Treating scoliosis pain: red flags

Chiropractic treatment is beneficial for scoliosis pain patients, but heed these 3 warning signs

SOME CHIROPRACTORS CLAIM THAT THEY CAN CURE SCOLIOSIS. Some chiropractors refuse to work on any scoliosis pain patient, as they were taught in chiropractic college that they can’t help scoliosis.

Scoliosis is an abnormal lateral curvature of the spine. It is a “dis-ease,” and like other diseases such as high blood pressure or diabetes, it can’t be cured but it can be controlled.

3 scoliosis pain red flags

There are several red flags to look for regarding scoliosis:

1. The Risser sign. The Risser sign is a measurement of skeletal maturity using an X-ray to see the degree of ossification of the pf of the iliac apophyses as it ossifies from the anterolateral crest medially. Risser sign goes from 0-5, with 5 being skeletally mature. From 0-3 the scoliosis is considered unstable and prob-ably will progress. Therefore, scoliosis pain with a Risser sign of 0-3 is a red flag.
2. The degree of the scoliosis. Scoliosis is defined as a lateral curvature above 10 degrees. The standard medical treatment is under 20 degrees with observation only to see if it gets worse, also know as “watch and wait.” Bracing is recommended at 20-25 degrees. Surgery is recommended at 40-45 degrees. Curves above 30 degrees will usually progress. Mid-back or primary thoracic curves also tend to progress more than low back or lumbar curves.
3. Age of the patient. Scoliosis is defined by age. Infantile is 0-3 years, juvenile is 3-10 years, adolescent is age 11-18, and adult scoliosis is above 18 years. The longer they have had scoliosis, the greater the possibility of progression. Our primary focus is adolescent scoliosis and 80% is idiopathic, meaning there is no direct or known cause. Neuromuscular scoliosis is related to some type of underlying disease or pathology.

The difference between girls and boys

Scoliosis is more common in girls than boys. Girls go through puberty first and their growth spurt second. Boys go through their growth spurt first and puberty second.

Both girls and boys should be monitored closely through puberty and growth spurts. In girls, the scoliosis curvature accelerates at the age of 11.7 years. Boys are two years behind girls, so their curvature will accelerate at 13.7 years. Girls should be checked around the age of 10 and boys around the age of 12. A posture evaluation will usually show forward head posture, right head tilt, right high shoulder and a left low hip.

The scoliometer is a great tool to use with Adam’s Test. Seven degrees on the scoliometer will measure about 20 degrees on an X-ray. If the scoliometer measures at 4 degrees or more, a scoliosis X-ray should be taken.

Pottenger’s Saucering

Chiropractic treatment is beneficial with scoliosis patients, but there are some red flags in the treatment. The degree of scoliosis is directly proportional to anterior thoracic sublux-ations. This is known as Pottenger’s Saucering, anterior thoracis, loss of normal thoracic kyphosis, or lordotisation. Because of this, the thoracic vertebra should never be adjusted posterior to anterior (high side of the rainbow), as that will make the scoliosis worse. Anterior thoracic adjusting is indicated in these cases.

Scoliosis pain patients have a substantial amount of ligament laxity, especially in the cervical spine. Therefore, manual manipulation or manual adjusting is also contraindicated. An adjusting instrument at 6Hzz is most beneficial.

All chiropractors should work on scoliosis patients from 10-20 degrees. Doing something is better than doing nothing. From 20-40 degrees, chiropractic treatment can be beneficial with the aid of an orthopedist or other scoliosis specialist. It is beneficial to work together and co-manage the patient in these circumstances. Scoliosis above 40 degrees is considered a surgical candidate and medical treatment is surgery.

In conclusion, an 11-year-old girl at 30 degrees and a Risser of 1 will have a worse prognosis than a 17-year-old girl at 20 degrees and a Risser of 4. All the variables must be considered to render the best health care possible for the patient.

There are a lot of variables in treating scoliosis and scoliosis pain. No two scoliosis cases are ever the same. For proper treatment, post-graduate education is recommended.

DENNIS WOGGON, BSc, DC, graduated cum laude from Palmer College of Chiropractic in 1974 with a bachelor of science in Biology. He has lectured worldwide, including two trips to Vladivostok, Russia, to work with doctors regarding scoliosis. He has written numerous publications and books on chiropractic, spinal biomechanics and scoliosis. He was certified in video fluoroscopy by Palmer College in 1992 and utilizes Digital Motion X-ray in his practice. He began CLEAR Scoliosis Institute in 2000 after realizing the need for a chiropractic approach to treating scoliosis. CLEAR Scoliosis Institute is a nonprofit organization to educate the public and help doctors work with scoliosis. The goal of CLEAR Institute is to implement an effective chiropractic system of scoliosis care to help people worldwide through research and spinal rehabilitation. You can find additional information at CLEAR-Institute.org.