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Definition
Scoliosis is the lateral deviation of the spine and affects not only adults, but more commonly affects children and adolescents. In today’s society, there is a great concern about scoliosis. Children are checked in elementary school and high school to see if this menace has gotten a hold of them.

About 80 percent of scoliosis cases are "idiopathic", meaning the cause is unknown. There is no research evidence that chiropractic treatment can cure idiopathic scoliosis. But, chiropractic treatment can help give relief for some of the pain caused by idiopathic scoliosis. That will help your child to stay active which is important for their general health and well-being.

Adults who had scoliosis as children are more likely to have chronic back pain than people in the general population. Therefore, the most important thing is to detect the scoliosis in the first place, diagnose the cause of the scoliosis and then treat it appropriately.

Scoliosis can run in families. A child who has a parent, brother, or sister with idiopathic scoliosis should have regular check-ups.

Prevalence
4% of children aged 10-14 have detectable scoliosis. 60-80% of those affected are girls. While most cases of childhood and adolescent scoliosis stop progressing once spinal maturity is reached, progression of the curve past spinal maturity is not uncommon.

General Types of Scoliosis

As the spine improperly twists and bends, the nerves emitting between the vertebrae (spinal bones) have the potential for being compressed and irritated. Once irritated, these nerves will lead to abnormal function in the organ that they control.

There are two general types of scoliosis, a structural scoliosis and a functional scoliosis.

The structural type is due to an improperly formed bone. The bone may have been malformed by a birth defect, or may have developed from a fractured bone which healed with an abnormal shape. Since gravity is always pulling down on the body, the structure which is resting on top of the malformed bone may not sit level. This is the beginning of a tilt to the spine.

Functional scoliosis, the most common type, is due to the tilting of an intervertebral disc (the shock absorber) between the vertebrae. The functional scoliosis is usually due to some type of spinal injury. Such an injury may be obvious like a physical trauma, or may not be so obvious, like carrying a heavy book bag over one shoulder.

Specific Types of Scoliosis

  • Infantile - Infantile scoliosis is a lateral spine deviation occurring during the first 3 years of life and is twice as common in males. Approximately 74-97% resolves on their own but those that do progress do so in a severe and disabling manner. This condition is, however, rare in North America.
  • Juvenile - Juvenile scoliosis refers to scoliosis occurring in children aged 3 until the age of puberty - approximately 10 years of age. Juvenile scoliosis can continue to progress in severity, and thus, monitoring every 3-6 months with radiographs is required. Continual monitoring is performed through adolescence because of the high risk of progression. If progression occurs without appropriate treatment severe spinal deformity and cardiovascular compromise can result.
  • Adolescent - Adolescent scoliosis is scoliosis detected in those who have reached puberty but have yet to reach adulthood. This is the most common type of idiopathic scoliosis (unknown cause). Like juvenile scoliosis, adolescents should be monitored until spinal maturity is reached to prevent possible progression and future health problems.

Common Physiological Effects of Idiopathic Scoliosis on the Body:

  • NEUROLOGICAL EFFECTS: Due to the compensatory head tilt, the orbits of the eyes in a scoliotic patient are unleveled. This unleveling in turn affects the balance mechanism, proprioception and oculo-vestibular function of the patient. The spinal cord is subjected to lateral deviation and the dorsal nerves are stretched in some areas and atrophied in other areas. Research shows that a 10% stretch applied to a nerve will affect the nerves ability to transmit impulses.
  • OSSEOUS EFFECTS: The most obvious aspect of this disease is the impact upon the spine itself. The vertebral bodies of the spine are subjected to abnormal pressures due to the distortion, which is developing. This may result in asymmetry in the individual vertebra. Interestingly, the vertebral bodies of the scoliotic patient are 50% taller and 15% wider than average.
  • BIOMECHANICAL EFFECTS: Scoliotic patients have hyperflexibility in the ligaments which hold the spine and this hyperflexibility contributes to the three dimensional distortion which occurs. The spine becomes laterally curved as well as rotated. This distortion negatively impacts the discs between the vertebra and causes fibrous changes to the ligaments.
  • MUSCULAR EFFECTS: The muscles that attach to the spine directly are greatly affected due to the curvature. As the origins and insertions of the muscles are contorted due to changes in the force vectors caused by the curvature, the muscles can begin to work against the patient. Ultimately, these compromised muscles add to the problem. With time the muscles also begin to develop scar tissue.
  • BIOCHEMICAL EFFECTS: Patients with Idiopathic Scoliosis also have nutritional challenges, which must be addressed. There is reason to believe that the scoliotic patient has digestion and absorption problems. They tend to have compromised immune systems leaving them subject to flu and viruses. These patients harbor some unusual and often extreme mineral imbalances as demonstrated by hair mineral analysis. These nutritional imbalances contribute to the hormonal imbalances which ultimately contribute to the ligamentous laxity which accelerates the condition.

The above is a simplified version of the problems experienced by the person with Idiopathic Scoliosis, but hopefully it has shed some light on the complexity of this disease. Being a multifactoral disease, a multi-faceted approach is required to treat this disease.

Diagnosis

Here is a home test for childhood scoliosis (courtesy of Dr. Fred Barge, Chiropractor, from his text “Scoliosis”) that may aid in the early detection of scoliosis. Have the child strip to the waist and observe her/his posture from behind:

  • Does the child hold their head tipped to one side?
  • Is one shoulder higher than the other?
  • With both arms hanging down to their side, is there more room between their body and an arm on one side or the other?
  • Looking at the child’s waist, does one side curve in more than the other?
  • Does one hip appear prominent than the other?
  • Have the child bend over at the waist (as to touch their toes). Does one side of the spine appear more prominent than the other? Is there a hump on one side between the shoulders or on the lower back?

If any of the above tests appear positive, then have your child checked by a chiropractor for scoliosis.

Since the abnormal curvature may not be obvious upon inspection of the back, even to the trained eye, an uneven shoulder height or clothes not appearing to hang off the body symmetrically may be the first indication. Also, a complaint of back pain, ache, discomfort or fatigue may be present. However, this does not generally occur until later stages after the spinal ligaments and muscles have been chronically irritated.

Complications

While most cases of childhood and adolescent scoliosis stop progressing once spinal maturity is reached, progression of the curve past spinal maturity is not uncommon. If the lateral curvature continues to progress, cardiovascular compromise can result - ultimately leading to severe disability or death.

Treatment

Scoliosis treatment in the child consists of:

  • monitoring the degree of curvature for increases,
  • chiropractic spinal adjustments to minimize spinal stresses, optimize biomechanics and keep the nervous system functioning properly,
  • therapeutic spinal exercises and stretches to strengthen spinal muscles on the convex side and keep muscles flexible of the concave side, and
  • soft tissue procedures and physical therapies to assist in symptomatic relief.

Like regular Dental care to maintain your teeth, it is essential for children to have regular spinal check-ups. The earlier detection of scoliosis, the easier it is to correct. While a scoliosis becomes readily visible in adolescence, with the pubertal growth spurt, it is more easily corrected prior to puberty. The longer you wait to correct a functional scoliosis the more likely it is to become a structural scoliosis. This results because of the constant abnormal force being placed on spinal bones – they remodel, changing their structural shape.

It has been proven that correction started early can speed the healing process, due to a young spine being more responsive to treatment than an order spine. Chiropractic care involves specific adjustments of the spine, as well as rehabilitative exercises. The goal is to eliminate discomfort and prevent progression of the lateral curvature. If the curvature continues to progress, severe spinal deformity can occur resulting in physical disability and cardiovascular compromise.

Chiropractic care maintains the mobility of the joints of the spine and allows the spine to develop normally. Proper treatment,especially if commenced earlier than later, can prevent progression of the curve and may help reduce it. With scoliosis particularly, an ounce of prevention is worth a pound of cure.

For further information or to schedule a postural and scoliosis assessment for yourself or your child, please contact Dr. Pisarek at Advanced Healthcare - (416) 633-3000.

References:

  1. Clinically Oriented Anatomy, 2nd Edition, Kieth L. Moore, Ph.D., F.I.A.C., Williams & Wilkens, 1985. Pgs 568-569.
  2. Principles of Anatomy and Physiology, 6th Edition, Gerald J. Tortora & Nicholas P. Anagnostakos, Harper & Row, 1990. Pg. 187
  3. Textbook of Clinical Chiropractic: A Specific Biomechanical Approach., Gregory Plaugher, editor.  Williams and Wilkens 1993, Pgs 266-278.
  4. Fundamentals of Orthopedics, 3rd Edition. John J. Gartland, M.D. , W.B. Saunders Company 1979. Pgs.339-343.
  5. Rothman, R., M.D., Simone, M.D., The Spine, 3rd edition W.B. Saunders Company, 1992.
  6. Bradford, D., M.D., Lonstein, M.D., Textbook of Scoliosis and Other Spinal Deformities, 3rd edition, W.B. Saunders Company, 1994.
  7. Kein, H., The Adolescent Spine, 2nd edition, Springer-Verlag, 1982.
  8. Cailliet, Rene, M.D., Scoliosis: Diagnosis and Management, F.A. Davis, 1975.
  9. Dingle, R.V., (ed.), The CIBA Collection of Medical Illustrations; Vol. 8, Musculoskeletal System; Part II Developments/Disorder, Tumors, Rheumatic Disease, and Replacement, Summit, NJ, CIBA-Geig Corp:31-36, 1990.
  10. Sallahian, C., Reduction of a Scoliosis in an Adult Male Utilizing Specific Chiropractic Spinal Manipulation: A Case Report, Journal of Chiropractic Research and Clinical Investigation, Vol. 7, No. 2, July, 1991.
  11. Cox, J., Low Back Pain
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