Scoliosis

Overview
Scoliosis classifications
Scoliosis and the “crooked person”
Scoliosis and flat feet
Systemic Effects of Scoliosis in Young Adults
Treatment of Scoliosis
Guidelines for Choosing Appropriate Shoes for a Scoliosis Patient

The presence of scoliosis is as emotionally charged for the patient as it is clinically challenging for the Chiropractor. Patients often come into our clinics incredibly concerned that they have been labeled as having scoliosis. We also experience dealing with parents bringing in their children, saying the school nurse or Pediatrician has diagnosed them with scoliosis and what it all means. Scoliosis is the most common spinal disorder in children and adolescents1.

Scoliosis is an abnormal lateral curvature of the spine in the coronal or frontal plane. It is most often diagnosed in childhood or early adolescence. While the degree of curvature is measured on the coronal plane, we have witnessed in clinical practice that scoliosis is actually a more complex, three-dimensional problem that involves multiple planes of movement.

According to the American Association of Neurological Surgeons, Scoliosis affects 2-3 percent of the population, or an estimated 6-9 million people in the United States. Scoliosis can develop in infancy or early childhood. However, the primary age of onset for scoliosis appears to be 10-15 years old, occurring equally among both genders. Females are 8x more likely to progress to a curve magnitude that requires treatment2. Previous studies note a prevalence of adult scoliosis of up to 32%. In a study by Schwab, et al., results indicate a scoliosis rate of 68% in a healthy adult population, with an average age of 70.5 years3.

Scoliosis is classified as idiopathic, congenital, or neuromuscular.

In Congenital scoliosis, there is an embryological malformation of one or more vertebrae anywhere in the spine. Curvature and deformities of the spine result because one area of the spinal column lengthens at a slower rate than the rest. The shape and location of these abnormalities determine the rate and severity of the scoliosis as the child grows. This type of scoliosis is present at birth, so it can be detected at a young age.

Neuromuscular scoliosis is secondary to neurological or muscular diseases (i.e., cerebral palsy, spinal cord trauma, muscular dystrophy, spinal muscular atrophy and spina bifida). This type of scoliosis generally progresses more rapidly than idiopathic scoliosis and often requires surgical treatment.

Idiopathic scoliosis is the most common, making up about 80 percent of all cases. It is a diagnosis of exclusion and is normally diagnosed during puberty4.

Much of the medical research pertaining to scoliosis seems to focus very little on the utilization of chiropractic and foot arch support as a form of conservative care. In one of the more comprehensive research articles, Karimia and Rabczuk did a study in 2018 that reviewed 40 papers on conservative approaches to scoliosis treatment5. They discussed every orthotic corrective brace along with physical therapy approaches and even acupuncture. But no mention of Chiropractic care or utilization of foot orthotics.

The Crooked Person Rears Its Ugly Head:

Starting at the young age of 6-7 years old, we can observe clinically how excessively pronated feet create a cascade of biomechanical stresses up the kinetic chain. The flattened arches create medial rotational forces on the tibia and femur that have negative effects on the pelvis and spine. On the side of the worse pronated foot, we find pelvic obliquity, low iliac crest/femoral head heights, a functional short leg and a resultant lateral curvature of the lumbar spine.

With the lumbar spine being curved towards the side of the worse pronation, the thoracic spine functionally curves towards the opposite side as compensation. This in turn affects the shoulders and neck.

Flat Feet Contribute to Functional Scoliosis:

All these biomechanical changes from the ground up cause a shift of load onto the various joints of the lower extremities and the spine. Flat feet essentially create a functional scoliosis in the lumbar and thoracic regions to some degree in everyone who excessively pronates. Since 9/10 people have flat arches, functional lateral curvatures can be seen frequently in patients consulting us for general aches and pains in their bodies.

The flatter the arches, the more the kinetic chain is stressed and the greater the contribution to the degree of functional scoliosis. Keep in mind that no matter what type of scoliosis classification the patient has, a faulty pedal foundation will make the situation worse.

Systemic Effects of Scoliosis in Young Adult Populations:

Idiopathic scoliosis is further subdivided into three groups; infantile, before age 3 years; juvenile, age 5 to eight years; and adolescent, age 10 years until the end of growth. 80% or more of idiopathic scoliosis is of the adolescent variety6.

Adolescent idiopathic scoliosis is a systemic, lifetime condition of unknown cause.

Untreated, adolescent idiopathic scoliosis does not generally increase the mortality rate or the rate of shortness of breath. However, patients with 50° curves at maturity or 80° curves during adulthood have an increased risk of developing shortness of breath. They do have increased pain prevalence and may have increased pain severity. Self-image is often decreased. Mental health is usually not affected. Social function, including marriage and childbearing, may be affected, but usually in more severe cases. As nice as this sounds, now switch gears, and talk about joint health and movement patterns.

Since plantar arch formation is fundamentally complete by age 7, this is where we begin seeing early stages of joint stress, compensation, and scoliosis in children. If we do not have the opportunity to identify and treat flat feet in the younger years, it will progress through adolescence and adulthood. During this whole time, increased load on the kinetic chain can lead to a host of musculoskeletal problems along with scoliosis.

Treatment:

 Chiropractic adjustments:

We know it is important to keep the vertebrae as aligned as possible, especially in the case of scoliosis. There are some very severe cases where the vertebrae seem “locked in place,” but efforts should be made by the Chiropractor to adjust the patient where appropriate and necessary to establish and maintain whatever degree of healthy movement is possible. 

Scoliosis Braces:

In 2021, Weiss, et. al. found in their research article that brace application may impact the patient with possible physical discomfort and psychological distress7. Good quality management in brace application for patients with scoliosis is needed to ensure the best possible outcome and least stressful treatment. The wide variation of success rates, as found in the literature, does not seem acceptable for patients when considering how they sacrifice their time and quality of life to wear the brace, sometimes for years.

Orthotic Support:

The importance of supporting all three arches that make up the plantar vault and leveling up the feet as the foundation of the body cannot be understated. Get the scoliosis patient in 3 arch, flexible, custom-made orthotics as soon as possible. This will help them stay aligned from toes to nose.

Guidelines for Choosing Appropriate Shoes for a Scoliosis Patient:

  1. Measure for the patient’s proper length and width. Height might need consideration.
  2. Should be made of flexible but sturdy material that will conform to their spine as it curves. The shoes should be comfortable.
  3. Avoid rigid materials like metal or plastic, as they may not be able to stretch enough for the patient’s needs.
  4. Should feel snug but not too tight so the fit is comfortable and stable.
  5. Scoliosis patients have difficulty wearing high heels because it causes increased spinal curvature. Low-heeled shoes, on the other hand, are a great option for these individuals as they not only prevent excessive spinal curvature but also relieve pain from neck and back problems.
  6. Select shoes with a low platform height so people can walk easily in them without feeling too restricted in their range of movement.
  7. Well cushioned. Shoes with a textile upper and EVA (ethylene-vinyl-acetate) foam in the heel and ball of the foot provide lightweight cushion, spring (rebound), and are resistant to hardening and cracking. It doesn’t absorb water, and stays flexible in the cold, all of which make it very useful for outdoor footwear.
  8. Look for shoes with a soft lining or padding, so that they will absorb the shock and distribute it evenly throughout your foot. Shoes with high heels or hard soles can cause more pain and discomfort.

 

References:

  1. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013 Feb;7(1):3-9. doi: 10.1007/s11832-012-0457-4. Epub 2012 Dec 11. PMID: 24432052; PMCID: PMC3566258.
  2. Janicki JA, Alman B. Scoliosis: Review of diagnosis and treatment. Paediatr Child Health. 2007 Nov;12(9):771-6. doi: 10.1093/pch/12.9.771. PMID: 19030463; PMCID: PMC2532872.
  3. Schwab, Frank MD*; Dubey, Ashok MD*; Gamez, Lorenzo MD*; El Fegoun, Abdelkrim Benchikh MD†; Hwang, Ki MD*; Pagala, Murali PhD‡; Farcy, J -P. MD*. Adult Scoliosis: Prevalence, SF-36, and Nutritional Parameters in an Elderly Volunteer Population. Spine 30(9):p 1082-1085, May 1, 2005. | DOI: 10.1097/01.brs.0000160842.43482.cd
  4. Sung S, Chae HW, Lee HS, Kim S, Kwon JW, Lee SB, Moon SH, Lee HM, Lee BH. Incidence and Surgery Rate of Idiopathic Scoliosis: A Nationwide Database Study. Int J Environ Res Public Health. 2021 Aug 1;18(15):8152. doi: 10.3390/ijerph18158152. PMID: 34360445; PMCID: PMC8346015.
  5. Karimi MT, Rabczuk T. Scoliosis conservative treatment: A review of literature. J Craniovertebral Junction Spine. 2018 Jan-Mar;9(1):3-8. doi: 10.4103/jcvjs.JCVJS_39_17. PMID: 29755230; PMCID: PMC5934961.
  6. Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006 Mar 31;1(1):2. doi: 10.1186/1748-7161-1-2. PMID: 16759428; PMCID: PMC1475645.
  7. Weiss HR, Çolak TK, Lay M, Borysov M. Brace treatment for patients with scoliosis: State of the art. S Afr J Physiother. 2021 Oct 26;77(2):1573. doi: 10.4102/sajp.v77i2.1573. PMID: 34859162; PMCID: PMC8603182.
Dr. Kevin Wong
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Dr. Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 Summa Cum Laude graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA.

As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting. See upcoming events with Dr. Wong and other Foot Levelers speakers at footlevelers.com/seminars. Check out his monthly blogs with proven practice tips to help you achieve optimal patient outcomes.