| I have been in private practice in Eau Claire Wisconsin | | | | growing number of health care professionals are |
| for four years. Upon entering Chiropractic College I | | | | challenging the "norm" to improve treatment |
| had intentions of practicing evidence-based medicine | | | | outcomes. |
| with outcomes such as: improved posture and | | | | Until recently, conservative health care professionals |
| function, with long-term resolution. The ability to | | | | have been unsuccessful at treating scoliosis; |
| achieve many of these outcomes, however, was | | | | however, innovation, research, and dedication have |
| sadly in absence of the school's curricula. Thanks to | | | | tilted the scales out of stagnancy. Conservative |
| innovative colleagues ahead of me, I fell in love with | | | | treatment is finding positive results through a |
| a niche that involved changing spines to change lives, | | | | thorough understanding of the inherent structural and |
| such as scoliosis treatment. The intention of this | | | | neurological adaptations associated with scoliosis. This |
| article is to assist the population at large with some | | | | movement is also placing emphasis on early |
| life-enhancing advice. | | | | detection, since we are commonly seeing both |
| Scoliosis: Screening and Effects | | | | children and adults with greater health concerns as a |
| Scoliosis screening remains a controversial topic | | | | result of failed, or lack of treatment prescribed |
| among health care professionals. In 1993, the US task | | | | previously. Cost has a large role in the reason not to |
| force concluded that the potential harms of routine | | | | screen as well as false positive referrals, and will |
| scoliosis screening did not outweigh the benefits. | | | | always be a concern if there is not a cost effective |
| Another study in 2000 performed on the Rochester, | | | | result. These measures aren't a "cure" or "quick-fix" |
| Minnesota school district calculated an average cost | | | | by any means; they require commitment on behalf of |
| of $24.66 per student to perform scoliosis screens. | | | | the patient; however, these individuals are |
| Cost and false positive referrals have been a large | | | | experiencing measurable success in their health. |
| reason why screening programs have been diminished | | | | Employ Multiple Screening Measures |
| or abolished; however, the need for appropriate | | | | There are some general factors to be aware of |
| screening and follow-up has not. Depending on the | | | | when "sizing up scoliosis". One factor is knowledge of |
| study, approximately 3-5% of the population has | | | | your family history. Scoliosis is largely a multifactorial |
| scoliosis, nearly 1 in 20 reading this article. The effects | | | | condition, although certain characteristics seem to be |
| of scoliosis go far beyond the potential cosmetic | | | | inheritable making some individuals more susceptible. |
| concerns imposed. Some of these include; decreased | | | | Families with scoliosis present should be diligent in |
| pulmonary function, headaches, chronic neck and | | | | routinely checking their children. A routine screening |
| back pain, reduced exercise capacity, digestive | | | | measure typically used is the Adam's forward bend |
| problems, psychological distress, reduced quality of | | | | test, which involves having the child bend in front of |
| life, and shortened life span. | | | | the observer while noting any rib humping. This is the |
| What is Scoliosis? | | | | primary screening method used in the school system. |
| Scoliosis is an abnormal curvature of the spine that | | | | If noticeable rib humping is present, the child's |
| looks like more of an "S", or "C", rather than a | | | | scoliosis is already at a higher magnitude. |
| straight line. In approximately 80% of scoliosis cases | | | | The next is the child's posture. Scoliosis often causes |
| the cause is unknown. A particular class that draws | | | | the waistline or shoulders to appear uneven. Posture |
| the most focus with screening programs is | | | | should be analyzed in a relaxed state, since many |
| adolescent idiopathic scoliosis (AIS). This simply | | | | children are able to mimic a normal posture. Clothing |
| means that the scoliosis develops during puberty and | | | | may also be uneven due to skeletal asymmetries. |
| has no known cause. | | | | Individuals with scoliosis may often exhibit a "librarian's |
| The word "scoliosis" typically brings to mind an image | | | | posture", in that they look out the top of their eyes. |
| of an adolescent wearing a cumbersome brace. | | | | This condition, called hyperopia, alters the visual field |
| Scoliosis also commonly progresses throughout | | | | and thus causes neuromuscular adaptation from the |
| adulthood; the rate is largely dependent on when the | | | | skull down. Hyperopia effects the visual system and |
| scoliosis began to develop and the size of the curve. | | | | is just one of the body's natural righting reflexes. |
| In the past, many health care professionals believed | | | | The body has five major righting reflexes that enable |
| scoliosis was caused from bad posture, muscle | | | | us to coordinate movement, perform tasks, stand |
| spasm, pain, etc., was non progressive and therefore | | | | upright and many others all in relation to gravity. |
| of little concern. We know now this is untrue. In fact, | | | | Scoliosis is typically associated with deficient righting |
| even these types of scoliosis can and do progress. | | | | reflexes. There are some simple and relatively |
| Traditional Treatment Procedures: | | | | inexpensive ways to test the body's natural righting |
| Current literature states that screening measures do | | | | reflexes, such as balance. One test is where the child |
| not reduce the need for surgery. Considering | | | | stands on one leg with his/her eyes open and closed |
| traditional portal of entry health care, this is not all | | | | for 30 seconds. Individuals with scoliosis will often |
| that surprising. If a child's scoliosis is fortunate enough | | | | have difficulty standing on one leg with their eyes |
| to be detected, here is a typical scenario. Children will | | | | closed and commonly fail this test before 30 seconds. |
| be "observed" until the curve reaches approximately | | | | Another test is having the child jump up and down |
| 25-30 degrees. Should it reach 25-30 degrees (and in | | | | for 50 seconds and observing for any rotation. |
| many cases does), a hard brace is prescribed to halt | | | | Alteration of the range of motion may also be |
| progression. Hard bracing recommendations continue | | | | apparent. An inability to touch the chest with the chin |
| from approximately 30-50 degrees. Beyond 45-50 | | | | may also indicate scoliosis. Scoliosis not only affects |
| degrees, surgery is typically considered, and in many | | | | the spine/posture, but also other systems. Relying |
| cases, the recommended treatment strategy. | | | | exclusively on one test, such as the traditional |
| To analyze the treatment process: first we did | | | | forward bend test excludes other signs/symptoms |
| nothing (observation), then we used a hard brace | | | | that may be apparent with other tests. Therefore, |
| (psychological impairment), which if successful only | | | | incorporating additional tests such as described will |
| halted the curve's progression. If the brace was not | | | | help you to be more conclusive, miss fewer cases, |
| successful, a potentially life-altering surgery would be | | | | and increase the chances of early detection. Lastly, |
| prescribed (high risk and permanent). Bracing is largely | | | | pain does not always accompany scoliosis in children, |
| debatable with regards to effectiveness. This is due | | | | so it is not recommended to consider pain as an |
| to compliance since the recommended wear time is | | | | indicator. |
| approximately 18-23 hrs/day. There is also research | | | | In addition to performing these tests, there are also |
| to illustrate that the curve slowly starts to "bend" | | | | instruments that a health care professional specializing |
| back to a pre bracing level throughout adulthood. | | | | in scoliosis may use. These include: a scoliometer |
| Generally, the results of surgery aren't any more | | | | which measures trunk rotation, advanced neurological |
| promising due to side effects and loss of correction. | | | | testing, gait analysis, and x-ray. As with any disease |
| These limited options have spurred further interest | | | | process, the outcome is generally much more |
| and innovation towards other conservative treatment | | | | favorable with early detection and additional options. |
| options. | | | | For further information regarding screening and |
| New Efforts Provide Effective Strategies | | | | treatment, the CLEAR Institute provides numerous |
| Efforts of the medical community are greatly | | | | articles, links, and provider directory to consult with a |
| appreciated and recognized; however, there is a | | | | local chiropractic physician with expertise in |
| demand for further education and implementation of | | | | conservative management of scoliosis. |
| more effective screening and treatment measures. A | | | | |