Dr Ryan Hislop - Chiropractor Mudgee  

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  • Current theories on Scoliosis

    2 February at 13:51 from atlas

    Scoliosis is a condition that has significant awareness in the general population, although it is not accompanied by much understanding in the underlying mechanisms that bring about abnormal spinal curves. As such, there has been considerable room for treatment strategies that are unproven or even dis proven.

    More recently, there has been a shift in scoliosis research towards brain based models. There is an amassing evidence suggesting that a sensory disorder may be the primary component of abnormal spinal curvatures. Proprioception (joint position sense) appears compromised in those suffering from idiopathic scoliosis along with impaired static balance and postural control. Furthermore, integration of visual and vestibular signals appear compromised in scoliosis patients, leading to problems with control when our balance is challenged. 

    Because of the complexity of this system, it is difficulty to say that one specific treatment works best, as the central processing mechanisms can be stimulated and assisted in many different ways. This can be through exercises, manual therapy, multiple different styles of chiropractic care and even surgical intervention. 

    As our understanding of spinal deformity grows, so does the appreciation for the central neurological effects of treatments such as spinal manipulation. Far from being the simplistic mechanical model of realightment, this treatment of the spine appears to influence the neuraxis at many levels. Current research in New Zealand has begun to assemble a significant amounts of data that look into this and are finding that treatment directed at the cervical spine has dramatic effects on sensorimotor integration. 

    Unfortunately, even with this knowledge and the ability to improve posture, balance and symmetry of spinal musculature, there is a lack of predictability. Therefore, once again, my answer would be that there is no single text book answer to what treatment works the best as it is an individuals condition that must be looked at and treated this way...

    Either way, as a final remark; it is definitely time to understand that previous theories of scoliosis being due to carrying the school bag on one shoulder has long outrun its course in this current day and age. 

    References:

    1. Chen PQ, Wang JL, Tsuang YH, et al. The postural stability control and gait pattern of idiopathic scoliosis adolescents. Clin Biomech (Bristol, Avon). 1998;13(1 suppl 1):S52YS58.
    2. Lao MLM, Chow DHK, Guo X, Cheng JCY, Holmes AD. Impaired Dynamic Balance Control in Adolescents With Idiopathic Scoliosis and Abnormal Somatosensory Evoked Potentials. J Pediatr Orthop 2008;28: 846-849
    3. Machida, M. Cause of idiopathic scoliosis. Spine. 1999.
    4. Simoneau, M., Lamothe, V., Hutin, E., Mercier, P., Teasdale, N., & Blouin, J. (2009). Evidence for cognitive vestibular integration impairment in idiopathic scoliosis patients. BMC Neuroscience, 10, 102. doi:10.1186/1471-2202-10-102
    5. Domenech J, Tormos JM, Barrios C, Pascual-Leone A. Motor cortical hyperexcitability in idiopathic scoliosis: could focal dystonia be a subclinical etiological factor? Eur Spine J (2010) 19:223-230
    6. Domenech J, Garcia-Marti G, Marti-Bonmati L, Barrios C, Tormos JM, Pascual-Leone A. Abnormal activation of the motor cortical network in idiopathic scoliosis demonstrated by functional MRI. Eur Spine J DOI 10.1007/s00586-011-1776-8
    7. Taylor, H. H., & Murphy, B. (2008). Altered sensorimotor integration with cervical spine manipulation. Journal of manipulative and physiological therapeutics, 31(2), 115-126. doi:10.1016/j.jmpt.2007.12.011
    8. Haavik-Taylor, H., & Murphy, B. (2007). Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 118(2), 391-402. doi:10.1016/j.clinph.2006.09.014
    9. Taylor, H. H., & Murphy, B. (2010). Altered Central Integration of Dual Somatosensory Input After Cervical Spine Manipulation. Journal of manipulative and physiological therapeutics, 33(3), 178-188. doi:10.1016/j.jmpt.2010.01.005
    10. Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: a crossover study. Journal of manipulative and physiological therapeutics, 33(4), 261-272. doi:10.1016/j.jmpt.2010.03.004
    11. Haavik-Taylor, H., & Murphy, B. (2007). Transient Modulation of Intracortical Inhibition Following Spinal Manipulation. Chiropr J Aust, 37, 106-116.

 

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