Crooked Back

[tjosh]

My chiropractor just took x-rays of my back and I have an abnormal curvature going to the left in my spine just at about hip level. This is new because I have had x-rays before and this was not a problem. The doctor told me this is causing me to have pain due to a pinched nerve.

What is strange is that my low back was fine (at least I felt no pain) until about 4 weeks ago. And I THINK it was during one of my advanced warrior wellness practices in a twisting motion that caused it.

Any recomendations on straightening this out and fixing the curvature in my back? I also have neck pain and the chiro told me this was because my neck was curving the opposite direction that it should.

What about resuming training? I want to get back into my WW BFlow and Clubbell training. I was making alot of progress until this happened. Resting has not made the pain any better. I even did a clubbell workout and my back felt the same after.

Thanks

[admin]

Josh,
As a long time sufferer of embedded body trauma (40+years) I'd like to make two little suggestions. First, don't fight the pain, don't expect it to go away immediately. Relax into it. Let it show you where you are not relaxed.

Second, try this. Lie on your back or stand comfortably, close your eyes, and with your eyes closed and your body as relaxed as it can manage, imagine that you are moving your neck or back, without moving. And as you imagine it (here's the voodoo) look in the direction of movement (eyes closed and body not moving) but your eyes are stuck way over in their socket in the direction that you imagine you are moving. Do this as you exhale long and slooooooowly.

I know it sounds a bit strange, maybe even silly. But if you try it in the spirit of discovery, you might find your body letting go in a way you never thought it would. There is something about the CNS and the eyes that can allow movement where before muscular tension blocked it. When it works, it seems like magic. The eyes hold us and guide us in ways we never even imagine.

Anyway, hope this helps. It can't hurt and at the very least, you get a moment of relaxation and calm breathing.

Good luck!

[rbibbs]

Josh, you're under professional care for a specific condition, us internet diagnosticians have to take a MAJOR backseat stance to the firsthand assessment and advice of a doctor. "Ordinarily", motion under control won't produce spinal misalignment... typically that comes from either uncontrolled motion (a fall, or a substantial overexertion), or from habitual misuse (like, always carrying a heavy book bag on the same shoulder).

It's "not altogether abnormal" for the spine to have a modest L/R curve to it, probably resulting from "handedness"... an arch supports loads better than a straight line, and if we habitually impose an asymmetrical load on the L/R plane, the spine will adapt to provide added strength in that habitual direction. You'll see this everyday, just walking around, that people's shoulders aren't "level". It's not a pathology per se.

But a drastic L/R curve over a short distance that produces symptoms is a pathology, and should probably be referred to a healthcare professional, as you have done. Follow the doctor's advice and treatment until the condition is resolved... unless at some point you have concerns about the validity of the diagnosis/treatment you're getting, then seek a second professional opinion.

And Michael's idea sounds good, doesn't seem to pose any risk.

Rick

[James Boelter]

Josh, these things do happen, more often than the lay public thinks. I used to think a 'disease' required an infectious agent to be called a disease, and then found out that there are plenty of body structural degenerative changes (ie spondylothesis, etc) that also are diagnosed as 'disease'. For some reason, this happened to you, and you are the
lab rat in another ongoing 'experiment' which advances our (medical sciences') understanding of what is going on. That sucks, and I am sorry.

Keep working with your doctors and don't get discouraged. There are many things you can do to help yourself, some of which are as simple as laying on your side over specially designed yoga props such as the 'BackBender' and the 'Whale' , to encourage the muscles in your lower spine to relax and allow the spine to return to its best configuration.

It's possible that the problem is due to degeneration of the spine, but much more likely that something drastic happened to the muscles, fascie and myofascial articulations that hold the spine in its usual positions, and the soft tissues can be greatly influenced by intelligent movement and good bodycare.

The mental exercise Micheal suggested is a very good example of something else you can do for your self as a supplement to your medical care; I think it is out of Feldenkrais. There is also the kind of ideokinetic approach called 'Body Mind Centering' taught by people like Bonnie Bainbridge Cohen; you can learn to influence your structure, your internal organs and your physical movement through deep concentration and applied ideomotor imagery.

I suggest you get yourself to Border's/B&N etc and pick up a copy of Eric Franklin's book 'Conditioning For Dance'. No, I am not pulling your leg. This is a very useful book to help you learn useful visual and kinesthetic metaphors for your body and the relations between its systems. The book is loaded with all kinds of helpful movement/visualization drills; some of the exercises can be done with Therabands - although you might want to use JumpStretch Bands instead, as they are much stronger. These may not 'solve' your problem, but they will definitely put more tools in your toolbox and empower your belief in your ability to deal with this.

Much luck, amigo!

[bob_stra]

My chiropractor just took x-rays of my back and I have an abnormal curvature going to the left in my spine just at about hip level. This is new because I have had x-rays before and this was not a problem. The doctor told me this is causing me to have pain due to a pinched nerve.


I'll get around to properly answering your question later on this week. In the mean time, here is everything you *never* wanted to know about the hows & why of "abnormal curvatures". (I wrote this for a class I had sometime ago - hopefully it's interesting background reading for you)


*******************************
[1] ABSTRACT

Idiopathic scoliosis (IS) is one the most common spinal disorders known to man. According to the National Institute for Health and Medicine, the incidence of infantile idiopathic scoliosis in industrialized nations is 5 / 1000 births. Ebenbichler estimates that up to 13% of the general population develops some degree of idiopathic scoliosis.

However despite the rate of incidence, the cause of IS remains elusive. A meta-analysis conducted by Byrd illustrates this point. Despite various investigations, the re-occurring sentiment is that idiopathic scoliosis is multi-factorial and thus difficult to pin down.

Against this background, this literature review was undertaken to assess what role genetic, familial, hormonal and biomechanical factors might play in the etiology of IS. Furthermore popular treatments for idiopathic scoliosis are reviewed.

[2] EFFECTS AND MANIFESTATIONS OF IDIOPATHIC SCOLIOSIS

Idiopathic scoliosis is defined as a lateral curvature of the spine. Though it can occur at any spinal level, the thoracic curve (with apex at T8 or T9) is thought to be the most common.

In actuality, scoliosis is a complex three dimensional adaptation. The laterality of the curve is at least in part influenced by normal growth factors. Of those, vascular asymmetries and blood flow are thought to be the initial impetus for the development of the curvature.

If curvature is suspected, it is most commonly confirmed via X-ray. Using the Cobb method, lines are drawn parallel to the end plates of the vertebral bodies at the beginning and the end of the curve. A second line is drawn perpendicular to each of the first lines, and the angle between these two lines is equal to the Cobb measurement. The typical curvature for idiopathic scoliosis varies by age group. Most cases are between 10 to 40 degrees deviation.

The actual effects of idiopathic scoliosis are harder to define. Symptoms depend on the degree of curvature. A fifty year longitudinal study done by the University of Iowa Hospital showed that patients with moderate untreated idiopathic scoliosis had unremarkable mortality, back pain, and function rates when compared to the general population. 22 per cent of those with Cobb angles over 80 degrees suffered shortness of breath upon exertion. This correlates well with Parsch et al, who notes a link between Cobb angle and capacity to play sport.

Other interesting adaptations may occur due to IS. Goldberg reports that equilibrium control, handedness and motor co-ordination have been correlated with the convexity of idiopathic scoliosis. Adolescents with IS were found significantly more developed for linguistic processing than the control group, suggesting a degree of left-right asymmetry throughout their cortex.

Interestingly motor co-ordination has a strong link to the development of linguistic centres in humans and chimpanzees. Hopkins implies that motor skills somehow prime the development of language centres. More interesting still is that deaf individuals have significantly lower rates of idiopathic scoliosis. Could this suggest some kind of neural link between the language areas of the brain and idiopathic scoliosis? Certainly there are significant
mal-adaptations in the neurological system as per Keessen, Sahlstrand and others.

[3] CHICKEN OR THE EGG – OSSEOUS OR NEUROMUSCULAR?

Dispute exists as to whether scoliosis is an actual disease or a symptom of other diseases. Recent investigations by Maiocco et al suggest that a significant correlation exists between IS and abnormalities of the brain stem and spinal cord, such as Arnold-Chiari malformation . In a further study, Dobbs et al identify the incidence of spinal abnormalities in infants with IS as to be as high as 20%. This almost exactly matches the rate found in juvenile and adult IS patients. Both authors raise the question – is idiopathic scoliosis in fact the manifestation of other pathological processes?

As noted in the previous section, IS has several neurological components. Thus confusion also exists as to whether the chief agent in idiopathic scoliosis is osseous or neuromuscular. For example Hopf et al studied the effects on gait patterns pre and post spinal surgery on IS patients. Using computerized electromyography, 23 patients were examined for asymmetrical muscle activation. Significant improvement in tonus and activation pattern was observed in all patients post surgery. Based on their treatment success, Hopf et al go on to hypothesize that muscular activation asymmetry is the end result of osseous deformities, not a causing factor.
Conversely Hadley-Miller et al emphasize the importance of connective tissue elements as a causative factor.

Regardless of whether the primary manifestation is osseous or neuromuscular, clearly changes to both systems are present in IS. The question is why.

[4] HORMONES, GENES AND FAMILIAL LINKS

Possibly the most interesting research into idiopathic scoliosis has been done using animal models. In 1995 Machida et al set out to investigate the effects of melatonin deficiency on the development of scoliosis in chickens. Melatonin has been suspected to play a part in vitamin D synthesis and thus by extension, bone formation. By inducing an artificial shortage of melatonin soon after hatching, Machida was able to show that low levels of melatonin would result in experimental scoliosis in chickens.

The following year, Machida investigated serum levels of melatonin in adolescents with idiopathic scoliosis. The results seemed to hold true for both chickens and humans – low melatonin levels were somehow linked to bone malformation. A study by Wang in 1997 further advanced the link, as did Machida’s follow up on rats in 1999. Interestingly the 1999 study showed that scoliosis only occurred if rats were kept in an upright, bipedal position.

However more recent studies have called the role of melatonin into question. Beuerlein et al suggest that perhaps it is damage to the pineal gland itself that causes scoliosis. This would connect well with the idea that brain and spinal cord malformations may be key in understanding IS.

Another hormone worth mentioning is estrogen. As of yet, no causative link is known. However there is evidence to suggest that damage to estrogen receptor sites correlates to the severity of curvature in girls with IS. One tantalizing possibility is that estrogen receptor polymorphism may be linked to country of origin. This would explain why women from certain countries exhibited higher rates of IS. Furthermore work underway by Justice et al points to the possibility that IS may be a sex linked diseased carried on the X chromosome.

[5] TREATMENT

Traditionally treatment for IS has focused on pragmatic outcomes, partially due to confusing etiology. Historically immobilization and plaster were used to treat IS. Recent guideline suggest that immobilization offers no significant benefit over physiotherapy

Commonly treatments for idiopathic scoliosis fall into two categories - surgical (Harrington rods, fusion etc) and non surgical (bracing, manual therapy, exercise etc).

Feedback from patients undergoing surgical treatments has been mixed. Merola et al indicate a level of post-operative patient satisfaction Haher points out that despite surgical success, patient satisfaction is subjective Satisfaction measures tend toward positive in follow up questionnaires.

Interestingly, not much variation in satisfaction exists between the various surgical techniques. The use of the older Harrington procedure seems to have comparable satisfaction outcomes to modern day techniques. However some studies suggest that complications from spinal fusion may be more common that thought. Furthermore, surgery is best suited to carefully selected cases

Although somewhat controversial, many types of braces are used in the treatment of IS. Again patient satisfaction is mixed, possibly due to the requirement for long term wearing of braces. Unfortunately reduction in curvature seems to be directly correlated to the duration the brace is worn.
New braces in production seek to minimize discomfort whilst maximizing patient compliance.

Scant evidence exists in peer reviewed journals for the use of manual therapy in the treatment of IS. Isolated case reports detail reduction in curvature using manipulation and TENS however these may be spontaneous. While biological plausibility may exist for the use of conservative manual therapy, further studies are required to identify their exact place. Notably evidence exists that manual therapy may have a significant palliative role in the management of IS



[CONCLUSION]

Idiopathic scoliosis is a common spinal disorder. Far from being a simple lateral deviation of the spine, IS presents as a complex, multi factorial problem. The effects are hard to define. IS patients with mild to moderate curvature are seemingly unremarkable when compared to the general population. However, several neurological mal-adaptations have recently been associated with IS. Whether these are causative factors remains largely uninvestigated. Some evidence does exist to support the idea that IS may have hormonal, genetic and familial elements.

Inquiry into the efficacy of treatment seems to be mainly focused on surgical and bracing methods. In the light of the above elements, further investigation in alternative treatments (hormonal manipulation, genetic counseling) may be warranted. While some hope exists for the use of manual therapy in treating IS, a great deal of further study is required before this is accepted by the mainstream.

REFERENCES

Ebenbichler G, Liederer A, Lack W. "Scoliosis and its conservative treatment possibilities"
Wien Med Wochenschr 1994;144(24):593-604

Byrd JA "Current theories on the etiology of idiopathic scoliosis" Clin Orthop 1988; (229):114-9

Phaigh, R. Onsen : A new approach in the treatment of pain. Publisher and date unknown

Taylor JR "Vascular causes of vertebral asymmetry and the laterality of
scoliosis" Med J Aust 1986 12;144(10):533-5

Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ,
Ponseti IV. "Health and function of patients with untreated idiopathic scoliosis:
a 50-year natural history study." JAMA 2003 5;289(5):559-67

Parsch D, Gartner V, Brocai DR, Carstens C,"Sports activity of patients with idiopathic scoliosis" Clin J Sport Med 2002;12(2):95-8

Goldberg CJ, Dowling FE, Fogarty EE, Moore DP. "Adolescent idiopathic scoliosis and cerebral asymmetry. An examination of a nonspinal perceptual system". Spine 1995 1;20(15):1685-91

Hopkins WD, Cantero M (2003). "From hand to mouth in the evolution
of language: the influence of vocal behavior on lateralized hand use in manual gestures by chimpanzees (Pan troglodytes)." DEVELOPMENTAL SCIENCE 2003; 6 (1): 55-61

Woods LA, Haller RJ, Hansen PD, Fukumoto DE, Herman RM "Decreased incidence of scoliosis in hearing-impaired children. Implications for a neurologic basis for idiopathic scoliosis." Spine 1995 1;20(7):776-80

Keessen W, Crowe A, Hearn M. "Proprioceptive accuracy in idiopathic scoliosis."
Spine 1992;17(2):149-55

Sahlstrand T, Petruson B. "A study of labyrinthine function in patients with adolescent
idiopathic scoliosis. An electro-nystagmographic study" Acta Orthop Scand 1979; 50:759-69

Maiocco B, Deeney VF, Coulon R, Parks PF Jr. "Adolescent idiopathic scoliosis and the presence of spinal cord abnormalities. Preoperative magnetic resonance imaging analysis." Spine 1997 1;22(21):2537-41

Dobbs MB, Lenke LG, Szymanski DA, Morcuende JA, Weinstein SL, Bridwell KH, Sponseller PD. "Prevalence of neural axis abnormalities in patients with infantile
idiopathic scoliosis." J Bone Joint Surg Am 2002 ; 84-A(12):2230-4

Hopf C, Scheidecker M, Steffan K. "Gait analysis in idiopathic scoliosis before and after surgery: a
comparison of the pre- and postoperative muscle activation pattern." Eur Spine J 1998;7(1):6-11

Hadley-Miller N, Mims B, Milewicz DM "The potential role of the elastic fiber system in adolescent
idiopathic scoliosis." J Bone Joint Surg Am 1994; 76(8):1193-206

Machida M, Dubousset J, Imamura Y, Iwaya T, Yamada T, Kimura J. "Role of melatonin deficiency in the development of scoliosis in pinealectomised chickens." J Bone Joint Surg Br 1995; 77(1):134-8

Machida M, Dubousset J, Imamura Y, Miyashita Y, Yamada T, Kimura J."Melatonin. A possible role in pathogenesis of adolescent idiopathic scoliosis." Spine 1996 15;21(10):1147-52

Wang X, Jiang H, Raso J, Moreau M, Mahood J, Zhao J, Bagnall K ."Characterization of the scoliosis that develops after pinealectomy in the chicken and comparison with adolescent idiopathic scoliosis in humans." Spine 1997; 22(22):2626-35

Machida M, Murai I, Miyashita Y, Dubousset J, Yamada T, Kimura J "Pathogenesis of idiopathic scoliosis. Experimental study in rats." Spine 1999; 24(19):1985-9

Beuerlein M, Wilson J, Moreau M, Raso VJ, Mahood J, Wang X, Greenhill B, Bagnall KM. "The critical stage of pinealectomy surgery after which scoliosis is produced in young chickens." Spine 2001; 26(3):237-40

Inoue M, Minami S, Nakata Y, Kitahara H, Otsuka Y, Isobe K, Takaso M, Tokunaga M, Nishikawa S, Maruta T, Moriya H. "Association between estrogen receptor gene polymorphisms and curve severity of idiopathic scoliosis" Spine 2002 ; 27(21):2357-62

Shohat M, Shohat T, Nitzan M, Mimouni M, Kedem R, Danon YL. "Growth and ethnicity in scoliosis" Acta Orthop Scand 1988; 59(3):310-3

Justice CM, Miller NH, Marosy B, Zhang J "Familial idiopathic scoliosis: evidence of an x-locus?" Spine 2003; 28(6):589-94

Burwell RG, Cole AA, Cook TA, Grivas TB, Kiel AW, Moulton A"Pathogenesis of idiopathic scoliosis. The Nottingham concept." Acta Orthop Belg 1992; 58 1:33-58

Diedrich O, von Strempel A, Schloz M, Schmitt O, Kraft CN. "Long-term observation and management of resolving infantile idiopathic scoliosis a 25-year follow-up". J Bone Joint Surg Br 2002; 84(7):1030-5

Merola AA, Haher TR, Brkaric M et al. "A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument." Spine 2002 15;27(18):2046-51

Haher TR, Merola A, Zipnick RI, Gorup J, Mannor D, Orchowski J. "Meta-analysis of surgical outcome in adolescent idiopathic scoliosis. A 35-year English literature review of 11,000 patients"
Spine 1995 15;20(14):1575-84

Padua R, Padua S, Aulisa L et al "Patient outcomes after Harrington instrumentation for idiopathic scoliosis: a 15- to 28-year evaluation". Spine 2001 1;26(11):1268-73

Turner JA, Ersek M, Herron L, et al. "Patient outcomes after lumbar spinal fusions"
JAMA 1992 19;268(7):907-11

Shapiro GS, Taira G, Boachie-Adjei O "Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes" Spine 2003 15;28(4):358-63

Katz DE, Durrani AA. "Factors that influence outcome in bracing large curves in patients with adolescent idiopathic scoliosis" Spine 2001 1;26(21):2354-61

Veldhuizen AG, Cheung J, Bulthuis GJ et al. "A new orthotic device in the non-operative treatment of idiopathic scoliosis" Med Eng Phys 2002 ; 24(3):209-18


Aspegren DD, Cox JM "Correction of progressive idiopathic scoliosis utilizing neuromuscular stimulation and manipulation: a case report" J Manipulative Physiol Ther 1987; 10(4):147-56

Danbert RJ. "Scoliosis: biomechanics and rationale for manipulative treatment".
J Manipulative Physiol Ther 1989; 12(1):38-45

Tarola GA "Manipulation for the control of back pain and curve progression in patients with skeletally mature idiopathic scoliosis: two cases" J Manipulative Physiol Ther 1994 ; 17(4):253-7



***********************************

[bob_stra]

Follow up essay, on the use of cybernetics principles re: treatment of abnormal curvature. Still just for your interest, though if you read between the lines ......

Oh, and FWIW: "Pinched nerves" is an analogy use to dumb things down for the patient. The actual impingement of nerves is pretty rare IMHO.


This link is controversial. It certainly has errors in it IMHO. But it's a worthwhile read.

http://www.chirobase.org/01General/chiropinch.html

Digest the following slowly. It *still* gives me headaches :lol:


********************

Idiopathic Scoliosis is a mystery. Commonly defined as an abnormal lateral curvature of the spine, modern theories (Dubousset, 1999) recognize idiopathic scoliosis (IS) as an three dimensional spinal disorder involving familial, genetic and bio-mechanical elements. The prevalence of IS is high. Ebenbichler estimates that up to 13% of the general population develops some degree of idiopathic scoliosis.

However despite the rate of incidence, the cause of IS remains mysterious. A meta-analysis conducted by Byrd illustrates this point. Despite various investigations, the re-occurring sentiment is that idiopathic scoliosis is multi-factorial and thus difficult to pin down.

Mysterious too are the symptoms of IS. Idiopathic scoliosis, perhaps named prophetically (idi = one’s own; pathos = disease) manifests itself uniquely is each case. Weinstein et al identified various symptoms and severities, including pain, difficulty in movement and shortness of breath. Shohat et al showed a trend towards increased height and lower bone density is subjects with IS. Others note significant alterations in proprioception and motor development. (Keessen, 1992)

Because of the complexity of the disease, IS has been difficult to categorize and manage. This essay will consider the application of cybernetics to the causation and management of idiopathic scoliosis within a chiropractic context.

Cybernetics has multiple definitions depending on context. While to the layman the word may conjure up images of robots and machines, its meaning has always been based on science. In fact the root word Kybernetes refers to the ancient Greek science of ship navigation.

In modern times Cybernetics is used to denote the science concerned with the organization and control of processes. Indeed Wiener’s classic definition is still in use today –

“The science of communication and control within the animal and the machine”

Similarly McCulloch, the “father of applied cybernetics”, describes cybernetics as -

“... Communication and control within the observer and between the observer and the environment.”

Implicated in these definitions is the inter-connection between communication and control. One author goes so far as to state that there is little difference between communication, control and organization. (Pask , 1975)

Thus because cybernetics is the science of communication and control it can be used to garner valuable insight into the process of idiopathic scoliosis.

In cybernetic terms the occurrence of an incorrect result, produced by an aberrant process, is called an error. It is interesting to note that while each manifestation of IS is unique, the “error of idiopathic scoliosis” is common and widespread.

One possible cause for this might be found in the interaction between individual and environment. Bullock et al define environment as the: -

“Sum total of the biological, chemical and physical factors in some circumscribed area... essentially an environment only exists because it is inhabited by an organism. Thus a field is the environment for a cow, cow dung the environment for a dung beetle and the exoskeleton of the dung beetle the environment for a parasitic mite. Therefore the field comprises an infinity of overlapping ‘environments’. ”

For the sake of clarity, habitat is often used to denote an individual organism’s environment. However the question remains – if each instance of IS is unique, why is idiopathic scoliosis so prevalent? In light of the above definition the answer seems to be that a common space (environment) links and affects the individual (habitat).

The cybernetic implications of this are three fold. Firstly external agents (environment) outside of the individual (habitat) affect the development of IS. Secondly these agents are widespread and common. Thirdly the individual is an “open system” – able to respond and modify their habitat according to external input.

Returning to our original cybernetic definitions we see that these external inputs can be classified as either “communication” or “control”. Thus the error must come about at one of these two points.

In terms of cybernetics, communication is considered a six part process. The communication chain consists of sender-encoding-emitter-channel-receiver- decoding. The purpose of a communication chain is to transmit a message. Specifically to transmit information – that is anything that organizes or reduces uncertainty about a situation. Flaws at one of these points will result in a scrambled message which is unable to organize or reduce uncertainty.

This concept of information bears elaboration. Any message which reduces or organizes uncertainty is considered to have informational content. Conversely any message which does not reduce uncertainty has no informational content. Thus the message “the sky is blue” has no informational content as no uncertainty is reduced. However the message “the sky is blue on Mars” certainly has information content.

Of course this depends on context. Pekelis uses the analogy of a bus trip to explain –

“Some passengers are traveling in a bus. The bus driver announces the name of the bus stop. Several passengers get out while the rest pay no attention to the words of the driver, to the information addressed to them. Why? Because as specialists say for different recipients...the information is of different value. Consequently the value of information may be defined by its ability to influence the behavior of the recipient.”

Thus one speculative possibility may be that information, mis-processed by those predisposed to IS, later leads to the development of IS. This idea finds biological plausibility in the work of Hadley-Miller et al who show that connective tissue abnormalities are common in patients with IS and may be a causative factor. Hopf et al further this idea by suggesting that abnormalities in gait and muscle tonus are due to underlying osseous malformation. Furthermore Jiang et al illustrated how over-stretching ligaments influences sensory feedback to the CNS. In essence the argument could be made that gravity (information) is mis-processed by connective tissue elements leading to scoliotic change.

If this idea is considered in terms of the communication chain, it can be seen that such errors would occur at the channel stage. Typically the channel is thought of as the message conduit, the means by which information travels from the sender to receiver. However error may just as easily arise at other stages. For example, error at the receiver stage (peripheral nervous system) would again give rise to message mis-representation. Indeed Keessen notes that neurological changes in proprioception are common in adolescence with IS. Abnormal reflex processing from PNS to CNS according to Maguire is also common in IS and may play a role in the development of scoliotic changes.

In fact an error at any stage of the communication chain would lead to similar outcomes. Because the process is identical in all circumstances, cybernetics goes some way towards explaining why IS can manifest itself uniquely (error at different stages) and yet be commonplace.

The other aspect of cybernetic theory is control. McLirk defines control as -

“Regulation of a function or process, by choosing inputs to a system so as to make the outputs change in some desired way.”

For the purposes of this essay we will focus on motor control. The reason is twofold. Firstly IS primarily affects systems related to motor function.
Secondly it is within the realm of chiropraxis to address the functioning of these systems.

How is control developed and maintained? According to our definition control is an outcome of choice. In reality choice is another facet of information - the ability to make appropriately informed decisions.

As illustrated by Ashby’s Law of Requisite Variety, choice is directly proportional to the information available. Without sufficient information, decisions become arbitrary. For example “The sky is cloudy. It’s winter. Perhaps it will rain.” leads to the following choices –

Is the sky cloudy – yes / no
Is it winter – yes / no
Is rain likely – yes / no
Therefore should I go outside – yes /no

Reducing the available information reduces the ability to choose. Using “The sky is cloudy” as a second example –

Is the sky cloudy– yes / no
Therefore should I go outside – yes /no

In this circumstance, going outside would be an arbitrary decision.

In similar fashion information inputs may affect internal choice and thus motor outputs. Experimental proof exists in the work of Wong et al who illustrated that the use of prismatic lenses could cause positive postural changes (reduction of angle of trunk mis-alignment) in patients with IS.

Exactly how this occurs is unclear. Summers implies that motor skills are encoded as General Motor Programs (GMPs). In combination with environmental cues, GMPs activate to achieve a goal. This activation is thought to be a top down process, that is to say perceptual filters sift out certain aspects of the input prior to it activating the GMP. It is suspected that this is done to reduce reaction time and computational load.

It is possible that in untreated IS specific perceptual filters exist which affect how the GMPs activate. These filters may sift out vital information, leading to a lack of choice and the activation of a “scoliotic” motor program. Certainly neurological alterations are not uncommon in idiopathic scoliosis (Sahlstrand, Ortengren & Nachemson, 1978) .

Geometrodynamic action theory offers a corroborating perspective. According to this theory, the interaction of environment and organism is subject to certain constraints. These constraints cause us to momentarily move as if we were comprised of springs and pendulums. Again this is thought to reduce reaction time and computational load. Bate explains it thus–

Imagine returning from the supermarket with a bag of groceries. You put them on a low bench in the kitchen. Amongst the assorted items is a bottle of juice...You reach down and hook two fingers through the handle as you turn towards the refrigerator. You let the container drop to the full length of your arm, it swings out a little way from your body, dragging your arm through a curvilinear path to the refrigerator. Towards the end of the arc the container gains just sufficient height to graze the lowest shelf. You add a little shove and it slides in to rest. What sort of mechanical system did your arm become? What principles of physics were exploited? Perhaps the muscles of the arm were constrained to act like a pendulum...”

According to Geometrodynamic theories motor programs dictate the relative stiffness and length of muscles. Certain ratios of stiffness to length are required to cause an arm to swing like a pendulum. However if information input is flawed, the choice of length to stiffness becomes flawed. Subsequent adjustments must be made to compensate for this so that the limb can achieve a simple machine configuration. In doing so, other structures must be displaced. Only a small conceptual step is required to apply this idea to idiopathic scoliosis.

The question remains as to how chiropractic can assist in the management of IS. Certainly there is reasonable rationale for the use of SMT (spinal manipulation therapy) in alleviating pain and reducing muscle spasm (Danbert , 1989). However most approaches have widely variable results. To date little peer reviewed evidence exists to show the benefit of chiropractic in IS. What little does exist points towards the use of SMT purely as palliative care (Tarola , 1994).

Other approaches in manual therapy have focused on strengthening / stretching of taut connective tissue. This is a mistake. Clear evidence exists to show there is no correlation between muscle strength and posture (Levine, 1997). Furthermore, beyond the temporary relaxation effect brought about by aggressive stretching, connective tissue elements remain impervious to direct, prolonged pressure (Threlkeld, 1992). In essence, the body acts to dissipate force, much like a rubber ball.

Applying a cybernetic point of view to the situation, one of the goals of manual therapy should be to increase choice in movement production. Furthermore awareness of perceptual filtering and information mis-processing are required to gain full appreciation of motor control. In doing so one of the main tenets of chiropractic can be achieved – a self correcting system.

One of the better ways to achieve this is through non coercive touch. As Yochanan notes the quality and quantity of information passed between sender and recipient drops sharply as force increases. Non coercive contact also allows for playful exploration of movement patterns while in a safe environment. Furthermore is grants the sender the ability to notice small, otherwise undetectable movements.

In true cybernetic fashion, such contact is replete with feedback between sender and receiver. What’s more the sender is able to create situations (feedforward) in which the receiver must overcome some obstacle to achieve a goal. In doing so perceptual filters are illuminated.

In conclusion, the cause of IS remains mysterious. While recent theories recognize several causative elements, little progress has been made in the management of idiopathic scoliosis. Cybernetic theories offer a possible avenue to base chiropractic handling of IS on. In accordance with these theories the transmission, detection and representation of information is key to the management of this disease. Should chiropractic adapt to fulfil this role, it will better serve as a useful tool in addressing idiopathic scoliosis.



REFERENCES

Bate, P (1996). “Motor Control: a possible foundation for the Feldenkrais
Method”. Journal of the North American Feldenkrais Guild

Bullock, A., Stallybrass, O (eds). (1988) The Fontana Dictionary of Modern
Thought. Fontana Press

Byrd, JA. (1988) "Current theories on the etiology of idiopathic scoliosis"
Clin Orthop ; (229):114-9

Danbert RJ. (1989) "Scoliosis: biomechanics and rationale for manipulative
treatment". J Manipulative Physiol Ther ; 12(1):38-45

Dubousset, J. (1999) ”Idiopathic scoliosis : Definition-pathology-
classification-etiology.” Bull Acad Natl Med ; 183(4):699-704

Ebenbichler G, Liederer A, Lack W. (1994) “Scoliosis and its conservative
treatment possibilities" Wien Med Wochenschr ; 144(24):593-604

Hadley-Miller N, Mims B, Milewicz DM (1994) "The potential role of the
elastic fiber system in adolescent idiopathic scoliosis." J Bone Joint Surg
Am; 76(8):1193-206


Hopf C, Scheidecker M, Steffan K. (1998) "Gait analysis in idiopathic
scoliosis before and after surgery: a comparison of the pre- and
postoperative muscle activation pattern." Eur Spine J 7(1):6-11

Jiang H, Moreau M, Raso J, Russell G, Bagnall K. (1997) "Identification of
the location, extent, and pathway of sensory neurologic feedback after
mechanical stimulation of a lateral spinal ligament in chickens." Spine
22(1):17-25

Keessen W, Crowe A, Hearn M. (1992) "Proprioceptive accuracy in
idiopathic scoliosis." Spine ; 17(2):149-55

Levine, D. (1996) “Static and dynamic relationships between pelvic tilt,
lumbar lordosis and abdominal muscle performance.” Physical Therapy
76; 74

Maguire J, Madigan R, Wallace S, Leppanen R, Draper V. (1993)
"Intraoperative long-latency reflex activity in idiopathic scoliosis
demonstrates abnormal central processing. A possible cause of idiopathic
scoliosis." Spine ; 15;18(12):1621-6.

McCulloch, W. (1975) as appears in Pask, G. Cybernetics of Human
Learning and Performance. Crane Russak & Co

Mclirk, T. (1968) Dictionary of Cybernetic - a primer in cybernetic. Keats
Publishing

Pask, G. (1975) Cybernetics of Human Learning and Performance.
Crane Russak & Co

Pekelis, V. (1974) Cybernetics A to Z Mir Publishers

Sahlstrand T, Ortengren R, Nachemson A. (1978) "Postural equilibrium in
adolescent idiopathic scoliosis." Acta Orthop Scand ; 49(4):354-65

Shohat M, Shohat T, Nitzan M, Mimouni M, Kedem R, Danon YL. (1988)
"Growth and ethnicity in scoliosis" Acta Orthop Scand ; 59(3):310-3

Summers, J. "Motor Programs" (1981) as appears in Holding, D (ed)
Human Skills John Wiley and sons.

Tarola GA (1994) "Manipulation for the control of back pain and curve
progression in patients with skeletally mature idiopathic scoliosis: two
cases" J Manipulative Physiol Ther ; 17(4):253-7

Threlkeld, AJ. (1992) “The effect of manual therapy on connective tissue.”
APTA Journal ;72(12).

Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ,
Ponseti IV. (2003) "Health and function of patients with untreated
idiopathic scoliosis: a 50-year natural history study." JAMA 5;289(5):559-
67

Wiener, N. (1986) Human Use of Human Beings: Cybernetics and Society.
Avon Publishing,.

Wong MS, Mak AF, Luk KD, Evans JH, Brown B. (2002) "Effect of using
prismatic eye lenses on the posture of patients with adolescent idiopathic
scoliosis measured by 3-d motion analysis." Prosthet Orthot Int ;
26(2):139-53

Yochanan, R. (1983) The Feldenkrais Method - Teaching by Handling.
Keats Publishing.

[JasonE]

Cool stuff! 8)

This caught my attention:


My chiropractor just took x-rays of my back and I have an abnormal curvature going to the left in my spine just at about hip level. This is new because I have had x-rays before and this was not a problem. The doctor told me this is causing me to have pain due to a pinched nerve.

What is strange is that my low back was fine (at least I felt no pain) until about 4 weeks ago. And I THINK it was during one of my advanced Warrior Wellness™ practices in a twisting motion that caused it.

This sounds like the misalignment of his spine may be a relatively new condition. According to the articles presented above, IS seems to be something that develops over time rather than something that comes on quickly. What indicated to you that this was a case of IS instead of an acute condition related to activity?

I'm a layman, but you don't need to dumb it down too much. :wink:

[tjosh]

Thanks to everyone for all of the quick replies. I need to spend some more time going over them all.

I would like to know what the views are on treating this problem by means of chiro adjustmets. That is my Doctors only pla of treatment for me. Adjustments and complete rest. Can adjustments really cause the spine to realign? What about the neuromuscular aspect?

thanks

[rbibbs]

"Since you asked" Josh... I'm gonna stick my neck out with a lay/intuitive answer (subject to full contradiction at any moment). As I read them, the technical papers seemed to say that "adjustment" wasn't fully effective. But here's the rub: we don't know what the underlying pathology is, if any, in your case.

"Classic" IS doesn't "just happen" in a matter of months, to an otherwise-healthy adult. How long was it between the "good" Xrays and the "bad" ones? How severe is the tilt/curve? What are the symptoms that took you to the Chiro in the first place? What does it feel like and how does it affect your motion? Was there a recent time when you felt "oops, something happened"? Did you sustain any injuries.. ANYWHERE? What's your history, i.e., did you start training aggressively from a period of relative inactivity?

Bearing in mind, even if you could email the Xrays, "virtual diagnosis" is going to be vague. It could be anything from a muscle spasm to (not to scare you) a genuine degenerative disease process.

Pending your answers to the questions above, were I in a similar situation, I would probably be looking for referrals to an MD musculoskeletal specialist. And I'm "allergic to doctors". I also wouldn't discount alternative therapies, including "wait-and-see". I definitely wouldn't say, "sure doc, cut me" to the first MD who proposed surgery.

Rick

[bob_stra]

Hey Josh.

As promised. For educational purposes only. This is by no means a diagnosis. Long story short - Mull it over, talk to your Dr and then decide for yourself a plan of action.

Re: 1st post

(1)
The are several types of scoliosis (lateral curvature of the spine). The one that I described above is called Idiopathic. Idiopathic really means "we don't know what causes it", and it accounts for roughly 80% of cases. There is also congenital scoliosis (born with spinal defect), neurological scoliosis (caused by stroke, brain injury, cerebral palsy), connective tissue scoliosis (cause by disease of CT) and perhaps even genetic scoliosis (due to genetic damage). In any case, these things don't just pop out of thin air - they take years to show up. (contradiction: idiopathic can *sometimes* develop in later life)

(2)
On *top* of this, there are pathological conditions ("pseudoscoliosis") that will cause a lateral displacement of the spine. Spinal cancer, lung cancer, tuberculosis, "slipped disc", spinal wear etc. These should be picked up by the Dr when he screens you, especially if you have recent "red flags" (nausea, vomiting, all over pains, night chills etc etc). These can appear "out of thin air"

(3)
And on top of *THIS*, there are know mechanical causes - muscle spasm, facet joint locks etc. I even read of a women who developed scoliosis after breast implants. These too can appear "out of thin air" (well, maybe not the boob job ;-)

So, in answer to your question "can chiropractic help", I would say maybe, if -

(1) The Dr competently identifies the root cause
(2) The condition is of a type that is amicable to correction ( usually in the (3) category and some of (2)

> This is new because I have had x-rays before and this was not a
> problem. The doctor told me this is causing me to have pain due to a > pinched nerve. What is strange is that my low back was fine (at
> least I felt no pain) until about 4 weeks ago. And I THINK it was

Look, I'm not going to second guess your Dr. But it sounds like (to me) that this might be case of "pseudoscoliosis", caused by something in the (3) category. I COULD BE WRONG SO TAKE IT WITH A PINCH OF SALT.

DC's *scour* over x-rays with a fine tooth comb. I should hope he would have identified something from the (1) or (2) category instantly *on sight*, and referred you out for further testing.

> Any recomendations on straightening this out and fixing the
> curvature in my back?

This is why net diagnostics is impossible. Because we don't know what is causing the curve (especially if it's from the (2) category) there's no way to recommend anything specific. I could say "oh, yes, please to be following this Swiss ball routine, very much to be healing". Meanwhile, a nice little spinal tumor festers in your spinal canal. IOW, it'd kinda be irresponsible of me. (BTW: Not trying to scare you - just pointing why the advice here is generic).

Having said that, the generic advice you've received so far is good. Gentle exercise, include ROM. Hip circles & spine circles etc. Contrast baths should alleviate pain, as should massage and chiropractic care. Beyond that, it needs professional screening for *you* to determine a plan of action.

Ask you Dr. "What is the cause of this? Do you suspect some kind of serious pathology (cancer, broken bones?). Or is this likely to be a idiopathic problem?"

Grill the guy. It shows you're being attentive ;-)

> I also have neck pain and the chiro told me this was because my neck > was curving the opposite direction that it should.

That may well be. Loss of neck curve / development of reverse curve seems to be pretty common. Chiropractic might be able to help you with that, so try it for a while. Use your common sense - if its making it worse, stop doing it. Amusing anecdote: all chiro students here were encouraged to undergo chiropractic care. After all, anything else would make us hypocrites, right? So I go along. After a while, I start *developing* pains DUE TO adjustment. Sure, I've got more neck mobility, but damned if it don't hurt. So I stopped going. Pain vanished.

Use your noggin. Educate yourself. Listen to your body.

> What about resuming training? I want to get back into my Warrior
> Wellness™ BFlow and Clubbell® training. I was making alot of
> progress until this happened. Resting has not made the pain any
> better. I even did a Clubbell® workout and my back felt the same
> after.

For right now, I'd tell you to cut back, because I'm conservative as hell ;-) Perhaps focus on Beginners Warrior routines, or create something *gentle* for your low back. Give the clubs a few weeks rest, because there is a chance that you could exacerbate things with improper exercise. Or, stick to exercise that don't involve excessive bending sideways - possibly dual armpit casts or fwd leverage.

Re: 2nd post

> I would like to know what the views are on treating this problem by
> means of chiro adjustmets.

As I said above, it depends on what's causing it. Some success if the condition is type (2). Lots of success if condition is type (3). Vague success if condition is type (1).

If it's type (2) or (3), some success using adjunct methods like contrast baths, acupuncture, traction (controversial, but topic for
another day. Should give some relief if nothing else) massage, somatic therapies etc. That last one (as you can see in my essays) might be valuable in any case, but remember, it they aren't a cure. Just a means to use your body better, given the circumstances.

> That is my Doctors only plan of treatment for me.

Be sure to ask him the questions I mentioned above.

It's sad to say, but there are some chiro's / PT's / MD's that are in it for the money. Gauge for yourself if this guy is trying to help you out or milk you dry.

> Can adjustments really cause the spine to realign

Sometimes, yes. See above rationale.

> What about the neuromuscular aspect

Not sure what you mean there. I will say that there is a "neuromuscular" knock on effect from undergoing an adjustment. Not sure how much the body learns from it though.

[bob_stra]

Jason E wrote

> Cool stuff!

I'm not entirely happy those two essays to be honest. I read them now and go "yeah, that's unclear, that's gibbrish". Still, I hope it has enough intresting content.

>This sounds like the misalignment of his spine may be a relatively new > condition. According to the articles presented above, IS seems to be
> something that develops over time rather than something that comes
> on quickly.

Yeah. I posted that cause I had them kicking around on the HDD and they seemed relevant. Also to show that "abnormal" spinal curves are kinda complicated. So the type of advice people most yearn for ( "do 10 reps of bent over rows, man! They rool !!") is kinda trite and condescending.

There are a few specific sub catagories of scoliosis that *can* appear quickly ( eg: hysterical scoliosis, pseudoscoliosis)

> What indicated to you that this was a case of IS instead of an acute
> condition related to activity?

See third post to Josh. "true" IS is but one possibility.

Hope that helps. Jarlo would of course be one of the man to chime in on this. (HINT NUDGE PUSH HINT NUDGE)

(bastard keeps hiding his light under a bushel. Honestly, he knows several times more abt these things than I do). I haven't see Dr Cobb on here in ages either.

*shrugs*

I guess ya'll are stuck with my chatty a$$. ;-)

[Jarlo Ilano]

There really isn't much that I can add that Bob hasn't! :) Really good stuff as always.

Here's some thoughts however...

X-rays can be notoriously read in many different ways by many different practitioners. Especially when you are not looking for things such as a frank fracture, true dislocations rather than the elusive "subluxation" (sorry Bob, that was a jab at chiropractic :wink: ), or neoplams and the like. For one it could be dependent upon the position the x-ray was taken along with the particular method the chiro was using to determine curvature. Also, when it was said that the previous x-rays were "normal", were these x-rays taken by the same chiropractor and he stated there was no curvature, or were they taken by another person, and they stated that they were "normal". This makes a BIG difference.

Also, as Rick stated, scoliosis doesn't just appear. A standard definition of a scoliotic curve is that it involves at least three vertebrae. (In osteopathic terms it is called a Type I Lesion). Also, just to make things a little simpler, you can separate scolioses into either structural or functional. Structural scolioses (scoliosisis? sorry couldn't resist!) involve true bony changes (bone "wedging" from severe trauma, osteoporotic weaknening.. etc.,). Whereas, functional or compensatory scoliosis do not have these immutable features. And these can come from a number of reasons (20 plus as a recent course of mine demonstrated), ranging from infectious disease, to vestibular problems, to the oft noted leg length discrepancy.

So how did this "abnormal curvature" occur? For sake of discussion, let's make one scenario (out of dozens)...

Say, at some point in time Josh "tweaked" his back in some manner, whether it was a lift and twist, or a fall in training. It was sore for a little bit, but then seemed to resolve. If we were to zoom in though, we could see that one vertebrae was relatively rotated and sidebent as compared to its neighbors. (This is the osteopathic Type II lesion) As compensation, the body then adjusts above or below to rotate and sidebend so that we either maintain uprightness (legs are beneath us), or maintain head position (we like to keep our eyes level, no matter what position that makes our head or spine assume). This is gradual over time, and depending on the mobility of our spine, will involve three or more vertebrae to "adjust" the levelness. This curvature is the functional or compensatory scoliosis. It is maintained initially neurologically, but over time can also be "assisted" by true soft tissue morphological changes (tight fascia, muscle shortening, and whatnot).
*The preceding is just one view that I have been trained in, take it with a couple shakes of salt*

So, idiopathic scoliosis in this case, explained!

Yet.......
This all begs the question as to whether this "abnormal curvature" exists in the first place. Again, not to be Mr. Chiro Basher, but you need to figure out for yourself if you think this is the problem. There is nothing wrong with placing trust in a health care provider. In fact you should give the benefit of the doubt, if their explanations make sense to you.
Thus, why I hesitate to post on your treatment plan. There are so many questions involved in your diagnosis, and I absolutely do NOT want to second guess the health care provider. I would not like it if some internet yahoo (such as myself!) contradicted my advice. I cannot say anything of substance, really, because I have not examined you, whereas your Chiro has. That really is the bottom line.

Summary?
All the information provided here is good and is on good faith. It is great information actually, and way more than most people get. You would do well to sort it out and find what is best for you. But, ultimately, you are the arbiter of your own well being. Take some time, go through your options, read, trust your gut, and you'll figure it out.

Good luck to you.

Good conversation,
Jarlo

[bob_stra]

Naw, that's good. Mostly now a subluxation is defined as some abnormal relationship of muscle : connective tissue : joint as it relates to the spine. I'd like to believe that chiros only take xrays to confirm these things, but I know better :-/ Still, one full spinal xray every six - twelve months isn't too invasive.

As for reading Xrays, beyond the basics (pathology and such), you're correct that each chiro has a unique system. I'm not even 100% sure they all use the Cobb method to determine angle size. Also, the naming is quite different between systems - A "C" curve can be called side bent right (apex in, as per Osteo), side bent left, translated right, rototranslated etc etc.

On final point - If it were me, I'd be interested to see what the DC has to say abt the relative height of the hips in standing vs sitting, as this relates to postural and phasic muscles of the low back and legs. You can start nailing down Type I and II from there. Assuming this is a purely mechanical problem.

Anyway, that's enough shop talk. Poor Josh is probably confused as hell by my windbaging-ness.

Josh - Find out what's causing it. Then you can make intellegent choices. Ask him why.

[tjosh]

Thanks again for all of the advice.

My Chiro is not to concerned with my condition because it is not too severe and he thinks it is caused by some sort of trauma or bad use. I can still do everything with my back but it just feels like it has a twinge all of the time.

Something else I have thought about that probably is connected to my low back is that I have always had problems with my left hip getting stuck when trying to turn it over, like when leg kicking. It seems to kind of get stuck and catch or pop when kicking.

My body has taken so much physical trauma over the years that I am not sure what could have caused it. This is definitely not the first time I have tweaked my back.

I also know I need to work on maintaing posture because of all the time I spend at my desk and driving.

Any advice on active recovery/rehab would be appreciated. Also, any advice on how to correct the curvature in the neck would be great.

[rbibbs]

This may be inanely obvious, especially after all the time and bandwidth we've spent on precisely defining vertebral structure/function/dysfunction... and perhaps ultimately inapplicable to your case Josh... but the "general" answer to back problems, from which some 70% of adults will generate a physician referral at some time in their lives... is suck your gut in.

The abdominals are the muscle-group that structurally supports "uprightness". It's not just a question of development or tonus, but of the neurological habit of putting the load where it's designed to be supported. The abdominals are as fascinating a network of musculature as the shoulder. They form the basis of "core strength", can articulate in all planes, and are the only voluntary muscle-set I know of where the equivalent functions of "flexors and extensors" directly overlay each other.

I can't currently describe it much better than this, or elucidate a program by which one can train that neurological habit. There's a balance of proprioception between how much work the lumbar inter-vertebral muscles are doing, how much (angular) pressure the discs are under, and how much tension the abs are under... I "have it"... slight-of-frame, not historically athletic, inactive over a period of decades, hyperactive now at relatively-extreme ranges-of-motion under load... and yet virtually immune to lower-back disorders. I can't quite convey that neurological awareness in a way that it's readily usable by others, just that it's there somewhere, look for it, develop it. The motions within WW that involve articulation behind your nominal dorsal/ventral plane activate this neurology... though done obliviously, these motions may be difficult-to injurious to perform.

Rick