3% of adolescents between the ages of 10-16 years develop scoliosis. About 80% of scoliosis are idiopathic with no known cause, 20% of scoliosis is related to an underlying pathology. Idiopathic scoliosis is defined as 10° of lateral bending with rotation present. Idiopathic scoliosis is more common in girls and curves progressing increase with curve size. Most experts believe that if scoliosis excesses a “critical threshold” between 30°-50° the risk of curve progression after skeletal maturity increases. Curve beyond this critical threshold have an increased risk of health problems in adulthood including decreased quality of life, cosmetic deformity and visible disability, pain, and progression of functional limitations.
In adults scoliosis is more common affecting approximately 10% of adults 40 years, 30% of adults 60 years and 50% of adults 90 years. Scoliosis in adults may be idiopathic scoliosis that developed as a child or adolescent or new scoliosis that develops in adulthood. De Novo scoliosis is degenerative scoliosis that develops during adulthood. De Novo scoliosis typically begins with facet and/or disc degeneration and leads to spine rotation. This in turn leads to the progression of scoliosis.
In 2004 the International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) was formed to bring about advances in research and treatments in non-surgical treatment methods for scoliosis and spine deformities. SOSORT meets annually and consists of medical doctors, orthotist, physical therapist and chiropractors. In 2017 at the SOSORT annual convention in Lyon, France it was voted to allow chiropractors on the SOSORT executive committee. In 2020 the SOSORT annual convention will be held in Melborne, Australia and will be part of Spine week. The host for 2020 SOSORT annual meeting in chiropractor and founder of Scolibrace, Dr. Jeb McAviney.
Although there is no evidence to support that chiropractic adjustments can slow the progression or improve structural scoliosis, adjustments can help improve spinal function and decrease pain. Scoliosis specific rehabilitation programs and scoliosis specific exercises have been found effective in slowing the progression of scoliosis and improving scoliosis in some cases in both adolescents and adults. Chiropractors are perfectly positioned as primary care provides for scoliosis patients as they are frequently the first line of detection and the first place many patents turn for non-surgical treatment options.
For chiropractors seeking to specialize in scoliosis additional training is available and is required. Scientific Exercises Approach to Scoliosis (SEAS) and Schroth is scoliosis specific exercise approaches that have been shown effective in treating scoliosis. SEAS training is available to chiropractors and can be implemented as part of scoliosis rehab methods. Chiropractic BioPhysics (CBP®) and CLEAR are chiropractic techniques that have specialized training in scoliosis treatment. The Italian Scoliosis Institute offers a year-long master's course for the healthcare professional that specializes in treating scoliosis. This is an intensive course that requires acceptance. If accepted, the program requires extensive hours (approximately 400) to obtain the title “Master in Principles and Practice of Scoliosis Conservative Treatment”.
Scoliosis bracing is another key component in scoliosis treatment. Soft braces such as Spinecor are available for chiropractors and have been shown effective in treating smaller curves. Rigid bracing has also been shown to be effective in treating scoliosis and is the gold standard treatment for larger and more aggressive curves. Unlike traditional rigid scoliosis braces that only tend to “squeeze” the spine like a cast using 3-point pressure methods, Scolibrace works to correct scoliosis in 3-dimensions by putting the patient in an overcorrected position. Scolibrace uses CAD/CAM (computer aided design / computer aided manufacturing) to make true custom
3D braces. Each brace is made specifically for each individual patient. A brace for a 12-year-old flexible girl with a progressive curve will be designed differently than a brace for a 60-year-old stiffer female with a degenerative scoliosis because the treatment goals are not the same and the spines are different.
Specializing in scoliosis is not for everyone, as to be truly competent in this specialty requires a fair amount of additional training and expertise in case management. Many chiropractors that specialize in scoliosis treatment and bracing work with nearby chiropractors to help manage their scoliosis cases. In my own office Square ONE, we work with many Fort Collins chiropractor locally and from a great distance. Chiropractors frequently refer patients to our office for scoliosis bracing and co-management; we provided bracing and scoliosis exercises and the referring chiropractor provides traditional treatment.