April 2002

Correcting Scoliosis With

Proprioceptive Re-Calibration

by Donald W. Meyer, D.C.

Dr. Donald W. Meyer graduated with honors from the Los Angeles College of Chiropractic in 1981. He maintains a full-time practice in Fountain Valley, CA. In 1986, he founded Circular Traction Supply, Inc. to create, produce and provide extension traction-oriented products to the chiropractic profession. In 1999, he developed the first wearable posture corrective cervical traction brace. Since then, he has also introduced a wearable thoraco-lumbar corrective brace as well as a new design for posture corrective body-weighting. He has combined the use of these devices into a new rehabilitative therapy entitled “Ambulatory Postural Remodeling™”. CBP® Non-Profit is currently helping Dr. Meyer to publish clinical cohort studies involving this new therapy.

INTRODUCTION

Current population studies characterize idiopathic scoliosis as a single-gene disorder that can have indirect effects on growth mechanisms and can cause abnormalities of connective tissue, skeletal muscle, platelets, the spinal column, and the rib cage.1 The scoliotic population is more at risk for back pain and experiences significantly more back pain than a control group.2 There is a higher prevalence of negative perception of health in scoliotic individuals.2

            “Although no consistent neurological abnormalities have been identified in patients with idiopathic scoliosis, it is possible that a defect in processing by the central nervous system affects the growing spine.”1 Herman et al., postulated that, in the case of idiopathic scoliosis, a sensory (ie. proprioceptive) rearrangement or re-calibration of the internal representation of the body in space is present, and that a non-erect vertebral alignment may be erroneously perceived as straight.3 Possible defects in proprioceptive postural control have been linked to the etiology of idiopathic scoliosis in numerous studies.4,5,6

            Current physical therapy treatments such as general spinal exercises or electrical muscle stimulation have been found to be ineffective in stopping curve progression.7 Only 23-hour a day spinal bracing has been shown to effectively stop curve progression.8 However, this intensive procedure still does not provide any long term reduction of the spinal curvature with approximately 28% of braced adolescents eventually requiring surgery for cosmetic improvement of their deformity.9 Full-spine chiropractic adjustments have also been shown to not be effective in reducing the severity of scoliotic curves.10 A recent study from Canada has shown that a shoe lift is effective in scoliotic patients who radiologically reveal pelvic obliquity.11 “The implementation of a shoe lift independent of the type of curve and amplitude significantly decreased the Cobb angle.” It also induced a change in pelvic tilt, a reduction of left to right iliac bone version, changed the lateral shift of the pelvis and anterior/posterior shift of the thorax.

            Because of the need for a truly effective corrective treatment for younger, more flexible individuals who present with no pelvic obliquity, but with a lateral translation scoliosis of the thorax on the pelvis (See Picture #1), I would like to share the following two case studies with you. These case studies demonstrate my belief that we must target the younger patient’s proprioceptive somato-sensory system for repair of lateral translation scoliosis before the altered structural pattern progresses or fixates and it is much more difficult (or too late) to effectuate

correction.

CASE STUDIES

            Case One: A 12-year-old male presented for treatment after a visual inspection revealed altered postural findings. There was no history of spinal pain. A computerized range of motion test was performed on his lumbar spine and demonstrated asymmetrical mobility. The lateral global posture appeared normal, but the AP global posture demonstrated a left lateral translation of the thorax to the pelvis with a right high pelvic tilt. 

            A standing AP radiographic study displayed a nine-millimeter left congenital leg length deficiency, a five-degree right superior sacral base line and four degrees of left lumbar angularity in relation to the sacral base line. A treatment plan of CBP® Mirror-image® diversified spinal adjustments at a frequency of two to three times per week and progression from a seven-millimeter heel lift to a nine-millimeter heel lift was performed. After seven treatments, another AP lumbar x-ray was taken with the heel lift and showed that the sacral base had leveled to just one and a half degrees left high, but the left lumbar angularity had increased to 11 degrees (See X-ray #1). 

            Because of the increase of thoracic lateral translation, corrective body-weighting was added to the patients treatments. Posture corrective body-weighting was first proposed as early as 1962 by Rene Cailliet, M.D.12 He instructed patients to “stand tall” with a weight upon their head for 10 to 30 minutes a day to improve the lateral body posture. In this case, using an

adjustable neoprene/velcro/lead weight belt that I designed and produce, I placed the weight on top of the patient’s shoulder on the side of thoracic translation. I have found that this will induce an involuntary, visible postural correction or even mirror-image® the patient into a contra-lateral thoracic translation. It is my belief that the patient should be ambulatory during this therapy to increase the proprioceptive response, so it was applied with the patient walking at approximately two miles per hour on a treadmill. These closed-chain, weight-bearing exercise sessions were started with one and a half pounds of shoulder weight and progressed to nine pounds over the course of one month. The sessions were eight minutes in length (See Picture #2).

            After 13 treatment sessions, the first re-evaluation revealed a reduction in thoracic lateral translation from 11 degrees to five degrees, after another 11 treatments the translation reduced to one degree with a level sacrum (See X-ray #2). The total course of corrective care was four months in length.

            Case Two: Similar results were obtained in a 16-year-old female patient. Her initial AP radiograph denoted eight and a half degrees of left lateral thoracic translation that reduced to three degrees after 17 treatments, and then to one and a half degrees after another 12 treatments

(See X-ray #3, 4). The same amount of shoulder weight and treatment time as the last case was utilized. Correction occurred over a time span of five months.        

CONCLUSION 

            Proprioception is defined as “sensing the motion and position of the body.”13 Specialized nerve endings are present throughout the soft tissues of the musculoskeletal system, which interact with the central nervous system and coordinate our body movements, our postural alignment, and our balance. They are present in the muscles and tendons as muscle spindle fibers and Golgi tendon organs and in the joint ligaments and capsules as mechanoreceptors. This system of proprioceptive sensory organs constantly monitor the status and function of the

musculoskeletal system. The normal coordination of this system allows for appropriate motor responses and 3-dimensional muscle tonus balance. A fault in this system will result in altered postural coordination and/or joint alignment.

            Research by Freeman, et al., on patients with chronically sprained ankles has found a phenomenon they termed “articular de-afferentiation” to recognize the importance of inappropriate afferent signals from injured ankle and foot proprioceptors.14 They pointed out, “Since articular nerve fibers lie in ligaments and capsules, and since these fibers have a lower

tensile strength than collagen fibers, it seems inevitable that a traction injury to a ligament or capsule will lead to the rupture of nerve fibers as well as collagen fibers.” It has become apparent to me that this same type of proprioceptive nerve fiber injury can and does occur in the ligaments and facet joint capsules of the spine following a past sprain/strain type of trauma and

needs to be recognized and addressed if we are to prevent a potentially chronic altered postural condition from occurring.                 

            In closing, I would like to comment that in the case of older, less flexible patients, posture corrective body-weighting requires longer treatment times. Adult patients should be sold or

rented a body-weight to wear for one to two hours per day, but only if the body-weight corrects or over-corrects their aberrant posture. My general rule is if the added body-weight does not

visibly correct or over-correct the posture, I don’t do it. I would concentrate my efforts on corrective traction and active, posture corrective exercise in these fibrotic, restricted individuals. 

REFERENCES

1.         Lowe TG, Edgar M, Margulies JY, Miller NH, Raso VJ. Reinker KA, Rivard CH. Etiology of idiopathic scoliosis: current trends in research. J Bone Joint Surg Am 2000 Aug; 82-A(8):1157-68.

2.         Bollini G, Jouve JL, Lecoq C, Garron E. Idiopathic scoliosis: evaluation of the results. Bull Acad Natl Med 1999; 183(4):757-67.

3.         Herman R, Mixon J, Fisher A, Maulucci R, Stuyck J. Idiopathic scoliosis and the central nervous system: A motor control problem. Spine 1984; 10:1-14.

4.         Keessen WIM, Crowe A, Hearn M. Proprioceptive accuracy in idiopathic scoliosis. Spine 1992; 17(2):149-55.

5.         Veldhuizen AG, Wever DJ, Webb PJ. The aetiology of idiopathic scoliosis: biomechanical and neuromuscular factors. Eur Spine J 2000 Jun; 9(3):178-84.

6.         Simoneau GG, Ulbrecht JS, Derr JA, Cavanagh PR. Role of somatosensory input in the control of human posture. Gait & Posture 1995 Sept; 3:115-22.

7.         Feise RJ. An inquiry into chiropractors’ intention to treat adolescent idiopathic scoliosis: A telephone survey. J Manipulative Physiol Ther 2001 Mar/April; 24(3):177-82.

8.         Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am 1997 May; 79(5):664-74.

9.         Goldberg CJ, Moore DP, Fogarty EE, Dowling FE. Adolescent idiopathic scoliosis: the effect of brace treatments on the incidence of surgery. Spine 2001 Jan 1; 26(1):42-7.

10.       Lantz CA, Chen J. Effect of chiropractic intervention on small scoliotic curves in younger subjects: a time-series cohort design. J Manipulative Physiol Ther 2001 Jul/Aug; 24(6):385-93.

11.       Zabjek KF, Leroux MA, Coillard C, Martinez X, Griffet J, Simard G, Rivard CH. Acute postural adaptations induced by a shoe lift in idiopathic scoliosis patients. Eur Spine J 2001 Apr; 10(2):107-13.

12.       Cailliet R. Low back pain syndrome, 3rd edition. Philadelphia: F.A. Davis Company 1962. p. 118-19.

13.       Gatterman MI, ed. Chiropractic management of spine-related disorders. Baltimore: Williams & Wilkins, 1990. p. 413.

14.       Freeman MAR, Dean MRE, Hanham IWF. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 1965; 47:678-85.