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3 May 2011

Chiropractic Management of Pain in a Young Scoliosis Patient

By Nancy Martin-Molina, DC, QME, MBA
Case History
The patient is a 14-year-old girl with a recent diagnosis of scoliosis received on medical referral.

She reports her actual pain onset started at menarche around 11-12 years of age, worsening in the past 6-9 months, during which time she underwent a growth spurt.  Written parental consent is obtained and an initial evaluation is provided with radiographic spinal record review performed. She hand-carried her medical radiograph report, dated six months prior.
The patient's complaint on pain drawing is neck / mid-back / low back / midline; the pain level was rated as a 6-7/10; severe on a scale of 1-10 with 10 being severe pain with moderate interference in activities of daily living. The quality of the pain is as follows: aches at suboccipital to upper dorsal, stabbing intrascapular, aches low back. Provocative: daily ADL. Palliative: nothing; mother has tried administering Tylenol. Source: oral history and pain.
Evaluation & Findings
Clinical evaluation showed a tall, thin female with significant right convex kyphoscoliosis, left convex lumbar with hyperlordosis, and generalized weakness, especially around the pelvic and shoulder girdles. Spinal listings detected at vertebral levels C2/3, T4/T5, L3 and PSI. Allis testing was negative for femoral shortening. Measurements: Umbilicus to medial knee: L 23," R 23." Sensation is normal on light touch and to vibration and light prick. Negative Romberg. Tandem gait intact. Coordination is normal on heel-shin, finger-nose and rapid alternating.
Radiological views submitted from outside imaging included posterior and lateral projected views of thoracolumbar; revealed 12-degree dextroscoliosis with apex at T10-11, Levoscoliosis of lumbar spine with apex at L3-L4.
Treatment Plan
I discussed my findings in detail with the patient and parent utilizing charts and diagrams. I recommended that the mother purchase a gym ball; they are available in most retail outlets for home use and assist in maintaining normal flexibility in a scoliotic spine.
The frequency of radiographic monitoring is also important for achieving maximal correction. We are now recommending routine radiographs every six months to monitor for any curvature progression beyond its current degrees. Should a rapid increase in curvature or decrease in flexibility occur, a neurological referral may be indicated. (Most often, curvatures of this type do not involve the viscera, but may in the event of any growth spurts; it may progress before full skeletal maturation occurs.)
I also discussed the importance of good posture and continuity of exercises designed for curve flexibility. As the patient is a typical young female teenager overtly concerned with body image, I warned against performing any abdominal exercises whereby both the psoas muscle and the back arching come into play. I also instructed on a particular order of abdominal muscle sequencing: lower abdominal work before upper abdominal work, and oblique abdominal work before straight abdominal work.
Medical IPA authorization from the medical director approved chiropractic manipulation at a frequency of 2-3 times/week for 4-6 weeks since spinal manipulation was not felt to be contraindicated. The patient reported a subjective pain reduction of 75 percent. This is a recognized and common response to chiropractic in that like any other joint, the motor segment may become locked. This is usually associated with pain. The patient was discharged after 18 sessions with good response and scheduled for follow-up in six months.

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