January 2009

Posture and the scoliotic patient

by Dr. Mark Payne

Let's talk about postural chiropractic as it applies to the scoliotic patient. Scoliosis results from a wide range of causes, some of which will prevent successful management under chiropractic care. In worst case scenarios, referral for orthopedic and/or surgical management may be the only option available to prevent a catastrophic outcome. Fortunately, most cases are not nearly so severe and have the potential to respond well under chiropractic care if effective treatment begins early enough. Many, if not most, curvatures result from simple postural imbalances which force young spines to grow abnormally.

Here's how it happens. Once the adolescent spine begins to habitually assume an imbalanced posture, weight is transmitted unevenly onto the growing vertebral endplates. If the imbalance is in the frontal (coronal plane) and the amount of asymmetrical loading is significant enough, one side of the vertebral body may begin to grow slightly faster than the other. This is known as the Heuter-Volkmann or Delpech effect in which endochondral growth is inhibited on the more compressed (concave) side of the curve. Gradually, the vertebral bodies become more wedge-shaped as growth on one side outpaces the other. Once the growth process is completed, the vertebral wedging, and consequently much of the associated curvature, becomes permanent.

With this in mind, a successful outcome depends largely upon short circuiting this vicious cycle before the patient reaches skeletal maturity. Once growth stops, the window of opportunity for successful management may well be closed forever. If postural correction can be achieved before the growth phase is completed, it is often possible for the concave side of the vertebrae to slowly "catch up" with the convexity. Postural rehab for scoliosis might include such things as reverse posture exercises, corrective traction procedures, spinal remodeling, or therapeutic stretching techniques. In order to give you a feel for how this takes place, I would like to share with you a real case which was managed by one of our clients.

Earlier this year, our client, Dr. Steve Blandford of Marion, Illinois, called to discuss a case. In January of 2007, a 13 year-old female consulted Dr. Blandford regarding a thoracolumbar scoliosis. The curvature was initially discovered nine months earlier by her medical practitioner and monitored without treatment during which time it had worsened considerably. Dr. Blandford's postural examination revealed pronounced right translation and left lateral flexion of the thorax relative to the pelvis. Fig. 1 shows our model simulating the patient's pre-treatment posture, which has been exaggerated somewhat for purposes of illustration.

The patient was x-rayed and the pre-treatment film (see Fig. 2) showed a 28-degree Cobb angle with the apex of the curve at L-1. A treatment plan was formulated and the patient was instructed to perform reverse posture exercises at home. Additionally, the patient performed 20-30 minutes of spinal remodeling daily in which she rested passively with the spine blocked into the reverse or "opposite" position of her initial presenting posture. Fig. 3 shows a firm wedge shaped, foam fulcrum placed beneath L-1 to facilitate stretching of tight tissues on the concave side of the curvature. Take a moment to review the initial presenting posture seen in Fig. 1 and then visualize how the posture is reversed in Fig. 3.

The patient was treated three times weekly for approximately three weeks and then re-checked once every four-six weeks until November of 2007, during which time the patient was very faithful in performing her spinal remodeling exercise sessions. Fig. 4 shows the post-care film with the Cobb angle improved to 15 degrees. That's a 13-degree correction in a period of 11 months with a total of only 16 office visits.

Discussion

Luckily, this case presented for care just before the growth process ended. It's likely that earlier intervention before the curve worsened would have resulted in even more correction. Nevertheless, this excellent outcome is a great example of the synergy created between a doctor well-versed in postural care methods and a patient disciplined enough to follow through with the vital home care program. Congratulations to Dr. Blandford for a job well done and our thanks for sharing this most interesting case!

(A 1979 graduate of Life Chiropractic College, Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehabilitation products since 1988. For more information regarding issues, products or methods discussed in this column, or to receive the free report, "Spinal Remodeling for the Frontal Plane Postures," call 334-448-1210. Visit www.matlinmfg.com for a free product catalog.)