466- Effective Scoliosis Management with Chiropractic Adjustments

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Lengmaid. On today's episode we are talking about scoliosis and the incredible impact that spinal adjustments in manual therapy can provide. A brand new study and it's a great one if you treat anybody that has scoliosis and if you are a practicing chiropractor, you do so there's going to be some take home messages, some clinical pearls and much more on all on today's episode. Before we get started, I want to say a few words about Neck Care, the best objective assessment tool for the cervical spine on the market. It is awesome if you have not checked it out. Neckcare.com reliable assessments and exercises for neuromuscular control, proprioception, range of motion, sensory motor integration. If you are somebody that digs into SFMA, if you're somebody that digs into DNS, you have to check out NeckCare. Neccare.com, i'll drop the link down down below in the show notes, but as I said at the top, today's episode is all about scoliosis. The title of the study is the Efficacy of Combined Physiotherapeutic Scoliosis Specific Exercises and Manual Therapy in Adolescent Idiopathic Scoliosis. This is brand new, hot off the presses as usual. I will drop a link down in the show notes if you want to check it out yourself. But let's take it from the top, which is understanding what's the prevalence of scoliosis to begin with. And adolescent scoliosis global scale estimated to be between 2 to 3%. That adds up to tens of millions of people. That is relatively large and quite larger than I anticipated. That 2 to 3% will have a prevalence is the point. Prevalence of adolescent idiopathic scoliosis, Big deal. A lot of people struggling and suffering from it and living with it. Scoliosis, as you know, is a structural spinal disorder that occurs during puberty and doesn't have a defined etiology. It's like difficult to track which is the idiopathic component. The people that experience scoliosis, they have a lot of different things that happen. 1 A severity of a lateral curve. Of course then we see decreases. Where does that trickle down? Well, it trickles down into decreases in quality of life, poor perception of Appearance, disability, pain, and it actually even extends to higher rates of suicide, which is monumental. So when we talk about the back end of this study and the impact you can make, it's important to understand this is not just about the spine, it's not just about fixing curves by any stretch. What this is about is impacting the lives of individuals and potentially saving the lives in a real sense of the individuals that are struggling with scoliosis. So to slow down the progression of scoliosis, there's a variety of non surgical ways to go about it and things that have been done throughout time. Braces, as we've all seen, as they call it, physiotherapeutic scoliosis specific exercises, I'm gonna call that exercise for the sake of brevity in this episode. These have been recommended in the past. Bracing has been considered essential when patients exceed 25 degrees. Now that 25 degree number, I do think there's some latitude there, depending upon the physician, depending upon what's being seen, but that's what they're highlighting in the study. Exercises, of course, as you can imagine, are a recommended and preferred treatment for individuals that have a Cobb angle with the measurement of that scoliosis of less than 25 degrees to slow down that progression. How does exercise work? Pretty self explanatory, but important to highlight. It's the integration of sensory motor information, the enhancement of motor control and three dimensional auto correction, as they say, through targeted exercise. That's really the goal there now. Manual therapy, this is the world we live in. Manual therapy defined as the use of hands to apply a force with the therapeutic intent. A lot of different ways that this can happen. Joint mobilization, massage, myofascial release, nerve manipulation, acupressure, and of course spinal manipulation. Spinal adjustments. There is existing evidence out there, this is exciting to suggest that manual therapy can play a really big role in helping reduce pain, decrease spinal stiffness and restore proper segmental function. Really important. Now let's dive even one level deeper. Let's look at high velocity, low amplitude spinal manipulation. I'll call them spinal adjustments on this episode. These techniques can do a variety of different things. As you probably are aware on this podcast, we're highlighting the mechanisms of action regarding spinal adjustments pretty much each and every week. But relative to this study, they're looking at eliciting muscle spindle activity by evoking high frequency peripheral sensory input. Basically getting your hands on somebody delivering that adjustment. We know things happen locally, we know then things happen in the peripheral nervous system, the central nervous system, the biomechanics of the joint, the facet, the disc, and of course, all the way up to those brain changes we have seen that occur when a spinal adjustment is delivered. There is, there have been other studies showcasing how spinal adjustments can facilitate cerebral cortex reorganization that can enhance sensory motor integration and movement control. You think that's impactful in scoliosis? Absolutely. We also know that after receiving an adjustment, there has been studies that have shown significant increases neuronal activity, electromyographic responses, paraspinal muscle activity, segmental acceleration responses. All of these things happening with what we do all day, every single day. The impact of that, I never want to be lost on anybody listening to this podcast. In terms of the true impact, the breadth and depth of what happens to the body when an adjustment is delivered, we take it for granted. You're adjusting people all day, every day, over the course of weeks, become months, become years, become decades, over the course of a career. It's. It's nearly impossible not to take it for granted, but it's really important to take a step back and say, man, wow, look at the impact what we are doing can make. And I'm going to tie it back to the beginning of where we started, specifically relative to scoliosis, which, by the way, many of the things I'm going to describe right now reign supreme. When we're talking about low back pain, radiculopathy, headaches, neck pain, we're talking about quality of life issues, potential for higher suicide rates, deterioration of social activities, dysfunction, low quality, all of these things, pain, obviously these facets of struggling with these conditions are very real and we see it turn on. And I'm sure you've seen it in your practice when you see somebody come in, in acute discomfort, in pain, and how their personality is just often bad, and then all of a sudden they start getting back to themselves. Why? Because pain can do that. And when acute pain becomes chronic pain, as which happens in 30% of individuals up to 30% that have acute pain quite often because they're not receiving the right care at the right time early enough on, that's a big deal. This can impact everything around how somebody experiences life. And there is nothing more powerful that we can do than to change that trajectory back to who they really are, what their goals are, what their enjoyment is, improving their quality of life. Nothing, nothing is more powerful or impactful than that. And we're privileged to have the opportunity to do that on such a vast array of individuals struggling with such a vast array of challenges. And scoliosis is One of those. This study aimed to look at the combination of exercise and manual therapy specifically related to trunk morphology, spinal mobility, movement abilities and quality of life in these individuals. Participants were recruited from February 2021 to February 2022. Inclusion criteria no surprises. They had to be diagnosed with scoliosis, age 10 to 18 years old at the time of the study and have a Cobb angle of minimum of 10 degrees, maximum of 45 degrees in the thoracic or lumbar spine. They had a control group intervention group. Let's highlight each Standard health education was provided to both groups. Participants in the intervention group got four weeks of intervention, 50 minutes of exercise, 10 minutes of manual therapy three times a week. Control group participants were taught about the exercise but not administered and then no manual therapy at all. So those were the differences in those two groups. 31 participants total enrollment 17 participants in the intervention group, 14 in the control group. No big differences between the groups for gender, age, height, weight or Cobb angle. All pretty much washed out in the end. So let's get into the exciting stuff and that's the discussion and the results. Improvements in Cobb angle, quality of life, movement capabilities, spinal mobility, and some of the trunk shape indexes were observed in the participants in the intervention group who got the exercise and the manual therapy. The change value and rate of change was also larger in the intervention group than the control group, demonstrating the benefits of combining exercise and manual therapy in scoliosis. If that gets you excited, wait what you're about to hear. Changes in Cobb angles. Significant changes in Cobb angles. As a matter of fact, in the intervention group, the average 21 degrees down to 18 degrees. That is a big deal. Additionally, we saw that the Cobb angle changes from the exercise and manual therapy group were higher than those with the home exercise alone, which actually had a deterioration of both Cobb angle and trunk shape. So let's pause there and highlight a couple things. One, I know there's been banter back and forth for decades in the chiropractic space. Can you change angles? Can you not change angles when the proper protocols are highlighted? Yes, you absolutely can. Does that mean every person, every single time? No. But what it does mean is over the course of studies, over the course of decades, we have seen angular change with manual therapy, with spinal adjustments, especially when combined with exercise. What we also can see here is this is binary and this is really important. Individuals who think they're going to do their exercise at home and not get manual therapy deteriorated. In this study, individuals who had monitored exercise and received manual therapy had a decrease so these are two wildly different paths. That's really important to highlight because if you have people coming, there's a couple things here that I'll probably highlight a few times as we finish out this episode, which is one, anybody receiving exercise that's not receiving manual therapy is shortchanging their ability to get well. I know there's a lot of physiotherapists and physical therapists that are referred individuals with scoliosis that quite frankly never co managed with chiropractors. That needs to stop because it is very, very clear that these patients will receive better overall results. With the combination of physiotherapeutic exercise and the manual therapy spinal adjustments you can deliver, which is not rocket science. If a segment is dysfunctional, which of course it's dysfunctional if it's undergoing abnormal stress over a long period of time, AKA scoliosis, no kidding, you're going to be fighting an uphill battle. If it's exercise alone and you're not addressing the underlying spinal biomechanics, it just makes sense. That's not very difficult thing to grasp. But I'm going to go on record by saying an overwhelming majority of individuals receiving exercise and therapy are probably not receiving concurrent adjustments. And that is a massive opportunity for you to communicate and build referral relationships in your community and really, really help these people. The other thing is that we see the intervention group had improved spinal mobility, including thoracic and lumbar flexion, lateral flexion and posterior extension. This ties back to what we just highlighted. This is about segmental biomechanics. Really, really important manual therapy has been shown variety of studies to adjust tension along the myofascial chain of the spine, which ultimately promotes balance recovery and may improve spinal range of motion because of those facets ensuring that the facets are sliding, gliding and moving to the best of their ability. All the exercise in the world, it's going to be difficult to do that. Whereas a spinal adjustment, it can be done in a momentary action. Through the delivery of that adjustment, reduced muscle strength and scoliosis has been linked to increased disc pressure contributing even that's a cycle contributing to a higher rate of scoliosis. Strengthening the core muscles through exercises can help reduce this disc pressure and adjust the muscle tension integrity, decreasing the risk of scoliosis. So all of these things play together so, so nicely when somebody is receiving truly the care, attention, focus that they need. The conclusion that they found was quote, the present study provides evidence supporting the potential clinical benefits of integrating exercise with manual therapy for Managing scoliosis. The combined intervention approach demonstrated improvements in Cobb angle, spinal mobility, movement ability, trunk morphology and quality of life. End quote. Massive improvements made when the combination is there. So couple things. Take home messages. I want to stress number one, don't, don't sleep on scoliosis in your practice. So when you see somebody that is at risk or experiencing, so to speak, scoliosis between 10 to 18, get on it. Make sure that you're delivering the care. And I'm just going to say it bluntly, don't get lazy. If you've been taking care of that individual over the course of their life and you just see them from time to time, you might want to continue to see them from time to time. I think this episode and this study, while it doesn't say how many times you need to see somebody, I'm going to make the suggestion, get serious about it, get in there, ensure that they are receiving the care at the frequency in this case they did three times a week for I think it was five weeks and they saw that improvement. Now, could there be continued improvement? Very well. So it doesn't mean over treat, but it certainly doesn't mean over under treat. And that's an important component. And make sure they're getting the combo. If you're recommending the exercise at home, there are apps and things like that that allow you to monitor compliance. You have to do that the bare minimum if you're not doing it in your practice. Because clearly in this study, it was not only the fact of that the control group didn't receive adjustments, it was also the fact that they were doing the exercises at home, which, as you and I both know, means they weren't doing the exercises. So ensuring that they're doing the exercise, delivering the care and the manual therapy, absolutely incredibly important and impactful for those individuals struggling with scoliosis. As we wrap up today's episode, I want to say a few words about turncloud. When you strip away anything that's not essential and make everyday function simpler, you end up with turncloud minimalist EHR design without being sparse. They create an intuitive application where nobody needs a user manual. Put them to the test. Check them out@TurnCloud.com no user manual. That is a tall claim and is something that I have seen turncloud deliver. If you'd like to see that and simplify your workflow, head over to turncloud.com, let them know we sent you over there. They support this podcast. I'll ask you to support them. Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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Sam.