scoliosiscarecenters-blog

[scoliosiscarecenters-blog]

Did you know you can quickly and easily calculate the risk a scoliosis curve (idiopathic) has to progress? Based on scientific evidence and publications this calculator makes it easy to tell your risk

[scoliosiscarecenters-blog]

5 Things to Know Before Choosing Your Scoliosis Treatment Provider

Choosing a scoliosis treatment provider is a difficult task. There are multiple types of treatment options all claiming to be better than the other. Many treatments are expensive, some treatments look extremely painful, other treatments look like they’re a huge time commitment, and others just don’t seem like they’d actually work. In an ideal world, you could simply do some stretches and your spine would miraculously straighten out. Unfortunately, that’s not usually the case for most scoliosis curves. So, how do you choose which scoliosis treatment is right for you? Before you either spend a lot of money, waste a lot of time, or do a treatment that’s irreversible – these are 5 things you should know before choosing your scoliosis treatment provider.

1. There are Multiple Types of Scoliosis

It’s extremely important to know which type of scoliosis you have prior to choosing a provider, as some types are much more difficult to treat as well as time sensitive. Some of the different scoliosis types include Congenital Scoliosis, Degenerative Scoliosis, Neuromuscular Scoliosis, and Adolescent Idiopathic Scoliosis. Among the different types, the most common type of scoliosis by far is Adolescent Idiopathic Scoliosis, also sometimes just referred to as Idiopathic. It is commonly believed that Idiopathic Scoliosis has no known cause; however, there have been multiple hypotheses on what the cause might be. For more information on what Scoliosis Care Centers has found to be the most common root cause, read The Root Cause of Adolescent Idiopathic Scoliosis.

2. There are Two Main Categories of Scoliosis Treatment

In a broad classification, there are two core types of scoliosis treatments; nonsurgical treatment and scoliosis surgery. With scoliosis surgery, there are two main options as well, Spinal Fusion Surgery and Vertebral Body Tethering. Both options are invasive (as surgery tends to be) Spinal Fusion Surgery is entirely irreversible and while VBT can be reversed on occasion, that is contingent upon the type and point of entry. There are a variety of different nonsurgical treatment options which include, but are not limited to, Scoliosis Soft Bracing, Scoliosis Hard Bracing, Traction Devices, Scoliosis Exercises, Schroth Therapy, and multiple combinations of those used in tandem (AKA a comprehensive treatment).

3. Time is of The Essence

Idiopathic scoliosis curve progression is directly correlated with increased rate of growth. In other words, the spinal curvature can quickly spiral out of control during growth spurts. Nonsurgical treatment works best while the body is still growing as the spine is not skeletally mature. The “wait and see” method of monitoring annually and taking no action is not a good strategy when you’re still growing. This begs the question –“How do I know if I’m done growing?” Doctors factor in a couple of things when assessing whether you’re still growing. First and foremost, age. If you’re 11 years old, it is highly likely you’re still going to grow. Secondly, if you’re female, if you haven’t had your first menses, you’re probably still going to grow. Lastly, doctors look at your Risser stage. Your Risser stage is determined by analyzing the ossification in the iliac crest or the growth plate in a hand through either an X-ray image or MRI. The stages go from 0-5, with 5 being skeletally mature.

4. Understanding Your Scoliosis Curve Measurements

The curvature of the spine is measured by calculating the angle of the topmost tilted vertebrae above the apex of the curve with the bottom-most tilted vertebrae. Where the lines intersect is the Cobb angle. The severity of scoliosis is determined by the Cobb angle. The ranges are as follows: 10-24 degrees is mild scoliosis, 25 to 39 is moderate scoliosis, and 40 degrees and above is severe scoliosis. 40 degrees is also the surgical threshold – most surgeons will not operate until the curve exceeds this measurement. There are two types of spinal curves, S-curves and C-curves. S-curves have two main curves. When referring to the severity of an S-curve, doctors will usually refer to the higher Cobb angle (see example). Given that S-curves have two main curves rather than one, they are generally more difficult to treat. That said, contrary to popular belief, S-curves can still be treated non-surgically, even severe cases.

5. Not All Scoliosis Braces are Created Equal

Scoliosis bracing is the most well-known method of non-surgical treatment. It is also one of the most heavily ridiculed, and for good reason. Although some braces are effective at straightening the spine, there are plenty of other braces that actually make the curve worse. That said, it’s important to point out that, through extensive studies, scoliosis bracing is the only nonsurgical treatment method proven to provide scoliosis curve reduction beyond a reasonable doubt. To ensure that you choose the best brace possible for your specific curve, here are some traits to look for in brace design:

A) Custom bracing — every spine and scoliosis curve is different, so every brace should be too. Avoid generic one-size-fits-all braces.

B) The spine will never be straighter than the brace makes it — if your spine is not straighter in-brace than it is out-of-brace, then it is not doing its job. The purpose of the brace is to hold the spine in a straighter and centered position.

C) Part-time bracing — for very small curves you might be able to get away with just a nighttime brace. However, as a general rule of thumb, the brace only works when you wear it, thus the longer you wear it, the better the results. This is only valid if point ”B” is true. So, if a brace is advertised as only needed to be worn for a few hours a day it is likely to be ineffective.

D) Monitoring the performance — arguably the most important thing in any brace design, it is critical to CHECK IF THE BRACE IS REDUCING THE CURVE. An in-brace X-ray or standing MRI (preferably standing MRI to avoid radiation) should be taken immediately after fitting to test the effectiveness of the brace and identify areas for improvement. The brace should be monitored every three months after initial fitting to ensure it’s still providing adequate correction.

If you’re interested in learning more about Scoliosis Care Centers’ nonsurgical scoliosis treatment, visit our treatment page or contact one of our case managers to discuss today!

[scoliosiscarecenters-blog]

7 Ways to Make Your Non-Surgical Scoliosis Improvement Last

A common concern of many parents who come to our clinic is “Will the changes last?”.  Meaning, “If my child’s spine grows straighter, what will make it stay that way?” Maybe a parent heard a story of a child going to a clinic to receive care where child’s spine improves, however, the improvement was only temporary and the scoliosis returned in greater severity.  These stories are real, and we have heard them first hand from patients coming to us from other non-surgical clinics.  With the looming threat of invasive surgery and horror stories of spines growing uncontrollably crooked, is there any way to be certain that one can win the fight against scoliosis and stay out of surgical range for good?

The good news is that there is a way to be certain of your successful outcome with non-surgical scoliosis treatment. Once you gain a straight spine, we know how to assure it stays that way. We have your problem solved.  One by one we can eliminate the reasons for your child’s spine to have scoliosis. Here’s how

Make the spine as straight as possible. Research generally supports the observation that a smaller scoliosis tends to be more stable and less prone to relapse.1  So, finishing with as small a curve as possible must be one of our key goals.  Thankfully we have tools that can help even large curves grow smaller.  For example, our Scoliosis Flexibility Trainer helps free up a stuck scoliotic spine to allow it to straighten out and untwist.  Our Silicon Valley BraceTM holds the progress made by the Scoliosis Flexibility Trainer.  Here is an example of a large scoliosis being “untwisted” and straightened by such a treatment tool and then following the treatment by wearing the SV Brace.

Hold the new ground you’ve gained for at least a year – and until fully grown (skeletal maturity). The longer you hold the “new”, more straightened spine, the spine becomes more stable and “cemented” into this new position.  This is much like orthodontic braces.  Once the spine is moved into its new corrected alignment, it must be held there for a period of time to make this change a permanent one.  Here is a graph of a child’s spine growing straighter over time.  It would be tempting to want to stop treatment at the red line mark.  That is where the patient has experienced significant straightening of the spine.  However, stopping treatment here would likely have allowed the curve to worsen again.  Notice the yellow arrow where we see a spike in the size of the patient’s curve.  This is where the patient experienced their rapid adolescent growth spurt.  To make the changes last, we need to continue the treatment all the way to the finish line, which usually is when the child is done growing (checkered flag).

Neutralize the root cause of your scoliosis. In other words, “Get rid of the driving force” that makes the spine want to coil down into a larger scoliosis.  That driving force, in most cases, can be identified and treated.  Usually, this is due to a short or tight spinal cord.2–5  Special neuro-elongation methods can be used to lengthen the short spinal cord safely, thus freeing up the spine to extend back into a straighter alignment.  When the driving force of the scoliosis is completely neutralized and the spine has been held straight for a solid period of time, a stable improvement can be attained.

Correct the scoliosis while the spine is still growing. Scoliosis gets worse the fastest when a child’s spine is at its highest rate of growth6,  however, this is also true in reverse; when a child’s spine is held straight during growth some of our fastest curve reductions are seen.  The bones can be more easily shaped and molded back into their desired (straight) shape.   Once a growing spine is held straight, like a green twig, it will soon turn into a strong branch which resists future change.  Similarly, a curve made straight during growth leads to a strong, straight spine that will last.  This graphic, used in Dr.Mehta’s study on “Growth As a Corrective Force”, illustrates this point beautifully by demonstrating how correcting the spine during growth leads to permanent correction as an adult. 7

Center the spine over the pelvis. When the upper body falls off to one side of the pelvis, this makes the spine unstable and allows the curve to worsen even in adulthood.8   By correcting the alignment of the posture and bringing the spine back to the center of the pelvis, stability is gained.  Here is what that looks like:

Train the muscles and brain to hold your new alignment. It is possible to utilize “weighted” exercise devices that will re-train the body and mind to automatically hold the newly aligned posture. Here is an example of a patient with a 60-degree curve training their spine straight in an exercise:

[scoliosiscarecenters-blog]

Can Chiropractic Help, Fix, or Cure Scoliosis?

While chiropractic adjustments may be effective for the reduction of pain in scoliosis, they generally are not effective in the correction of the curvature of adolescent idiopathic scoliosis. 1,2  Attempting to rely solely on chiropractic adjustments for the treatment of a childhood scoliosis can potentially lead to harm, as idiopathic scoliosis can rapidly worsen during the child’s peak rates of growth if a brace is not worn.3  Highly corrective 3-D braces are the most proven tool in the success of treating scoliosis in growing spines. 4,5

Surprisingly, learning how to straighten a scoliosis curve is not a requirement in most chiropractic schools, and most chiropractors are not adequately prepared to deal with treating adolescent scoliosis.  However, Chiropractors can elect to become trained in bracing and exercise methods specific for adolescent scoliosis, enabling them to provide effective care in the management and possibly reduction, of adolescent scoliosis.

Part of the confusion regarding what chiropractic can and cannot do for scoliosis lies in understanding the term “chiropractic”.  When someone says “chiropractic”, they could mean one of two things:

Chiropractic manipulation or adjustments. Chiropractic adjustment refers to the art of manipulating individual vertebra, often by hand, to improve the alignment or function of the spine.  This often may produce a “crack” sound from the joints, and many know this as “cracking the back”.

Chiropractic may also be used to describe the general practice of chiropractic, much like the term “medicine” can be used to describe the practice of medicine. The general scope and practice of chiropractic includes more than just chiropractic manipulation.  The practice of chiropractic may include exercises, physiotherapy, bracing, orthotic supports and, of course, diagnostics; all as it pertains to neuro-muscular-skeletal problems of the human body.  In this sense of the definition, saying “chiropractic” does NOT mean a chiropractic adjustment, but rather the practice of chiropractic as a holistic, non-surgical method for the care of the human body.

Both of the above uses of the term “chiropractic” are correct uses.  When asking the question. “Does chiropractic help scoliosis?” the question could mean two things:  “Can Chiropractic Adjustments help scoliosis?” or it could mean “Can a chiropractor, practicing chiropractic, help scoliosis”.  The answer to the first question is often, “No”, but to the second question, it may be “Yes.”

Some Scoliosis May Straighten With Chiropractic Adjustments, While Others Grow Rapidly Worse

There lies one more point of confusion with our question, “Can Chiropractic help scoliosis?” The condition of “scoliosis” has many different sub-types, some of which are aggressive, highly deforming and worsen rapidly.  Other kinds of scoliosis are benign and stable, tending to stay the same over time, or are even self-resolving.  Let’s begin with the broad definition of scoliosis.

Scoliosis – Any curve in the spine over 10 degrees of Cobb angle.

The above definition of scoliosis does not distinguish between stable and progressive curves.  The severity of scoliosis and its tendency to rapidly worsen depends on its causes.  For the sake of this article, let’s divide scoliosis into two groups: a group in which scoliosis can be benign and self-limiting, and a group in which scoliosis tends to be progressive and very deforming to the spine.

“Functional Scoliosis” – Benign, Self-Limiting Scoliosis.  These are generally small curves and do not involve significant twisting or deformity of the rib cage.  These curves can be easily reversed with little or no permanent structural change.  The chiropractic profession has reported good success in correcting these types of curves with chiropractic manipulation, heel lifts, and physiotherapy.  Examples include:

• Short Leg Scoliosis – When one leg is shorter than the other, it causes a tipped pelvis and usually only a small, functional scoliosis. Wearing a heel or full foot lift often solves the problem. •Acute Antalgic Scoliosis – When someone injures a disc in their back they will lean away from the painful position. Leaning away from pain is referred to as “antalgia”.  When acute antalgia results in a curve over 10 degrees, this is referred to as antalgic scoliosis.  Typically the scoliosis resolves as the pain alleviates allowing a return to normal posture and alignment. • Postural Scoliosis – Children can appear to have scoliosis due to a wiggly, unstable posture. Standing in a shifted or tilted position may result in a Cobb angle measure of more than 10 degrees, but will lack the characteristic 3-dimensional twist of the spine and rib cage.  These will often resolve as the child acquires better postural stability or maturity.  Chiropractic adjusting can sometimes help a child develop better postural stability, improving their functional, postural “scoliosis”.

“Structural Scoliosis” – Aggressive, Rapid-worsening-with-Growth Scoliosis.  Structural scoliosis often begins as small, functional curves that rapidly grow into large, structural curves.  This can make it difficult to tell the difference between the two types in the early stages of curve development.  By the time one realizes that they are dealing with a severe problem, much damage can occur that is difficult to reverse without surgery.

• Adolescent Idiopathic Scoliosis Syndrome (AIS) – In growing children and adolescents, a new curve develops which is usually caused by a tight spinal cord. The faster the child grows, the faster the curve tends to get worse.  The key difference between just a “scoliosis” (small curve or distortion) and AIS is that AIS will typically grow rapidly worse and includes twisting deformity of the spine and rib cage.  Adolescent scoliosis curves of 25 degrees or more, and with a Risser skeletal maturity below 3, are at high risk for rapid worsening with growth.

Orthopedic surgeons routinely tell our patients that “Chiropractic cannot help scoliosis.  What I believe they are trying to convey is, “Chiropractic manipulation will not reliably help adolescent idiopathic scoliosis syndromes grow straight.”  This is a true statement, since utilizing chiropractic adjustments alone for the correction of adolescent idiopathic scoliosis has been repeatedly demonstrated to be ineffective. 1,2

• Neuromuscular Scoliosis – These are usually moderate to severe scoliosis curves caused by neuromuscular disorders such as cerebral palsy, muscular dystrophy, or any other neuromuscular disorder.  This type of scoliosis will usually not straighten in response to chiropractic manipulation. • Congenital Scoliosis. In this type, a child is born with asymmetric bones in the spine or ribcage, causing scoliosis.  They may or may not aggressively worsen with growth, but will not straighten in response to chiropractic manipulation.

The Problem of Misdiagnosis:  Mistaking Aggressive Structural Scoliosis for a Benign Functional Scoliosis

Many chiropractors have experienced the success of seeing a small, functional 10 or 15-degree scoliosis curve dramatically reduce in response to chiropractic adjustments.  A chiropractor may lack awareness of the critical differences between functional scoliosis and structural adolescent scoliosis.  Past success experienced in treating a functional curve may be mistakenly extrapolated to potential success in treating rapidly progressing adolescent idiopathic scoliosis.  A well-meaning chiropractor may sincerely believe that they can provide the same result for the adolescent idiopathic scoliosis as they did for the functional.

Even if a chiropractor is aware of the critical differences between a functional case and a structural adolescent scoliosis, the two can be very difficult to differentiate, especially since the structural AIS case first begins as a small and flexible curve.  Structural scoliosis curves, such as AIS, always begin as small curves that appear quite similar in presentation to the benign functional type.  Misdiagnosing the type of scoliosis can allow for rapid curve progression into a severely twisted and disfiguring scoliosis.  Mistaking the identity of the type of curve being dealt with is a common problem when a growing child with scoliosis presents to a doctor’s office.

Functional Scoliosis

It can be difficult to tell the difference between a curve that is merely functional and one that is structural and progressive.

Both curves were treated without a brace, with chiropractic adjustments and scoliosis specific traction.

Structural Adolescent Idiopathic Scoliosis (AIS)

The functional curve responded beautifully to scoliosis-specific chiropractic adjusting and traction.

The Adolescent Idiopathic scoliosis case grew progressively worse.

3 Basic Chiropractic Treatment Regimens

There are 3 basic categories of treatment regimens used by chiropractic professionals when treating scoliosis. They are Chiropractic Adjusting, Scoliosis Specific Therapy, and Bracing.

1. Chiropractic Adjustments (No Brace).

Small, functional scoliosis curves in the range of 10-20 degrees may be safe and effective to treat with chiropractic adjustments alone if the patient is not growing.  Evidence of effectiveness on treating scoliosis in this range is weak but does exist in the scientific literature.6,7 Adolescent Idiopathic scoliosis, with curve size exceeding 25 degrees in a growing spine, should NOT be treated with Chiropractic Adjustments alone for curve correction.  

2. Brace-less, Scoliosis Specific Therapy (Exercises & Traction)

When it comes to structural adolescent idiopathic scoliosis cases over 25 degrees in size, which are still growing and skeletally immature, there is no solid evidence for good long-term success rates utilizing these methods without a brace.  Some successful cases of reducing structural scoliosis without a brace are reported, primarily in scoliosis cases that are toward the end of growth or beyond the peak adolescent growth spurt.6,8,9

There are numerous anecdotal reports of growing adolescent cases initially responding to brace-less treatment, only to continue to grow worse over the long-term.  This matches the published literature on the matter.  For example, one study tracked progress over 6 weeks of brace-less traction and exercise treatment.  Significant curve reduction was reported at the 6-week mark but did not have any follow-up beyond the reported 6 weeks.11  A similar study on the same method tracked patients over 6 months and reported significant long-term worsening of a majority of skeletally immature patients.10

Sadly, these results mirror our past experience in attempting to treat AIS in growing kids without a brace. Our clinical observation found an unacceptably high failure rate when utilizing these methods without a brace in children with growing spines (Risser 0-3).

Most successes arising out of these brace-less approaches are in cases that have the following characteristics:

Skeletally mature, or nearing the end of the adolescent growth spurt (Risser 3 or above)

Low Thoracic Apex – When the apex of the curve is below the rigid bulk of the rib cage, greater improvement may be seen as the spine is more flexible in this area.

Translational – There is a large shift of the upper body to one side, and the pelvis to the opposite side. Simply centering the body over the pelvis often results in significant reduction of the scoliosis.

C-curves, NOT S-curves – Translational S-curves, in our observation, do NOT respond significantly to brace-less treatments.

Flexible curves. Many small to moderate curves that are highly flexible and toward the end of growth have good potential for improvement with scoliosis-specific therapy.

Case Features

• Skeletally mature • Low Thoracic Apex (T12) • Translational • C-shaped • Flexible

Results

Chiropractic failure utilizing: • No Rigid Brace • Scoliosis Traction • Scoliosis Exercises • Manipulation

So, while there has been limited success in treating scoliosis without braces, it is usually in lower-risk cases that are skeletally near maturity.  Remember, treating adolescent scoliosis without a brace tends to have a high failure rate; meaning for each success, there are also many failures.

Case Features

• Skeletally Immature (Risser 0) • High Thoracic Apex • Some Translation • S-Curve in Making • Rigid, even at small size

Results

Chiropractic failure utilizing: • No Rigid Brace • Scoliosis Traction • Scoliosis Exercises • Manipulation

3. Brace-Based Therapy (Using a brace and may include exercises, traction, and adjustments listed above.)

If your child has a curve over 20 to 25 degrees and is growing, brace-based scoliosis therapy has been shown to be the most effective. The two most researched treatment regimens for adolescent idiopathic scoliosis are A) Bracing in conjunction with scoliosis specific exercises, and B) Bracing alone; both of which have shown promise.  The more corrective the brace and the more the child wears it, the better the expected outcome.

A handful of chiropractors around the world have become proficient in bracing methods for managing AIS, and are capable of successfully navigating the challenges of a growing spine.  The braces used by chiropractors have included SpineCor, Gensingen, Rigo-System-Cheneau, ScoliBrace, and the Silicon Valley Brace.  Scoliosis-specific therapies will usually be included with the bracing regimen, often with the hope of improving the effectiveness of the brace treatment.12–14

Warning Signs of Chiropractic Mismanagement of Adolescent Idiopathic Scoliosis

Depending solely on chiropractic adjustments

Anti-Brace. Published research is conclusive on this matter:  Wearing a scoliosis brace drastically reduces progression into surgical ranges.3

Ignoring Growth. The faster a child is growing, the faster the curve may worsen.

Ignoring Bone Age. Knowing bone age helps predict future growth spurts.

Misuse of X-rays.  Misuse of X-ray can occur in a number of ways.

The Scoliosis Curve is Growing Worse

Examples of X-ray Misuse

Signs of Good Chiropractic Management of Adolescent Idiopathic Scoliosis

Dependence on a highly-corrective, 3-dimensional scoliosis brace

Regular Imaging of the scoliosis (spine) with low-dose, shielded X-rays or with standing MRI every 3 to 6 months. Results are used to help keep the spine growing straighter.

Monitoring Growth

Monitoring Bone Age

The Scoliosis Curve is Growing Straighter

So, can Chiropractic cure scoliosis?  If by Chiropractic, we mean chiropractic adjustments, and by scoliosis, we mean adolescent idiopathic scoliosis, then the answer is, “No.”  Chiropractors can, however, become knowledgeable and skillful in proven interventions for helping a growing adolescent with scoliosis. Chiropractor Jeb McAviny put it well in saying, “Chiropractic specific treatments of spinal manipulation and rehabilitation should not be recommended over treatments that have demonstrated evidence, such as bracing and scoliosis specific rehabilitation programs.”2,3

Chiropractors can and should become trained in the utilization of scoliosis braces if they intend to manage conditions such as adolescent idiopathic scoliosis.  Utilizing the Silicon Valley Scoliosis Method, a 100% success rate is being attained with scoliosis cases under 25 degrees, and a 95% success rate in treating high-risk cases between 25 and 39 degrees.  Some cases as high as the 30’s are able to reduce their curve size to below 10 degrees and become scoliosis-free, which, so far, is the closest thing there is to a scoliosis cure without surgery.

References

Lantz CA, Chen J. Effect of chiropractic intervention on small scoliotic curves in younger subjects: a time-series cohort design. J Manipulative Physiol Ther 2001;24:385–93.

McAviney J. Chiropractic treatment of scoliosis; a systematic review of the scientific literature. Scoliosis 2013;8:O15.

Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013;369:1512–21.

Aulisa AG, Guzzanti V, Falciglia F, Galli M, Pizzetti P, Aulisa L. Curve progression after long-term brace treatment in adolescent idiopathic scoliosis, Comparative results between over and under 30 Cobb degrees – SOSORT 2017 award winner. Scoliosis Spinal Disord 2017;12:36.

Mauroy JC de, Pourret S, Barral F?d?r. Immediate in-brace correction with the new Lyon brace (ARTbrace), Results of 141 consecutive patients in accordance with SRS criteria for bracing studies. Ann Phys Rehabil Med 2016;59:e32.

Byun S, Han D. The effect of chiropractic techniques on the Cobb angle in idiopathic scoliosis arising in adolescence. J Phys Ther Sci 2016;28:1106–10.

Romano M, Negrini S. Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review. Scoliosis 2008;3:2.

Haggard JS, Haggard JB, Oakley PA, Harrison DE. Reduction of progressive thoracolumbar adolescent idiopathic scoliosis by chiropractic biophysics® (CBP®) mirror image® methods following failed traditional chiropractic treatment, A case report. J Phys Ther Sci 2017;29:2062–7.

Bettany-Saltikov J, Turnbull D, Ng SY, Webb R. Management of Spinal Deformities and Evidence of Treatment Effectiveness. Open Orthop J 2017;11:1521–47.

Stitzel CJ, Dovorany B, Morningstar MW, Siddiqui A. Clinical evaluation of the ability of a proprietary scoliosis traction chair to de-rotate the spine, 6-month results of Cobb angle and rotational measurements. Clin Pract 2014;4.

Morningstar MW, Woggon D, Lawrence G. Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. BMC Musculoskelet Disord 2004;5:32.

Romano M, Negrini A, Parzini S, et al. SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis 2015;10.

Schreiber S, Parent EC, Hill DL, Hedden DM, Moreau MJ, Southon SC. Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis, How many patients require treatment to prevent one deterioration? – results from a randomized controlled trial – “SOSORT 2017 Award Winner”. Scoliosis Spinal Disord 2017;12:26.

Kwan KYH, Cheng ACS, Koh HY, Chiu AYY, Cheung KMC. Effectiveness of Schroth exercises during bracing in adolescent idiopathic scoliosis, Results from a preliminary study-SOSORT Award 2017 Winner. Scoliosis Spinal Disord 2017;12:32.

[scoliosiscarecenters-blog]

What is the Difference Between Scheuermann’s Hyperkyphosis and Scoliosis

Scoliosis and kyphosis both refer to some kind of abnormal curvature of the spine that can lead to discomfort and pain if the situation is severe enough. However, while they are both conditions that affect the spine, there are some differences between the two that are worth noting.

Scoliosis

Scoliosis is a spinal condition that presents as a lateral bend in the spine along with vertebrae that have twisted out of normal alignment. People suffering from this condition may also experience a loss of normal spinal curves, which can impact posture, appearance, and more.

While it is possible for newborns to have scoliosis, it usually doesn’t develop until later in their adolescence. That does not, however, mean that it is strictly a problem for children because it is also an issue with the adult spine.

Of course, every case is different, and the curve in the spine can range from very mild to very severe.  The root cause of the curvature may be very different, too, and understanding the cause is extremely important to help determine the treatment.

The three root causes of scoliosis include:

• Nerve tension – This is likely the most common cause and occurs when tumors or cysts or something like Tethered Cord Syndrome cause the spine to coil down into scoliosis.

• Structural causes – Sometimes the bones are abnormally shaped or half-formed. Sometimes one leg may grow longer than another. There are also cases where ligament damage or trauma can lead to scoliosis.

• Neuro-muscular pathology – If there is a disconnect in the body’s control system (the brain or the nerves) then the muscles may not work correctly, leading to a bent spine.

Kyphosis

Kyphosis is actually a perfectly normal condition in which the spine bends forward. Hyperkyphosis is when the spine bends forward more than normal. If the condition is severe enough, it can give the back a rounded appearance. Like scoliosis, this condition usually becomes visible once a child hits adolescence, but usually only becomes painful in extreme cases.

There are several potential causes of hyperkyphosis, including everything from poor posture to osteoporosis to spine tumors. There are three basic types of kyphosis that can be diagnosed in adults:

Age-associated – Eventually, as bones lose calcium and the discs degenerate through the aging process, kyphosis may result.

Post-traumatic – This is one of the most common forms and usually results after a person has fractured one or more of their vertebrae through an injury.

Scheuermann’s kyphosis – This form usually develops during adolescence but can progress into adulthood. In this case, the abnormal shape of the vertebrae can lead to a stiff spine.

Non-Surgical Treatments

Whether you are suffering from hyperkyphosis or scoliosis, there are some non-invasive, non-surgical treatments that can help correct the curvature and stabilize the spine. This, in turn, can help improve neurological function and alleviate the pain.

At Scoliosis Care Centers, our goal is to get our patients back to doing what they love. We also believe that finding the best treatment starts by determining the cause of the spine twists and bends. Once we know that, we can begin to help the patient with our safe and effective treatments.

We employ Schroth physical therapy and the Silicon Valley Method as well as several other forms of exercise to help improve posture, minimize pain or discomfort, and get our patients back to their normal lives.

We also understand that everyone’s situation is different, and your spinal problems may be impacted by other health conditions. Through these therapies, we can help individual patients achieve improvements in body appearance, lung capacity, and sitting standing and walking postures.

Of course, continued success requires continued effort, so we also help you learn proper body mechanics to help protect your spine as you go throughout your daily activities.

You don’t have to keep putting up with the pain and discomfort associated with scoliosis or kyphosis. Contact us today and we’ll get started with a detailed evaluation of your situation.

[scoliosiscarecenters-blog]

A key factor in both determining the necessity for scoliosis treatment as well as the quality of the treatment provided is the aesthetic postural improvement. This page simply lists many of the before and after results of patients who have done at least 3 months of our scoliosis treatment.

[scoliosiscarecenters-blog]

All of the following images display posture correction achieved through nonsurgical scoliosis treatment. The treatment programs included the silicon valley scoliosis brace, scoliosis exercises, the scoliosis flexibility trainer, and root cause treatment. 

[scoliosiscarecenters-blog]

Scoliosis Nonsurgical Treatment Results. The graphs illustrate the time allotted during treatment and the current state of the spine now. 

[scoliosiscarecenters-blog]

Mild scoliosis treated with nonsurgical treatment at scoliosis care centers. Treatment methodology included the Silicon Valley Scoliosis Brace, Scoliosis Flexibility Trainer, scoliosis exercises, and more. 

[scoliosiscarecenters-blog]

Reducing a 90-degree curve without surgery. For more information visit scoliosiscarecenters.com

[scoliosiscarecenters-blog]

Avoided surgery using the Silicon Valley Method only available at Scoliosis Care Centers

60-degree curve reduced to below 40 degrees in 10 months using the Silicon Valley Method from Scoliosis Care Centers. This includes a back brace, scoliosis exercises, and the flexibility trainer. For more information visit scoliosiscarecenters.com

[scoliosiscarecenters-blog]

What is Adolescent Idiopathic Scoliosis?

Adolescent Idiopathic Scoliosis (AIS) is an abnormal curvature of the spine exceeding 10 degrees, diagnosed in adolescence and in which the cause is unknown.  The deformity occurs with rotational misalignment, often marked by a hump in the ribs or low back, as well as loss of the normal sagittal curves of the spine.

• Adolescent: The diagnosis is made in adolescence. • Idiopathic: The reason for the scoliosis has not yet been determined. The term “Idiopathic” comes from Greek and literally translated would mean “one’s own private suffering”.  A case will be labeled “idiopathic” if there are no obvious neuromuscular diseases, genetic syndromes or congenital malformations. • Scoliosis: Three-dimensional deformity of the spine marked by both curvature beyond 10 degrees as well as a twist

Misuse of “Adolescent Idiopathic Scoliosis” Diagnosis

In practice, AIS is used as a final diagnosis for adolescent scoliosis with a specific, recognizable pattern of symptoms.  Rather than as an admission we don’t have a diagnosis yet, AIS is being treated as the diagnosis. When one receives the diagnosis of AIS, it should mean that the doctors have more work to do in an effort to understand the cause of the curve.   That being said, the types of cases that end up in the AIS category do present with characteristic syndrome features.  So, what is the AIS syndrome?

The Adolescent Idiopathic Scoliosis (AIS) Syndrome

Even though AIS is supposed to simply represent adolescents with scoliosis in which the cause is not yet known, there are many characteristic “syndrome-like” behaviors of curves in this diagnostic category.  Below are some of the key clinical features of AIS:

• Three-Dimensional. AIS is a true Three-dimensional scoliosis, having both a bend and twist of the spine, in contrast to postural deformities which have no twisting.  Such postural deformities, or “pseudo-scoliosis” cases, are not progressive and may occasionally respond well to traditional physical therapy or chiropractic intervention.  This is not the case with “true” Adolescent Idiopathic Scoliosis.  Confusion over what is a true scoliosis and what is a “pseudo-scoliosis” has led some chiropractors and therapists to erroneously conclude that they can treat or cure scoliosis.2 • “No Identifiable Cause”. In the traditional medical model, this means that obvious causes of scoliosis have been ruled out.  This means that the adolescent case of scoliosis has:

– No neuromuscular disorders (though mild “sub-clinical” neuromuscular deficiencies are observed with AIS3,4) – No congenital anomalies – No Genetic syndromes such as Marfan’s, Ehlers-Danlos, or any other known syndrome which is associated with scoliosis. AIS cases are otherwise healthy kids, with a progressive scoliosis of unknown cause.

• Progresses with growth. Adolescent Idiopathic Scoliosis progresses (worsens) with skeletal growth5,6.  The faster a child grows, the faster the curve becomes worse, and this worsening of the curve may continue for months after a growth spurt6.  The problem is, that while some AIS cases grow only slightly worse, others can grow severely worse and require highly invasive spinal surgery.  Predicting who is at risk for a severe curve is a key priority in the management of AIS.7 • Rapid worsening stops with skeletal maturity. As growth slows to a stop, rapid worsening of the scoliosis comes to an end.  From that point, as the child enters adulthood, AIS may or may not progress slowly over the decades.8  This may depend on variables such as the size of the curve, the location of the curve, and the postural balance of the spine.

• Adam’s Forward Bending Test is positive. The classic screening test for scoliosis, often performed by pediatricians and by school screenings, is the Adam’s Forward Bending Test9.  The standing child is instructed to bend forward while the examiner views the back from behind.  If a rib hump appears when the child is in the forward bent position, this is considered a positive test.  A more sensitive screening can be obtained through the use of a “Scoliometer” to measure the degrees of rib hump.10

• Structural Deformity. Characteristic structural changes can take place in both the muscles and bones of the spine.  Bear in mind that these changes begin with what is a normal, straight spine, but as the patient grows, the following changes can be observed:

– Rib Hump. Often the rib hump is first only observed when performing the Adam’s Forward Bending Test, and it will disappear upon returning to the upright posture.  Over time, rib humps transition from being present only when bending forward to being present when standing upright. – Flat Back. A flattening of the thoracic spine’s normal kyphotic curve will often precede any scoliosis bending or twisting.  It has been observed to be one of the first structural changes of scoliosis. – Rib hump and flat back? This may seem contradictory, yet the occurrence of both these phenomenon reveal great insight as to the probable cause of AIS.  Both of these changes allow for a shortening of the overall length of the spinal canal, which houses the spinal cord. – The Spinal Cord is the Center of the Twist. The spine coils-down around the axis of the spinal cord. – Structural changes in the soft tissue and bone. Bones, ligaments, muscles, and discs will change shape to accommodate the coiled-down posture of the spine.  This change in shape happens gradually as the curves persist during growth, and can become quite rigid as scoliosis matures.

• Skinny, tall and flexible females. AIS tends to be more common in females with low body mass11 and hyper-mobile joints12.  Female dancers and gymnasts seem to have a higher prevalence of scoliosis as they fit this stereotype.  However, there are also a fair share of normal and overweight females of average height with the condition.

• Characteristic Response to Treatment. In general, a true AIS case will have the following responses to treatment:

– AIS is Non-responsive to traditional physical therapy and chiropractic treatment13. – Bracing is the only non-surgical treatment shown to significantly reduce the risk of progression in high-risk case types (curves 25 + degrees, skeletally immature)14. – Scoliosis-specific exercises may help, though not without being used in combination with a brace. – Surgery is the primary treatment option if curve exceeds (or threatens to exceed) 40-50 degrees. – The belief among many doctors that AIS can only be helped by surgery is so strong, that if a case happens to improve with non-surgical treatment, it will often be concluded that, “It must not have been Idiopathic Scoliosis.” (Not that this is very scientific!) It is possible to effectively treat AIS without surgery, as well-designed clinical studies have revealed.14–20

• Tight spinal cord: Most AIS cases have a short, tight neural tissue within the spinal canal, such as a tight spinal cord or cauda equina.  When surgically correcting Adolescent Idiopathic Scoliosis, the short, tight spinal cord is what limits how straight the spine can be made.   The surgeon can remove all other hindrances to a straight spine, cutting out bone and soft-tissue contractures that bind the spine, however, one should not cut the tight spinal cord, for obvious reasons.

When a scoliosis is straightened, the canal that the spinal cord lies within becomes longer (taller), leading to a tensile stretch of the spinal cord.  The straighter the surgeon makes the spine, the more tension this can place on the cord.  Surgical straighten can pull the cord so tight as to cause paralysis. For this and other reasons, it is now standard procedure to monitor the status of the spinal cord so that over-straighten complications are avoided.21,22

The bottom line is, a common feature of AIS syndrome is a tight spinal cord.  It has been hypothesized that this tight spinal cord may be the cause of most cases.23–27

What Causes Adolescent Idiopathic Scoliosis?

All the structural changes that take place as a normal spine transitions into AIS can be explained by a tight spinal cord.  More accurately, tension anywhere along the spinal canal, also called the neural axis, can explain all the changes we see in the alignment of the spine.  The official name for this hypothesis first put forward by Dr. Roth is “Asynchronous Neuro-Osseous Development“28,29.  The theory states that as the child’s bones grow rapidly, the nervous system or spinal cord is unable to keep up the pace.  This results in tension along the axis of the spinal canal, which is relieved by the scoliotic posture.

The mere fact that surgeons are limited by this tightness should be a big hint as to the significance of the tight spinal cord observation. Here are some of the key structural findings of AIS that are 100% explained by tension along the spinal canal:

• Adam’s test is a nerve tension test. The scoliosis screening test known as Adam’s forward bending test, is a nerve tension test.  The forward bending posture of Adam’s test results in an elongation and stretch of the spinal canal.  Nerve tension increases in this forward bent position, and to relieve that tension the spine twists and collapses down like a spring.  This twisting is evidenced by the rib hump which appears when the child bends forward.

• “Flat Back” relieves the tight spinal cord tension. The Flat Back posture which precedes the onset of severe scoliosis is explained by nerve tension.  Flat back posture is simply the opposite of the forward bent posture.  Since the Adam’s forward bending Test increases stretch on the spinal cord, the flat back posture shortens the spinal canal, relieving nerve tension.

• Scoliosis itself is a posture that shortens the spinal canal, relieving nerve tension.

• Worsening with growth. Asynchronous growth between the spinal cord and the bones.  It is common sense that during growth spurts the bones are growing tall at a fast rate.  If the spinal cord is unable to keep up with this growth, a continual increase in nerve tension will occur.  More rapid growth means a more rapid increase in nerve tension.  Since scoliosis is a posture that shortens the spinal canal and relieves nerve tension, rapid growth results in rapid worsening and collapse of the scoliosis.

“Adolescent Idiopathic Scoliosis” should be a term reserved for a scoliosis curve that is still awaiting a diagnosis.  Clearly, it is not being used that way.  Rather, the term is being used as a diagnosis of a syndrome with the above features.  A preponderance of evidence points to a tight spinal cord as a probable cause for many cases.

So, if you or your child are told they have Adolescent Idiopathic Scoliosis, remember this:  It happens for a reason, its causes are knowable, and the condition can be successfully treated without surgery.  For more information on how AIS can be treated successfully without surgery, visit our scoliosis treatment page.

References

Burwell RG, Dangerfield PH, Moulton A, Grivas TB, Cheng JC. Whither the etiopathogenesis (and scoliogeny) of adolescent idiopathic scoliosis? Incorporating presentations on scoliogeny at the 2012 IRSSD and SRS meetings. Scoliosis 2013;8:4.

Byun S, Han D. The effect of chiropractic techniques on the Cobb angle in idiopathic scoliosis arising in adolescence. J Phys Ther Sci 2016;28:1106–10.

Cakrt O, Slaby K, Viktorinova L, Kolar P, Jerabek J. Subjective visual vertical in patients with idiopatic scoliosis. J Vestib Res 2011;21:161–5.

Antoniadou N, Hatzitaki V, Stavridis SΙ, Samoladas E. Verticality perception reveals a vestibular deficit in adolescents with idiopathic scoliosis. Exp Brain Res 2018.

Ylikoski M. Growth and progression of adolescent idiopathic scoliosis in girls. J Pediatr Orthop B 2005;14:320–4.

Cheung JPY, Cheung PWH, Samartzis D, Luk KD-K. Curve Progression in Adolescent Idiopathic Scoliosis Does Not Match Skeletal Growth. Clinical Orthopaedics and Related Research 2018;476:429–36.

Dimeglio A, Canavese F. Progression or not progression? How to deal with adolescent idiopathic scoliosis during puberty. J Child Orthop 2013;7:43–9.

Agabegi SS, Kazemi N, Sturm PF, Mehlman CT. Natural History of Adolescent Idiopathic Scoliosis in Skeletally Mature Patients: A Critical Review. J Am Acad Orthop Surg 2015;23:714–23.

Bunnell WP. An objective criterion for scoliosis screening. J Bone Joint Surg Am 1984;66:1381–7.

Coelho DM, Bonagamba GH, Oliveira AS. Scoliometer measurements of patients with idiopathic scoliosis. Braz J Phys Ther 2013;17:179–84.

Liu Z, Tam EMS, Sun G-Q, et al. Abnormal leptin bioavailability in adolescent idiopathic scoliosis: an important new finding. Spine (Phila Pa 1976) 2012;37:599–604.

Arponen H, Mäkitie O, Waltimo-Sirén J. Association between joint hypermobility, scoliosis, and cranial base anomalies in paediatric Osteogenesis imperfecta patients: a retrospective cross-sectional study. BMC Musculoskelet Disord 2014;15.

Lantz CA, Chen J. Effect of chiropractic intervention on small scoliotic curves in younger subjects: a time-series cohort design. J Manipulative Physiol Ther 2001;24:385–93.

Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013;369:1512–21.

Aulisa AG, Guzzanti V, Falciglia F, Galli M, Pizzetti P, Aulisa L. Curve progression after long-term brace treatment in adolescent idiopathic scoliosis, Comparative results between over and under 30 Cobb degrees – SOSORT 2017 award winner. Scoliosis Spinal Disord 2017;12:36.

Bettany-Saltikov J, Turnbull D, Ng SY, Webb R. Management of Spinal Deformities and Evidence of Treatment Effectiveness. Open Orthop J 2017;11:1521–47.

Kwan KYH, Cheng ACS, Koh HY, Chiu AYY, Cheung KMC. Effectiveness of Schroth exercises during bracing in adolescent idiopathic scoliosis, Results from a preliminary study-SOSORT Award 2017 Winner. Scoliosis Spinal Disord 2017;12:32.

Moramarco M, Moramarco K, Fadzan M. Cobb Angle Reduction in a Nearly Skeletally Mature Adolescent (Risser 4) After Pattern-Specific Scoliosis Rehabilitation (PSSR). Open Orthop J 2017;11:1490–9.

Shokei Yamada, MD, PhD, FACS. Tethered Cord Syndrome. https://rarediseases.org/rare-diseases/tethered-cord-syndrome/.

Romano M, Negrini A, Parzini S, et al. SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis 2015;10.

Pastorelli F, Di Silvestre M, Plasmati R, et al. The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring. Eur Spine J 2011;20 Suppl 1:S105-14.

Mineiro J, Weinstein SL. Delayed postoperative paraparesis in scoliosis surgery. A case report. Spine (Phila Pa 1976) 1997;22:1668–72.

Chu WC, Lam WM, Ng BK, et al. Relative shortening and functional tethering of spinal cord in adolescent scoliosis – Result of asynchronous neuro-osseous growth, summary of an electronic focus group debate of the IBSE. Scoliosis 2008;3:8.

Chu WCW, Deng M, Hui SCN, et al. Spinal cord morphology predicts curve progression in adolescent idiopathic scoliosis treated with bracing?, A prospective cohort study with magnetic resonance imaging. Scoliosis 2015;10.

Porter RW. The pathogenesis of idiopathic scoliosis: uncoupled neuro-osseous growth?, Uncoupled neuro-osseous growth? Eur Spine J 2001;10:473–81.

Porter RW. Can a short spinal cord produce scoliosis? Eur Spine J 2001;10:2–9.

Roth M. Idiopathic scoliosis caused by a short spinal cord. Acta Radiol Diagn (Stockh) 1968;7:257–71.

Roth M. Neurovertebral and Osteoneural Growth Relations, A concept of normal and pathological development of the skeleton. Univerzita J.E. Purkyne, Brno: Radiodiagnositic Clinic, Medical Faculty, 1985. 101 p.

Roth M. Idiopathic scoliosis from the point of view of the neuroradiologist. Neuroradiology 1981;21:133–8.

[scoliosiscarecenters-blog]

60-degree curve reduced to below 40 degrees in 10 months using the Silicon Valley Method from Scoliosis Care Centers. This includes a back brace, scoliosis exercises, and the flexibility trainer. For more information visit scoliosiscarecenters.com