Background
This 26 year old seamstress was diagnosed with a short leg and scoliosis at 13. As an emerging fashion designer, severe pain and cosmetic disfiguration were concerns. Pain was noticed while sitting at the drawing table, during long road trips (anywhere from 1+ hours) and from standing for prolonged periods of time. A disciplined and active lady, she enjoyed spin classes, yoga, body balance and Taichi group fitness classes 2-3 /wk. Previous attempts at scoliosis reduction via muscle strengthening were unsuccessful. Her scoliosis progressed during this time and her spine began leaning to the left. Veterbral rotation associated with a spinal bump on forward bending was also evident.
Treatment
Spinal care began with a 2-week daily program in order to select the most beneficial exercises. Behavioural activities were analyzed to enhance awareness awareness of dangerous habits that could aggravate the scoliosis. Specific exercises were used to reverse the curve. In the second week a specified plan of action was identified and has remained constant till the present.
Neck restoration exercises were also incorporated into the routine also to reduce the Forward Head Carriage. Once the 2-week intensive was completed, Skype consultations were performed twice weekly at first to monitor progress. Skype enabled both ‘fine-tunings’ to exercises and a further analysis of in home/office activities.
Results (Over 6 weeks, the following results were noted):
- By day 10, she achieved a 4 degree drop (32 to 28 degrees)
- Successive decreases were noted. Overall, the curve reduced by 25%.
- Her spine was centered completely. This change was noticeably different in her visual appearance.
Discussion
Here are several points of interest.
At 26, it is commonly understood that a curve can only be stabilized during this time. Here we present a reduction in the curve. Over six weeks she was able to decrease the angle of her bottom (terminal) vertebra, from 19° to 14°(as measured from horizontal). In the same amount of time the top (apical) vertebra’s inclination was reduced form 13° to 10°.
In this case, the spine’s central alignment was achieved first, followed by the reduction of the angles of the apical (top vertebrae) and terminal (bottom vertebra).
I. AIS is often discovered by parents around the early teens time, especially in the absence of school screening programmes. Bending forward, as in to touch the toes, can be a simple enough test to look for signs of AIS.
II. The “watch and wait” (traditional) scenario is ill-advised. It disempowers and wastes precious time often resulting in angst and worry. Valuable healing time is lost here.
III. This patient’s first week was used to eliminate faulty Yoga positions and other prescribed exercises. This selection/elimination process can take two or more weeks to refine, though once the correct strategy is identified, results can be seen within hours (see Case 4).
IV. Scoliosis and pain do not necessarily coincide. In this particular case the patient suffered from acute pain as well as cosmetic deformity (only some people with Scoliosis suffer back pain.
V. Scoliosis may affect family planning, occupational objectives and quality of life.
VI. Arthritis commonly occurs on the concavity of a spinal curvature (see case 2), so through the curve’s reduction, the risk of arthritis is also reduced.
VII. All big curves start out small. Progression often occurs AFTER skeletal maturity is reached (contrary to common belief). This is why when a brace is removed the curve needs to be monitored. Deterioration is common. In some studies only 1 in 6 people will hold their corrections after bracing.
VIII.The use of x-rays is the gold standard for analyzing curve reduction / progression.
1. Have films taken the films from Back to Front. (not Front to Back) This is the most direct way to see and measure scoliosis curves,
2. Avoid successive lateral views (side-on views). Most of the time these are unnecessary for viewing Scoliosis curves unless specifically warranted. They yield little additional information and carries far more exposure (up to x3 more) than a Back to Front film.
3. Shield the ovaries (lead filters), breast tissue and thyroid. Wherever possible this is to be encouraged.
4. Avoid full body scanning where possible and use single films that capture one or all curvatures.
5. All films are to be done weight bearing (standing) where possible.
IX. Remote consultations (Skype) were successful in achieving a further drop (28 to 24 degrees) after the intensive period of care. This is an interesting development in that people with Scoliosis in remote areas or with families with time/travel constraints and other dependents may find assistance via telemedicine (Skype).
X. Anatomical Leg Length differences are quite common in the population and Leg Length Inequality (LLI) may account for sacral unleveling and subsequent scoliosis. The use of a left heel lift may be beneficial in this case. To date, success has been achieved without it.
XI. Curve reductions are definitely possible for people in their 20’s or above. A youthful spine will not determine success.
No supports, bracing or products were used to achieve this reduction. There is hope without bracing or invasive surgery.
If you are interested in seeing whether we can help change your Scoliosis today, please phone us on 02 8005 6561. We would love to help.
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