Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series

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Abstract

Background

The combination of spinal manipulation and various physiotherapeutic procedures used to correct the curvatures associated with scoliosis have been largely unsuccessful. Typically, the goals of these procedures are often to relax, strengthen, or stretch musculotendinous and/or ligamentous structures. In this study, we investigate the possible benefits of combining spinal manipulation, positional traction, and neuromuscular reeducation in the treatment of idiopathic scoliosis.

Methods

A total of 22 patient files were selected to participate in the protocol. Of these, 19 met the study criterion required for analysis of treatment benefits. Anteroposterior radiographs were taken of each subject prior to treatment intervention and 4–6 weeks following the intervention. A Cobb angle was drawn and analyzed on each radiograph, so pre and post comparisons could be made.

Results

After 4–6 weeks of treatment, the treatment group averaged a 17° reduction in their Cobb angle measurements. None of the patients' Cobb angles increased. A total of 3 subjects were dismissed from the study for noncompliance relating to home care instructions, leaving 19 subjects to be evaluated post-intervention.

Conclusions

The combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. These results warrant further testing of this protocol.

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Most cited references 57

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Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.

Ignacio Ponseti, Kevin Spratt, Michael Peterson … (2003)

Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history. To present the outcomes related to health and function in untreated patients with LIS. Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years). Mortality, back pain, pulmonary symptoms, general function, depression, and body image. The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain. Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

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Relations between standing stability and body posture parameters in adolescent idiopathic scoliosis.

S Hinse, Olivier Caron, Marie-Lyne Nault … (2002)

A retrospective study of standing imbalance and body posture in 71 able-bodied girls and subjects with adolescent idiopathic scoliosis was conducted. To test the hypothesis that postural parameters are related to standing stability parameters. Spinal deformity not only modifies the shape of the trunk, but also changes the relations between body segments affecting posture in scoliotic children. These postural adaptations to the scoliotic curve progression could be linked in part to increased body sway in upright standing. This has not yet been related to specific postural parameters involving the head, trunk, and pelvis in nontreated idiopathic scoliosis. The head, trunk, and pelvis orientations of each subject were measured by a Flock of Bird system. An AMTI force platform was used to assess quiet standing stability and to monitor the position and displacement of the center of pressure (COP). The center of mass (COM) excursion was estimated from a biomechanical model using force plate information only. Analyses of variance (ANOVAS) were performed to determine the statistical differences between the scoliotic and nonscoliotic subjects, and backward stepwise multiple regression analyses were performed to identify any correlation between measures of quiet standing stability and body postural parameters The scoliotic group was characterized by a decrease in standing stability. There was an increase in the sway areas measured by the variations of the COP and COM. From the backward stepwise multiple regression analysis, it appears that for the able-bodied girls, the body posture parameters were correlated only with the mean anteroposterior center of pressure (COP(AP)) position. For the scoliotic group, the sway areas and the mean position of the centers of pressure and the COP(AP)-COM(AP) were correlated significantly with body posture parameters. The higher COP-COM differences for the scoliotic group were attributed to a greater neuromuscular demand to maintain standing balance. The coefficients of correlation of the multiple regression analyses ranged from 0.64 to 0.85 for the nonscoliotic group and from 0.55 to 0.72 for the scoliotic group. The use of backward stepwise multiple correlations highlighted the interaction between several body parameters and their relation to standing stability in both able-bodied girls and scoliotic subjects. The scoliotic group displayed a much larger number of correlations between standing stability and body posture parameters than the nonscoliotic group. Standing imbalance was related to altered body posture parameters measured in the frontal and horizontal planes only. Although the correlation coefficients were relatively high, factors other than body posture parameters appeared related to standing imbalance in adolescent idiopathic scoliosis. These findings support the concept of either a primary or a secondary dysfunction in the postural regulation system of scoliotic subjects.

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Etiology of idiopathic scoliosis: current trends in research.

T Lowe, M. Edgar, J Y Margulies … (2000)

Current population studies characterize idiopathic scoliosis as a single-gene disorder that follows the patterns of mendelian genetics, including variable penetrance and heterogeneity. The role of melatonin and calmodulin in the development of idiopathic scoliosis is likely secondary, with indirect effects on growth mechanisms. Reported abnormalities of connective tissue, skeletal muscle, platelets, the spinal column, and the rib cage are all thought to be secondary to the deformity itself. Although no consistent neurological abnormalities have been identified in patients with idiopathic scoliosis, it is possible that a defect in processing by the central nervous system affects the growing spine. The true etiology of idiopathic scoliosis remains unknown; however, it appears to be multifactorial.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date Collection: 2004

Publication date (Electronic): 14 September 2004

Volume: 5

Page: 32

Affiliations

[1 ]Director of Research, Pettibon Biomechanics Institute 3416-A 57 ^thSt Ct. NW; Gig Harbor, WA 98335, USA

[2 ]Director, CLEAR Institute; 437 North 33 ^rdAve; St. Cloud, MN 56303, USA

[3 ]Director, Lawrence Chiropractic Clinic, 13961 60 ^thSt North; Stillwater MN, 55082, USA

Article

Publisher ID: 1471-2474-5-32

DOI: 10.1186/1471-2474-5-32

PMC ID: 520751

PubMed ID: 15363104

SO-VID: 0c99199d-6570-4262-8506-b95c7b392f23

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series

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Abstract

Background

Methods

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Conclusions

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Orthopedics

Most cited references 57

Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.

Relations between standing stability and body posture parameters in adolescent idiopathic scoliosis.

Etiology of idiopathic scoliosis: current trends in research.

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