The Osteopathic Approach to the Child with Scoliosis

The term scoliosis means a distortion
of the body structure into a curvature. This is usually
recognized in the spine but may also be found in the pelvis,
and occasionally in the mechanism of the cranial

Spinal scoliosis may be structural due
to a bony developmental defect as for example the absence of
a rib on one side, or an incomplete development of a
vertebra. It may be the result of a neuromuscular disease
such as cerebral palsy in which the spinal muscles are more
spastic on one side than the other or a paralytic condition
in which the muscles are much weaker on one side. In these
conditions the spinal muscles exert a greater contraction or
side-bending force on one side of the spine than the other.
Abdominal surgery in infancy or childhood may leave a scar
on one side of the abdominal wall which may, as the child
grows, cause a curvature in the back because the soft
tissues around the scar are hardened with fibrous tissue and
cannot lengthen equally with those of the other

But these structural causes of
scoliosis are rare. Far more common are the idiopathic
adolescent functional spinal curvatures. “Idiopathic” means
that the cause is unknown, “adolescent” implies that it is
most commonly found as the child enters the adolescent or
teenage years; and functional indicates that there is no
bony deformity.

There are however some causative
factors recognized by the osteopathic physician that are
responsive to osteopathic manipulative treatment. In order
to appreciate them regard this patient as a dynamic unit of
function from head to feet and not merely a vertebral column
with an unusual curve in it. Examining the standing patient
from the back the level of ears, the shoulders, the scapulae
or shoulder blades, the crests of the ilia are noted for
their symmetry, is one side higher than the other. If the
patient then bends one knee but keeps the weight equally on
two feet it is possible to observe side-bending in the
lumbar area – do they move symmetrically or is the side
bending greater to one side. Next ask the patient to
balance on one leg and note how far the pelvis drops on the
opposite side. Is the range of motion equal to that when
standing on the other leg. Less motion indicates
restriction of physiological motion in the sacroiliac joint.
How far can the patient bend forward toward touching the
toes without bending the knees. As the patient uncurls note
whether the rib cage is symmetrical on the two sides. A
prominence of one side may be the earliest evidence of a
scoliosis of the spine. Is there freedom of motion to
permit elevation of the straight arms beside the

Is the scoliosis still evident when
the patient is seated? Standing behind the seated patient
place hands on the front of the chest or the sides of the
chest to note whether the ribs move symmetrically.
Asymmetric expansion on one side may be due to scoliosis.
The patient is then examined lying on the back, to evaluate
leg length symmetry, pelvic balance, symmetrical motion of
the sacrum within it, and to evaluate the spinal muscles for
symmetrical tension or vertebral rotation.

The cranial mechanism is then palpated
for distortion of position or asymmetry of motion. The
question may be asked, what has the head to do with a spinal
curvature. From a functional point of view the body hangs
from the head and distortion of the cranial mechanism,
commonly from a long or traumatic birth, predisposes to
curvature in the spine by way of unequal fascial drags on
the body. Orthodontic treatment which endeavors to change
and intends to improve the relationship of the jaws may also
induce or aggravate spinal curvatures.

The diagnosis will also include a
standing X-ray which not only evaluates the nature and
degree of the spinal curvature, but also provides a study of
the equality of leg lengths.

The treatment will include osteopathic
manipulative treatment to the pelvis and the head, the rib
cage, the abdominal wall and the fascial mechanism of the
body as well as the area manifesting the spinal curve. If
there is an anatomical shortness of one leg a corrective
lift might be added to that shoe. In addition to, but not
in place of the manipulative treatment some simple exercises
may be given to perpetuate the benefit of the

Carrying a backpack must be carefully
monitored. If used it must not be overloaded and must be
equally balanced across both shoulders.

The fitting of a brace may be
indicated in a severe structural scoliosis. Surgery may be
indicated if the condition has rapidly deteriorated or
structural anomalies exist. But in our experience if
osteopathic treatment is administered first these more
drastic measures are needed less frequently.

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Written by Viola Frymann DO FAAO FCA

Explore Wellness in 2021