Scoliosis
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Cobbs method of measuring the the angle of scoliosis.
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What is Scoliosis?
The symptoms vary from neck and back stiffness to nothing at all. A scoliosis is a sideways curve in the spine. When viewing the spine from behind it is normally a straight column. If you have scoliosis there may be a visible S-(shape)-curve rather than the usual “I” straight.
What causes scoliosis?
I believe one of the most significant initial causes is an anatomical short leg when the person is very young. So this should always be checked. Rarely have I come across a person with scoliosis who did not have a shorter leg on one side. A heal lift should be used on the shorter leg in most cases, but that may (Chen & Chiu, 2008)1, or may not be enough to resolve the problem on its own (Lantz & Chen, 2001)2. This is probably due to neuromuscular changes that take place in the neck and nervous system that control posture (Seaman & Winterstein, 1998)3.
Types of Scoliosis
Idiopathic: The most common is idiopathic, which means the underlying cause is unknown to the person making the diagnosis, and there may be an underlying genetic association.
Functional Scoliosis: If there is no Rib hump on forward bending, or the curvature disappears, it is unlikely to be idiopathic, and more likely what is termed a functional scoliosis. Even trauma later on in life can effect leg length in some way, or the pelvis can rotate creating a functional scoliosis and your chiropractor can assess this, and with the corrective treatment should disappear: manipulation and a heal lift, or pelvic manipulation.
Congenital Scoliosis: Bone abnormalities from birth can result in congenital scoliosis. Early conservative treatment for scoliosis is desirable, particularly as the ribcage can often enlarge on one side and narrow on the other, which may have an effect on the heart or lungs.
Neuromuscular Scoliosis: Spina bifida and cerebral palsy can be seen with nerve and muscle abnormalities called neuromuscular scoliosis.
Rarely is scoliosis associated with anything sinister, but if it is suspected there is a problem with the spinal cord, such as syringomyelia the patient will need a scan to rule out this possibility.
How is scoliosis assessed and treated by chiropractors?
The most widely used method of assessing the degree of scoliosis is Cobbs angle, which is measured on X-rays by surgeons and chiropractors. The literature strongly suggests that a combination of chiropractic adjusting and rehabilitation can reduce Cobbs angle, and prevent the likelihood of degeneration (Morningstar, et al, 2004)4 (Tarola, 1994)5. Chiropractors also use postural analysis and motion palpation, range of motion and contour analysis to determine the position of your skeleton and possible neuromuscular forces acting on the skeleton (Lewit K, 1985)6. However, X-ray analysis of the spine is used by chiropractors to assess how adjust the spine and pelvis with scoliosis patients and to deliver the rehabilitation strategies. London Chiropractors favour using a combination of mobilisation, manipulation, heal lifts, traction, and neuromuscular re-education to deal with scoliosis.
FOOTNOTES
1 Chen KC, Chiu EH. (2008) Adolescent idiopathic scoliosis treated by spinal manipulation: a case study. J Alternative Complementary Med. 2008 Jul(6):749-51.
CONCLUSIONS: Chiropractic treatment was associated with a reduction in the degree of curvature of adolescent idiopathic scoliosis in this case, after half a year of conventional medical treatment had failed to stop curve progression. This suggests that in at least some severe and progressive cases of scoliosis, chiropractic treatment including spinal manipulation may decrease the need for surgery.
http://www.ncbi.nlm.nih.gov/pubmed/18673077?dopt=AbstractPlus
2 Lantz CA, Chen J. (2001) Effect of chiropractic intervention on small scoliotic curves in younger subjects: a time-series cohort design.
J Manipulative Physiol Ther 2001, 24:385-393.
Life University, Marietta, GA, USA.
CONCLUSION: Full-spine chiropractic adjustments with heel lifts and postural and lifestyle counselling are not effective in reducing the severity of scoliotic curves.
3 Seaman DR, Winterstein JF. (1998) Dysafferentation: a novel term to describe the neuropathophysiological effects of joint complex dysfunction. A look at likely mechanisms of symptom generation.
J Manipulative Physiol Ther 1998, 21:267-280.
Postural control dependent significantly upon cervical joint mechanoreceptors and other afferent input from ligament and musculotendinous sources. It may be that the unleveling of the pelvis and sacrum sometimes has a dramatic knock on effect with the spine that sits on the sacrum, all the way up to the skull, affecting postural control.
4 Morningstar MW, Woggon D, Lawrence G. (2004) Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. BMC Musculoskeletal Disorders 2004, 5:32doi:10.1186/1471-2474-5-32
Outstanding results on a group of 19 patients who had an average reduction of Cobbs angle by 17º over a 4 to 6 week period, employing a combination of chiropractic manipulation and rehabilitation.
5 Tarola GA. (1994) Manipulation for the control of back pain and curve progression in patients with skeletally mature idiopathic scoliosis: two cases. J Manipulative Physiol Ther. 1994 May;17(4): 253-7.
Diversified-type CMT has a favourable effect on acute back pain when used palliatively. The procedure may also have a favourable long term effect of preventing recurrence of back pain and on retarding curve progression when used routinely 1-2 times per month.
http://www.biomedcentral.com/1471-2474/5/32#B51
6 Lewit K. (1985) Muscular and articular factors in movement restriction. Manual Medicine 1985, 1:83-85
Loss of cervical lordosis with forward head carriage may elicit a pelvo-ocular reflex, which would shift the pelvis forward to balance the centre of gravity for the head.