Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series

BACKGROUND: The combination of spinal manipulation and various physiotherapeutic procedures used to correct the curvatures associated with scoliosis have been largely unsuccessful. Typically, the goals of these procedures are often to relax, strengthen, or stretch musculotendinous and/or ligamentous structures. In this study, we investigate the possible benefits of combining spinal manipulation, positional traction, and neuromuscular reeducation in the treatment of idiopathic scoliosis. METHODS: A total of 22 patient files were selected to participate in the protocol. Of these, 19 met the study criterion required for analysis of treatment benefits. Anteroposterior radiographs were taken of each subject prior to treatment intervention and 4–6 weeks following the intervention. A Cobb angle was drawn and analyzed on each radiograph, so pre and post comparisons could be made. RESULTS: After 4–6 weeks of treatment, the treatment group averaged a 17° reduction in their Cobb angle measurements. None of the patients' Cobb angles increased. A total of 3 subjects were dismissed from the study for noncompliance relating to home care instructions, leaving 19 subjects to be evaluated post-intervention. CONCLUSIONS: The combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. These results warrant further testing of this protocol

Idiopathic scoliosis and balance organisation in seated position on a seesaw

The aim was to determine the biomechanical processes involved in postural regulation when self-imposed disturbances occur in the seated position in the antero-posterior direction. Twelve female adolescents with right thoracic scoliosis (SG) (Cobb = 30.4° ± 9.7) and 15 control adolescents (CG) were included in this study. The ground reaction forces (GRF) were studied whilst the subjects maintained their balance in the sitting position on a seesaw. Six conditions were tested: eyes open and closed; with an additional load placed on the subject’s right or left shoulder; and with an additional load on the subject’s right or left pelvis. The SG showed significantly higher force amplitudes and variability and fewer oscillations than the CG in all the conditions. In the SG, the time analysis showed that the duration of the GRF was significantly higher in forward and left directions. Whatever the condition tested, the intra-group differences were not significant. The scoliotic patients in seated position were characterised by larger changes of the GRF, especially with a postural control in the forward and left directions, corresponding to that on the concave side of their spinal curvature. No significant differences were found to exist between the various conditions (load and unload, eyes open and eyes closed). Clinical tests and rehabilitation methods should include assessments of seated patients’ spatio-temporal adaptation to GRF

Dynamical asymmetries in idiopathic scoliosis during forward and lateral initiation step

Adolescent idiopathic scoliosis (AIS) is characterized by morphological trunk modifications acting on body mass distribution. Some specific biomechanical strategies during postural regulation have been reported. Given that spinal deformity is three-dimensional, some strategy analysis resulting from different stepping directions should lead to a better understanding of the dynamic adaptation of behaviour. The aim of this study is to identify dynamic strategies of AIS patients stepping in lateral and forward directions. Ten AIS patients with a right thoracic curve and 15 controlled volunteers have been tested. Ground reaction forces (GRF) have been recorded for right-limb stepping and for left-limb stepping associated to forward and lateral directions. Force amplitudes, corresponding occurrences, impulses of stepping phases and an asymmetry index have been computed. Asymmetry and variability increased in the AIS group, compared to the control group, whatever the stepping direction is. Asymmetry for AIS patients systematically provides an increased left initiation GRF compared to a right initiation. Nevertheless, for both groups, lateral initiation shows the largest asymmetry index reported for a forward initiation. More precisely, adaptive dynamic strategies for the AIS group have been characterized by an asymmetry between right and left limbs for lateral and forward initiation. These results can be explained by the influence of scoliosis pathology on dynamic movements due to spinal deformity. A right thoracic curve leads to an extra weight on the limb, which needs to be moved; consequently, stepping initiation with the right limb was more challenging for patients than stepping with the left limb. For the AIS group, the observed variability can also depend on the ontogenesis of adaptive strategies. Lateral step initiation has to be considered as the most relevant paradigm to study scoliosis and may also serve as a clinical basis for treatment to analyse the dynamic postural control and asymmetry strategies of the scoliosis patient

Idiopathic scoliosis: relations between the Cobb angle and the dynamical strategies when sitting on a seesaw

The aim of this study was to determine the influence of the severity of the spinal curve on the postural regulation when self-imposed disturbances occur in a seated position in anteroposterior (AP) and mediolateral (ML) orientations. Twelve female adolescents with a right thoracic scoliosis (Cobb = 30.4° ± 9.7) were included in this study. The ground reaction forces (GRF) were studied while the subjects were maintaining their sitting on a seesaw (ML or AP destabilisation). Five conditions were tested: eyes open; with additional loads placed onto the subject’s right or left shoulder; or onto the subject’s right or left pelvis. We tested the correlation between the Cobb angle and the postural parameters (index of performance and GRF variability) for each condition. When the destabilisation was AP, the Cobb angle was significantly correlated with GRF variability and anterior and concavity index of performance. Two conditions showed higher correlations: stabilisation with the concavity pelvis load (GRF variability) and the open eyes (index of performance). In contrast, whatever the condition tested was, no link was found when the destabilisations were applied in ML direction. The destabilisation in a seated position highlights the influence of the curve severity on the postural organisation. In seated position, the postural control strategies specific to the scoliotic patients were always correlated by severity of curve, especially when the destabilisation is applied in AP directions. This study showed that the unstable seating position can be considered as a pertinent paradigm to help finding a postural clinical index for adolescent idiopathic scoliosis