Scoliosis and Cox® Technic
By Dr Danica Newbold
B.HSci (Chiro), M.ClinChiro, Ad.Dip Myo.
Certified Cox® Flexion-Distraction Chiropractor
What is Scoliosis?
Scoliosis derived from the Greek word ‘skoliosis’ meaning bent or curved, is a musculoskeletal condition of the spine in which it bends or curves sideways (laterally) from the centre. Scoliosis is not a diagnosis; it is more of a descriptive term for a condition. Scoliosis appears in about 3% of the population (1), typically affects girls (more than boys) and is usually identified during the 10-20-year age range (2).
When a scoliosis develops, the spine bends and twists along the vertical axis of the body. Curvatures can either appear as ‘C’ or ‘S’- shaped. These curvatures can have cosmetic and physiological effects on the body, and long-term may have significant health problems in cases of severe curvatures.
What are the types of Scoliosis?
There are numerous types of scoliosis. In some cases, the degree of curvature is stable and non-progressive; in others, it can increase over time. Mild Scoliosis typically does not present any problems to a person and is often discovered as an incidental finding. While severe cases of Scoliosis can be painful and affect multiple systems throughout the body.
- Structural (idiopathic) Scoliosis: Often referred to in the literature as Adolescent Idiopathic Scoliosis (AIS), is the most common form of scoliosis and is typically discovered during adolescence in young girls aged 11-14 years and. In 80% of cases, the cause of scoliosis is unknown (idiopathic) (3). A family history of scoliosis has been observed in 1 in 4 cases of scoliosis (3). If left untreated, scoliotic curvatures may progress.
- Functional scoliosis: Developing later into adulthood as a result of injury or repetitive asymmetrical strain (e.g., tennis, golf swing). The curvature of the spine forms due to over- and underuse of different muscular groups around the spine. Since this type of scoliosis is more musculoskeletal based, reduction of the curvature may be achieved.
- Pathological Scoliosis: Typically develops from a neuromuscular disease such as Muscular Dystrophy or in response to traumatic or severe injury to the spinal column/ cord (i.e., quadriplegia). Pathological scoliosis can also be identified during other diseases such as osteoporosis where fractures of the spinal vertebrae can cause the spine to curve away from the centre.
- Burning, Tingling, and/ or Numbness – this can be mild to severe and be located close to the pain source or radiating out into the extremities such as the shoulder, arm or hand in cervical disc bulges; hip, buttock, leg or foot especially in lumbar disc bulges.
What are the signs and symptoms of Scoliosis?
There are several outwards signs of scoliosis which can aid in its diagnosis. If more than one of the following signs is noted, a thorough spinal screening examination is recommended to confirm the presences of abnormal spinal curvature.
- Uneven shoulders – one or both shoulder blades may stick out (“winged” scapula).
- Head is not centered on the body (directly above the pelvis)
- Uneven hips – one side of the pelvis may be elevated/ tilted and more prominent
- Prominent or protruding rib cage/ torso with uneven gaps between arms and trunk.
- Visualized spinal curvature from behind
While small curves are common and rarely of clinical significance, about 2% of the young girls with scoliosis have curvatures that necessitate medical observation during growth and, approximately 3:1000 requiring medical intervention during this time (4).
Due to variations in the shape and size of the torso, severe scoliosis patients may have other secondary complications associated with progressive scoliosis. These may include (but are not limited to):
- Constant back pain- this can range from mild and uncomfortable local pain to severe whole spinal pain.
- Inflammation of the spinal joints (zygapophyseal or facet joints) – due to increased load and wear from the additional pressure that scoliosis provides.
- Breathing difficulties – due to compression of the thorax and rib cage in association with the degree of the spinal curvature (usually in patients with a degree of curvature greater than 110 degrees (3).
- Injury to the heart and lungs- as a result of deformities in the thorax/ rib cage causing direct compression on the sensitive organs beneath.
- Increased risk of bone wear and loss- The increased pressure on the spinal vertebrae can cause the spinal joint (zygapophyseal or facet joints) to sheer and degrade the joint surfaces over an extended period.
Contrary to popular belief, scoliosis does not develop from poor posture. However, it may progress pre-existing spinal curvatures due to weakened musculature. Without monitoring and intervention, scoliotic curvatures worsen by up to 0.73 degrees per year (3).
How is Scoliosis diagnosed?
Checking for scoliosis is done during routine examinations by qualified Chiropractors. The practitioners at Malvern Chiropractic Clinic and Melbourne Spine Clinic, are well educated in diagnosing, treating and managing scoliosis patients at any stage of life.
During an examination, the Chiropractor will evaluate a patient’s posture assessing any asymmetry that may be present. Several orthopaedic and neurological tests will also be conducted to assist in the overall diagnosis of scoliosis. Referral for plain film x-rays is the final step in confirming the presence of Scoliosis in a patient. On x-rays, the Chiropractor can visualize the degree of curvature of the spine taking specific measurements called the Cobb Angle- The Cobb Angle measures the degree of severity of scoliosis. Curvatures of less than 25 degrees should be monitored carefully and routinely re-examined for any signs of progression or deterioration.
How is Scoliosis treated?
The primary goals of treating any form of Scoliosis is to:
- Reduce spinal joint compression and tension that may be causing pain.
- Release tightened spinal musculature.
- Improve strength and flexibility throughout the spine and core muscles.
- Prevent any recurrent pain and avoid further progression of the curvature.
How is Cox® Flexion Distraction and Spinal Decompression therapy used to treat Scoliosis?
Reduction or ‘straightening’ of the spinal curvature is not considered a realistic goal when seeking conservative management for Scoliosis. Scoliosis can be managed quite efficiently from a pain reduction and spinal mobility perspective. A rehabilitation program will be prescribed by your Chiropractor to incorporate appropriate spinal mobility and strengthening exercises. This can ensure that returning to ‘normal’ activities of daily living without the aggravation of pain and symptoms. Since in many cases, scoliosis is a permanent condition, ongoing active and passive management is paramount in preventing further irritation and deterioration of the spine.
Spinal Bracing is a recognised option when treating Scoliosis patients. According to the research, for curves between 25 – 48 degrees, below the 8th thoracic vertebral level and, if there is a risk of curve progression; bracing should be considered (3). The spinal brace is most effective when applied during adolescence. Their main aim is to halt any progression in the curvature of the spine. Research has shown a 93% success rate for patients who wear a brace for 23 hours per day. However, for many people, compliance tends to the main issue with long term effectiveness of this type of treatment.
Surgical interventions for severe scoliosis patients have been used to stabilise curvatures greater than 45 degrees and generally improve the cosmetic appearance of the distortion patterns associated with scoliosis. The primary focus of the surgery is correcting the deformity (scoliosis) through the fusion of the spinal column using surgical rods and screws. Consultations with an orthopaedic surgeon will determine whether this is a viable intervention for the individual scoliosis patients.
How is Cox® Flexion Distraction and Spinal Decompression therapy used to treat Scoliosis?
Chiropractors at Malvern Chiropractic and Melbourne Spine Clinic use Cox® Flexion-Distraction and Spinal Decompression therapy. Cox® Flexion-Distraction and Spinal Decompression therapy is a first-line therapy for back and neck pain treatment with more than 40 years of research in successfully treating back pain.
Pioneered by Dr. James (‘Jim’) M. Cox in Fort Wayne, Indiana (USA), The Cox® Technic is a well-researched, evidence-based system of Flexion-Distraction and Spinal Decompression. The Cox® Technic is well documented in federally funded research in the USA and worldwide. Dr. Cox and his team are continually training and educating Chiropractors on becoming Cox® Technic Certified Practitioners. In the US, Cox® Certified Chiropractors are referred to as “back pain specialists.” Although this term is not recognised in Australia, Cox® certified chiropractors have extensive training, experience, and success in the delivery of effective treatment in back and neck pain conditions.
Back and neck pain treatment using Cox® Flexion-Distraction Therapy is a safe, low-force, doctor-controlled technique performed using the highly specialised Cox®8 Table, which allows the effective administration of flexion-distraction and spinal decompression adjustments. The goal of Cox® Flexion-Distraction and Spinal Decompression is to help the patients go from “pain” to “no pain” as quickly as possible (5).
Spinal mobilisation or back and neck pain treatmtent using Cox® Flexion-Distraction therapy works by gently stretching the spine. This changes the force and position of the spine and will take the pressure off the spinal discs and joints. Long term, this therapy helps promote movement of water, oxygen, and nutrient-rich fluids into the disc and joint spaces so they can heal, decrease pain, and increase mobility.
By using Cox® Flexion-Distraction therapy, the Chiropractors can physically mobilise the spinal curvature and promote flexibility and stability. Based on the many years of research, we know Cox® Flexion-Distraction and Spinal Decompression can:
- 1. Decrease intradiscal pressure by up to 192mmHg (millimeters of mercury)
- 2. Improve intervertebral disc height by up to 17%
- 3. Improve spinal nerve openings (foramina) by up to 28%
- 4. Improve range of motion and flexibility
- 5. Decrease pain and sensitivity.
What does Cox® flexion-distraction therapy feel like?
The treatment performed by the Certified Cox® Flexion-Distraction Chiropractors at Malvern Chiropractic and Melbourne Spine Clinic, is gentle, safe and non invasive. It is a method of gentle traction, performed as a slow-moving pumping action, and spinal mobilisation technique with the assistance of the highly specialised Cox® 8 Table. Overall, it feels like a deep but mild stretching feeling to the spine. All movements are slow and within the patient’s tolerance.
Fig 4. Low Back (lumbar spine) using Cox® F/D Treatment
Fig 5. Neck (cervical spine) using Cox® F/D Treatment
(1) Shakil H, Iqbal ZA, Al-Ghadir AH (2014). Scoliosis: review of types of curves, etiological theories, and conservative treatment. Journal of Back and Musculoskeletal Rehabilitation. 27 (2): 111–5. doi:10.3233/bmr-130438. PMID 24284269.
(2) Questions and Answers about Scoliosis in Children and Adolescents. NIAMS. December 2015. Archived from the original on 25 August 2016. Retrieved 12 August 2016.
(3) Choudhry MN, Ahmad Z, Verma R. Adolescent Idiopathic Scoliosis. Open Orthop J. 2016; 10: 143–154. doi: 10.2174/1874325001610010143
(4) Adolescent Scoliosis Spinal Curvature. Self-Detection Fact Sheet. Scoliosis Australia. www.scoliosis-australia.org.
Fig 1. https://www.scoliosissos.com/news/post/s-curve-vs-c-curve-scoliosis-treatment
Fig 2. www.scoliosis-australia.org
Fig 3. https://en.wikipedia.org/wiki/Cobb_angle
Fig 4. https://www.coxtechnic.com/patients/treatment
Fig 5. https://www.coxtechnic.com/patients/treatment
About the Author
Dr Danica Newbold is a Chiropractor and Cox® Certified Practitioner at Malvern Chiropractic Clinic and Melbourne Spine Clinic. Dr Newbold completed her Chiropractic studies and graduated from RMIT University in 2016. Prior to this, she had qualified and was working as a Myotherapist. After witnessing a family member undergo the pain and struggle associated with a disc condition, Danica developed a keen interest in the conservative management and treatment of spinal and disc injuries and diseases. Dr Newbold became fully certified in Cox® Technic in November 2017.
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