SCOLIOSIS: WHAT IS IT, WHAT CAUSES IT, AND HOW CHIROPRACTIC CAN HELP
When new patients come in for their initial exam, they will often inform us that they have scoliosis. When we inquire further, we more often than not come to find that when they were a preteen or young teenager, their school nurse “diagnosed” them with scoliosis by having them bend forward and touch their toes while looking for any left or right curvatures of the spine from behind (this procedure is known as “Adam’s Test”). This procedure is simple, quick, and valuable when evaluating for scoliosis, but it doesn’t capture all that scoliosis is; nor does it definitively determine if you do or don’t have scoliosis. The most reliable way to determine whether or not someone has a scoliotic curve in their spine is to take an x-ray of the area in question, have the x-ray properly analyzed, and have the proper measurements made on the x-ray.
What is scoliosis?
Scoliosis is an abnormal left or right curvature of the spine that measures more than 10 degrees (when viewed from behind) that is combined with rotation of the spinal bones (vertebrae).
What is the mechanism of action behind scoliosis?
Ultimately, scoliosis is a rotational problem. Yes, the curve exists and is a significant challenge. But, how did the curve get there? The curve developed because of rotation of the spine. As the spine rotates, it buckles to the side. To illustrate this phenomenon, consider what would happen if you held a shoelace at either end and twisted it. At some point, that shoelace is going to start to bend to the side and coil up onto itself. The same concept occurs within the spine. As the spine rotates more and more, it bends further and further to the side. Thus, scoliosis is a rotational problem that results from a rotational misalignment of a section of spinal bones. As stated above, the most reliable way to evaluate for whether or not a deviation of the spine to the side qualifies as a scoliotic curve, X-rays must be taken to adequately capture the entirety of the scoliotic curve. Once the image is captured, a measurement known as a “Cobb angle” must be accurately made to assess the degree of the curve. If the degree can reliably be considered beyond 10 degrees, and the spinal bones all rotate in a particular direction, then the curve is considered scoliotic.
How does scoliosis start?
The majority of scoliosis cases are classified as “idiopathic,” meaning the cause is unique to the individual or unknown. However, there are some common sense biomechanical reasons why an individual may develop a scoliotic curve in their spine over time. For instance, consider an individual born with a significantly short left leg, say, 15mm shorter than the right leg (most people have a short leg, but normally the discrepancy in leg length is significantly less than 15mm, such as a 3-5mm difference). As they stand flat on their feet, it is likely that their pelvis will drop down on the left because of the left short leg. This means that their lumbar spine may compensate for this left pelvic drop and create a curvature to the left. If this is the case, it is likely that the mid back (the area between the shoulder blades) will compensate for the sideways lumbar spine curvature and create a curvature pointing to the right. These compensations occur to keep your posture as upright and level as possible. With these postural abnormalities set in motion, consider what would happen should this individual not address their structural asymmetries. Over time, the condition may very well worsen, especially during a growth spurt in a younger individual.
But, the postural scenario described above is really just too simple. Our neuro-musculo-skeletal system is very complex, so it is very likely that many things contribute to an individual developing scoliosis beyond just an abnormally short leg. Imagine again the above individual who has a 15mm left short leg. Consider the likely scenario that their pelvis is misaligned. Depending on how a pelvic bone misaligns, it will push the leg on one side down (making it functionally longer), or draw it up (making it functionally shorter). What would happen if the left pelvic bone in this hypothetical scenario misaligned 6mm? The answer: It would potentially draw the 15mm left short leg up, making it functionally 6mm shorter. Thus, this individual is really dealing with a left leg that is 21mm shorter than the right, dropping the pelvis even more and leading to an even greater likelihood that the lumbar spine will compensate with a left side curve and that the mid back will compensate with a right side curve. Please note: This is just one very simple scenario for the sake of illustration. There are many more factors that can (and probably would) contribute to the exacerbation of this hypothetical individual’s postural scenario. Tension on the spinal cord via a loss or reversal of the curve in the neck and/or an increase or decrease of curve in the low back, or even a condition such as Tethered Cord Syndrome (a condition where a lot of tension is placed on the spinal cord), are also conditions that can contribute to the development of a scoliotic curve. Hopefully, you can now see why describing the majority of scoliotic curves as “idiopathic,” (the cause is unique to the individual) makes some sense. There is a good chance that scoliosis develops in individuals for a slew of combined issues, many of which may very well be biomechanical in nature.
How does scoliosis progress?
As stated above, scoliosis may occur for a number of reasons, whether neurological in nature, biomechanical in nature, or a combination of things. Once the conditions for developing a scoliotic curve are set, it is commonly exacerbated by skeletal growth spurts in children. These growth spurts generally occur between birth and age two and during the pre-puberty period.
Dysfunctions occur within the spine for various reasons and to varying degrees. As that dysfunction goes uncorrected (and potentially worsens), and the spine rapidly grows, that dysfunction may be exacerbated, resulting in a scoliotic curve. As chiropractors, our concern would be that the spine of a scoliosis patient has dysfunctions called Vertebral Subluxation Complexes, a biomechanical dysfunction. Essentially, a vertebral subluxation complex is made up of two or more spinal bones (vertebrae) that aren’t moving well relative to one another. As a result of this poor joint motion, and likely some malposition (sliding, tilting, or rotation), the surrounding tissues have to maladapt and don’t function properly, including the discs, ligaments, muscles, spinal cord, and other nervous tissue in that area. As these subluxation complexes accumulate over time, the spine becomes more and more dysfunctional, which may increase the likelihood or the severity of a child developing a scoliosis. This is why we love to see and take care of children of all ages. From our perspective, if we can have the opportunity to properly evaluate a child’s spine and keep their spine free of vertebral subluxation complexes, we will be able to greatly reduce the risk of that child developing scoliosis. This is accomplished by accurately finding subluxation complexes within the spine and fixing them with a series of chiropractic adjustments. As a result, their spine will improve biomechanically and their nervous system will function better.
How do I know if I have scoliosis? What about my child?
The most reliable way to know if you or your child have scoliosis is to be properly evaluated. In most cases, that is going to include an x-ray of the area in question so that the exact location of the scoliotic curve can be discovered, as well as the specific spinal bones involved. Depending upon the age of the child and the suspected severity of the scoliosis, it may or may not be appropriate to take an x-ray.
Can chiropractic care help scoliosis?
The short answer: Yes! Chiropractic care can be helpful for managing scoliosis and its related symptoms. At Ollis Chiropractic, we provide high-quality chiropractic care to the whole spine and extremities. We also focus heavily on rehabilitating the spine through posture corrective exercise techniques. In combining chiropractic adjustments and posture corrective techniques, we improve an individual’s overall body posture, the posture of their spine, and the motion of their spine. This allows our scoliosis patients to move better, feel better, and it improves their ability to manage their condition.
So, if you or someone you know has (or is suspected to have) scoliosis, we would appreciate the opportunity to evaluate and treat you. You can reach the Ollis Chiropractic team and set up an appointment at (502) 412-8580 or at [email protected]. We look forward to hearing from you!