A New Look at Adolescent Idiopathic Scoliosis This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
FROM: The American Chiropractor
By Mark Sanna, D.C.
Scoliosis comes from the Greek word skoliosis which means crookedness. Adolescent Idiopathic Scoliosis (AIS) is a deformity of the spinal column with an onset between the ages of ten and eighteen. Most types of scoliosis are classified as idiopathic, meaning that the reasons for this type of deformity of the spine are unknown. Many assumptions concerning the causative factors for the dysfunction have developed. These include: birth trauma, visceral tensions, psychological problems, unilateral shortening of the psoas muscle, nutrition, genetic factors, and so on. Yet, when applying the standards of scientific research, none of these claims have been substantiated, despite the fact that every year impressive amounts of research dollars are spent in an attempt to further understand the causes of this dysfunction.
Both the correction and stabilization of AIS has troubled chiropractors and other healthcare practitioners for decades. The traditional medical approach to treating scoliosis involving braces and surgery has produced frustration and ineffective results. From my earliest days in chiropractic practice, I developed my own hypothesis for the pathogenesis of the dysfunction. Based upon successfully treating multiple patients with AIS, I began to believe that there was a connection between the central nervous system, in particular the system of proprioception, and AIS.
My patients with AIS consistently experienced positive outcomes when, in conjunction with chiropractic adjustments, they were placed on the program of proprioceptive training that I will outline later in this article. While it is most likely that the etiology of AIS is multifactorial, I have been pleased to note that recent efforts in scoliosis research have been concentrating on seeking defects in proprioceptive mechanisms, substantiating my long held hypothesis of proprioceptive involvement. Let’s begin our AIS research review with a study performed by W. Keesen in the Netherlands. [1]
This study proposed that the diminished postural control exhibited by scoliotic patients is the result of a perceptual weakness based upon an inaccurate “body image” in the brain. The researchers performed an experiment involving 200 patients. Patients were asked to place a finger into one of 24 dome-shaped holes in the undersurface of a table and then, without looking under the table, to bring the same finger on the opposite hand as close as they could to the corresponding position on the top surface of the table. Try a version of this experiment yourself. You’ll find that the accuracy of your ability to place one finger over the one under the table deviates by only a few millimeters. When compared to a child or teenager, you’ll find that your accuracy is greater, suggesting that proprioceptive function improves with age. In their study, Keesen, et al., established that there was a significant difference between the average accuracy between scoliotic patients and those without the dysfunction. To quote the authors, “In the present study, an inaccurate proprioceptive performance was established in patients with idiopathic scoliosis.”
You might wonder if the spinal asymmetry produced by scoliosis caused the inaccurate proprioception, rather than the other way around. The study found that the ability to bring both fingers together was not influenced by the degree of scoliosis. Other studies have attempted to pinpoint the connection between faulty proprioception and scoliosis.
A study by M. Yekutiel, et al., in Japan and Sweden, proposes that faulty postural equilibrium reactions result from abnormalities in the muscle spindle system in patients with adolescent idiopathic scoliosis. [2] Another study by R. Barrack, et al., involved proprioception testing and gait analysis on a group of patients with idiopathic scoliosis. He found that scoliotic patients exhibited a deficit in their ability to reproduce angles between their knees when compared to normal subjects. According to Barrack, the results of this study support the presence of a neurologic deficit in idiopathic scoliosis, although he was unable to specifically localize the site of damage in the neural pathway. [3] Also, U. M. Ahn, et al., found that brain stem or equilibrium abnormality may exist in scoliosis patients, leading to proprioceptive mechanism defects that affect vestibular function and joint proprioception. [4]
My AIS protocol involves providing chiropractic adjustments (Diversified Technique) along with rehabilitative procedures, which include proprioceptive neuromuscular reeducation using a stability ball. Take a slow steady approach and make sure the patient understands the importance of performing the exercises at home on a twice daily schedule.
In the first exercise, the patient is instructed to sit on the ball and to maintain as close to normal as possible alignment of the head over the shoulders over the hips while they gently bounce up and down on the ball for approximately 10 minutes. Later patients learn to balance sitting on a ball without their feet touching the ground by constantly adjusting their relative upper body position to the movements of the ball.
A second exercise involves having the patient place the “high side of the rainbow” (major lateral convexity) on the ball in a side-lying position. The patient is directed to kneel with their side next to the ball and with the arm closest to the ball draped over it. The patient is then instructed to slowly roll their torso up onto the ball and to stretch laterally across the ball, opening the curve. If this movement causes pain, the exercise should immediately be discontinued. The sidelying position is maintained for 30 seconds, followed by a return to the starting position. Three sets of ten repetitions of this movement with 30 seconds of rest in-between is the protocol.
While no scoliosis will be “cured” by proprioception enhancement alone, these exercises are powerful adjuncts to the chiropractic adjustment. Most adolescent patients find the exercises playful and compliance is excellent. This proprioceptive therapy is done twice a day for approximately 20 minutes, compared to wearing a scoliosis brace for 23 hours. And, contrary to medical misinformation, scoliosis correction is not age dependant and it does not stop at osseous maturity. In my practice, I have achieved positive results with patients from 7 to 27 years old and have measured a decrease from 29 degrees Cobb angle to 12 degrees which, I assure you, produces a lasting smile on the face of the patient, their parents and the chiropractor!
Dr. Mark Sanna is the CEO of Breakthrough Coaching. For more information, visit www.mybreakthrough.com, e-mail info@mybreakthrough.com or phone 1-800-723-8423
References:
Spine. 1993.
Crow. A. and Hearn, M.
Proprioceptive Accuracy in Idiopathic Scoliosis. W. Keesen
Spine. 1981 (Nov); 6 (6): 560-6.
Proprioceptive Function in Children with Adolescent Idiopathic Scoliosis.
Yekutiel M, Robin GC, Yarom R.
Spine: October 1984.
Proprioception in Idiopathic Scoliosis,
Barrack, Robert L.; Whitecloud, Thomas S. Iii; Burke, Stephen W.;Cook, Stephen D.; Harding, Amanda F.
Am J Orthop. 2002 (Jul); 31 (7): 387-95.
The Etiology of Adolescent Idiopathic Scoliosis.
Ahn Ahn UM, Ahn NU, Nallamshetty L, Buchowski JM, Rose PS, Miller NH, Kostuik JP, Sponseller PD.
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