Scoliosis-New Ideas for Etiology and Treatment
Scoliosis is a spinal curvature that develops in children during their growing years. It results in a three-dimensional deformity that leaves the spine growing in a spiral. Curves of more than 25º are reported to occur at the rate of 1.5/1000 children in the US. It is estimated that 70% of pediatric cases are idiopathic.
A variety of treatment possibilities have been described. They include bracing, chiropractic, myofascial release, and spinal surgery with instrumentation. While the non-surgical treatments have been reported to reduce associated pain, none have been shown to reduce or stop progression of the deformity.
At the Blatman Health and Wellness Center, we have pioneered a different treatment of scoliosis based on the theory that it is caused by fascia restriction that prevents a child’s vertical growth.
Fascia as a Cause of Idiopathic Scoliosis
Fascia is a fibrous tissue that is continuous throughout the body and holds it together. It holds muscles to bone, muscles to muscle, bones to bone in joints, and keeps organs like the heart, lungs, uterus, and bladder where they belong in the body so that they do not flop around or fall due to gravity.
Fascia is contiguous throughout the body. It makes up tough sheets and cords that have been dissected and demonstrated to go from head to foot as one piece of tissue. Indeed, a technique called “fascia sparing dissection” has demonstrated shallow and deep lines of continuous fascia in the front, back, and sides of the body. There are also spiral lines of fascia through the abdomen and chest (reference Anatomy Trains and www.anatomytrains.com).
Fascia has been shown to contain contractile fibers and has contractile properties as a result. Sometimes these fibers cause pathological contraction of fascia as seen in Duypuytren’s contracture. This contraction occurs slowly, and is so strong that relief of the deformity traditionally requires excision for the palmar fascia cords that bind the fingers. There is also a percutaneous “needle cutting” technique that has been shown to release the fascia cords without the more drastic surgery.
If scoliosis is indeed caused by fascia restriction or contraction, it would be idiopathic, different in each child, and relatively unpredictable in its pattern and progression through time. The restriction would prevent vertical growth of the spine, and as the child develops the spine would grow in a path of least resistance—which would result in the classical spiral deformity. It would also result in the greatest progression of deformity occurring during more rapid growth during childhood and very little progression after age 18. In addition this possible etiology would also mean that bracing, physical therapy, muscle balancing, and chiropractic cannot have much effect on reducing progression of the developing deformity. Fascia tension would define scoliosis as coming from inside the body, making outside treatments such as bracing ineffective. Indeed, all of these issues are characteristic of idiopathic scoliosis.
In addition, if scoliosis is caused by fascia restriction or contraction, a skilled examiner should be able to palpate and discover the tightest of the restricting fascia cords in the trunk of the body. We have learned in collaboration with David Lesondak, that we can indeed feel many of these restricted fascia cords in both children and adults with scoliosis. The cords we are not able to palpate are deep and sometimes anterior to the spinal column in the chest and lower back.
Scoliosis Treatment Based on Fascia
As we have learned to feel the tight cords, we have been able to treat children with percutaneous needling that releases the fascia much like what has been described for treating Dupuytren’s contracture. Children in the program have all been girls and they have varied in age from 10 – 18 years. Every child has gained vertical and shoulder height with each treatment. We have found this percutaneous technique to be less successful in areas of tight thoracic curves. In these cases the fascia restriction may be best released with surgery as it requires access through the chest and lungs. The most dramatic success has been with a 10 year old child whose curve was no longer noticeable one year after 4 consecutive days of treatment. As children age with this progressive deformity, their vertebrae deform into an oblique trapezoid shape that is difficult to reverse. Therefore, the earlier in life the fascia cords are released, the better the chances to minimize progression of the deformity. The children have to be able to lie still and tolerate discomfort that is similar to a trigger point injection.