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Although still considered investigational for the use in the treatment of scoliosis, research shows whole body vibration increases the effectiveness of exercise programs. For this reason, we may recommend specific exercises be performed in conjuntion with whole body vibration.

Whole Body Vibration (WBV) is a relatively new method of increasing muscle spindle activation during exercise. It has been shown to be helpful in bone remodeling as well as improving exercise efficiency.

Scoliosis Systems utilizes exercise programs as part of a complete management program lasting over an 18-24 month period. WBV can be utilized to retrain muscle recruitment patterns, influence bone remodeling, and improve the parietal brain somatotopic representation of body position in space.

Patient recommendations are made on an individual basis and may not include physiotherapy or muscle re-education procedures described on this website.

Scoliosis Journal

A comprehensive neurological examination is recommended although it is not mandatory to be fitted with an orthosis. Our approach to the non-surgical management of scoliosis is focused on neuro-muscular re-education of the postural support systems. The evaluation may include a sensory/motor exam, vestibular screening/evaluation, oculomotor screening/evaluation.

Neurological patterns of dysfunction have been reported in the literature, although typical orthopedic management neglects most functional analyses and appropriate rehabilitation. In the event neurological imbalances are revealed, further testing, neuro-diagnostic imaging and appropriate therapy programs may be prescribed.

Etiology of Idiopathic Scoliosis: Current Trends in Research. (Click here)

(Lowe et al 2000)

…A number of studies have shown an abnormal nystagmus response to caloric testing in patients with idiopathic scoliosis, suggesting an oculovestibular abnormality. Herman et al.46 proposed that a dysfunction of the motor cortex that controls axial posture results from a sensory input deficiency concerning spatial orientation and that this effect probably results from central proprioceptive sources involving visual and vestibular function. Other reports have supported this concept. The clinical syndrome of symmetrical horizontal or lateral gaze palsy is associated with a high prevalence of scoliosis of the idiopathic type. The site of neurological abnormality is thought to be the paramedian pontine reticular formation, which links the preocular motor nuclei and the vestibular nuclei. It is reasonable to speculate that the site of neuropathy in idiopathic scoliosis could also be the paramedian pontine reticular formation.

Video Electronystagmography is the “gold standard” test in the assessment of brain, brainstem and cerebellar control of eye movements. This non invasive diagnostic test can objectively diagnose cerebello-vestibular dysfunction, vestibulospinal and cortical imbalances which may be an underlying cause of progressive spinal curvatures.

Abstract from Scoliosis Research Society (SRS) 2003 Meeting

Matthew T. Provencher M.D., Derin Wester, Ph.D., Bruce Gillingham M.D.; Naval Medical Center- San Diego, CA. Orthopedic Research and Education Foundation- Resident Research Grant

Conclusion: A central vestibular deficit is present in scoliosis patients. Central vestibular function is worse with larger curves, and the dysfunction is opposite to the curve. Curves with location in the mid-thoracic region demonstrated less central deficit than low-thoracic and lumbar scoliosis curves. The data supports a central vestibular dysfunction in patients with scoliosis

Spontaneous nystagmus (SN) and positional nystagmus (PN) were found in 24 out of the 47 patients with single curvatures and in only one subject in the control group (P less than 0.001).

Significant differences were observed in the caloric response between right and left scoliotic patients (P less than 0.05). The right convex patients had a sensitivity dominance in the right labyrinth and the left convex patients in the left labyrinth (Acta Orthop Scand 1979 Dec;50(6 Pt 2):759-69 Sahlstrand T, Petruson B.)

(Arch Ital Biol 2002 Jan;140(1):67-80 Manzoni D, Miele F.Dipartimento di Fisiologia e Biochimica, Universita di Pisa, Via S. Zeno 31, I-56127 Pisa, Italy)

…It appears, however, that, in children, a slight imbalance in the activity of vestibular complex of both sides escapes the neuronal mechanisms responsible for vestibular compensation and leads to the spinal curvature which characterizes Idiopathic Scoliosis.

…The recommendation was made that a neurological examination, including assessment of vestibular function, be incorporated into screening methods for scoliosis.
(Jensen GM, Wilson KB. Phys Ther 1979 Oct;59(10):1226-33)

…Significant differences were found between patients with right convex curves and those with left convex curves in the distribution of eye predominance and in labyrinthine sensitivity
(Spine 1980 Nov-Dec;5(6):512-8 Sahlstrand T.)

Romano Michele, Zaina Fabio
ISICO (Italian Scientific Spine Institute), Via Carlo Crivelli 20, 20122 Milan, Italy – michele. romano@isico.it

Objective: The Unterberger stepping test is normally used to identify vestibular dysfunction and not to detect central disorders of balance. However we already made a previous study where we found a significant statistical difference in a sample of 30 scoliotic patient compared with a healthy control group. Our aim was to study if there is a relationship between direction of rotation during the test performance and convexity of scoliosis major curve.
Study design: 59 patient with adolescent idiopathic scoliosis (range: 14-55° Cobb) performed an Unterberger test (50 steps on place with closed eyes) before physical therapy session. Patients were divided into two groups: single curves, 29 subjects with 11 left and 18 right curves; double curves, 30 patients.
Results: There was a statistically significant concordance between the side of the curve and patient displacement after test performance in the single curves group when compared with the double curves, even if not all patients performed in the same way. There was not a significant statistical difference among left and right curve behaviors.
Conclusion: These results could be explained both with neuro-motorial changes primary or secondary to the pathology, and biomechanical ones due to vertebral displacements.

While surgery may be necessary in some cases, in many cases it is not. Paul Harrington, known for inventing the surgery that implants metal rods in scoliotic spines, stated in 1963, “metal does not cure the disease” of scoliosis, which is a condition involving much more than the spinal column.

Consider these facts:

• Complications of surgery include: hooks becoming dislodged, fracture of the rods, skin protrusion of the upper end of the rods, pseudarthrosis (spine did not fuse), and pain where there once was none (neurological problem).
• Younger patients are susceptible to crankshaft phenomenon (worsening of the rotation and rib deformity).
• Scoliosis affects the entire skeleton (i.e. rib deformities) and impacts on neurological and hormonal systems. Surgical rods do nothing to address the wide range of bodily structures and systems affected by the disease.
• Initial average loss of spinal correction post-surgery is 3.2 degrees in the first year and 6.5 after two years with continued loss of 1.0 degrees per year throughout life.
• Researchers have reported increased incidences of arthritis and pain in adulthood when there was a history of spinal surgery for scoliosis.

Scoliosis is generally viewed as a lateral curvature of the spine with an axial twist that causes a distortion of the ribs. Current research shows that ideopathic scoliosis is a multifaceted disease that compromises five of the body’s systems: digestive, hormonal, muscular, osseous (bones), and neurological.

Scoliosis affects the entire skeletal system including the spine, ribs, and pelvis. It impacts upon the brain and central nervous system and affects the body’s hormonal and digestive systems. It can deplete the body’s nutritional resources and damage its major organs including the heart and lungs.

Some factors that can cause scoliosis include: palsy, birth defects, muscular dystrophy and Marfan syndrome. However, 80% of scoliosis is idiopathic (unknown in origin).

According to the International Scoliosis Society, one in nine females and a smaller percentage of males have some sign of scoliosis. Approximately 4% of the general population is affected. While the average patient is between 10-15 years of age, many adults suffer from this disease as well.

Conditions arising as a result of scoliosis include rib deformity, shortness of breath, digestive problems, chronic fatigue, acute or dull back pain, leg, hip, and knee pain, acute headaches, mood swings, and menstrual disturbances.

Scoliosis is a progressive condition that can continue to progress even after skeletal maturity. Millions of scoliosis sufferers are routinely misinformed about the accelerating nature of their spinal curvature progression

Adolescent idiopathic scoliosis: the effect of (Rigid) brace treatment on the incidence of surgery.

Children’s Research Centre and Orthopaedic Department, Our Lady’s Hospital for Sick Children, Dublin, Ireland. caroline.goldberg@ucd.ie

STUDY DESIGN: Retrospective analysis of outcome in terms of incidence of surgery for adolescent idiopathic scoliosis during a period when bracing was not practiced.
OBJECTIVES: To determine whether centers with an active bracing policy have lower numbers undergoing surgery for adolescent idiopathic scoliosis than a center where nonintervention is the practice.
BACKGROUND DATA: Two major recent publications have claimed that bracing significantly improves the outcome in adolescent idiopathic scoliosis. However, one had no control subjects and the other did not examine the final status of the subjects under review. While statistically significant differences in progression have been observed, what will convince patients to submit to an onerous treatment is the conviction that it will make a substantial difference, such as the avoidance of surgery.
METHODS: Since 1991, bracing has not been recommended for children with adolescent idiopathic scoliosis at this center. The scoliosis database was searched for patients with adolescent idiopathic scoliosis who were at least 15 years of age at last review and who had adequate documentation of curve parameters. The incidence of surgery was compared with that of published data from other centers.
RESULTS: A total of 153 children, 11 boys and 142 girls, fitted the criteria. Forty-three of these (28.1%) have undergone surgery. This was not statistically different from the surgery rate reported from an active bracing center.
CONCLUSIONS: If bracing does not reduce the proportion of children with adolescent idiopathic scoliosis who require surgery for cosmetic improvement of their deformity, it cannot be said to provide a meaningful advantage to the patient or the community. Recent studies notwithstanding, the question of the efficacy of orthoses in idiopathic scoliosis remains unresolved.

Rigid bracing with the Boston Brace, the Providence Brace, and the Wilmington Brace all utilize a three point pressure system to reduce the cobb angle measurement. The mechanism of action is to maintain a more corrected posture during the growth spurts to reduce the forces which promote curvature progression. Unfortunately the constraints of a hard brace may reduced muscle activity and restriction of movement, which may contribute to cortical depression, clinical depression, and a decreased awareness of body position and muscle control.

Dynamic bracing, such as SpineCor, uses muscle activity to enhance cortical activation while encouraging the bodies natural reflexes to improve muscle recruitment patterns, thereby potentially rehabilitating the postural support systems.

Studies now confirm in Adolescents, SpineCor has a 93% success rate after 5 years post brace wearing, whereas the Boston Brace has not been able to show any success in creating curvature reduction after the same time frame.

The question needs to be asked, “If the spinal deformity associated with scoliosis were the sole result of bone deformity, then how does a rigid brace reduce scoliosis immediately when applied to a patient? The logical explanation is simply the curvature is more so a result of a postural muscle failure. Obviously the bones of the spine do not instantaneously change during an active side bend, or if an orthosis is applied. A rigid brace artificially substitutes a lateral pressure for the loss of supportive muscle tone.

Adult treatment has long be assumed to be ineffective due to the attempt to apply the same paradigm of treatment which is successful in adolescents. Adult management of scoliosis requires an active neuro-muscular rehabilitation program which can be managed effectively by a Doctor of Chiropractic.

To simplify this concept, consider that bones are moved by muscles, and muscles are activated by nerves. Peripheral nerves create the connection between the muscle and the spinal cord. But muscle control of the vertebra and ribcage extends beyond its segmental (spinal) innervation. The postural muscles are influenced by brainstem and cerebellum sensory systems which transmit information about gravity and acceleration via receptors in joints, muscles and the inner ear (vestibular system). Brainstem connections to the spinal muscles called the Reticulospinal and vestibulospinal systems, which create tonic and phasic activation of the postural muscles. Without this appropriate suprasegmental activation muscle tissue type changes are inevitable. Much like the muscles of a birds wings, spinal postural muscles are resistant to fatigue, without vestibulospinal, reticulospinal and corticospinal activation, these fibers will become more like the biceps muscle which is highly fatigable. Coupled with the reduced amount of muscle spindles and mechanical disadvantage due to vertebral rotation, patients with scoliosis require a comprehensive approach to non surgical care. Furthermore, brainstem or cerebellar damage is well known to cause scoliosis. Imbalances in muscle recruitment has also been shown to be prevalent in patients with scoliosis. This can be explained by two mechanisms. Obviously vertebral rotation creates a mechanical disadvantage and therefore would require the patient to recruit lateral flexors to bend forward or backward, and the opposite is also true. The other mechanism which must be explored is the motor planning systems of the higher cortical brain. Studies do support a higher cortical imbalance as an etiological factor in scoliosis. Language processing imbalances and eye movement disorders support this hypothesis.

The reason the orthopedic community continues to believe scoliosis isn’t manageable without the use of surgery and rigid bracing is because they are not doing enough to be successful. Martha Hawes supports these claims quite clearly. Click here.