Chiropractic treatment in scoliosis
If one searches the web for information on chiropractic care
and scoliosis, the American Chiropractic (ACA) Association would be a logical
place. According
to the ACA, “chiropractic is a health care profession that focuses on disorders
of the musculoskeletal system and the nervous system, and the effects
of these disorders on general health. Chiropractic services are used most often
to treat neuromusculoskeletal complaints, including but not limited to back
pain, neck pain, pain in the joints of the arms or legs, and headaches.”
So scoliosis is not a diagnosis directly referred to, but the “not limited to” part
of this statement does not eliminate scoliosis from the conditions they may
advocate to treat.
Further digging around on the ACA website
one finds very little information about scoliosis or chiropractic treatment of
scoliosis. One item that is posted is a
patient information handout produced by the ACA which states “Spinal manipulation, therapeutic exercise, and electrical muscle
stimulation have also been advocated in the treatment of scoliosis. None of
these therapies alone has been shown to consistently reduce scoliosis or to
make the curvatures worse. For patients with back pain along with the
scoliosis, manipulation and exercise may be of help.” Let’s break down and analyze these three
sentences. Sentence one is factually
correct, these therapies along with many others have been advocated in the
treatment of scoliosis, with most therapies eventually being shown to be
ineffective. The second sentence of this
quote one can essentially boil this down to this revised statement: we (the
ACA) can’t come right out and say it, but there really isn’t any evidence spinal
manipulation, therapeutic exercise and electrical stimulation really prevents
scoliosis from getting worse. The third
sentence is partially accurate, short-term back pain may be helped with
manipulation and exercise may be of help.
Long-term back pain related to scoliosis has not proven responsive to
chiropractic treatment.
Another website to search on this topic is from the Scoliosis
Research Society (SRS). This is the most
authoritative website, produced by medical doctors and doctors of osteopathy
who specialized in spinal deformity in children and adults. This website has a section of FAQs on
scoliosis, and it is here one can find the following information:
Will chiropractic treatment help my scoliosis?
Chiropractic is a controversial
method of treatment that seems most effective in treating acute, short-term
pain. Chronic conditions do not seem effectively managed by long-term
chiropractic care. Patients who have scoliosis and choose chiropractic treatment
should be referred to a spinal orthopaedist or neurosurgeon if their curves
keep increasing. Insurance may or may not cover chiropractic treatment.
Thee two large organization can
obviously be biased in their position on this subject, and one would expect
both organization to support their mission and members. So let’s look at the science behind this
topic. In this era of evidence-based
medicine we should constantly strive for the highest level of evidence to
support our treatments. By searching Pubmed,
the U.S. National Library of Medicine and National Institute of Health’s online
search engine, one can search over 26 million citations for biomedical
literature from MEDLINE, life science journals and online books. This is a good place to search for information
on “scoliosis and chiropractic treatment”.
If one does this the results of the search will demonstrate a lack of
scientific evidence supporting the position that chiropractic treatment/manipulation
alters the natural history of scoliosis (prevents progression or worsening of
the deformity). The existing literature on
this topic is replete with cases reports and small, retrospective, single
center case series which lack control groups, have inadequate numbers of
patients, insufficient follow-up, lack rigorous statistical analysis and are
generally underpowered statistically. Testimonial
medicine advertisements, however appealing, should not be used as evidence a
treatment is helpful and safe.
Hence based on the
currently available data, there is
no scientific evidence that chiropractic therapies alter the natural history is
scoliosis. This statement, though
grounded in evidence based medicine, is often vigorously contested by some
chiropractic or homeopathic practitioners. Often talking about chiropractic
treatments with families is much like discussing politics and religion,
individuals often have firm beliefs in either direction and will not be swayed
by a five-minute conversation in the office.
When my patients ask me about my perspective of chiropractic
treatment of their child/adolescent with a spinal deformity I state the
following:
1.
Spinal manipulation
should never be done on a spinal deformity.
Catastrophic injuries (fractures, paralysis, etc…) have occurred when
the spine was “manipulated”.
2.
There is no scientific
chiropractic treatments prevent progression of scoliosis.
3.
Often when chiropractic
treatment is initiated the recommended plan of treatment (with multiple x-rays)
to parents/caregivers is for several treatments per week for months or
years. This can be extremely expensive,
and time consuming, for families and can drain Health Savings Accounts quickly.
4.
The only benefit
chiropractic treatments may help is acute, short-term back pain.
5.
The most effective
interventions for pediatric and adolescent back pain related to scoliosis are:
a.
Rule out more serious and
non-muscular causes of back pain (such as urinary tract infection, hip
pathology, and fractures).
b.
Develop a physical
fitness program in which the individual is doing some type of aerobic activity
(raising the heart rate and breaking into a sweat) for 20-30 minutes a time, 3
times per week.
c.
Maintain ideal body
weight
d.
Do not use tobacco
products.
I hope this helps. Let me know if there are any questions. Happy Holidays.
