Scoliosis is a condition that can affect all areas of the spine. There are many different types of scoliosis, which are grouped according to their known cause. The most common types of scoliosis seen by doctors of chiropractic can be divided into structural and functional divisions.
When the deviation of the spine is permanent, and does not change while bending, it is termed a structural scoliosis. There are many possible causes of a structural scoliosis the most common causes are congenital (due to abnormal formation), neuromuscular (due to a disease of the nerves or muscles) and idiopathic (the reason is unknown).
The curvature associated with a structural scoliosis is often progressive, and conservative (non surgical) attempts to reduce the curvature are not successful to a significant degree. However, conservative treatment can help with the pain associated with a structural scoliosis.
Functional scoliosis will usually respond well to conservative care. The most common causes of a functional scoliosis are compensatory (due to a leg length difference), postural (due to bad postural habits and muscle imbalance), and transient (due to injury).
The key common factor in all of these conditions is that the curvature in functional scoliosis will reverse with various positions and movements.
The most common cause of on-going functional scoliosis is a ‘short leg’ which then leads to the pelvis not being level. The difference in leg length can be due to an actual physical (anatomical) difference in leg length, or excessive foot pronation.
The foot experiencing excessive pronation will create a functional ‘shortening’ of that leg. Whether the short leg is anatomical or due to pronation, it is necessary to address the problem of the short leg to improve alignment of the spine.
The loss of arch height that occurs with excessive pronation allows the pelvis to drop to that side during standing and walking. The resulting lateral pelvic tilt creates a curvature of the spine.
If this curvature progresses up the spine it may create a mild rib ‘hump’. This hump should disappear as the leg length difference is treated.
The use of custom orthotics to reduce pronation can provide substantial correction for most functional short legs. It is important to determine the cause of the short leg; is it an actual anatomical difference or pronation of one of the feet.
Treating a short leg that is due to pronation with a heel lift instead of orthotics will not address all of the biomechanical issues. Without orthotics to correct the lower leg rotation that occurs with pronation, the pelvis will continue to rotate and create stress on the associated joints.
When a curvature of the spine has been found to be due to functional causes, conservative treatment can be very effective.
A careful chiropractic examination will usually reveal any asymmetry in the lower extremities which creates unleveling of the pelvis.
The combination of custom orthotic support and chiropractic treatment is often very effective in treating functional scoliosis, much to the relief of the patient and their concerned family members.