Scoliosis is defined as the abnormal, lateral deviation of the spine with a minimal Cobb angle of 10� in the coronal plane. It may be characterized as either non structural or structural scoliosis.
Non-structural scoliosis is identified as a non-progressive curve resulting from a leg length discrepancy, herniated disc or improper bearing which can be corrected by removing the causing factor. Structural scoliosis is identified by not only its vertebral distorted shape, but by a vertebral rotation towards the convex side, where the spinal processes also rotate toward the concave side, additionally, including rib deformity along with the convex sided ribs shifting posterior and superior while the concave sided ribs changing anterior and inferior.
After diagnosis, a person with scoliosis may present a pelvis that is not leveled in the transverse plane with unequal shoulder height, a thoracic or lumbar hump, and an asymmetrical lumbar triangle, loss of lumbar lordosis or loss of balance in the sagittal and coronal planes.
Scoliosis approximately affects up to 2 to 3 percent of the population and it may be classified as congenital, neuromuscular, degenerative or idiopathic. Furthermore, scoliosis diagnosed after skeletal maturity, between the ages of 20 to 50, known as adult scoliosis, amounts up to 6 to 10 percent of the population. Adult scoliosis is divided into four types: Primary degenerative scoliosis resulting from the asymmetrical erosion of the disc, endplates and/or facet joints; progressive idiopathic scoliosis not previously treated or post-surgical; secondary adult curvature due to a pelvic obliquity; and secondary adult curvature due to metabolic bone disease.
According to research studies, the clinical presentation associated with adult scoliosis requiring immediate medical attention from a healthcare professional includes: back pain which manifests as muscle soreness, muscular exhaustion or mechanical instability; symptoms of radicular pain present during standing or walking; neurological deficits; and curve progression resulting in from axial overload or vertebral bodies with osteoporosis.
Literature has described a variety of treatments for scoliosis predicated on surgical and non-surgical classification, dependent on the severity and the character of the curvature as well as the danger of progression. Surgical intervention is an alternative treatment option for individuals that have completed the growth cycle and whose curve is greater than 50� and or whose curve is above 45� and are still in the growth cycle. Bracing and projecting is utilized for people in the growth interval and whose curve is between 20� and 40�. An individual with a curve of less than 25� and has completed growing might be observed throughout their life for curvature progression of 5� in one year, which can be determined to need surgical intervention.
Many healthcare professionals recommend surgery for scoliosis rather than an alternative, non-surgical treatment for scoliosis. In a study by Brigham and Mooney, a progressive exercise plan focusing on exercises combined with torso turning exercises were utilized to raise the strength in patients with scoliosis measuring 15�to 41�. The results showed a 20% � 23% improvement in the curvature without any type of bracing or casting.
In comparison to America, conservative measures are more vigorously executed worldwide. Along with plans, such as for example SEAS (Scientific Exercise Method Of Scoliosis), FITS (Functional Individual Therapy of Scoliosis), Dobosiewicz method, ASCO (Anti-Scoliosis Shaking-Decompression) procedure, Lyonaise method, and physiologic�, the Schroth method is a scoliosis treatment approach which attempts to conservatively treat the spinal condition by emphasizing patient specific postural analysis and corrections in a multidimensional plane. In line with the method first created by Katharina Schroth, the torso is divided into three and sometimes four vertically stacked anatomical blocks. As an outcome of scoliosis, these blocks deviate in the vertical line and laterally shift and rotate against each other creating areas of convexities and concavities.
Depending on sensorimotor and kinesthetic principles, patients utilize proprioceptive and exteroceptive stimulus (visual, tactile, verbal) to achieve the proper spinal alignment through corrective breathing patterns and postures. This is a big element of the Schroth method for scoliosis. Three dimensional postural corrections and remedial exercises are used to achieve spinal de-rotation, de-flexion and elongation in order to re-gain postural symmetry and muscular equilibrium as well as for the stabilization of the corrected bearing through isotonic and isometric tension and reflex holding of muscles. Simultaneous performance of rotational angular respiration (RAB) helps correct the placement of the ribs by directing air into the thoracic concavities. Through the specific exercises of the Schroth method for scoliosis, patients learn to lift themselves out of passive alignments and endure a position that is corrected throughout their day-to-day activities.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
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