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Effective Scoliosis Treatment Depends on Individualized Diagnosis

The most appropriate treatment options for scoliosis is when the care is determined in a case-by-case manner. Individualized diagnosis is paramount to effectively treating and managing scoliosis, no exceptions.

Over the past several years that I have treated scoliosis, I found that one of the most frustrating and confusing aspects for a patient or a parent of a child with scoliosis, is understanding how to navigate the many different treatment options available and ultimately feel confident enough to choose the right solution.  Many patients are given conflicting opinions on treatment from various health care professions including:  watch & wait, physical therapy, bracing and scoliosis specific rehab programs. This often leaves patients and parents of patients feeling unsure of who to trust and how to proceed with care.

I suggest a different approach. First, every scoliosis case is unique and specific recommendations need to be given on a case-by-case basis. Second, there is no need for guess work as the International Society on Scoliosis Orthopedic Rehabilitation & Treatment (SOSORT) has established treatment guidelines for scoliosis based on age, severity of curve and risk of progressions.  These guidelines should be used to assess each scoliosis case and determine the most appropriate treatments options.  Also, there are a variety of causes of scoliosis, we are primarily talking about treatment for idiopathic scoliosis here. These guidelines may also apply to other forms of scoliosis.

A Couple Of Key Points To Understand About Scoliosis:

  • Scoliosis is defined as a lateral bending of the spine of 10° or greater with rotation.
  • Curve angles are measured by using Cobb angle, which is the measure of the most superior and inferior vertebra with the greatest lateral bending.
  • Risser sign is a measurement of skeletal maturity and if the growth plates have begun to close.  It’s a predictor of how much growth an individual has left.  Risser zero means the growth plates have not begun to close and there is more growth expected.  At Risser 5 the growth plates have closed and skeletal maturity is reached. Scoliosis curves have the greatest risk of progress during growth spurts and the Risser sign helps to distinguish the likelihood of curve progression.

Progressive Treatment Options for Scoliosis:

  1. Physical therapy:  Physical therapy for scoliosis is not just general exercises but rather scoliosis specific rehab and application of such rehab must be administered by a health care professional with training in scoliosis specific rehab wether it be a chiropractor or physical therapist.  Physical therapy for scoliosis is generally performed in the clinic along with home rehab for 3-7 sessions per week for 3 months. After 3 months exercises every 2 weeks may be sufficient.
  2. Scoliosis Intensive Rehabilitation (SIR):  SIR has been shown to be effective in treating scoliosis where available and may also be a great option for patients traveling longer distances.  SIR involves a 3-5 week program with 4-6 hours of treatment per day.
  3. Brace treatment is a 3rd option and has been found to be the most effective treatment for preventing curve progression and thus preventing surgery and frequently improving scoliosis curves.  Brace treatment is usually used in conjunction with a scoliosis specific rehab program.

Progressive Scoliosis Treatment Guidelines:

1.  Children (no signs of maturity)

a.  <15° Cobb:  Observe every 6-12 months.

b.  Cobb angle 15-20°:  Scoliosis specific exercise program with home rehab programs.  Part-time scoliosis brace if curves do not improve.

c.  Cobb angle 20-25°: Scoliosis specific exercise program, scoliosis intensive rehabilitation program where available.

d.  Cobb angle >25°: Scoliosis specific exercise program, scoliosis intensive rehabilitation program and part-time brace wear.

Risk Of Progression

Scoliosis Progression Factor (SOSORT)
Scoliosis Progression Factor (SOSORT)

 Progression Risk Factor = [ Cobb Angle – (3 x Risser sign)] / Chronological age.

II.   Children and adolescents, Risser 0-3:  These recommendations are based on progression risk rather than curve angle alone. (see above chart)

a.  Progression risk less than 40%:  Observation every 3 months.

b.  Progression risk 40%:  Scoliosis specific exercise.

c.  Progression risk 50%:  Scoliosis specific exercise and scoliosis intensive rehabilitation program.

d.  Progression risk 60%:  Scoliosis specific exercises, scoliosis intensive rehabilitation program + part-time brace.

e.  Progression risk 80%:  Scoliosis specific exercises, scoliosis intensive rehabilitation program and full-time brace.

III.  Children and adolescents with Risser 4

a.  <20° Cobb:  Observation every 6 months.

b.  <20-25° Cobb:  Scoliosis specific exercise.

c.  >25° Cobb:  Scoliosis specific exercise, scoliosis intensive rehabilitation program.

d. >35° Cobb:  Scoliosis specific exercise, scoliosis intensive rehabilitation program + brace.

IV. First presentation with Risser 4-5

a.  >25° Cobb:  Scoliosis specific exercise

b.  >30°  Cobb:  Scoliosis specific exercise, scoliosis intensive rehabilitation program.

Adults with Cobb angels >30°

Scoliosis specific exercise and scoliosis intensive rehabilitation program.

VI.  Adolescents and adults with scoliosis (of any degree) and chronic pain.

Scoliosis specific exercises, scoliosis intensive rehabilitation program and brace treatment.

At Square ONE all of our scoliosis treatments follow guidelines set by SOSORT.  Our treatments include a combination of Chiropractic BioPhysics, Scientific Exercises Approach to Scoliosis (SEAS), Scoliosis Intensive Rehabilitation and Scolibrace.

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Auto Injury Diagnosis and Treatment

In treating patients who have been injured from a Motor Vehicle Collision (MVC), I frequently end up discussing treatment frequency and durations with the patient’s attorney and/or insurance adjustors.  This subject does not have to be subjective or confusing as there are guidelines that have been adopted by the national clearing house and have also been adapted by both the International Chiropractic Association and the Colorado Chiropractic Association.

Before we dive into the specifics about treatment guidelines for chiropractic care, including both frequency and duration, we need to realize that guidelines are “simply guidelines” and each case needs to be dealt with on an individual basis.  Guidelines are simply guidelines and the treating providers should make clinically appropriate recommendations for each individual patient.

Probably the most important determining factor in a patient’s treatment regimen depends on the exact injuries the patient has received.  I can’t count the number of times I’ve been told by an insurance adjustor or an IME (Independent Medical Evaluator) that the patient simply has soft tissue injuries that should heal in a few weeks; to which I usually reply:  “Can you send me some research that backs up that statement?” or “Which specific soft tissue injuries are you talking about?”  I have yet to receive one piece of research to support such claims.

All treatment plans need to be driven by a proper diagnosis of the exact injuries the patient has.  A soft tissue injury could mean a muscle strain that will heal in a few weeks or it could mean a severe ligament instability that will never heal and is a permanent whole body impairment.  Additionally, the brain is soft tissue; how long does it take for a traumatic brain injury to heal?

Point being a specific diagnosis will lead to a more appropriate treatment plan and better outcome.

Grades of Severity of Injury

The Management Guidelines for Whiplash Associated Disorders by the International Chiropractic Association (which as been adopted by the Colorado Chiropractic Association), has met the stringent criteria of the Federal Agency for Healthcare Research & Quality (AHRQ), located at www.guidelines.gov.  The NGC is a comprehensive database of evidence-based clinical practice guidelines and related documents produced by the Agency for Healthcare Research and Quality (AHRQ), in partnership with the American Medical Association and the American Association of Health Plans.  The purpose of the NGC database is to provide healthcare professionals and providers access to objective, detailed information on clinical practice guidelines and to further the dissemination, implementation and use of those guidelines.

Grades of Severity

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Guidelines for Frequency and DurationScreen Shot 2017-12-17 at 9.29.40 PM

Guidelines for both treatment frequency and duration can be determined once the severity of the injury is established.  Keep in-mind these are just guidelines and each patient may need less or more care.

Regardless of treatment frequency all patients should have a re-evaluation every 30 days to monitor patient’s progress.  If patients are not improving as fast as the treating doctor would like or he/she continues to have symptoms such a radiculopathy the treating provider may decide additional diagnostics are needed such as an MRI.  This is also an excellent time to decide if additional treatment from other healthcare providers or specialists is needed.

When it comes to treatment frequency and duration each patient needs to be dealt with on a case-by-case basis but proper diagnosis  and routine re-evaluations are critical to ensure the patient gets the most appropriate treatment.  There are established guidelines to help guide the treating doctor, but they do not replace clinical excellence and experience.  There are many factors that complicate the case and make recovery more difficulty such as old age, obesity, degenerative disc disease, osteoarthritis, etc.

Chris Gubbels D.C.

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Get more info on treatments for injuries related to a car crash.

 

3 Backpack Tips To Prevent Poor Posture

Poor posture in kids leads to poor posture and chronic pain in adults.

Slouching in desk, sitting on the couch playing video games and watching TV and improper back pack use are some of the more common problems leading to poor posture in kids.

Poor posture in kids is usually associated with forward head posture and kyperkyphosis (increase in curve in the mid-spine).   Left uncorrected; these can cause back pain, neck pain, headaches and lead to abnormal spinal development and more severe health problems.

Proper backpack use can help kids prevent from developing poor posture.

In this short video you will learn 3 tips on proper backpack use to help prevent your kids form developing poor posture.

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For a FREE consultation for you or you kids call 970-207-4463 or click on the box bellow.

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