
From this table we can see that Scoliotic curvatures worsen during periods of rapid growth therefore it is imperative that your child be checked as early as possible.
Chiropractic management of Scoliosis is largely dependent upon the age at which it is detected as well as curvature severity. If it is determined that Chiropractic treatment may be beneficial for your child there are a variety of techniques which may be used to not only reduce spinal curvature but also limit its progression.
- Manual spinal manipulation is the most recognised technique used by Chiropractors and other manual therapists. Spinal manipulation involves repositioning a joint which may assist with improving overall spinal curvature and flexibility
- Flexion-distraction therapy describes a particular therapy that is unique to the Chiropractic profession. A flexion-distraction table allows the Chiropractor to ‘untwist’ the curvature of the spine while also opening restricted spinal joints to improve spinal flexibility, movement and reduce pain levels
- Massage for muscular tightness and tension is common for Scoliosis sufferers due to the abnormal spinal positioning. Specific massage and muscle releasing techniques are ideal for improving muscle tension and therefore relieving pain
- Flexibility & strengthening exercise prescription is necessary. Specific exercises depend on the nature of the curvature and must only be recommended by a trained professional
Bracing is usually considered in cases where progression is expected. In some cases bracing may prevent the need for surgery and the process involves specifically designing a brace to fit the torso of the individual, almost like a corset. The brace places pressure to specific areas of the spine in order to attempt at straightening the curvature
Casting involves a plaster mould being wrapped around the torso which is thought to assist with ‘moulding’ or permanently changing the position of the spine as the child grows and develops
Spinal rods have been shown to straighten scoliosis curvatures however there are side effects which must be seriously considered prior to the procedure. Most commonly spinal rods are placed along the spine, however demonstrated negatives of this are usually chronic back pain as an adult, restricted movement and sciatica.
CHIROPRACTIC & SCOLIOSIS RESEARCH
- Spinal manipulative and rehabilitation techniques resulted in clinically significant improvements in Scoliosis severity. Villafane, J et al (2012). Manipulative and rehabilitative therapy as a treatment of idiopathic scoliosis without psychological sequelae: A case report. Journal of Chiropractic Medicine, 11(2); 109 – 114
- Following a schedule of multi-modal Chiropractic management improvements were demonstrated both subjectively and objectively in radiographic changes, pain levels and overall disability. Morningstar, M. (2011). Outcomes for adult scoliosis patients receiving Chiropractic rehabilitation: A 24-month retrospective analysis. Journal of Chiropractic Medicine, 10(3); 179 – 184
- Chiropractic care resulted in a reduction in overall spinal curvature in an adolescent with idiopathic scoliosis suggesting it is an effective scoliosis treatment option. Kao-Chang, C. (2008). Adolescent idiopathic scoliosis treated by spinal manipulation: A case study. Journal of Alternative and Complementary Medicine, 14(6); 749 – 751