June is scoliosis awareness month—making it a fitting time to talk about the important role that DCs can play when it comes to both detection and treatment of this particular condition.
According to the National Scoliosis Foundation (NSF), scoliosis affects approximately seven million people in the United States alone. This means that there is high likelihood that you will have patients with this abnormal curvature of the spine that “can impact the quality of life with limited activity, pain, reduced respiratory function, or diminished self-esteem.” And since the NSF further states that it “is a multifactorial disorder, which requires multidisciplinary research and treatment,” this is where chiropractic comes in.
Research has found that chiropractic can help individuals with scoliosis in a number of ways. For instance, one study published in the Journal of Chiropractic Medicine in late 2011 which involved 28 subjects with scoliosis found that, after six months of chiropractic care, they “reported improvements in pain, Cobb angle, and disability immediately following the conclusion of treatment.” Additionally, they still enjoyed these same advantages two years post-chiropractic treatment.
Marc Moramarco, DC, was the first U.S. physician certified in the Schroth Method (a non-surgical treatment that involves the use of scoliosis-specific exercises) in Germany, and he was generously willing to share what role he feels chiropractors play when it comes to scoliosis detection and treatment.
When it comes to scoliosis detection, “DCs can easily identify scoliosis via postural evaluation,” Moramarco says.
When conducting this type of visual inspection, you want to look for “shoulder and/or pelvic un-leveling, a dorsal rib cage prominence to one side (usually the right), and a ventral prominence on the opposite side of the dorsal rib cage prominence,” he says. “Sometimes in boys, pectus excavatum (a depressed sternal area) may be present.”
Two other ways to identify scoliosis, according to Moramarco, are with an Adam’s forward bend test and a scoliometer reading. When doing the scoliometer reading, Moramarco says that a five degree reading should prompt an x-ray. Additionally, he stresses that “history is important as well, because there is a 30 percent familial correlation.”
If scoliosis is diagnosed, Moramarco says that it is important to determine the cause as “the treatment plan will vary according to the origin.” Medical News Today reports that approximately 80 percent of the cases have an unknown cause (referred to as idiopathic scoliosis), and the remainder are mainly a result of neuromuscular conditions, such as cerebral palsy or muscular dystrophy. Yet, in rare circumstances, the cause can be congenital scoliosis (which means it’s been there since birth) or related to the gene GPR126. Sometimes differing leg lengths, bad posture, and the use of bags that can strain the back can create scoliosis as well.
As far as treatment is concerned, Moramarco says that “chiropractic manipulation may help with spinal and rib cage mobility. However, the main focus when treating scoliosis conservatively is via scoliosis specific exercise rehabilitation,” referring to the Schroth Practice which he provides his patients regularly at his Scoliosis3DC practice. “Schroth corrective breathing exercises are tremendously helpful but require special training,” he says. “As does the ADL (activities of daily living) instruction.”
Moramarco also states that chiropractors should take a more “proactive approach rather than ‘watch and wait’, the traditional model for a mild scoliosis.” This means monitoring the patient via photos and scoliometer, prompting an x-ray if a red flag arises.
“Chiropractors can begin to make a positive impact via 3D bracing which addresses the coronal, transverse, and sagittal planes in growing children at high rates of progression,” he says. “Part-time bracing also helps adults requiring pain management, spinal stabilization, and to help prevent progression.”
Research has confirmed the effects of bracing, with one study published in The New England Journal of Medicine reporting “the rate of treatment success was 72% after bracing, as compared with 48% after observation.”
Ultimately, DCs play a very important role with scoliosis, both with detection and treatment. That makes you an important player in effective healthcare for someone with this particular condition.