This case is an example of a 51 year old adult male with Scoliosis. He was able to reduce his Cobb angle from 28 degrees to 16 degrees, improve his visual appearance, and return to hobbies he enjoyed (e.g. tennis).
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Background

This patient is a 51 year-old illustrator who enjoys his work, gym and tennis. His scoliosis was measured at 28˚ 11 years prior to entering St Jude’s. He was leaning even further in the direction of his scoliosis to reduce pain, which served to further exacerbate his existing curve.

The condition at this time prevented him from work, walking, sitting and any recreation or exercise (yoga). He attempted to relieve this pain through massage and acupuncture before turning to professional care at St Jude’s Clinic where he reported having back pain a steady 75% of the time. The pain was worse after sitting for long periods and was gradually changing and worsening with time. The patient reported that his father, and quite possibly his sister, also had the condition.

The pain, in addition to the Scoliosis, was the patient’s main concern now and was thought to be related to recent renovations during the past 5 months. The first episode occurred in 2002, the next 3 months ago and the last episode 3 weeks ago. The Scoliosis was never treated prior to attending St Jude’s Clinic. The client was also diagnosed with an acute right sided disc bulge.

Treatment

Specific behavioral techniques were employed to return the bulging disc to a more central location.

A combination of exercises were suggested in an attempt to:
1. Straighten as much of the spine as is possible.
2. Restore neck curvature and decrease forward head posture/translation.

Bracing was excluded from all therapy. No heel raises / lifts were used to achieve the straightened spine.

Exercises were performed in the clinic and at home with clinic sessions lasting 2 hours on a 3-weekly basis. The frequency was then reduced after re-evaluating, to twice a week for 6 weeks and then weekly throughout Dec 2013. Home exercises were encouraged for two 30 minutes sessions per day.

Visual Improvement over 5 weeks

Results

• The gentleman was able to touch his toes by his 3rd visit and perform a confidence-building sit-up by the 5th visit.
• The patient’s curve was reduced from 28˚ to 16˚, though at this curve our patient still suffered from debilitating lower back pain which restricted his mobility.
• The inclination of his bottom vertebra (L3) initially measured 14˚ from the horizontal. One month later from his initial consultation at St Jude’s, the L3 was now at 12˚. As the next few days progressed, cosmetic improvements appeared. Notice that the left side of the body regains its crease (similar to the right side), and the body became more midline.
• 2 months after his initial consultation the bottom tilted vertebra was reduced to 4˚ from horizontal and the spine appears “straight”. This improvement has been maintained since 4th October 2013.

Discussion

Disc pain and the irregular postures it can cause, are created by bulging discs and muscle spasms. The body attempts to remain upright but off centre to compensate for this pain, thus creating an irregular position, which gradually becomes a natural posture to the person concerned.

Relapse is quite common, even after treatment, especially in the hotter months, which is why it is important to continue the prescribed exercises with consistency and persistence to maintain improvements.

Our patient’s lopsided presentation is due to a right-sided disc bulge, and a supposed pre-existing scoliosis adding to the asymmetry. His previous episode of sciatica in 2002 was avoided, as this case was caught early. Home renovations and the hotter weather were the likely aggravating factors. Surgery in repeated cases of sciatica is a last resort option and can frequently be avoided.

Given factors such as the man’s age and muscle build, mobility was able to be achieved and reduction of antalgic scoliosis (as opposed to adolescent idiopathic scoliosis) was also possible – creases appearing on either side of the waist now. The patient has now returned to the tennis court with key behavioural factors in place as his guide to safe and enjoyable playing. These behavioural factors are vitally important in creating a more symmetrical appearance and are required to maintain improvements or even achieve further reduction of the scoliosis (to 4˚) where possible. Stabilisation may be all that is achieved in some cases while a reduction possible is easily within reach for others.

Factors such as age and body-type are thought to hinder correction due to rigidity and chronic changes. In this particular case of acute induced scoliosis a reduction was achieved. The 1st and 3rd x-ray reveal a structural short leg of 13mm. Spinal alignment was achieved without the use of any foot orthoses (heel lift). When a heel lift is introduced the 4 degree L3 inclination is reduced to 2 degrees.

Results vary from case to case. Our commitment is to make a break-through for large curves and to prevent smaller curves from getting bigger. Where reduction is possible it is often seen within months. This man received treatment and from us and saw results in only 3 months.

If you are interested in seeing whether we can help change your Scoliosis today, please phone us on 02 9440 0995. We would love to help.

See Also

• Scoliosis Case Study 1
• Scoliosis Case Study 3
• Scoliosis Case Study 4
• Scoliosis Case Study 5
• Scoliosis Case Study 6 (NEW)

Background

A 52 year old  shift worker (driving electric fork-lift from 11pm – 7 am) presented with Scoliosis, deteriorating gait, and balance problems. Previously a footballer, he was concerned about his loss of of motor control and function of lower limb. He did not want to lose his independence, and end up in a wheelchair. His limp has progressively deteriorated over the last 22 years. A tendency to constipation (1 in 3 days) and increased urinary frequency had also been noted.

Treatment

A workplace assessment was performed, and a combination of specific exercises and key behavior modifications were used to address this occupationally induced curve. No bracing procedures were involved.  Exercises were performed for 1.5 hours per day every day, and visits to the office were done twice weekly.

Visual improvement over 8 weeks

Results

• Cosmetic improvement in the body was seen within the first two weeks
• The incline of the bottom vertebra (L3) reduced from 30 degrees to 20 degrees over a 4 week period. As of end November 2013, the Cobb angle had also reduced from 47 degrees to 40.
• Movement of the spine to midline (From 71mm away to 44 mm away from midline)
• Further reductions are likely given the short span of time. The posture picture also indicates that the December reading may also be favorable.

Discussion

This case demonstrates the spine’s potential, even in severe surgical cases (40+ degrees), to show signs of correction once key behavioural factors are identified and corrected. It is insufficient to think that this in itself will reduce the curve however it is plausible to suggest that a curve of this magnitude maybe stabilized once aggravating factors are removed / controlled.

Although this dramatic reduction may not be achievable in every case it shows that even in surgical cases reduction and progression can occur within short time frames, hence it is extremely important that monitoring be done regularly. Monitoring of key behavioural factors and the implementation of isometric and body positioning exercises are required to maintain the correction or achieve further reduction. Stabilization may be all that is achieved in some cases and a reduction may be possible in others.

NB: Results vary from case to case. Our commitment is to make a break-through for large curves and to prevent smaller curves from getting bigger. Where reduction is possible it is often seen within months.

If you are interested in seeing whether we can help change your Scoliosis today, please phone us on 02 9440 0995. We would love to help.

See Also:

• Scoliosis Case Study 2
• Scoliosis Case Study 3
• Scoliosis Case Study 4
• Scoliosis Case Study 5
• Scoliosis Case Study 6 (NEW)