Scoliosis Definition, and the role of conservative treatment such as osteopathy

Introduction

Scoliosis is an abnormal side curvature of the spine. The curve or curves may be C or S shaped and must have an angle greater than 10 degrees for it to be classified as a scoliosis [1]. A curve may be structural or functional [2]. A structural scoliosis is where the spine is curved and rotated whereas a functional scoliosis is when there is a structural abnormality elsewhere in the body which gives the spine a curved appearance, but otherwise the spine is structurally in alignment. An example of what can cause a functional scoliosis is unequal leg lengths [2].

Experts categorise scoliosis into 3 groups: idiopathic, congenital or neuromuscular [3].

    1. Idiopathic is the most common type of scoliosis and it means there is no known cause or that there are a multitude of factors which could have contributed to the disease. In idiopathic scoliosis there are 3 subcategories – infantile, juvenile and adolescent [3].
    2. Congenital scoliosis stems from a defect which is present from birth. This type of scoliosis is usually caused because of failure of vertebral formation and/or segmentation (the embryological development of vertebra) [3].
    3. Neuromuscular scoliosis is a curvature which develops due to another disease such a muscular dystrophy. This is a very rapidly growing type of scoliosis [3].

Diagnosis

Some scoliosis cases are very easy to spot, and others are so minor that it would take a trained eye of an osteopath or other practitioner to spot. The signs and symptoms of scoliosis can be:

  • Back, shoulder, neck and buttock pain [4]
  • Difficulty breathing [5]
  • Cardiac issues [6]
  • Abdominal discomfort
  • Bloating, constipation or diarrhoea
  • Leg length differences [4]
  • Problems with walking [7]
  • Limited mobility [7]
  • Uneven ribs at the front [4]
  • Uneven shoulders, waistline [4]

 

Scoliosis Patterns

There can be different patterns in the way the curve of the spine presents [8]. There are three main scoliosis patterns:

1. Thoracic scoliosis

This is the most common form of scoliosis and is where the upper spine curves to the left or right. This can affect the ribs and shoulder blades, and can often present as one of the shoulders lifting higher than the other [8].

2. Lumbar scoliosis

This where the lower back vertebrae move to either the left or right. This can also make one hip appear higher than the other, or one leg be longer [8]. 3.

3. Thoracolumbar scoliosis

With this type of scoliosis, the curve involves vertebrae from the lower thoracic and upper lumbars. It most often curves to the right and can develop 3-6 weeks in utero, therefore is often congenital [8].

 

Treatment Approaches

Osteopathy

A study suggests that neuromuscular stimulation and manipulation may stop and reverse scoliotic curves by a substantial amount [9]. However, this study is dated and lacks large enough sample sizes to be able to generalise the results.

A more up to date study from 2006 with a larger sample size showed exercise rehabilitation therapy combined with manipulations reduced Cobb angle measurements in 19 patients with scoliotic curves [10].

Myofascial release is a technique often used by osteopaths. A review showed myofascial release and postural control programmes to be effective at reducing pain and curvatures in patients with idiopathic scoliosis [11]. However, further research with larger sample sizes is warranted.

A study by Hasler et al where women with adolescent idiopathic scoliosis were given 3 osteopathic treatments over a course of 5 weeks showed no effect on symptoms or curve structure [12]. However, it could be that 3 treatments over 5 weeks wouldn’t be long enough to see an improvement in most conditions seeing as the standard number of treatments for any condition is 4-6.

Another study by Feely et al showed osteopathy to significantly improve infantile scoliosis [13]. However this was a case study on one baby, and there is likely to be individual differences in each infant which means the results can not be generalised. Therefore, studies with larger sample sizes need to be carried out. Furthermore, “spontaneous resolution” may have accounted for the correction of the child’s spinal curve, however, this is unlikely as the condition usually gets dramatically worse.

A literature review by Lotan and Kalichman in 2019 showed that manual therapy interventions such as manipulation, mobilisation and soft tissue techniques reduced pain and improved function in participants with adolescent idiopathic scoliosis [14]. In fact, only one study in this review concluded that such techniques were ineffective [14].

Chiropractic treatment

There is some evidence which shows chiropractic treatment, including rehabilitation programmes, were effective and reduced the Cobb angle in participants with scoliosis [15]. However, no long term follow was carried out in this study, so the curves could have gone back to how they were. However, one study has revealed that chiropractic treatment and rehabilitation has improved scoliosis-related pain and reduced the Cobb angle in scoliotic curves 24 months after treatment ceased [16]. A review released in 2018 which analysed 27 experiments into the effect of chiropractic treatment on scoliosis showed that only 2 of these studies were laid out as the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) advised. It also stated that the quality of chiropractic studies is low and that crucial measurements such as pain outcomes were not measured in the majority of studies [17].

Acupuncture

A study by Wei et al in 2015 showed that traditional Chinese Medicine including acupuncture could reduce the Cobb angle, muscular tension and improve functional mobility in participants with adolescent idiopathic scoliosis [18].

A case study concluded that acupuncture could reduce pain scores and Cobb angles in elderly patients with degenerative scoliosis, and that acupuncture could be a valuable source of relief before surgery is considered [19].

Yoga

Research has revealed that participants had a significant reduction in scoliotic curves by using a side plank pose for 1.5 minutes, 6 days a week for 6.8 months [20]. Furthermore, a study showed scoliotic curves to reduce by using half moon and plank yoga poses [21].

Physiotherapy

The most accepted and widely non surgical method of treatment for scoliosis is a package of observation, physiotherapy and bracing [22]. These procedures are accepted by the 2011 SOSORT [22]. In the physical therapy part of treatment, training activities of daily living (ADLs) are the aim [22]. A study reviewed clinical evidence from research carried out on seven different schools and methods (including the widely used Schroth method) which claim to be able to significantly improve the alignment of the spine in individuals with scoliosis. It is clear from the research and photos that these schools can have an impact on the aesthetic aspect of the diagnosis, with Cobb angles appearing dramatically reduced in many of the photos that were taken after intervention [22].

Cupping

Many osteopaths and other healthcare practitioners have started using cupping therapy in treatments. Cupping is part of Chinese medicine and involves placing cups on tense muscles in an attempt to gather soft tissues into the cup via a suction method [23]. A study researched the combination of cupping and acupuncture on a 34 year old male with scoliosis. The study found the pain was reduced by 85%, but the scoliotic curve did not change [24].

Conclusion

In conclusion, there are many non surgical treatment options that patients with scoliosis can use. There are some studies and reviews which show that osteopathy can reduce the scoliotic curves and pain scores in patients with idiopathic scoliosis [9-14]. However these studies require larger sample sizes to be able to take into account individual differences and to be able to apply them to the general public. Other therapies such as chiropractic care, physiotherapy, acupuncture, yoga and cupping have been researched [15-24]. However, more research needs to be done using pain scores as an outcome rather than just curve reduction because this is a major reason why people seek conservative treatment for their scoliosis.

 

 

 

 

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