Treatment of Scoliosis

00:01 So treatment of scoliosis.

00:03 You are going to see these patients, they're going to ask for treatment.

00:07 And witnessing the disease, sharing with them what's gonna happen is the first start to treatment.

00:14 You want to get them to the point where they know when they're starting to get weaker, or lose use or function.

00:20 We do know that physical therapy and chiropractic therapy have been shown to be ineffective.

00:26 But we do know that individuals will feel better when they're being treated and monitored on a regular basis.

00:32 So we wanna find what is the most effective that has no downside to it.

00:37 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.

00:48 This is an issue that people are gonna live with.

00:50 This is going to affect them and just measuring the angle is not gonna be enough.

00:55 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.

01:05 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.

01:13 With a mild scoliosis we often do OMT.

01:16 We often prescribe exercises or do orthotics and other ways to optimizing function.

01:24 If the pain in the back occurs with a lot of walking, we'll work on getting shoes that do better.

01:30 or can support or bracing or wrapping With moderate scoliosis, OMT is also indicated.

01:38 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.

01:54 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.

02:05 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.

02:19 For severe scoliosis, when there's gonna be organ involvement, we generally refer for surgery and adjunctive treatment.

02:27 I just wanna mention OMT because we're using OMT as a palliative procedure here.

02:33 The goal was to optimize structural function and to minimize weakness and loss of function.

02:39 You are not straightening the spine with osteopathic manipulative medicine.

02:44 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.

02:54 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.

03:24 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.

03:32 For adolescent idiopathic scoliosis, the goal is to minimize progression of the curve.

03:38 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.

03:47 You wanna minimize the number of surgeries.

03:50 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.

03:58 The rate of progression with each individual is a key factor.

04:02 So having records is gonna be important.

04:05 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.

04:50 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.