Treatment Process for Severe Scoliosis
Scoliosis is an extremely complex condition. It involves much more than just the spinal column. Each scoliosis is its own specific entity. There is no magic treatment or adjustment that will work on every case. Specific plans are designed to address the individual’s condition. The majority of larger curvatures (greater than 25 degrees) will require a more extensive treatment plan and potentially multiple in-office treatment plans over time; especially until the patient reaches skeletal maturity. Your individualized scoliosis treatment plan will be a combination of in-office procedures and at home rehab that keeps your spine working towards improvement between in-office treatment sessions.
Before treatment can begin, a thorough case history, physical examination, and precision x-rays must be taken to understand the biomechanical function of the individual’s spine. Seven x-rays in total are taken to evaluate the condition. These x-rays all together are equivalent to just one full spine shot (the x-ray typically taken to evaluate scoliosis). This is because these x-rays are considered ‘spot shots.’ These small shots zone in one area of the spine, therefore using much less radiation to obtain the image.
Once your case has been reviewed, a specific treatment protocol will be utilized called, MIX, FIX, and SET. The soft tissue (spinal discs, ligaments, muscles, ect) slowly begin to adapt to the abnormal spinal position, essentially “locking” the scoliosis in place. This makes it necessary to “unlock” the spinal position from the maladapted soft tissue (MIX), so the spine can be repositioned by specific adjustments (FIX), and finally the soft tissue can be re-trained (SET) to hold the spine in the new straighter position.
The MIX, FIX, SET protocol is relatively painless, but you may experience some mild stretching discomfort during the initial onset of treatment as the body adapts and heals in its newly corrected position. It is similar to working out for the first time or playing a sport that you have not played in a while. Some patients have reported mild muscle soreness the day after treatment. It's extremely rare that a patient is unable to complete treatment due to physical discomfort.
MIX (Warm Up)
At first, the patient needs to warm up the spine.
Numerous devices such as the Active Rehabilitation Chair (which sits upon a ball-and-socket joint and flexes in every direction to put the spine through a full range of motion), the Cervical Traction (which is used actively by the patient to achieve gentle, repetitive spinal traction), and the Vibrating Traction (which uses a slow, relaxing vibration which has been scientifically proven to relax the ligaments & soft tissues of the spine) are used. A special motorized table with belts that pull (not push!) the scoliotic curves out of the spine, called the Eckard Flexion/Distraction table, achieves the goal of re-structuring & re-modeling the ligaments after they have been relaxed.
If the MIX protocols are not followed, the intervertebral discs will be rigid and inflexible, and it will be difficult if not impossible to effect structural changes to the spine.
Once the spine has been warmed up, the spine is then put into proper alignment following the CLEARTM guidelines.
Mechanical adjusting instruments and specialized drop pieces enhance the precision & effectiveness of the adjustment. Almost all adjustments are based on the findings on the x-rays. Follow up x-rays should confirm improvement and correction of these areas.
SET (Rehabilitation Stage)
Following the adjustments, the spine needs to be re-educated so that it learns how to hold and maintain the changes that were just made.
This involves spinal weighting protocols (typically on the head & hips), whole-body vibration therapy such as the Vibe and the Scoliosis Traction Chair, and gait therapy which re-trains patterns of moving & walking and neuromuscular re-education. In addition to the home exercise program, exercises should be done in the clinic on an exercise ball and on the whole-body vibration platform (which has been shown through research to increase the effectiveness of exercise by 2-3 times).
If the SET protocols are not followed, any corrections achieved in the spine will be temporary in nature.
A series of post x-rays will be taken to validate the effectiveness of the treatment protocol. The exact re-examination visit will depend on the specific plan of care given. The average post x-rays can be taken between the 12th and 36th visit. The specific x-rays which are necessary are limited as much as possible to the patient's specific condition. For example, if the initial x-ray demonstrated that the patient's low back was in pretty good shape prior to beginning care, a sideways view of the low back might not be necessary.
It's important to keep in mind that not every patient will show a reduction in the severity of the scoliotic curve, as measured by Cobb angle, within this time frame. This is due to the fact that Cobb angle is a measurement of only one dimension of the spine, and scoliosis is, in fact, a three-dimensional condition. Before the sideways curve can be reduced or corrected, the spine must be de-rotated and de-compressed in the other two dimensions. Treating a complex spinal disorder such as scoliosis is a little like reversing the path of a runaway train. It takes time to first slow down the momentum, then more time is needed to change the course of the disease.