Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series

Abstract

Background: The combination of spinal manipulation and various physiotherapeutic procedures used to correct the curvatures associated with scoliosis have been largely unsuccessful. Typically, the goals of these procedures are often to relax, strengthen, or stretch musculotendinous and/or ligamentous structures. In this study, we investigate the possible benefits of combining spinal manipulation, positional traction, and neuromuscular reeducation in the treatment of idiopathic scoliosis.

Methods: A total of 22 patient files were selected to participate in the protocol. Of these, 19 met the study criterion required for analysis of treatment benefits. Anteroposterior radiographs were taken of each subject prior to treatment intervention and 4-6 weeks following the intervention. A Cobb angle was drawn and analyzed on each radiograph, so pre and post comparisons could be made.

Results: After 4-6 weeks of treatment, the treatment group averaged a 17 degrees reduction in their Cobb angle measurements. None of the patients' Cobb angles increased. A total of 3 subjects were dismissed from the study for noncompliance relating to home care instructions, leaving 19 subjects to be evaluated post-intervention.

Conclusions: The combined use of spinal manipulation and postural therapy appeared to significantly reduce the severity of the Cobb angle in all 19 subjects. These results warrant further testing of this protocol.

Figure 1

The picture on the left demonstrates the mechanically assisted manipulation used when a patient's skull is restricted in extension on lateral cervical radiograph. The picture on the right is the procedure used when the skull flexion is restricted.

Figure 2

This picture shows the placement of the pelvic blocks for an anterior right ilium. The blocks are placed opposite of the pelvic rotation.

Figure 3

The above picture illustrates a sample placement of the Pettibon Bodyweighting System. Here we have an anterior headweight, right shoulderweight, and left-back and right-front hipweights.

Figure 4

This figure shows a demonstration of the positional traction procedure. The cervical block is placed under the patient's cervicothoracic junction, allowing the head to extend back over the sloped portion of the block. The low back support is placed under the patient's thoracolumbar junction, posterior to the lowest palpable ribs. The blocks are outlined in white.

Figure 5

This figure illustrates some of the pre and post x-rays taken after 4–6 weeks of treatment.