Scoliosis Correction Protocols 1.Static and Stress xrays Assessment for amount of correction 2.Neurologic component change afferentation by restoring the lordotic curves C/S, L/S 3.Cross Crawl Exercises 4.Stabilize Pelvis 5.Adjust using drop techniques 6.Correct biomechanics of the calf 7.Take post x-rays
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Scoliosis Correction Protocols
1. Static and Stress xrays Assessment for amount of correction2. Neurologic component change afferentation by restoring the
lordotic curves C/S, L/S3. Cross Crawl Exercises4. Stabilize Pelvis5. Adjust using drop techniques6. Correct biomechanics of the calf7. Take post x-rays
My Hero’s CBP The Harrison’s
Donald D. Harrison, PhD, DC, MSE Deed E. Harrison, DC
Scoliosis Chair and Neurologic Exercises
Great for correction
MUST be coupled with restoration of the Lordotic Curves
Scoliosis Bracing1. Must be dynamic = allow for movement2. Must be designed for correction NOT Stabilization
Good
Bad
Ugly
Stress X-rays laterally flex into the convexity
1. Stress X-rays give minimal amount of Correction (Goal)
2. If no Change on Flexing then Change will be hard to predict
3. Change in 90 days full correction can take between 3 – 8 years
Neutral A-P Right Flexion
Stress X-raysThis is the minimum amount of
Correction
You and Patient see the Goal
Look at the osteophytes
Upright MRI was found to be superior to recumbent MRI (did not miss or underestimate condition)
Eur J Radiol 2007;
The AMA Guides notes that no pain-producing trauma can be found for 85% of patients who complain of back pain.
…the failure of medical and surgical investigations may result from looking at the wrong place and at the wrong time…
MRI’s Recumbent vs Weight bearingDON’T TRUST DISC FINDINGS FROM MRI’s
Micro discectomy post surgical pain(They Operated in the Wrong Spot) Liquid Lock or Abnormal disc motion
You Can See Disc Function on a Stress X-RayNeutral Left BendingRight Bending
Disc Injuries Are NOT the Problem they are a clue to improper biomechanics :
Slipped Bulging
Herniated
Discs Get Nutrition
thru imbibition
or movement
Disc = 80 bands of Ligament
Another artificial disc … can you see the Real Problem
Front View Before Side View After
Before After7 Back Surgeries
Postural vs Phasic muscles
Postural no conscious control they increase in tone under proprioception
Never relax muscles under proprioceptive firings
Loss or reversal of curves
Convex vs Concave
Increased in tone on the convexity
Convex muscles increase in tone
10 cycles a sec relaxes ligaments only on the concave part
NEVER Relax the muscles on the convex area
1st Nasium View 1st Goal1st post at 9 monthsNew Goal
Lauren 25 yo Change Goals at Re-exam
Thoracic Adjusting for Scoliosis
1. Most Protected area of the body2. Low ROM
Left Thoracic rotation with a left convexity preload by turning the head to the spinous rotation
Right Upper Thoracic Convex
Adjusting
Keys:•Line-o-drive = elbows thru palm•Grab the Table and Gentle Thrust•Use rib cage •Rotate at the Last Part of the Thrust
Start with the Head supportedNote: •Palm on left rib cage•Doc uses Back Leg for Leverage
L.O.D elbows Thru Palm• Grab the table gentle thrust
Left Convex Scoliosis upper T/S
Thoracic Scoliosis Exercises 1. Restore the Lordotic Curves2. Rolled up towel on convexity 20 min3. Arm on Door way
Left Upper ConvexityLower Right Convexity
T1 /T2 Left Curve Left leg forward
T3 /T6 Left CurveLeft leg forward
Use Scapula and the 18 Muscles to distort the Thoracic CageHold for 2 - 4 min. 3 to 4 times a day
Use Scapula and the 18 Muscles to distort the Thoracic CageHold for 2 - 4 min. 3 to 4 times a day
Left Upper ConvexityLower Right Convexity
T7/T10 Right CurveRight leg forward
Hold Elbow in tight to T-spine
Restore Lordotic Curves and Decrease Lateral Curves
Plastic / elastic deformation curve = 18 min.
Exercises:• rolled up towel on convexity•Neck extension •Deno roll
Turn Sitting into Therapy•Bottom of the elbow is the bottom of the towel•Base of the rib cage•20 min on •10 min off
Ball Chair stabilizes pelvisOnly time for No Towel
Rolled Towel Exercise1. Roll tight as Possible2. Diameter between 4” – 8”3. Support Head and Pillow Between Legs for the Pelvis Stability4. Place at the Apex of the Convexity5. For 18 Min.
Right leg drop for a left convex scoliosis
RL
Leg Drop Exercise for Lumbar Scoliosis
1. Stand Straight Concave (side) Leg out2. Drop Heal to floor by dropping pelvis3. Hold for 2 – 4 min 3 to 4 times a day
Bad Posture
Right leg drop perfect for this
Stabilizing the Pelvis a Must to Correct Scoliosis• Approximate hips 1st visit if symptoms change try a trochanter support
•Unstable pelvis from long term LBP, scoliosis, sedentary lifestyle
•“the adjustment feels good but the pain comes back in a hour”
•Takes about 3 weeks to stabilize
•Trochanter support $ maker
Approximate hips 1st visit
Sit Like a cowgirl/cowboyStable sitting position
Or Ball Chair
Bad Stretch
Good Shoe
Bad Calf Notice only 90 degrees of dorsiflexion
Calf Stretch Vital for a Stable Pelvis
Good StretchBend the Knee over
the toe
Must Check Calf to Correct:
•Scoliosis•Long term LBP•Unstable pelvis•Past pregnancy•High Heels•Tennis, B-Ball, jumping•Runners
Foot on block Stretch:“Hold for 1 min 2 times a day”
Bend into convexity for goalInitial neutral A-P 18 Months Post Care
Challenging thoraco-lumbar correction
Don’t get fooled by loose pants and a hurt knee16 yo with back and knee painPediatrician wanted steel rods
Before After
Initial 8 Months Post Care
64 yo Nurse7 Back Surgeries / 4 Screws / 2 Artificial Discs
Linda 68 yoScoliosis / Unstable pelvis / Loss of foot dorsiflexion / Diffuse pain
9 months post
Scoliosis Patients Are Missing lateral Lordotic Curves…“Linda”
13 neck surgeries = is a C1 Technique important?
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