Historically, only a small fraction of the nation's scoliosis cases are treated in chiropractic offices. When a parent, school nurse or pediatrician detects scoliosis, the child is referred to a pediatric orthopedist for an evaluation.The orthopedist will usually take the "wait and see" approach for curves under 25 degrees and will recommend a hard brace for curves between 25 and 40 degrees. During the time the child is in the hard brace, the doctor will once again take a "wait and see" approach. When the curve goes over 40 degrees, they are allowed to recommend surgery. Some orthopedists will wait until 45 or even 50 degrees, but 40 degrees is generally the magic number.
The chiropractic profession has also taken a back seat in regards to scoliosis. Very few graduates of chiropractic schools can say they are comfortable taking on a moderate to severe scoliosis case. Yet the chiropractic profession is actually in the best position to be the primary gatekeeper for scoliosis management. The chiropractor by license can educate, screen, evaluate, X-ray, treat and refer out if necessary.
The orthopedist focuses on the cases they suspect will become severe and require surgery. They do not focus on - either directly or indirectly through their rehabilitation arm, physical therapists - the cases that never make it to 40 degrees. In the current orthopedic model, the orthopedist would have to refer the patient to a PT who is familiar with nonsurgical treatment options and therapy. Among other considerations, the orthopedist would have to strongly believe that conservative treatment is effective and be willing to lose some surgical cases.
So, what about chiropractors; why haven't they come to the forefront in conservative scoliosis care? The first reason is that for the most part, the chiropractic colleges haven't taken on scoliosis. Second, chiropractors are only seeing scoliosis cases in families that are already pro-chiropractic or when the chiropractor is the one to discover it first.
My practice has been focused on scoliosis for many years. I have seen many patients respond to conservative treatment and avoid surgery. I know that chiropractors can be the quarterbacks in scoliosis management. This is what we are doing to make it happen:
- We formed the Scoliosis Care Foundation, a 501(c)3 nonprofit organization, in 2001 to educate the public on the benefits of early detection and conservative treatment of scoliosis.
- We published a booklet, "The Parents Guide to Scoliosis," which shows parents the early postural changes that accompany scoliosis. Using this guide, parents can be the first to detect scoliosis in their children.
- We created the "Scoliosis Awareness Program," a slide presentation from the book. This presentation was recently distributed to every chiropractic state association by the Congress of Chiropractic State Associations, to be further distributed to every chiropractor in the country who belongs to a state association.
The Scoliosis Awareness Program is designed specifically for the chiropractor to teach the public at PTA meetings, churches, temples, or wherever groups of parents can be brought together. This program will open the door to the public to see the chiropractor as an integral part of detecting and managing scoliosis.
My vision is to see chiropractors all over the country teaching this awareness program to millions of parents nationwide. This will empower parents to be in the driver's seat in detecting scoliosis early, so they will not have to rely on the occasional physical exam that may or may not pick up a developing curvature.
The other issue is what a chiropractor does with a scoliosis case that presents in their office. In working with many chiropractors around the country, we have found that the combination of adjusting techniques and rehabilitation combined with flexible tension bracing yields much better results than rigid bracing and waiting for serious progression and surgery.
Bear in mind that the chiropractor who teaches a group of parents how to detect scoliosis in their children does not have to be the chiropractor who treats the children. The first chiropractor can refer out those patients or co-manage patients with a DC trained in scoliosis treatment, tension bracing etc.
We also have found that research from around the world shows that scoliosis can be managed and improved conservatively without surgery in most cases. So, why has the orthopedic community put their eggs in the surgery basket? The answer is that the orthopedist is a surgeon. The orthopedist has taken on the job of being the gatekeeper for scoliosis management because no other profession has stepped up to take over that responsibility.
The time has come for the chiropractic profession to pull up its sleeves and come together for the sake of children, their families and the chiropractic profession. No one else is competing with us for this task. It's almost as if everyone is waiting for us to get organized and do it.
We urge you to contact your state association for access to the Scoliosis Awareness Program. Feel free to contact us directly through the Scoliosis Care Foundation Web site: www.scoliosiscare.org
Dr. Marc Lamantia is chairman of the foundationís scientific advisory committee.