A look at Scoliosis from a non-linear Perspective Epidemiology
Scoliosis affects approximately 7 million people in the United States.[1] A scoliosis spinal columns curve of 10° or less affects 1.5% to 3% of individuals.[2]
Scoliosis ranges from the seemingly benign variety to life encumbering degrees. It can be assessed by measurements of radiographic image by using the Cobb Angle. This system was originally used in the coronal plane, but has subsequently become used in the Sagittal plane as illustrated below. In assessing the Cobb angle, one must first decide which vertebrae are the end-vertebrae of the curve. These end-vertebrae are the vertebrae at the upper and lower limits of the curve which tilt most severely toward the concavity (the hollow side) of the curve. Once these vertebrae have been selected, [t3 through t7 in the diagram below] one then draws a line along the upper endplate of the upper body and along the lower endplate of the lower body.
As a reference tool for evaluating the severity of one’s scoliotic condition, it is a useful tool.
There are different types of scoliosis. Some are merely functional adaptations to an improper asymmetry of the feet (a fallen arch). These types of scolioses may be readily improved by orthotic usage and muscle strengthening in restoring integrity to the arch of the foot into a neutral position.
Mechanical restoration to the feet, the foundation of the spine can provide the body with greater stability and balance and help to prevent degenerative changes in the spine due to improper biomechanics. It is also helpful in the treatment and prevention of bunions and plantar fascitis.
Idiopathic Scoliosis is a more complex condition. It can range from 10degrees to over 100 degrees. It has been linked to neurological deficiencies that are becoming an area of investigation.
As the vertebral bodies rotate, the spinous processes deviate more and more to the concave side and the ribs follow the rotation of the vertebrae. The posterior ribs on the convex side are pushed posteriorly, causing the characteristic rib hump seen in thoracic scoliosis. The anterior ribs on the concave side are pushed anteriorly. [3]
Typical Distortion Of Vertebra And Ribs In Thoracic Scoliosis As Seen From Below. (See image)
What I would like to present is that with combining the findings for Vestibular function deficiencies and the hypothesis that the cerebral or emotional control network ]. Therefore, a discussion of the efficacy of acupuncture must be prefaced with an understanding of the problems that occur when researchers attempt to evaluate treatments from one diagnostic paradigm (i.e., TCM) to diagnoses made with a different paradigm (i.e., allopathic medicine)
The studies that have been done in treating scoliosis with acupuncture are few. When evaluating the referenced study, it provides for the more common points that would be utilized in the general assessment of an individual, but not for the emotional or cerebral content of that individual's development of their condition. My thought is that when combining the systems of our vestibular and cerebral functions, that the effectiveness of the treatment for the scoliotic condition would improve.
The conclusion from a single blind controlled pilot study in the treatment of scoliosis with acupuncture were as follows: One session with real (verum) acupuncture seems to have an influence on the deformity of scoliosis patients with no more than 35 degrees. The findings during verum acupuncture clearly are different to sham acupuncture or just lying, while in the whole group of patients also including patients with curvatures of more than 35 degrees no obvious changes have been found. The results of this study justify further investigation of the effect of acupuncture in the treatment of patients with scoliosis.[4]
Because acupuncture theory allows for the ability to diagnose a condition such as scoliosis into broader syndrome type categories, other dimensions of an individuals homeostasis are considered. What I would like to present is that with combining the research for vestibular function deficiencies and implementing the conceptual model that vestibular and emotional dysregulation may have a common basis, there may be a functional cerebral systems framework that may begin to explain the etiopathogenesis of Idiopathic Scoliosis. Approaching the treatment protocol for acupuncture in a comprehensive framework may greatly enhance the effectiveness.
In Traditional Chinese Medicine language this would be the same as connecting the emotional quality of the meridian to the functional aspect of it. For example there may be a feeling of getting dizzy when one experiences an extreme level of anger. When treating the points along the spine with acupuncture, there is a different paradigm at work. The patient may have had a level of anxiety that began at the time that their spine began it's scoliotic development. This would be discovered through the history and pulse evaluation. Thereby, the points that would help to release the scoliotic pattern would be at the Heart Shu Point or Pericardium Meridian. This aspect of the cerebral component of involvement interacting with the vestibular function may get lost if the practitioner is thinking only in an allopathic paradigm.
The neurological findings linking vestibular function to Idiopathic Scoliosis are found in much of the literature available now. "The assessment of vestibular function throws new light on scoliosis. Vestibular morphological anomalies are frequent in scoliosis. This communication has two aims: to correlate the dysfunctions of the semi-circular canal system with morphological anomalies. to include the vestibular assessment in the management of the scoliotic subject".[5]
Other fields of thought are connecting the vestibular with the cerebral hemispheres and expanding the possibilities to yet an even more comprehensive view.
"Throughout history, vestibular and emotional dysregulation have often manifested together in clinical settings, with little consideration that they may have a common basis. Regarding vestibular mechanisms, the role of brainstem and cerebellar structures has been emphasized in the neurological literature, whereas emotion processing in the cerebral hemispheres has been the focus in psychology. A conceptual model is proposed that links research in the 2 disparate fields by means of a functional cerebral systems framework".[6]
In summary, there is more and more data to substantiate a comprehensive evaluation and approach to treating maladies and conditions. Chinese medicine is ancient and has withstood the test of time. Translating the essence of pulse taking, tongue diagnosis and stored emotional content into a treatment that can restore homeostasis is an art that is still finding it's way into mainstream thought. The paradigm that allows for the most effective treatment in Chinese Medicine does not translate directly into western thought. Therefore, a more eastern thought analysis is needed. Placing a needle where there is pain is one aspect of Qi and Chinese Medicine. Placing a needle in the hollow of a curve for scoliosis is another aspect of Chinese Medicine. But alone, they do not address the entire syndrome that is involved in the condition. Interestingly, Chinese Medicine always allows for the encompassing of the emotions as they are woven into the states of our physical being.
1. Good, Christopher (2009). "The Genetic Basis of Adolescent Idiopathic Scoliosis". Journal of the spinal Research Foundation 4 (1): 13-5. http://www.spinemd.com/publications/articles/the-genetic-basis-of-adolescent-idiopathic-scoliosis.
2. Herring JA (2002). Tachdjian's Pediatric Orthopaedics. Philadelphia PA: W.B. Saunders. ISBN 0-7216-5684-6.
4. Acupucture in the treatment of scoliosis – a single blind controlled pilot study Hans-Rudolf Weiss*, Silvia Bohr, Anja Jahnke and Sandra Pleines Tan G, Craine MH, Bair MJ, Garcia MK, Giordano J, Jensen MP, McDonald SM, Patterson D, Sherman RA, Williams W, Tsao JC: Efficacy of selected complementary and alternative medicine interventions for chronic pain. J Rehabil Res Dev 2007, 44(2):195-222. PubMed Abstract | Publisher Full Text
5. J Bone Joint Surg Br 2008 vol. 90-B no. SUPP III 432-433 ACCURATE VESTIBULAR ASSESSMENT: INTEREST IN THE ADOLESCENT IDIOPATHIC SCOLIOSIS. J.P. Deroubaix and D. Rousie Author Affiliations Paris, France
6. Psychol Bull. 2009 Mar;135(2):286-302. Extending the functional cerebral systems theory of emotion to the vestibular modality: a systematic and integrative approach. Carmona JE, Holland AK, Harrison DW. Source Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA. [email protected]