So treatment of scoliosis.
You are going to see these patients,
they're going to ask for treatment.
And witnessing the disease, sharing with them what's
gonna happen is the first start to treatment.
You want to get them to the point where they know when
they're starting to get weaker, or lose use or function.
We do know that physical therapy and chiropractic
therapy have been shown to be ineffective.
But we do know that individuals will feel better when
they're being treated and monitored on a regular basis.
So we wanna find what is the most
effective that has no downside to it.
And this is just a quote from Socrates, "As it is
not proper to cure the eyes without the head,
nor the head without the body, neither is it
proper to cure the body without the soul"
This is a chronic condition.
This is an issue that
people are gonna live with.
This is going to affect them and just
measuring the angle is not gonna be enough.
You know it's going to affect their functioning, you
know it's going to affect their self-perception
and what they feel comfortable doing
and not comfortable doing.
It's important to hold hands and to walk
through the disease with the patient
to help them get to their
optimal level of health.
With a mild scoliosis we often do OMT.
We often prescribe exercises or do orthotics
and other ways to optimizing function.
If the pain in the back occurs with a lot of
walking, we'll work on getting shoes that do better.
or can support or bracing or wrapping
With moderate scoliosis,
OMT is also indicated.
Exercise is gonna help keep the person
active and stop the weakening of the muscles
or the loss of the small
muscles between vertebrae
Education on the future of the disease on
what to expect is gonna be very helpful
And we'll start bracing.
Bracing is very controversial, we do know that it
does slow progression but doesn't stop progression
We do know it slows progression when
it's used on a long term basis.
So we generally offer the option to parents and
let them come to a decision as to whether or not
they want to use the
bracing to delay surgery
or they want to use the bracing in times of rapid
growth or if they want to do it all the time.
For severe scoliosis, when there's
gonna be organ involvement,
we generally refer for surgery
and adjunctive treatment.
I just wanna mention OMT because we're
using OMT as a palliative procedure here.
The goal was to optimize structural function
and to minimize weakness and loss of function.
You are not straightening the spine
with osteopathic manipulative medicine.
I generally do indirect treatments or fascial
treatments, loosening of the muscles
work on that hypertonic muscles or tight
muscles doing soft tissue or efflurage.
Things that a lot of person know
what they are capable of doing,
taking them to their physiologic bariers and then helping
them understand what their anatomic barriers are
Those are just range of motion activities that are
types of OMM that can have some ancillary benefit
We also bring up the abdominal muscle
as a stabilizer of core muscles
that help prevent deterioration
as well as flexors like the psoas
and work on strengthening them and some
kind of regimen that keeps them going.
You could treat systematic dysfunction
of the joints as they develop
but it's not done on a regular basis
as part of the general maintenance.
For adolescent idiopathic scoliosis, the goal
is to minimize progression of the curve.
And even if you're not
gonna prevent progression,
waitng, so they dont need surgery until after
they've completed growth is gonna be critical.
You wanna minimize the number
Yes, if the Cobb angle's greater than 50
degrees, there's gonna be some organ compromise
and they may need to go
for surgery earlier.
The rate of progression with
each individual is a key factor.
So having records is gonna be important.
Is it 1 degree over 1 month
or 1 degree over 1 year?
Are they above average in the growth
of the curvature or below average?
And that's where the longitudinal care, the
relationship with the patient is gonna be critical
How long do you watch something
before you refer them for surgery?
and when do you get the
orthopedic surgeon involved?
So again, the Cobb angle is
something that we use to monitor
and know if we're going to observe,
observe closely and repeat
What when we talk about bracing and
other things to help slow progression,
whether we're gonna talk about exercises
activity on addiiton to bracing,
and when we say you need to meet
a surgeon and need to make plans
that you don't have to deterioration
of the viscera system as well.
So this is an important chart to know and to have
a sense of what your interventions are gonna be
and how you're gonna make this person's
life the best possible life they can have.