Scoliosis

What is Scoliosis?

Scoliosis affects about 5-7 million people in the U.S., scoliosis is a lateral curvature of more than 10 degrees in the spine. A person with scoliosis will have a C- or S-shaped curve in their spine. It can appear at any age, but it often presents from the age of 10 to 12 years, or during the teens, but infants can sometimes have symptoms. The reasons for the change in shape are not usually known, but some cases are linked to cerebral palsymuscular dystrophy, spina bifida, or a birth defect.

A structural curve is permanent, and may be due to another condition. A nonstructural curve is temporary and it is likely to disappear with time. A very small number of patients with scoliosis may require surgery. Complications of scoliosis include chronic pain, respiratory deficiencies, and decreased exercise capacity.

 

What are the Symptoms of Scoliosis?

The most common form of scoliosis appears in adolescence. It is known as adolescent idiopathic scoliosis. It can affect children from the age of 10 years.

Idiopathic means that there is no known cause. Symptoms can include:

  • The head is slightly off center
  • The ribcage is not symmetrical – the ribs may be at different heights
  • One hip is more prominent than the other
  • Clothes do not hang properly
  • One shoulder, or shoulder blade, is higher than the other
  • The individual may lean to one side
  • Uneven leg lengths

Some types of scoliosis can cause back pain but it is not usually very painful. Back pain is not uncommon in older adults with long-standing scoliosis.

If scoliosis is left untreated, problems can arise later in life, such as impaired heart and lung function.

What are the Causes of Scoliosis?

  • Neuromuscular conditions: These affect the nerves and muscles and include cerebral palsy, poliomyelitis, and muscular dystrophy.
  • Congenital scoliosis (present at birth) This is rare and occurs because the bones in the spine developed abnormally when the fetus was growing inside the mother.
  • Specific genes: At least one gene is thought to be involved in scoliosis.
  • Leg length: If one leg is longer than the other, the individual may develop scoliosis.
  • Syndromic scoliosis: Scoliosis can develop as part of another disease, including neurofibromatosis and Marfan’s syndrome.
  • Osteoporosis: This can cause secondary scoliosis due to bone degeneration.
  • Other causes: Bad posture, carrying backpacks or satchels, connective tissue disorders, and some injuries.

What are the Types of Scoliosis?

There are a number of ways to differentiate between the various forms of scoliosis, but the most common method for classification is based on etiology, or the underlying cause for the condition. The American Association of Neurological Surgeons (AANS) suggests there are three categories into which the different forms of scoliosis fit: idiopathic, congenital, and neuromuscular.

Most types of scoliosis are idiopathic, which means that the cause is unknown or that there is no single factor that contributes to the development of the disease.

Congenital forms of scoliosis typically result from a spinal defect present at birth, and are therefore usually detected at an earlier age than idiopathic forms of scoliosis.

Neuromuscular scoliosis is spinal curvature that develops secondary to some kind of neurological or muscular disease, such as muscular dystrophy or cerebral palsy. This form of scoliosis tends to progress much more quickly than others.

What is the Treatment for Scoliosis?

As a Chiropractic Physician, I will do a physical examination, postural analysis, and take x-rays. I design an individualized treatment plan that will focus on pain management and postural fixation. Spinal manipulation, therapeutic exercises, and other treatments may also come into play. Initial treatment usually lasts 4-8 weeks and I then recommend my patients to follow up every 1-2 months to monitor the curve of the spine in clinic.

The following factors will be considered by the doctor when deciding on treatment options:

  • Sex: Females are more likely than males to have scoliosis that gradually gets worse.
  • Severity of the curve: The larger the curve, the greater the risk of it worsening over time. S-shaped curves, also called “double curves,” tend to worsen over time. C-shaped curves are less likely to worsen.
  • Curve position: A curve that is located in the center part of the spine is more likely to get worse compared with curves in the lower or upper section.
  • Bone maturity: The risk of worsening is lower if the person’s bones have stopped growing. Braces are more effective while bones are still growing.

What About Braces?

If the patient has moderate scoliosis and the bones are still growing, I may recommend a brace. This will prevent further curvature, but will not cure or reverse it. Braces are usually worn all the time, even at night. The more hours per day the patient wears the brace, the more effective it tends to be.

The brace does not normally restrict activities of daily living. If the patient wishes to take part in physical activity, the braces can be taken off.

When the bones stop growing, braces are no longer used. There are two types of braces:

  • Thoracolumbosacral orthosis (TLSO) – the TLSO is made of plastic and designed to fit neatly around the body’s curves. It is not usually visible under clothing.
  • Milwaukee brace – this is a full-torso brace and has a neck ring with rests for the chin and the back of the head. This type of brace is only used when the TLSO is not possible or not effective.

One study found that when bracing is used on 10-15 year olds with idiopathic scoliosis, it reduces the risk of the condition getting worse or needing surgery.

References

Nordqvist, C. (2017, December 22). Scoliosis: Treatment, symptoms, and causes. Retrieved from https://www.medicalnewstoday.com/articles/190940.php

7 Types of Scoliosis & Their Differences [Comprehensive Guide]. (2018, December 28). Retrieved from https://www.treatingscoliosis.com/blog/scoliosis-types-differences/

Forward Head Posture

Forward head posture, sometimes called “Scholar’s Neck”, “Text Neck”, or “Reading Neck”, refers to a posture where the head appears to be positioned in front of the body. It is a very common condition that I see in the office almost on a daily basis.

Technically speaking, forward head posture means that the skull is leaning forwards, more than an inch, over the atlas (which is the first vertebrae in your neck). Forward head posture is considered to be the most common postural deformity, affecting between 66% and 90% of the population.

With a few simple exercises, posture awareness and workstation modifications and you can start correcting this posture!

How Do You Know if You Have Forward Head Posture?

Stand with your back towards a wall with your heels positioned shoulder width apart

Press your buttocks against the wall and ensure that your shoulder blades are in contact with the wall.

So, What’s the Problem with This Posture?

Forward head posture doesn’t just affect the neck and shoulders; the center of gravity of your entire body is also altered, which affects your torso and every joint in your body.

Your body tries to adapt to these positional changes be altering the balance control mechanisms of the body, which actually decreases your ability to balance when engaging in different activities throughout the day, and increases your risk of injury.

A study published in the Journal of Physical Therapy Science breaks down what happens to the body in individuals with forward head posture:

The muscles and joints at the front of the neck become weak, while the muscles in the upper back and shoulders get really tight.

The center of gravity of your head shifts forward (anteriorly), which increases the load on your neck (for every inch of forward movement, there is an extra 10 pounds of weight placed on your neck!). This can consequently lead to musculoskeletal, neural, and vascular system dysfunction.

The changes that occur with forward head posture can lead to persistent and abnormal pressure in the muscles, tissues, and nerves of both the neck and shoulders, which can lead to rounding of shoulders (increased thoracic kyphosis) and herniated discs in an effort to compensate, which results in a higher load being placed on the back and shoulder muscles (Like Trapezius).

When you combine all of these changes, you’ll eventually end up with a condition called “tension neck syndrome” – symptoms of this condition can mimic tension headache.

What are the symptoms of Forward Head Posture:

  • Back pain
  • Neck pain
  • Muscle spasms
  • Cervical (Neck) spine arthritis
  • Restricted breathing
  • Hyperkyphosis (Excessive rounded shoulders)
  • Bulging Discs
  • Herniated Discs
  • Headaches and migraine
  • Insomnia
  • Numbness and tingling of the arms and hands
  • Temporal mandibular joint (TMJ) pain

What causes Forward Head Posture?

Forward head posture is the result of a variety of factors, including:

  • Poor posture
  • Weakness of your neck muscles
  • Previous neck strains or sprains
  • Sleeping with your head elevated too high on pillows
  • Frequently sleeping on a sofa with your head propped on the arm rest
  • Extended computer use
  • Extended cellphone use (“text neck”)
  • Prolonged driving
  • Incorrect breathing habits
  • Carrying heavy backpacks
  • Participating in sports that involve the dominant use of one side of the body (i.e. golf, tennis, hockey, baseball, etc.)
  • Certain professions are more at risk due to repetitive movements of the body (i.e. hair stylists, massage therapists, writers, computer programmers, painters, etc.)

What is the treatment for Forward Head Posture?

Practicing good posture while performing your daily activities, combined with stretching and strengthening the muscles involved in forward head posture, can put you on the right path towards correcting this postural abnormality. Below, there are some good exercises that can help with forward head posture.

Neck Flexion (Suboccipital Stretch)

This will stretch the back of your neck muscles including the Suboccipital muscles.

  • First, tuck your chin in using 2 fingers of one hand.
  • Place your other hand on the back of your head and apply a gentle force down as you pull your head towards your chest.
  • When you feel a stretch at the back of your neck, hold the position for 20 to 30 seconds.

Repeat this stretch 3 times.

** Keep your chin tucked as you do this stretch

Chin Tuck Exercise

This exercise will activate and strengthen your deep cervical muscles (front of the neck muscles).

  • Place 2 fingers at the bottom of your chin.
  • Gently tuck your chin in and retract your head backwards. At the same time, use your fingers to keep the chin tucked in the entire time.
  • Hold the end position for 3 to 5 seconds.
  • Relax your neck for a moment (Let the neck come forward).

Aim for 2 to 3 sets of 10 repetitions.

** Your eyes should stay level and you should feel like the back of your neck is lengthening or “pulling up”.

Doorway Pectoralis Stretch

  • Position your elbows and hands in line with a doorframe.
  • Step through the door slowly, until you feel a stretch.
  • Hold this end position for 15 to 20 seconds before returning to the starting position.

Repeat this stretch 3 times.

Shoulder Blade Squeeze (aka Brugger’s Relief Position)

This exercise will activate and strengthen your low and mid back muscles.

  • Position your feet and knees slightly wider than your hips and slightly rotated outwards.
  • Maintain a chin tuck and raise your chest up, allowing your spine to be in a neutral position.
  • Rest both of your arms down by your sides.
  • Now bring your arms back and externally rotate them so that your thumbs are pointing backwards.
  • Hold this position for 5-10 seconds and release.

Aim for 2-3 sets of 10-15 repetitions.

* Breathe normally as you do these reps.

Lastly, Proper Ergonomics are very important when it comes to forward head posture. If you sit at a computer for extended periods of time, the single most important thing you can do to improve your workstation is to ensure that your computer monitor is positioned properly to allow your neck to remain in a neutral and relaxed position while you work.

Ensure that the top third of your screen is at eye level

Your monitor should be between 18 and 24 inches away from your face.

REFERENCES

McQuilkie, S., Joel, Kim, J., Ron, Turetsky, L., Ron, . . . Beth. (2019, March 14). How To Fix Forward Head Posture Fast – 5 Exercises And Stretches. Retrieved from https://backintelligence.com/how-to-fix-forward-head-posture/

Lee J. H. (2016). Effects of forward head posture on static and dynamic balance control. Journal of physical therapy science28(1), 274–277. doi:10.1589/jpts.28.274

Whiplash Injuries

What is a Whiplash Injury?
Whiplash, also called neck sprain or neck strain, is an injury to the soft tissues of the neck. Whiplash injuries occur in sports where a forceful impact (commonly from behind) causes an athlete’s head and neck to snap forward and back in an abrupt, violent motion. It is commonly seen in car accidents, but some contact sports, such as football, can lead to whiplash injuries. The sudden force stretches and tears the muscles and tendons in your neck. This causes movement of the structures within the neck changing the normal curve of the upper back and neck. The sudden backward movement (extension) and forward movement (flexion) can cause the joints of the neck to be injured and can also cause the muscles and ligaments of the neck and upper back to be over-stretched. The neck is particularly vulnerable to this type of injury because of its ability to move in many directions.

Symptoms of Whiplash
The primary symptom of whiplash is neck or upper back pain. The pain can start immediately or develop days, weeks, or sometimes even months later. Symptoms can vary widely among individuals. Some may only suffer minor discomfort while others experience one or more of the following:

  • Tightness or spasms of the muscles the neck or upper back
  • Pain with movement of the neck, headache and dizziness (symptoms of a concussion)
  • Abnormal sensations such as burning or tingling
  • Shoulder pain
  • Upper back pain

Severe whiplash can also include injury to the intervertebral joints, discs, ligaments, cervical muscles and nerve of the neck or upper back. Fortunately, with time, the vast majority of people who have had a whiplash injury fully recover.

How is Whiplash Diagnosed?
Even if your neck pain is only mild, you should be examined by a health professional such as a Chiropractor as soon as possible. X-rays may be done to rule out any bone fractures. A CT scan or MRI may also be done if there is concern you have a herniated disc or significant ligament injury. These tests are better able to identify soft tissue injuries than plain radiographs.

Treatment Options
Most cases of whiplash are treated using conservative methods such as:

  • Encouraging the patient to remain as active as possible.
  • A cervical collar should be used for only a very short period of time (less than a week). Ice or heat can be used to control pain, muscle spasm, and inflammation.
  • A course of spinal manipulation or mobilization can help in restoring normal positioning of the muscles and joints.
  • Chiropractic and/or Physical therapy helps to increase circulation, restore range of motion, and promote healing.
  • The use of modalities such as ultrasound and electrical stimulation should only be used in the early stages of treatment to reduce pain and assist in getting an active therapy program started.

Prevention Tips
Since most cases of whiplash occur as a result of rear-end car crashes, the best way to protect yourself on the road is to wear your seat belt correctly and on every ride. Also, make sure the headrest in your vehicle is not too low and avoid driving in an overly reclined position.

For Athletes and Sports Enthusiasts if you participate in sports (especially contact sports), make sure you wear appropriate equipment and always use good technique to avoid neck injuries.

While it may be impossible to avoid some injuries, maintaining good overall health can help speed recovery if one occurs. This includes getting regular exercise, eating healthy foods, and not smoking. If you are experiencing neck or upper back pain, visit us at SHC for a complete evaluation.

Reference
Malanga, G., MD. (n.d.). Whiplash: 5 Things You Should Know. Retrieved from https://www.spineuniverse.com/conditions/whiplash/whiplash-5-things-you-should-know