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Scoliosis Questions and Answers?
Why is Early Intervention Important?
Scoliosis is the result of small genetic faults in symmetrical growth. The earlier intervention is offered the greater
the opportunity to reduce the abnormal forces which ultimately exacerbate the abnormal growth pattern seen in scoliosis.
Research published in 2006 by Hawes et al agrees earlier intervention is the key to correction. Published in the Journal
Scoliosis Journal Hawes and O'brien concluded,
"Spinal curvatures can routinely be diagnosed in early stages, before pathological deformity of the vertebral elements is induced
in response to asymmetric loading. Current clinical approaches involve 'watching and waiting' while mild reversible spinal curvatures
develop into spinal deformities with potential to cause symptoms throughout life. Research to define patient-specific mechanics of
spinal loading may allow quantification of a critical threshold at which curvature establishment and progression become inevitable, and
thereby yield strategies to prevent development of spinal deformity."
The breakthrough of the Spinecor system is in its design to retrain movement and reduce the abnormal forces during movement. Retraining
of posture and movement is a consequence of the adaptability of the "central pattern generators" which control postural muscle activity.
In research published in SPINE (2004) researchers concluded changes in muscle recruitment patterns can serve to reduce the severity
and progressive nature of scoliosis.
The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment., Hawes MC, O'Brien
JP. Scoliosis 2006 Mar 31:1(1):3.
Muscle Activation Strategies and Symmetry of Spinal Loading in the Lumbar Spine with Scoliosis. SPINE 2004 Oct 1:29 (19):2103-7 Stokes
IA, Gardner-Morse M.
Sensory Feedback Mechanism Underlying Entrainment of Central Pattern Generator to Mechanical Resonance. Biol Cybern 2006 Apr:94(4):245-61.
Epub 2006 Jan 10.
Why does the ribcage become deformed, and can it be limited?
Scoliosis is a three dimensional deformity characterized by excessive rotation of the spinal bones (vertebrae) as well as lateral bending.
When the apex of the curvature is in the thoracic spine, the rotational component of the deformity causes the ribcage to rotate just as
the spinal bones do, thereby causing the signature "rib hump". Corrective procedures should include de-rotation of the ribcage as well
as the spinal bones in order to reduce the ribcage deformity.
What is Brain Lateralization?
In a study published in SPINE 1995, researchers tested linguistic processing, a higher cortical function, and concluded children with
scoliosis had an entire brain dominance lateralized to one side, unlike unaffected children in the control group. This study demonstrates
the need for advanced neuro-diagnostic testing and clinical correlations which leads to meaningful neurologically based rehabilitation.
Adolescent Idiopathic Scoliosis and Cerebral Asymmetry. An Examination of the non-spinal perceptual systems.
SPINE 1995 Aug 1;20(15):1685-91.
What factors influence the spinal curvature?
Researchers believe a genetic disturbance in the initiation sequence of growth is the primary dysfunction in Idiopathic Scoliosis.
Growth centers in the anterior portion of the vertebrae are thought to grow faster than those in the posterior regions, thereby causing
a flattening of the normal side (sagital) curves. Further delay in lateral growth centers leads to buckling and a wedging of the bones at
the apex of the resultant curvature. Muscle spindles are known to be abnormal and potentially absent at the level of the apex
further compounding the problem. Reduced spindle numbers means reduced awareness and motor control of the surrounding musculature,
all leading to brain lateralization affecting much more than postural tone.
Can exercises help reduce the deformity associated with Scoliosis?
Researchers from Europe and the United States have published literature which supports the use of exercise and other physiotherapy to
reduce the deformity associated with Scoliosis. Specific breathing exercises as well as resistance and postural re-education based
exercises can be prescribed to reduce the neuro-musculature imbalance associated with scoliosis. Scoliosis Systems (TM) utilizes the
Corrective Exercise Continuum as taught by the National Association of Sports Medicine (NASM). See illustrated below.
How can the body's innate reflexes help to reduce Scoliosis?
Normal body posture is maintained via a natural balance between the proprioceptive systems (dorsal columns of the spinal cord and
muscle spindles), the vestibular system (inner ear and brain) and the visual system. Research confirms both children and adults with
scoliosis have abnormalities in all of these systems in varying degrees. It is therefore important to evaluate each patient individually
to determine which, if any of these systems are potentially lending to the progressive nature of their scoliosis. In the event an
imbalance is identified, certain procedures and exercises can be prescribed which are designed to improve the systems in question.
Muscle spindles in the paraspinal musculature of patients with adolescent idiopathic scoliosis. Ford DM, Bagnall KM, Clements CA,
McFadden KD. SPINE 1988 May:13(5):461-5
Does neurological testing lead to treatment changes?
Patients with scoliosis are known to have neurological dysfunction which contributes to the progressive nature of scoliosis, as well as
interfering with the rehabilitation of posture in the adult and child. Studies have identified an increased incidence of brainstem
and cerebellar abnormalities such as brainstem hypoplasia and Arnold Chiari Malformation in patients with Scoliosis. Certain findings such
as cervical lordosis, thoracic kyphosis, abnormal Somatosensory evoked potentials (SSEP) and nystagmus on electronystagmographic testing
have been linked to neurogenic causes of scoliosis. In the event neurological dysfunction is identified, MRI imaging may be necessary.
Other interventions may include neuromuscular rehabilitation which can be offered on an individual basis. Vestibular and oculomotor
dysfunction has been shown to respond to personalized treatment programs, which are designed to re-educate the brain perception of
subjective postural vertical.
Do you use chiropractic care in every case?
In cases of adult scoliosis, bending radiographs and functional assessments can be helpful in identifying areas of spinal subluxation
which can lead to arthritic changes in the spine as well as proprioceptive and muscular imbalances. These conditions require
specialized chiropractic adjustments or physiotherapy procedures to improve range of motion and the normal coupling in spinal
mechanics. In cases of adolescent or juvenile scoliosis, chiropractic may be appropriate to increase the frequency of firing of
certain neural pathways. Each patient is evaluated on and individual basis and recommendations are made accordingly.
Do you take bending x-rays on children as well as adults?
Bending radiographs are utilized to determine the beginning and the end of certain curvatures, as well as to assess the relative flexibility
of the curvatures. Although rare, if there is a clinical necessity, bending films may be taken on either children or adults.
Why do you recommend myofascial release technique be performed on the muscles of the concavity?
Physiotherapy techniques have been successfully utilized in scoliosis treatment for the past sixty years. Myofascial Release Technique
(MRT) is designed to neurologically inhibit the connective tissues which become fibrotic when a muscle is in a shortened state for a
prolonged period of time, thereby preparing the muscle to be lengthened.
Why do you discourage slow stretching of the concavity musculature?
Slow stretching causes an overall increase in resting muscle tone, and is therefore not recommended on the concavity musculature. Techniques
which utilize fast stretch can be successful in reducing muscle tone and therefore are recommended on the concavity musculature.
What involvement do platelets have in Scoliosis?
Blood platelets have been found to be abnormal in children with scoliosis. It is believed that the similarities between platelets and
muscle spindles as contractile proteins makes them susceptible to genetic influences present in Idiopathic Scoliosis. In a study performed
by Dr. Lowe at the University of Nottingham, platelet changes were linked to paraspinous muscle activity in children with Scoliosis.
Platelet calmodulin levels in adolescent idiopathic scoliosis (AIS); can they predict curve progression and severity"? Eur Spine J.
2004 May:12(3):257-65. Epub 2004 Jan 9
Can adult pain syndromes be related to the brain?
A recent article in The Journal of Neuroscience, November 17, 2004, 24(46):10410-10415 highlighted the relationship of the brain to back pain.
See below:
Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density
A. Vania Apkarian, Yamaya Sosa, Sreepadma Sonty, Robert M. Levy, R. Norman Harden, Todd B. Parrish, and Darren R. Gitelman
We compared brain morphology of 26 chronic back pain (CBP) patients to matched control subjects, using magnetic resonance imaging brain
scan data and automated analysis techniques. CBP patients were divided into neuropathic, exhibiting pain because of sciatic nerve damage,
and non-neuropathic groups. Pain-related characteristics were correlated to morphometric measures. Neocortical gray matter volume was
compared after skull normalization. Patients with CBP showed 5-11% less neocortical gray matter volume than control subjects. The magnitude
of this decrease is equivalent to the gray matter volume lost in 10-20 years of normal aging. The decreased volume was related to pain
duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain. Regional gray matter density in 17 CBP patients was
compared with matched controls using voxel-based morphometry and nonparametric statistics. Gray matter density was reduced in
bilateral dorsolateral prefrontal cortex and right thalamus and was strongly related to pain characteristics in a pattern distinct
for neuropathic and non-neuropathic CBP. Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology
of chronic pain includes thalamocortical processes.
Why do you use Russian Stimulation on the muscles of the convexity?
Studies confirm the muscles of the convexity undergo atrophy due to disuse. Electrical stimulation at a frequency of 2500hz has been
successfully used to create muscle contraction and ultimately muscle hypertrophy in denervated or under used musculature. Proprioceptive
activation is another benefit leading to increased somatotopic representations of the deformed area of the trunk and thorax.
Do you have any Athletes under your care?
Our patients include an Olympic Skier, competitive gymnasts, a Champion Golfer, an ice skater, and many ballerinas, all who are able to
continue to practice and compete in their sports while wearing our brace.
Do you accept non-traditional cases?
Dr. Gary Deutchman and his team has successfully managed children and adults with scoliosis secondary to Cerebral Palsy (CP), Prader
Wilie Syndrome, Polio, Ehrler Danlos Syndrome, Spinal Muscle Atrophy (SMA), Post Stroke, and Parkinsonism.
Why do you recommend treating mild
curvatures? I've been told even a moderate
curvature is harmless
Ventilatory Functional Restriction in
Adolescents
with
Mild or Moderate Idiopathic Scoliosis
Barrios
and coworkers recently demonstrated, for the
first time,
that patients with mild and moderate
idiopathic scoliosis have
impairment of cardiopulmonary function.
Those investigators
noted a worse tolerance to maximal exercise
testing, lower ventilatory
efficiency at maximal exercise, an earlier
anaerobic
threshold, and a lower normalized maximal
aerobic capacity in
subjects with scoliosis than in matched
nonscoliotic controls.
That important study received the Hibbs
Award for clinical research
at the annual meeting of the Scoliosis
Research Society in
2002. The study established that there is
impairment of cardiopulmonary function even
in patients with mild and moderate
scoliosis, necessitating a reassessment of
our understanding of
and approach to mild and moderate scoliosis
as a benign condition.
Individuals with idiopathic scoliosis had a
significantly
lower tolerance to maximal and submaximal
exercise but did not exhibit significant
cardiopulmonary restrictions.
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