What does it mean to have Curvature of the spine and why should you care?

The diagnosis, "curvature of the spine", could mean you have Scoliosis.  Scoliosis affects an astounding 12 million+ people today (1 in 7 people has scoliosis).  So what? Curvature of the spine (scoliosis) can reduce one’s life on average by 12 years!  So how do you know if you have scoliosis? What does it look like?  A scoliosis curvature of the spine is when your spine has a lateral curvature. 

Spine curvatures above 10 degrees, as measured via X-rays,  are considered scoliosis.  Scoliosis can happen in the thoracic spine, lumbar spine or both. It is more prevalent in girl then boys. If scoliosis runs in your family or if you suspect your kids may have scoliosis you want to make sure to look for the following signs/symptoms and stay on top of it:

Rib hump- have you child bend over and have her hands hang by the knees if you see a hump in her ribs (usually on the right ) this could be an indication of scoliosis.

Low/High hips- have the patient stand in front of you and look at their hips if you notice one hip lower than the other this is another indication.

Leg length discrepancies- have them lay face up and face down if the feet are not balanced it could mean there is a curvature of the spine. In children, Scoliosis is considered to be highly progressive and needs to be monitored by a health care professional.

Curvature of the spine could also mean that there is simply an increased curve in the thoracic spine ( or dowager’s hump) . The person presents with a greater than 40 degrees thoracic curve (i.e., hump in their back) and forward head posture.  Hyperkyphosis can present in children and in adults.  When it presents in adults the most common cause is osteoporosis.

Postural Analysis for Scoliosis

The use of postural analysis as a screening tool for idiopathic scoliosis screenings it vastly under used.  This is particularly unfortunate, because it provides the most sensitive data and earliest spinal curvature detection warnings.  While posture analysis may not be terribly helpful to the untrained observer, it can be an invaluable tool with a few basic tips from the pros.

            Limit your focus points.  Evaluating posture is just like eating an elephant; you need to do it one bite at a time just like everything else.  Instead of just gazing across your child’s posture and attempt to take everything in at once, try starting with observing 5 key pieces of information.

• Eye line:  Is it level or tilted to one side or the other?

• Shoulder level:  Do the shoulders hang evenly or is one higher than the other?

• Hips:  Do the hips appear even or is one higher or more pronounced than the other?

• Forward head posture:  Does your child’s ear hole line up with the tip of their shoulder?

Head to hip line: Imagine a line that extends for between your child’s eyes and goes straight down to their hips. Does the center of the head line up with the center of their hips?

Any one of these or a combination of any of these could indicate a spinal curvature in its early stages and should be evaluated by a trained posture analysis expert immediately. 

Please contact one of our Early Stage Scoliosis Intervention clinics to schedule a free phone consult if you suspect your child is developing signs of mild scoliosis.

       The importance of early scoliosis screening and Early Stage Scoliosis Intervention

1.               It is agreed that very little is known about the cause and cure of the scoliosis patient.  Obviously, there is no cure for the disease, or no one would have it.  However, an effective system of treatment for the reduction and stabilization of scoliosis has emerged on the scene.  The fight against early stage scoliosis is being lead by doctors Clayton J. Stitzel and Brian T. Dovorany;  Who specialize in a system of scoliosis exercises, spinal adjustments, and vibration therapies that essentially “reverse engineer” the condition. This treatment provides a viable alternative to the “wait & watch” observation, traditional scoliosis bracing and scoliosis surgical treatment choices.

1.               Due to the lateral bending and rotation of spinal movement patterns, scoliosis creates a twisting of the spine around its own axis.  Much like twisting a rubber band from the top and bottom, the middle of the rubber band is susceptible to buckling into a curved and rotated position which is the beginning appearance of the spinal curvature.   
 

1.               The twisted and bent position of the spine creates a tremendous amount of torque which then further drives the existing spinal curvature into more twisting and bending and results in further buckling (increase in the spinal curvature).  This becomes a self feeding loop which is often referred to as the “coil down effect”.  Often at this point the spinal deformity starts becoming outwardly apparent in the form of a torso translation or a rib hump.

        A large scale, medically peer reviewed study clearly shows that curvatures under 30 degrees (measured with the Cobb angle method) in early spinal development (Risser’s sign of 0-1 indicting skeletal immaturity) will see their spinal curvature progress 68% of the time. (1)  Since the majority of spinal curvatures under 30 degrees are diagnosed in pre-adolescents, a progression of the spinal curvature can be expected over 2/3 of the time!

 

1.               The current medical standard for the treatment of scoliosis does not recommend any treatment for spinal curvatures until they progress to a lofty 25 degrees Cobb’s angle.  At that point, spinal bracing is recommended which has not been showed to effect the progression of the curvature until it reaches a measurement above 30 degrees Cobb’s angle. (2)  While there have been no research attempts to introduce the concept of highly invasive surgery into the early intervention of scoliosis, one study shows a worse outcome for patients whom had the surgery at a younger age than patients whom were older at the time of the surgery. (3)  Spine Cor has attempted to introduce bracing into the realm of early scoliosis intervention with little to no success. (4)  Despite early scoliosis intervention in terms of patient age and size of curvature, both scoliosis bracing and scoliosis surgery have shown poor results.  It is apparent that a non-surgical, non-bracing early stage scoliosis intervention for the treatment of spinal curvatures and idiopathic adolescent scoliosis is long over-due. 

1.               The early stage scoliosis intervention program is built on the clinical observation that curvatures under 30 degrees when treated using their protocols respond even better than curves over 30 degrees. In most cases of curvatures under the 30 degree mark, full correction to under 10 degrees is not only obtainable, but fairly common.(insert pre post film). Spinal curvatures reduced to below 10 degrees are no longer considered a scoliosis by most authorities meaning it would be defined as a cure. The bio-mechanical reasoning for this response is most likely due to a lack of “crankshaft phenomenon” being present in curves at this smaller level. Radiographic review of smaller curves, under 30 degrees, demonstrate much less visible spinous process rotation at this level indicating less torque, and therefore more flexibility. The higher the degree of flexibility of the curve the greater amount of correction is possible.
2. There are several ways to identify smaller curvatures including visual posture analysis demonstrating a tipped shoulder, high hip, or even translation of the skull or pelvis, scoliometers can detect even relatively small curvatures.  The most reliable and definitive test would be to take a spinal x-ray. Other factors to consider when suspecting a possible curvature are forward head posture or sway back type postures. For more information regarding early detection of scoliosis curvatures please visit the “screening techniques” section of the website.

1. References:
2. 1.  Lonstein & Carlson, The prediction of curve progression in untreated scoliosis during growth, J Bone Surg Am 1984 Sep;66(7):1061-71

1. 2.  The etiology of Adolescent Idiopathic Scoliosis

                 Am J Orthop 2002 Jul;31 (7) :387-95

 Ahn et al, New Hampshire Spine Institute

1. 3.   Brace treatment during pubertal growth spurt in girls
   with idiopathic scoliosis (IS): A prospective trial
   comparing two different concepts                                                                                         
2. Pediatr Rehabilitation. 2005 Jul-Sep;8(3):199-206 (ISSN: 363-8491)
   Weiss HR; Weiss GM

1. 4. Hawes M., University of Arizona, Tucson, AZ 85721, USA. Pediatr Rehabilitation. 2006   

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.

Adolescent idiopathic scoliosis accounts for over 80% of all scoliosis cases and generally occurs between the ages of 9-14 years of age.  For unknown reasons, it targets females to males by an 8 to 1 ratio most of the curve progression occurs during times of rapid growth.  While the condition isn’t life-threatening, it can create massive permanent spinal and body deformity and particularly at a time when teenage girls are often already self conscious about body image.

Clinically speaking, approximately 80% of adolescent idiopathic scoliosis cases will not cause any significant medical issues (although they are at an increased risk of back pain and spine degeneration as adults), but even smaller, non-progressive spinal curvatures can and will have a negative impact on one’s quality of life.  The unfortunately 20% whose spinal curvatures progress though out adolescence are usually presented a very limited number of unattractive, uncomfortable, and ineffective scoliosis treatment options such as scoliosis brace treatment or scoliosis surgery; both of which only focus on treating the spinal curvature and not the neurological root cause of idiopathic scoliosis.

Brand new data supplied by the developers of the Scoliscore genetic test for scoliosis, Axial Bio-Tech, has raised new questions in regards to why certain idiopathic scoliosis cases become progressive curvatures and other don’t.  Only 1% of all idiopathic scoliosis cases are considered “genetically high risk” for scoliosis curve progression, yet approximately 20% of idiopathic scoliosis cases demonstrate progression.  While this would be illogical if idiopathic scoliosis was solely a genetic condition, researchers have long suspected adolescent idiopathic scoliosis to be a multi-factorial condition with both genetic pre-disposition and environmental influences.  Given the fact, that only a tiny percentage of cases are “genetically high risk” for severe progression, and in fact a large percentage of idiopathic scoliosis cases do experience significant scoliosis curve progression it would seem that environmental factors make the most significant role in the progression of idiopathic scoliosis curve progression. 

While teens are notorious for sitting and standing with bad posture (an environmental risk factor for scoliosis curve progression), there are a many other environmental factor/ lifestyle factors to consider as well.……

Sleeping on one’s stomach is not advisable for patients with thoracic scoliosis.  The prolonged position places un-due stress on the mid back and the head turned to one side can increase spinal rotation.

Repeated back bends in ballet or gymnastics can cause scoliosis curve progression.  The repeated hyper-extension of the mid back (back bends) can cause a flattening of the thoracic spine and the de-stabilization may allow a spinal curvature to progress father than it would otherwise.

Spinal trauma that results in ligament damage to the neck is common.  Most people don’t understand the bio-mechanics of ligament damage and think it requires a large amount of force to damage the ligaments in the cervical spine, when it fact it only requires a very “rapidly applied” force.  Minor fender benders are a prime example of trauma that causes ligament damage in the neck.  The resulting instability can change the patient’s head position with profound effects on the scoliosis spine curvature.

Scoliosis in teenagers is a challenging diagnosis to deal with and condition to treat, but new early stage scoliosis intervention therapies that are based on rehabilitating the automatic postural control centers in the brain are having amazing success in halting the progression of scoliosis and reversing the spinal curvature to a large degree.  This new focuses treatment on the reduction/elimination of the environmental factors that combine with the genetic pre-disposition to create the idiopathic scoliosis spine condition rather than only focusing on the spinal curvature.

The CLEAR Institute scoliosis treatment system is a completely new and revolutionary system of scoliosis treatment that achieves scoliosis reduction and stabilization by "unlocking" the curvature from the original position, mobilizing the spinal joints back ot a normal range-of-motion, and then "re-locking" the new, straighter spinal curvature by re-training the brain to learn the new spinal position.

Here is one way of thinking about it......

MIX FIX SET – the computer analogy

 
Mix – Format the hard drive.

Erase and brake down the soft tissue resistance in your scoliotic spine, is like clearing the errors and bugs on your hard drive formatting it.

Fix – Hit the power reset button.

Adjusting the misaligned spine spinal units, that were measured of your x-rays with spinal manipulation, is like hitting the power reset button on your formatted computer. This will force the body to recalibrate adjusted spinal segments, like your computer will have to reboot again.

Set – Install the new software.

Scoliosis Traction Chair (STC) and Spinal Weighting system is like installing the new operating software on your hard drive, retraining your brainstems ‘Body Set Point’ or ‘Body Scheme’ to adapt to its new alignment.

Personally, I like using the "making bread" type analogy......

Throw eggs, flour, yeast, oil, ect into a bowl and toss it in the oven and you won't get bread.....you'll get warm goo. However, if you knead the ingredients into dough, let it rise in the fridge, cook it in a pre-heated oven for the prescribed amount of time you will most likely get bread. Same ingredients, different protocols, dramatically different outcomes.

And that is how the CLEAR Institute Scoliosis Treatment program works.

Early Stage Scoliosis Intervention is the best opportunity for a scoliosis patient to overcome and successfully manage their condition. This will require a completely new treatment schedule and system of treatment process.

“The treatment goals for an early stage scoliosis intervention program should be to hold the curvature under 20 degrees during the growing years and have the curvature measure no more than 25 degrees by the time the patient reaches skeletal maturity”

While there is still no cure for adolescent idiopathic scoliosis, theories abstracted from current research suggests the natural course of the condition can be altered with an active rehabilitation program that targets the involuntary postural control centers in the patient’s brain.

For many early stage scoliosis patients, treatment will be a necessary and ongoing process until they reach skeletal maturity (16-17 for females and 18-20 for males), and some patients will require ongoing treatment throughout life. However, the risk of progression significant curve progression in skeletally immature patients and skeletally mature patients can greatly reduced by developing a “20/25 vision” ongoing treatment plan during their “growing years” and before skeletal maturity.

Current research has found that younger patients with spinal curvatures that measure 0-19 degrees have a 14%-22% risk of further progression while they are growing, but the risk increases more than 3 fold (68%) for the same patients if their increases to the 20-29 degree range (1). Therefore, it is vitally important to halt or reduce the curvature below the 20 degree mark in order to reduce the adolescent patient’s risk of progression by up to 46%.

Long-term research has discovered that idiopathic adolescent scoliosis patients whom have spinal curvatures that measure greater than 25 degrees have a 68% risk of continued progression in their scoliotic curvature throughout adulthood that will cause severe pain and disability, however scoliosis patients who whose curvatures measured 25 degrees or less only experienced further curve progression 8% of the time throughout adulthood.(2)

(1) Lonstein et el, The prediction of curve progression in untreated idiopathic scoliosis. J Bone Joint Surg AM.1984,661061-1071

(2) Curve Progression in Idiopathic Scoliosis – Follow up study to skeletal maturity
Ken-Jin Tan, et al.
SPINE.2009.vol34(7).697-700