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Chapter 13 from: Clinical Biomechanics
By Richard C. Schafer, D.C., FICC
In traditional medicine, scoliosis is commonly ignored until gross cosmetic effects or signs of structural destruction are witnessed. In chiropractic, however, even minor degrees of distortion should be considered at the time of spinal analysis because of their subtle biomechanical and neurologic consequences, and to halt potential progression at an early stage. To give a better appreciation of these points, this chapter describes the general structural, examination, and biomechanical concerns that should be considered, along with the highlights of conservative therapy.
Physical Examination of the Lungs and Thorax
Chapter 3 from: Physical Diagnosis: Methodology in Chiropractic Practice
By Richard C. Schafer, D.C., FICC
The term scoliosis refers to any combination of lateral curvature from a straight line with twisting of the spine when viewed from the front or the back. What is grossly viewed in the typical scoliosis from the posterior are the
typical spinal curves normally seen from the lateral. That is, the curves are situated in the wrong plane, frontal rather than sagittal, and the vertical axis rotation is usually in the wrong direction and often exaggerated. Simply, it is
often as if the spine were fixed in space and the head and pelvis were rotated +/- several degrees in the same direction. Thus, the majority of the distortion seen in scoliosis is the result of rotation. This is the gross effect of scoliosis. The segmental effect is abnormal focal motion-unit disrelationship where normal rotation, lateral tilting, and A-P facet slip has become fixed, functionally and/or structurally. Scoliosis is a mechanical disorder when gross, but there are always many biologic influences operating as well as purely mechanical forces.
Knowledge and Management of Adolescent Idiopathic Scoliosis Among Family Physicians, Pediatricians, Chiropractors and Physiotherapists in Québec, Canada: An Exploratory Study
J Can Chiropr Assoc. 2013 (Sep); 57 (3): 251–259 ~ FULL TEXT
Health professionals (HPs) are likely to encounter adolescent idiopathic scoliosis (AIS) patients. Best practice dictates that early detection leads to better decision making regarding optimal management. The aim of our study was to appraise the basic knowledge, evaluation and management skills concerning AIS care among family physicians, pediatricians, chiropractors, and physiotherapists. The majority of HPs (70-90%) would refer the patient who required prompt referral, but only 38-60% actually rated the case as requiring prompt referral. Forty percent of HPs (predominantly physiotherapists and family physicians) stated that they would not be comfortable providing AIS patient follow-up.
Outcomes For Adult Scoliosis Patients Receiving Chiropractic Rehabilitation:
A 24-month Retrospective Analysis
Journal of Chiropractic Medicine 2011 (Sep); 10 (3): 179–184
This report is among the first to demonstrate sustained radiographic, self-rated, and physiologic benefits after treatment ceased. After completion of a multimodal chiropractic rehabilitation treatment, a retrospective cohort of 28 adult scoliosis patients reported improvements in pain, Cobb angle, and disability immediately following the conclusion of treatment and 24 months later.
Four-Year Follow-Up of a Patient Undergoing Chiropractic Rehabilitation
for Adolescent Idiopathic Scoliosis
Journal of Pediatric, Maternal & Family Health - Chiropractic 2011; 2: 54-58
A 14 year old female with adolescent idiopathic scoliosis presented to a private chiropractic rehabilitation clinic for care. She had complaints of mild thoracic and right sacroiliac pain which worsened during prolonged sitting or while running long distances. Her scoliosis measured 24° in the thoracic spine and 17° in the lumbar spine. Abnormalities in chest expansion and axial trunk rotation were also observed and recorded. Patient participated in a multimodal chiropractic rehabilitation program consisting of 28 clinic visits over 17 months. She also committed to a specific home exercise program. After 17 months, her curvatures decreased to 15°/6°, while showing concomitant improvements in peak expiratory flow, axial trunk rotation, and chest expansion. These outcome measures further improved at follow-up after 4 years with the Cobb angles reducing to 12°/4° respectively.
Adolescent Idiopathic Scoliosis Treated by
Spinal Manipulation: A Case Study
J Altern Complement Med. 2008 (Jul); 14 (6): 749–751
This report of one case illustrates the potential effect of chiropractic manipulative therapy on back pain and curve progression in the at-risk, skeletally immature patient with adolescent idiopathic scoliosis. Chiropractic treatment was associated with a reduction in the degree of curvature of adolescent idiopathic scoliosis in this case, after half a year of conventional medical treatment had failed to stop curve progression. This suggests that in at least some severe and progressive cases of scoliosis, chiropractic treatment including spinal manipulation may decrease the need for surgery.
Chiropractic Manipulation in Adolescent Idiopathic Scoliosis: A Pilot Study
Chiropractic & Osteopathy 2006 (Aug 21); 14: 15 ~ FULL TEXT
Adolescent idiopathic scoliosis (AIS) remains the most common deforming orthopedic condition in children. Increasingly, both adults and children are seeking complementary and alternative therapy, including chiropractic treatment, for a wide variety of health concerns.
Scoliosis Treatment Using Spinal Manipulation and the Pettibon Weighting System:
A Summary of 3 Atypical Presentations
Chiropractic & Osteopathy 2006 (Jan 12); 14: 1 ~ FULL TEXT
Each patient was treated with a novel active rehabilitation program for varying lengths of time, including spinal manipulation and a patented external head and body weighting system. Following a course of treatment, consisting of clinic and home care treatments, post-treatment radiographs and examinations were conducted. Improvement in symptoms and daily function was obtained in all 3 cases.
Concerning Cobb angle measurements, there was an apparent reduction in Cobb angle of 13 degrees , 8 degrees , and 16 degrees over a maximum of 12 weeks of treatment.
Adolescent Idiopathic Scoliosis Screening For School, Community, and
Clinical Health Promotion Practice Utilizing the PRECEDE-PROCEED Model
Chiropractic & Osteopathy 2005 (Nov 30); 13: 25 ~ FULL TEXT
The social assessment of quality of life is limited with few studies approaching the long-term effects of AIS. Epidemiologically, AIS is the most common form of scoliosis and leading orthopedic problem in children. Behavioral/environmental studies focus on discovering etiologic relationships yet this data is confounded because AIS is not a behavioral. Illness and parenting health behaviors can be appreciated. The educational diagnosis is confounded because AIS is an orthopedic disorder and not behavioral. The administration/policy diagnosis is hindered in that scoliosis screening programs are not considered cost-effective. Policies are determined in some schools because 26 states mandate school scoliosis screening. There exists potential error with the Adam's test. The most widely used measure in the PP model, the Health Belief Model, has not been utilized in any AIS research.
Effect of Chiropractic Intervention on Small Scoliotic Curves
in Younger Subjects: A Time-series Cohort Design
J Manipulative Physiol Ther. 2001 (Jul); 24 (6): 385–393
Forty-two subjects completed the program of chiropractic intervention. Age range at entry was 6 to 12 years, and patients were included if their entry-level x-ray films revealed curves of 6 degrees to 20 degrees. Participants had adjustments performed for 1 year before follow-up. Full-spine osseous adjustments were the major form of intervention, but heel lifts and postural and lifestyle counseling were used as well. There was no discernable effect on the severity of the curves as a function of age, initial curve severity, frequency of care, or attending physician.
Children and Scoliosis
By Kim Christensen, DC, DACRB, CCSP, CSCS
Dynamic Chiropractic ~ February 12, 2001
Successful treatment is dependent upon differentiating the underlying cause of the spinal curvature. In most children, the scoliotic spine is not symptomatic; the spinal curvature is first noticed either by a parent who becomes concerned about a child's posture, or during a screening examination, usually at school. The importance of a good evaluation and early treatment is to prevent progression and worsening of the curvature. Children with all three major causes of scoliosis should have a careful evaluation of the lower extremities as part of their spinal examination to determine associated or contributing components to the spinal deviation.
A New Look at Adolescent Idiopathic Scoliosis
By Mark Sanna, D.C.
My patients with AIS consistently experienced positive outcomes when, in conjunction with chiropractic adjustments, they were placed on the program of proprioceptive training that I will outline later in this article. While it is most likely that the etiology of AIS is multifactorial, I have been pleased to note that recent efforts in scoliosis research have been concentrating on seeking defects in proprioceptive mechanisms, substantiating my long held hypothesis of proprioceptive involvement. Let’s begin our AIS research review with a study performed by W. Keesen in the Netherlands. 
Adolescent Idiopathic Scoliosis
By Dr. Diane Benizzi DiMarco
A lateral bending of the spine, adolescent idiopathic scoliosis can present with a lateral and rotary deformity. Spinal curvatures can be the result of varied factors including; muscle diseases or spasms, neurological disease, diseases of the CNS or PNS, congenital vertebral deformities, leg length inequalities, tumors, pain, injury and degenerative spinal arthrosis. The most common cause of scoliosis, adolescent idiopathic scoliosis, accounts for approximately 80% of all diagnosed scoliosis cases.  Females are affected at a rate of 9:1. Idiopathic scoliosis, juvenile and adolescent affect females ages three to ten years of age and ten years to skeletal maturity, respectively. [2,3]
Anatomical Leg Length Inequality, Scoliosis and Lordotic Curve
in Unselected Clinic Patients
J Manipulative Physiol Ther 1991 (Jul); 14 (6): 368–375
The results of this study indicate that while there is no strong correlation between any one of the particular postural adaptations to anatomic leg length deficiency, nevertheless at least one abnormal spinal adaptation (scoliosis or hypo-hyperlordosis) occurs in over half of subjects who have LLI greater than 6 mm.
Scoliosis: Biomechanics and Rationale for Manipulative Treatment
J Manipulative Physiol Ther 1989 (Feb); 12 (1): 38–45
Since scoliosis is a lordotic problem, associating lateral curvatures with gender, age, and attitude of the thoracics during growth spurt may answer questions of a female disposition and a male tendency to Scheuermann's disease. Further, this paper evaluates the lateral curvatures of the spine concerning normal curve mechanics and idiopathic scoliosis. Mechanical stability is considered, applying engineering principals to understand buckling and critical loading. By examining the factors of spine slenderness, flexibility and strengths of the trunk muscles, and applying this understanding to curve mechanics-biomechanics of scoliosis, the chiropractor has a rationale for the treatment of mild lateral curves.