Gathering place for osteopaths
Osteopathy and structural scoliosis
I've had this patient today who has a mild structural scoliosis, since a very young age. She's now 45.I'm very interested to get people's thoughts, experiences, whatever, on whether osteopathy can make it all straight again or not.
Tags: scoliosis
Replies to This Discussion
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Permalink Reply by Yan-Chee Yu on -
hey clement. you'll have to excuse my ignorance: what's a structural scoliosis (as opposed to any other type of scoliosis, if there are any other types)?
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Permalink Reply by Bruno Moreira Campos on -
I think that what Clement means by structural is congenital or idiopathic scoliosis, opposing to a scoliotic attitude acquired with bad postures during adolescence or later on in life.
Scoliosis is divided into three categories: congenital, idiopathic and neuromuscular. Idiopathic Scoliosis is very common and is divided in infantile, juvenile and adolescent. The last one has a better prognosis and is more common in women. I'm guessing that this is the type of scoliosis you're patient has.
At the age of 45 there's nothing you can do to correct the scoliosis. It would be relevant at the age of 10 or 12, to measure the Cobb angle and do some specific exercises, do some follow ups ( x- ray) and in curves superior to 20º it could be necessary the use of a brace.
Clement, with my patients i give advice on postural exercises (pay attention to the muscular chains that are contracted and the ones that are stretched), breathing exercises, do soft tissue work , mobilise joints etc. It's important to study carefully the restrictions and compensations.
Cheers
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Permalink Reply by Clement Rhein on -
Merci
I divid scoliosis in to only two groups (for my simple brain): Structural, where there is bony deformity of the spine. And functional, where there is no bony deformity i.e. due to muscle action, compensatory for a leg length discrepancy - correct it and scoliosis goes away...
So I put congenital and idiopathic in the same box, structural. Even-though, its not every idiopathic scoliosis that has bony anomalies...
So, if there is bony deformity, how does that correct with postural exercises (pay attention to the muscular chains that are contracted and the ones that are stretched), breathing exercises, do soft tissue work , mobilise joints etc>>.
I'm not questioning your results at all or your way of working, but rather would like to understand how you think about it. For you, how will soft tissue work affect a bony deformity for example?
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Permalink Reply by Bruno Moreira Campos on
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I agree with you. There's nothing one can do to change the structural deformity unless the patient is still growing. At the age of 45 you can't change the structural aspect but you can improve your patient quality of life by improving his posture, stretching the necessary muscles, eliminating contractures, improving respiratory function (in a severe dorsal scoliosis), etc.
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Permalink Reply by sebastien on -
Well using a mallet for this case won't be appropriate as you should know. Where does the structural scoliosis can come from? Mostly some early birth patterns affecting the occiput and the oaa junction (congenital torticollis) can cause this kind of scoliosis but pelvic issues can be indeed too. Most people think there is nothing to do with these case but as bones are living structure, thanks got i don't want to see my face if not, they still evolving and moving during all life...Have you heard about intra-osseus pattern... look by this patient if she gets any trouble with her cranial base...The relief of hyper density within bony structure can allow a better range of motion and get the patient to balance her fascial-muscular chain.
Could help...Spinal fasciae unwinding as V.Fryman did, can help to. Let's jump into living bodies concept and not stiff and creaky ones.
Anything can move and evolve during one's life, even the "bony scoliosis".
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Permalink Reply by Andy Cotton on -
Bruno,
"At the age of 45 there's nothing you can do to correct the scoliosis."
What a strange position to take. This is flat out wrong. You sound like you are quoting from an Orthopaedics text book. All scoliosis has come from somewhere, and is going somewhere. Excursions from the midline provoke exponential increases in strain according to a square law. From this it is clear that even small degrees of improved symmetricality and lift can have profound functional effects. No scoliosis is monochromatically structural, it only looks that way in a brief snapshot.
Anybody who uses the term idiopathic is hopelessly corrupted by medical thinking. Bone is alive and ever changing. If you leave it most likely it will get worse. If you treat it most likely it will get (to extent n) better. So what should our action be?
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Permalink Reply by Yan-Chee Yu on
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andy
this sounds very interesting. are you saying that something like a wedge vertebra could have it's shape changed to that of a normal vertebra? What sort of rates of shape change in bone have you observed?
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Permalink Reply by Andy Cotton on
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Yan-Chee...
Very few scoliosis cases are from wedge vertebrae, and these obviously do not come under idiopathic. It does not affect the applicability of treatment to the vast majority of cases by pointing out the most extreme and least likely to respond. This is simply a rhetorical posture*. And, as I pointed out, all is in flux within bone, and extreme curves tend to progress as they get less stable. In this case each case is treated according to the circumstances, perhaps achieving excellent compensatory function elsewhere. A true wedge is by it's nature unstable, and positional displacement gives way to shear and dislocation. Treatment to achieve system lift will oppose this process, and yes the bony changes will either be less bad, stop progressing or progress less quickly. Any of these is better than "nothing you can do".
Mild structural is more typical, which actually means bony change and functional strain. I have had teenage patients headed for drastic surgery that lost their scoliosis after a remarkably few treatments. If the strain pattern which has been extant since early days is reduced, or eliminated, then the bone will change. Slowly , but it will. That is what bone does.
*
http://en.wikipedia.org/wiki/Straw_man
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Permalink Reply by Bruno Moreira Campos on
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To maintain the academic level i'll ignore the "hopelessly corrupted" statement.
From Clement's description i assumed he was referring to Idiopathic Adolescent Scoliosis, these terms are used universally and in my view they're needed for a better communication between professionals.
The cause of this type of scoliosis is not idiopathic but multi-factorial, including altered melatonin production, skeletal muscle abnormalities, contractile protein dysfunction or a nerve function problem. Now, depending on the severity of the Cobb's angle (it could be up to 70º) it is reasonable to think that there's some bone deformities at the age of 45. In that sense i said that you can't do anything to the structural damage (if that's the case), but one can and should improve the patient quality of life, alleviating pain and musculoskeletal function using miofascial techniques, exercises, stretching affected muscles chains etc. These will translate into a healthier, improving patient.
Giving up on the patient is completely out of the question and an Osteopath should try everything to the extent of his knowledge and capacity.
These is completely different from a functional scoliosis or scoliotic attitude where there's a mechanical cause and that obviously can be corrected.
Andy, i like based evidence statements, if you have some articles or randomized studies you would like to share, regarding surgery recommended scoliosis that were treated effectively with Osteopathy or other manual therapy, i would love to read them.
Thank you. :)
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Permalink Reply by Jody Jakob on -
I think you are right Andy..but please give Bruno a break!!!!
He is not speaking in his native language and he is eager to learn (like me)
He is a few years out of college and a talented and motivated osteopath who NEEDS your input and not your put downs.
Zen master you may be but kindness rules!! OK?
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Permalink Reply by Clement Rhein on
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Yes yes yes, this is good stuff!
So, just to re-center the discussion a bit: what I had in mind was (My patient may not have that...) a congenital bony abnormality. Where the primary is actually the bone itself - the vertebrae being wedge shape. So you can treat all the stuff you want around it, but what will you do about the primary in the bone - the cause? Will you attempt and manage to decrease/resolve the bony deformity? And what really interest me is your thinking behind how that will work...
I wouldn't discard the mallet option too quickly Seb: add a chisel, and we can chip the extra bits of vertebral bone to make it level again :-D
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Permalink Reply by Clement Rhein on
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What do you mean by "There is always a functional component"? You mean the adaptation process you mentioned?
Yes, i was thinking hemivertebral type thing. Do you think you can resolve the bony deformation - the cause? So that the patient won't need osteopathy afterward for that problem...
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