SCOLIOSIS AND CHIROPACTIC

The impact of preventing scoliosis curve progression

Scoliosis, from the ancient Greek word “skolios” (curved, crooked), was first identified between 130 and 201 AD and is the most prevalent spinal disorder in children and adolescents. Characterized by a curvature of the spine (Cobb’s angle >10°), it typically involves a rotation of the vertebrae and, frequently, a reduction in kyphosis in the thoracic curve.¹ 

Scoliosis patients are classified into distinct types, which are separated according to age of onset, etiology, severity and type of curve. Each type exhibits unique traits, including the curve progression rate, pattern and degree of three-dimensional deformity. The most prevalent type is Adolescent Onset Idiopathic Scoliosis (AIS), which predominantly occurs between age 10 and skeletal maturity, manifesting a considerable curve progression rate. This may result in early degenerative joint disease, cardiopulmonary compromise, negative body image and psychosocial disturbances.  

Although precise AIS prediction is impossible, there is a need to prevent the curve progression. AIS can cause postural changes, standing instability and gait variations, as well as pain, poor quality of life and negative self-image. The prevalence of AIS in athletes can be associated with sports injuries.² 

Factors influencing curve progression

The Virginia Spine Institute and the Mayo Clinic indicate several factors affecting scoliosis progression. 

Age: The younger the patient is at the time of diagnosis, the more room there is for bone growth. We know the curve progresses during periods of growth; therefore, the more likely the curve or curves progress during the growing years in adolescence. According to a 1984 study on children aged 10 or younger, a slight curve (from 5-19 degrees) stood a 45% chance of progression, while a medium curve (from 20-29 degrees) invariably progressed.³ 

Skeletal maturity: Skeletal maturity is determined by the closure of the growth plates around particular ages for both genders. The Risser sign, visible on an X-ray, indicates the calcification level of the human pelvis as a measure of skeletal maturity. It is graded on a scale from 0-5, with five being adult bone growth. A Risser sign of 0-1 shows 68% progression, while those in grades 2-4 progress by 23%.⁴ The bigger the curve with more growth remaining means the curve will likely continue to progress. 

Gender: Girls are much more likely to have scoliosis curves that progress to the point of requiring treatment. For curves exceeding 30 degrees, the progression ratio is 10:1 in favor of girls over boys. 

The pattern of the curve: According to Yale Medicine, a thoracic curve is one of the most prevalent patterns in AIS, with 90% of cases occurring on the right side (right convexity). On the other hand, a double major curve describes a right thoracic curve (convex on the right) paired with a left lumbar curve (convex on the left). 

The positive role of sports

Youths and adolescents engaging in graded, supervised and age-appropriate sporting activities present positive outcomes concerning their scoliosis. 

A 2019 study set out to determine if sports participation impacted pain, function, mental status and self-perception of deformity. The data showed, for adolescent IS patients with statistically similar bracing status and coronal and sagittal deformities, those who participated in sports were more likely to have improved functionality, self-image, expectations and parental perception of deformity.⁵ 

How can chiropractic care help?

Main adjustments

Spinal vertebral alignment in a scoliosis situation will benefit the area by reducing biomechanical stress and muscular strain, along with supporting the other soft tissues in the area. Research conducted by Byun and Han showed chiropractic methods can effectively decrease the Cobb angle in as little as four weeks.⁶ 

Importance of foundational foot support

The medical community often prescribes braces for moderate to severe scoliosis, and there could be instances where these are essential. However, we should not overlook the significant influence the three arches of the feet have on the pelvis and spine. Notably, nine out of 10 people globally overpronate, which often occurs bilaterally and asymmetrically. 

The flatter foot will cause excessive internal rotation of the tibia and femur. This then causes tilting and rotating of the pelvis. This creates a functional lumbar scoliosis (curvature toward the side of the flatter foot) with compensatory functional thoracic spine scoliosis to the opposite side. Thus, flat feet can induce the development of functional scoliosis in the lumbar and thoracic spines. 

Providing them with three-arch, custom flexible orthotics will stabilize and support their pedal foundation. This reduces the strain up the kinetic chain, the functional scoliosis and the strain on the spine. Appropriately designed orthotics promote alignment from toes to nose, encompassing the rotational aspects of scoliosis and misalignments of the spine. 

Prevention of curve progression with a posture program

Young patients often do not comprehend how the impact of habitual activities, such as studying or relaxing at home, and the way they sit or stand at school, will influence their bodies. Having “good” posture takes some work. Analysis of their home workspace, discussions about their seating posture at school, backpack fitting and evaluating their study positions at home (e.g., on the bed or couch) can aid in promoting healthier posture and prevent further progression of spinal curves. 

KEVIN M. WONG, DC, is a graduate of the University of California, Davis, and a 1996 graduate of Palmer College of Chiropractic West. He has been in practice for more than 26 years and is the owner of Orinda Chiropractic and Laser Center in Orinda, Calif. As a member of Foot Levelers’ Speakers Bureau since 2004, Wong travels the country speaking on extremity and spinal adjusting. 

References 

1. Kane WJ. Scoliosis prevalence: A call for a statement of terms. Clin Orthop Relat Res. 1977;(126):43-46. PubMed. https://pubmed.ncbi.nlm.nih.gov/598138/. Accessed Dec. 18, 2023.
2. Konieczny MR, et al. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 20137(1):3-9. PubMed. https://pubmed.ncbi.nlm.nih.gov/24432052/. Accessed Dec. 18, 2023.
3. Negrini A, et al. Sports participation reduces the progression of idiopathic scoliosis and the need for bracing. An observational study of 511 adolescents with Risser 0-2 maturation stage. Eur J Phys Rehabil Med. 2023;59(2):222-227. PubMed. https://pubmed.ncbi.nlm.nih.gov/36892518/. Accessed Dec. 18, 2023.
4. Lonstein JE, Carlson JM. The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am. 1984;66(7):1061-1071. PubMed. https://pubmed.ncbi.nlm.nih.gov/6480635/. Accessed Dec. 18, 2023.
5. Ahmed N, et al. Noncontact sports participation in adolescent idiopathic scoliosis: effects on parent-reported and patient-reported outcomes. J Pediatr Orthop B. 2019;28(4):356-361. PubMed. https://pubmed.ncbi.nlm.nih.gov/30489444/. Accessed Dec. 18, 2023.
6. Byun S, Han D. The effect of chiropractic techniques on the Cobb angle in idiopathic scoliosis arising in adolescence. J Phys Ther Sci. 2016;28(4):1106-1110. PubMed. https://pubmed.ncbi.nlm.nih.gov/27190435/. Accessed Dec. 18, 2023.