by Dr. Allan G. Oolo, B. Sc., D.C.
Introduction and Definition
You may have seen or heard of the recent television program on spinal surgery to correct scoliosis. I have many patients that commented on how taken they were by this program and how vividly it presented the seriousness of scoliosis. Quite a number of my patients consequently asked me when it would be advisable for one to be initially examined for scoliosis. I realized the necessity for more education on this condition and, henceforth, endeavoured to write this article.
Let us begin by defining scoliosis. Scoliosis has been defined as a lateral curvature of the spine with vertebral rotation and the absence of any congenital spinal anomaly or musculoskeletal condition. This means that a twisting spinal curvature develops similar to that of a spiral staircase but not nearly as uniform or symmetrical. The initial development of this "twist" or scoliosis is almost always without symptoms. It is also very difficult for the untrained eye to conclusively detect the presence of a beginning scoliotic curve. Proper evaluation which directs us to effective treatment requires expert knowledge of the spine.
Scoliosis is therefore something that must be examined for and detected by a professional trained to specifically diagnose and treat such a condition. There are two main types of scoliosis:
1. PRIMARY - (idiopathic). This is the type of scoliosis where, the cause is completely unknown. This type of scoliosis has a predisposition to females. The ratio is 9:1 with respect to incidence in females versus males. Such an imbalance has led many of the researchers to suspect a genetic cause with the greater influence of genetic predisposition within the female line of heredity. It has been proven that a child born from parents that both have scoliosis has a 40% chance of developing idiopathic scoliosis.
2. SECONDARY - (compensatory). The spinal curvature and twist in this case is the result of a readily identifiable cause such as poor posture, subluxation, the difference in leg lengths, injury, or certain diseases. Subluxation is basically defined as a spinal joint which has lost its normal degree of mobility and has therefore become restricted in its range of motion. This restriction eventually leads to interference with the normal nerve transmission at that level of the spine and interference with the normal muscular function at that level. If left unattended subluxation can lead to excessive stress on the spinal joint with consequent deteriorative changes such as arthritis and degenerative disc disease.
Development
Many spinal problems begin in childhood and develop gradually. In infancy such serious problems as vertebral subluxations, spinal curvatures and other structural distortions can have their beginnings. The birth process is one of life's most traumatic experiences. Stress on the infant's spine can be tremendously forceful during birth which can lead to the development of subluxations and other spinal related problems. As we develop through childhood our spines are also normally subjected to a variety of stresses, bumps, twists and falls, etc. These stresses may not produce notable symptoms during childhood and even into early adulthood, but by the time the symptoms do develop there may already be negative damaging alterations. It is during infancy and childhood that underlying problems are most easily and adequately corrected before the body has accommodated and structurally compensated.
Chiropractic is the only profession that approaches spinal care on the basis of prevention. In examining your infant's or child's spine a chiropractor will not only address any gross biomechanical alterations or curvatures but he will also intricately examine each and every spinal segment, in order to ascertain proper neuromusculoskeletal function at every level. No other health care profession concerns itself with such a detailed spinal examination. Although some forms of scoliosis can be detected in infancy and childhood, the most obvious influence on the progression of an idiopathic scoliosis in both males and females is during the period of pre-adolescence. It is during this time that the child's growth rate is at its peak and it is also during this time that the progression of the scoliotic curve is at its peak.
Effects
It is important to realize that scoliosis will usually begin to develop without the appearance of major symptoms. Symptoms, however, will inevitably develop. Development of scoliosis in children may be associated with symptoms such as "growing pains", fatigue, back pain or pain in the knees or ankles. As I have said however, these types of symptoms may not appear until the scoliosis is well advanced.
If the curvature is left to develop to a significant degree,
patients are often plagued during their adult life with aches and pains
that would not normally exist. Interference with spinal nerve function
is also hypothesized to develop as a result of scoliosis. This in turn
can lead to disfunction of the organ systems as well as the muscular
system and the immune system. Progression of scoliosis can also impair
the individual in his or her participation of sports activities.
Scoliosis is also a condition that most sufferers find to be
aesthetically unpleasant and this in turn may effect their
self-confidence. If the curvature develops beyond 40 degrees,
encroachment of the thoracic and abdominal organs may also develop with
consequent impairment of function.
Stress on the spinal bones from scoliosis will eventually cause
deterioration with resultant osteoarthritis and disc disintegration.
Although symptoms are not always associated with the initial
development of scoliosis, new studies have shown a much higher
prevalence of back pain in children than previously thought. Ina study
of children 12 -15 years old (Olsen et al, 1992, Am. J. Public Health)
30.4% reported a history of low back pain. Mierau and Cassidy (1984)
found 22.8% of elementary school and 33.3% of secondary school aged
children complained of low back pain. Even infants have been found to
suffer from symptoms related to spinal problems. A 1989 study
(Klougart, Nilsson et al) of 316 colicky babies showed a 94% success
rate (colic ceased 60%, improved 34%) after two weeks of chiropractic
care. The average age of patients in this study was 7.7 weeks.
Treatment
As stated in The Clinical Symposia of Scoliosis by Hugo A. Keim, MD, FACS, "The best treatment for scoliosis is early detection. Most curves can be treated non-operatively if detected before they become too severe." To this end, scoliosis screening from as early an age as possible should be conducted on all children. As spinal scoliosis develops it can be most effectively modified in pre-school and early school-aged children. It is during this period that the vertebrae is still cartilage and not yet bone; thus the structure can be more easily modified. In certain cases it may be necessary to accurately measure and determine the angle and degree of rotation and curvature through X-ray studies. Such radiographic studies provide for extensive evaluation of the nature of the curvatures, classification of the phases of rotation, changes in the architecture of the spinal segments, facilitation for measurement of the curvature and a basis of comparison for future radiographic studies to evaluate progress.
A doctor of chiropractic is specifically trained to determine which approach to treatment would be best for the child. Treatment will usually include spinal manipulation which involves gentle painless mobilization of the spinal segments that have become "jammed up" causing improper spinal mechanics. Chiropractors specialize in spinal manipulation and there is no health profession more qualified to carry out this important form of treatment. Chiropractic manipulation will help maintain the mobility of the joints of the spine in order to allow the spine to develop normally. This type of treatment applied regularly over a prolonged period of time is meant to help prevent development of the scoliotic curve and to reduce the degree of the curvature. In conjunction with manipulation, specific exercises, orthotics and transcutaneous electrical devices may be used.
Summary
As stated by the Ontario Chiropractic Association,
"Parents appreciate the importance of having check-ups for their child's teeth, eyes, and ears, but when it comes to spinal check-ups, the necessity may be overlooked."
In the developing embryo, the first visible structural development is the spine and skull. This illustrates the importance the body places on protecting the baby's nervous system. It's important that our children have the opportunity to grow with an uncompromised spinal structure.
Spinal check-ups should be your child's most important regular appointment. Early detection and regular corrections of these vertebral subluxations can keep your child's system functioning at its maximum capability."
With regard to scoliosis, an ounce of prevention may prevent a lifetime of serious spinal problems.
If your child has not had a scoliosis screening it would be well advised for you to have this done as promptly as possible. Early recognition and proper preventative care are the keys to preventing these types of progressive deformities that are still far too common around the world.
Remember
"As the twig is bent...
"...so grows the tree."