The term scoliosis means a distortion of the
body structure into a curvature. This is
usually recognized in the spine but may also
be found in the pelvis, and occasionally in
the mechanism of the cranial bones.
Spinal scoliosis may be structural due to a
bony developmental defect as for example the
absence of a rib on one side, or an incomplete
development of a vertebra. It may be the
result of a neuromuscular disease such as
cerebral palsy in which the spinal muscles are
more spastic on one side than the other or a
paralytic condition in which the muscles are
much weaker on one side. In these conditions
the spinal muscles exert a greater contraction
or side-bending force on one side of the spine
than the other. Abdominal surgery in infancy
or childhood may leave a scar on one side of
the abdominal wall which may, as the child
grows, cause a curvature in the back because
the soft tissues around the scar are hardened
with fibrous tissue and cannot lengthen
equally with those of the other side.
But these structural causes of scoliosis are
rare. Far more common are the idiopathic
adolescent functional spinal curvatures.
"Idiopathic" means that the cause is
unknown, "adolescent" implies that
it is most commonly found as the child enters
the adolescent or teenage years; and
functional indicates that there is no bony
deformity.
There are however some causative factors
recognized by the osteopathic physician that
are responsive to osteopathic manipulative
treatment. In order to appreciate them regard
this patient as a dynamic unit of function
from head to feet and not merely a vertebral
column with an unusual curve in it. Examining
the standing patient from the back the level
of ears, the shoulders, the scapulae or
shoulder blades, the crests of the ilia are
noted for their symmetry, is one side higher
than the other. If the patient then bends one
knee but keeps the weight equally on two feet
it is possible to observe side-bending in the
lumbar area - do they move symmetrically or is
the side bending greater to one side. Next ask
the patient to balance on one leg and note how
far the pelvis drops on the opposite side. Is
the range of motion equal to that when
standing on the other leg. Less motion
indicates restriction of physiological motion
in the sacroiliac joint. How far can the
patient bend forward toward touching the toes
without bending the knees. As the patient
uncurls note whether the rib cage is
symmetrical on the two sides. A prominence of
one side may be the earliest evidence of a
scoliosis of the spine. Is there freedom of
motion to permit elevation of the straight
arms beside the head.
Is the scoliosis still evident when the
patient is seated? Standing behind the seated
patient place hands on the front of the chest
or the sides of the chest to note whether the
ribs move symmetrically. Asymmetric expansion
on one side may be due to scoliosis. The
patient is then examined lying on the back, to
evaluate leg length symmetry, pelvic balance,
symmetrical motion of the sacrum within it,
and to evaluate the spinal muscles for
symmetrical tension or vertebral
rotation.
The cranial mechanism is then palpated for
distortion of position or asymmetry of motion.
The question may be asked, what has the head
to do with a spinal curvature. From a
functional point of view the body hangs from
the head and distortion of the cranial
mechanism, commonly from a long or traumatic
birth, predisposes to curvature in the spine
by way of unequal fascial drags on the body.
Orthodontic treatment which endeavors to
change and intends to improve the relationship
of the jaws may also induce or aggravate
spinal curvatures.
The diagnosis will also include a standing
X-ray which not only evaluates the nature and
degree of the spinal curvature, but also
provides a study of the equality of leg
lengths.
The treatment will include osteopathic
manipulative treatment to the pelvis and the
head, the rib cage, the abdominal wall and the
fascial mechanism of the body as well as the
area manifesting the spinal curve. If there is
an anatomical shortness of one leg a
corrective lift might be added to that shoe.
In addition to, but not in place of the
manipulative treatment some simple exercises
may be given to perpetuate the benefit of the
treatment.
Carrying a backpack must be carefully
monitored. If used it must not be overloaded
and must be equally balanced across both
shoulders.
The fitting of a brace may be indicated in a
severe structural scoliosis. Surgery may be
indicated if the condition has rapidly
deteriorated or structural anomalies exist.
But in our experience if osteopathic treatment
is administered first these more drastic
measures are needed less frequently.
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