scoliosis 101

Scoliosis Scoliosis 101 101

CLEAR CLEAR Institute Institute

www.CLEAR-Institute.com

Dr. Clayton J. StitzelDr. Clayton J. Stitzeldrstitzel@clear-drstitzel@clear-

institute.orginstitute.org

Dr. Clayton Stitzel, 1-866-627-3009, [email protected],

http://www.treatingscoliosis.com/

Spinal BiomechanicsSpinal Biomechanics

Ideal curves of the spineIdeal curves of the spine Primary and secondary curvesPrimary and secondary curves Function of curves Function of curves

StrengthStrength FlexibilityFlexibility



What’s so Special About What’s so Special About Scoliosis?Scoliosis?

Said to effect 4.5% of Said to effect 4.5% of population. It is population. It is probably closer to 10%probably closer to 10%

Mortality rate of 15%. Mortality rate of 15%. (1)(1)

Decreases life Decreases life expectancy by 14 years. expectancy by 14 years. (1)(1)

A study in 1988 A study in 1988 revealed that 12% of revealed that 12% of college age women had college age women had Scoliosis. (2)Scoliosis. (2)

1 Ahn et al, New Hampshire Spine Institute. The etiology of 1 Ahn et al, New Hampshire Spine Institute. The etiology of adolescent idiopathic scoliosis. Am J Orthop 2002 Jul;31 (7):387-adolescent idiopathic scoliosis. Am J Orthop 2002 Jul;31 (7):387-9595

2 “Scoliosis screening of 3,000 college-aged women. The Utah 2 “Scoliosis screening of 3,000 college-aged women. The Utah Study – Phase 2”, Brigham Young University, Provo, UT, Francis Study – Phase 2”, Brigham Young University, Provo, UT, Francis RS. Phys Ther 1988 Oct;68(10)RS. Phys Ther 1988 Oct;68(10)

What is Scoliosis?What is Scoliosis? Abnormal curvature of Abnormal curvature of

the spine greater than the spine greater than 10˚ in the sideways or 10˚ in the sideways or coronal plane (Cobb coronal plane (Cobb angle)angle)

Spine looks more like Spine looks more like an “S” or “C” than a an “S” or “C” than a straight linestraight line

Many cases have Many cases have rotational componentrotational component Shoulders and/or waist Shoulders and/or waist

appear uneven (3)appear uneven (3)3 Fysh, Peter. “Scoliosis and the Child’s Spine.” Dynamic 3 Fysh, Peter. “Scoliosis and the Child’s Spine.” Dynamic Chiropractic. 1994 Oct; 21 (12). Chiropractic. 1994 Oct; 21 (12).



Cobb AngleCobb Angle



Types of ScoliosisTypes of Scoliosis Infantile

before the age of 3 Juvenile

prepuberty: 4 – 12 (girls) 4– 14 (boys)

Adolescent puberty to

maturity Adult

after maturity



True cause still unknownTrue cause still unknown Genetics (no isolated gene)Genetics (no isolated gene) growth hormone secretiongrowth hormone secretion connective tissue structure connective tissue structure vestibular dysfunctionvestibular dysfunction melatonin secretionmelatonin secretion platelet microstructureplatelet microstructure 100% patients have proprioception 100% patients have proprioception

mechanism defects (1)mechanism defects (1)

Etiology of ScoliosisEtiology of Scoliosis

1 Ahn et al, New Hampshire Spine Institute. The etiology of 1 Ahn et al, New Hampshire Spine Institute. The etiology of adolescent idiopathic scoliosis. Am J Orthop 2002 Jul;31 (7):387-adolescent idiopathic scoliosis. Am J Orthop 2002 Jul;31 (7):387-9595 Dr. Clayton Stitzel, 1-866-627-3009,

[email protected], http://www.treatingscoliosis.com/

Etiology of Scoliosis Etiology of Scoliosis (Continued)(Continued)

**27% of cases show brain stem **27% of cases show brain stem asymmetries asymmetries

**Changes in muscle appear to be **Changes in muscle appear to be secondary to the CNS disorder, NOT secondary to the CNS disorder, NOT the CAUSE the CAUSE

Birth Trauma / ComplicationsBirth Trauma / Complications Yes (71) 30%Yes (71) 30% No (165) 70%No (165) 70%

Survey results from Survey results from www.scoliosis-world.com



Incidence of ScoliosisIncidence of Scoliosis

Develops between ages 8 to 15 Develops between ages 8 to 15

(growth spurt)(growth spurt) 7 times more prevalent in 7 times more prevalent in

femalesfemales 80% of scoliosis origin unknown 80% of scoliosis origin unknown

(1)(1)

1 Ahn et al, New Hampshire Spine Institute. The etiology of 1 Ahn et al, New Hampshire Spine Institute. The etiology of adolescent idiopathic scoliosis. Am J Orthop 2002 Jul;31 (7):387-adolescent idiopathic scoliosis. Am J Orthop 2002 Jul;31 (7):387-9595



Physiological Effects of Physiological Effects of ScoliosisScoliosis

Mid-back pain, lower Mid-back pain, lower back pain, neck pain, back pain, neck pain, headaches, TMJ headaches, TMJ syndromes, premature syndromes, premature disc and joint disc and joint degenerationdegeneration

Decreased pulmonary Decreased pulmonary functionfunction Breathing Exercise & Breathing Exercise &

FHPFHP Dramatic body image Dramatic body image

concernsconcerns Coach Potato SyndromeCoach Potato Syndrome

Decreased ability and Decreased ability and willingness to participate willingness to participate in physical activitiesin physical activities



Your Child Has Scoliosis Your Child Has Scoliosis What Do You Do?What Do You Do?

OptionsOptions Watch & WaitWatch & Wait BraceBrace Herrington Rod Herrington Rod

SurgerySurgery Chiropractic Care Chiropractic Care

& & NeuromusculoskeNeuromusculoskeletal letal RehabilitationRehabilitation



BracingBracing 44% of bracing attempts are 44% of bracing attempts are

considered failures considered failures do not stop the progressiondo not stop the progression

Less than 30Less than 30°, there were no significant , there were no significant differences between braced and non-differences between braced and non-braced patientsbraced patients Typically brace is prescribed when scoliosis is Typically brace is prescribed when scoliosis is

<20<20° 60% felt bracing handicapped their lives60% felt bracing handicapped their lives 14% considered bracing left a 14% considered bracing left a

psychological scarpsychological scarDr. Clayton Stitzel, 1-866-627-3009,

[email protected], http://www.treatingscoliosis.com/

SURGERY SURGERY

Herrington rod surgeryHerrington rod surgery Average pre operative Average pre operative

curve = 72curve = 72° Average post operative Average post operative

curve = 44curve = 44°



Posterior Spinal Fusion and Instrumentation

Scoliosis surgery

Harrington Rods



Are They Cured?Are They Cured? Unfortunately, most patients return for Unfortunately, most patients return for

22ndnd, 3, 3rdrd, and 4, and 4thth surgeries surgeries Rod maintenanceRod maintenance Side effectsSide effects

InflexibilityInflexibility LBPLBP HeadacheHeadache

““40% of operated treated patients with 40% of operated treated patients with idiopathic scoliosis were legally defined idiopathic scoliosis were legally defined as severely handicapped persons” (4)as severely handicapped persons” (4)

4 Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck 4 Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrmentation and their relevance for scoliosis after Harrington instrmentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8Oct;140(5):492-8

How Do We Find How Do We Find Scoliosis?Scoliosis?

Orthopedic Orthopedic Screening TestsScreening Tests

PosturePosture Rib humpRib hump X-ray X-ray

confirmationconfirmation



Preliminary Results of the Scoliosis Reduction and Rehabilitation Protocol: A Pilot Study Mark W Morningstar, DC, Dennis Woggon, DC, Gary Lawrence, DC, November 2004

Results: After 4-6 weeks of treatment, the entire sample size (22 ) averaged a 62% reduction in their Cobb angle measurements.

Conclusion: The Scoliosis Reduction and Rehabilitation Protocolappeared to markedly reduce the severity of the Cobb angle in all 19 subjects.

http://www.biomedcentral.com/1471-2474/5/32



Cobb Angle Measurements After 4-6 Weeks (Degrees)Cobb Angle Measurements After 4-6 Weeks (Degrees)

Subject #Subject # InitialInitial PostPost %% Subject #Subject # InitialInitial PostPost %%

11 3232 2424 2525 1111 4040 2222 4545

22 2323 88 6565 1212 3131 99 7171

33 2929 1111 6262 1313 2727 1414 4848

44 5252 1919 6363 1414 3333 77 7979

55 1919 44 7979 1515 3232 1818 4444

66 2828 1111 6161 1616 1616 44 7575

77 1616 22 8888 1717 1515 44 7373

88 2525 1111 5656 1818 2121 66 7171

99 3535 2020 4343 1919 3838 1111 7171

1010 2828 1313 5454

Average Reduction: 28 to 11 degrees

8/19 No Scoliosis

Average Reduction: 62% in 4-6 Weeks

8/19 No Scoliosis



Treatment (Mix, Fix, Set)Treatment (Mix, Fix, Set)

Scoliosis Chiropractic CareScoliosis Chiropractic Care Warm-up (Mix)Warm-up (Mix) Adjustment (Fix)Adjustment (Fix) Rehabilitation (Set)Rehabilitation (Set)

Maybe a little chocolate therapyMaybe a little chocolate therapy



Wobble chairWobble chair Cervical TractionCervical Traction Core Stimulation Core Stimulation

(ligaments) & (ligaments) & Muscle Muscle StimulationStimulation

Warm up (MIX)Warm up (MIX)



Eckard TableEckard Table



Adjustments (FIX)Adjustments (FIX)

#1 PRIORITY: #1 PRIORITY: Restore cervical Restore cervical lordosislordosis

Adjust Anterior & Adjust Anterior & Posterior HipPosterior Hip



Rehabilitation (SET) Rehabilitation (SET)

Proprioceptive neuromuscular re-Proprioceptive neuromuscular re-

education & rehabilitationeducation & rehabilitation Head weightsHead weights Hip weightsHip weights Tight rope Tight rope

exerciseexercise



Traction and

derotation!



The Crankshaft Phenomenon: Is Cobb angle progression a good indicator in AIS? Delorme, Labelle, Aubin Research Center, Sainte-Justin Hospital Montreal Quebec, Canada

No!The History channel had a program about ancient Egypt where they would take a 1/8" strand of a gold strip and then twist it. The best necklaces were a perfect "coiled" position, but at a certain point, the necklaces would twist on themselves and deform and fold into themselves. Once they hit that "Euler Buckled" position, the necklace was garbage.This is the "Crankshaft Phenomenon.”

The Crankshaft Phenomenon

Compression and Rotation!



The Crankshaft Phenomenon can be “un-done” through traction and de-rotation.



JamieOctober 30-31, December 27-29, 2006



DeJeanne March 24 – March 29, 2006

Dr. Clayton Stitzel, 1-866-627-3009, [email protected], www.treatingscoliosis.com

Sharon – 55 y/o female

1/19/05 2/28/05



Marvin – 82 Years Young



Websites on scoliosisWebsites on scoliosis

www.clear-institute.org/freeinfo

www.fixscoliosis.comwww.fixscoliosis.comwww.scoliosis-world.com

Resources for parents Resources for parents and kidsand kids



scoliosis 101

Education

clayton stitzel

etiology of scoliosis

scoliosis screening

incidence of scoliosis

scoliosis origin unknown

stitzel email

types of scoliosis infantile

spine primary