Dr. Charles Edwards II of the Maryland Spine Center at the Mercy Medical Center recently made a rather startling, yet not surprising admission in the Baltimore Sun newspaper. The Article entitled “Exercise Can Reduce Scoliosis Symptoms” does a relatively accurate job of profiling the disease and Dr. Edwards discusses various methodologies of managing and treating scoliosis. As the title implies, active rehabilitation of the spine can and will reduce symptoms of scoliosis, but the article omits is that active rehabilitation of the spine can reduce the scoliosis curvature itself. I have seen and read many of the studies showing how exercise protocols that include core strengthening exercises like sit-ups, chin-ups, and pelvic tilts have no effect on scoliotic curvatures, but those studies have over-looked a critical aspect of the disease. Scoliosis is primarily a disease of neurological control of the spine in response to gravity. In short, the brain is incorrectly perceiving gravity and therefore mis-orienting the spine accordingly. This is why scoliosis is 5 times more common in the blind population, but only 25% as likely in the hearing impaired population. However, neurological control doesn’t seem to be the only factor involved in the progression of the disease. Spinal curvatures under 20 degrees have an approximately 22% risk of progression, but the risk of progression jumps to 68% for curvatures 20-29 degrees. This dramatic jump in progression rates can probably be contributed to the increased “coil down” effect seen at this stage of the disease. No one seems to know why the “coil down” effect occurs, but it appears to be connected to adverse mechanical tension on the spinal cord. This also explains why the bending and rotation patterns appear to become “uncoupled” when the curvature reaches or surpasses the 30 degree angle mark. The normal coupled bending and rotation pattern normally forces the spinal cord over the outside of the curvature which increase tension on the spinal cord, but maintains a relatively low amount of torque in the spinal curvature; however, when the spinal curvature reaches 30 degrees or larger, the bending and rotation pattern become uncoupled and the rotation component begins turning towards the inside part of the curvature. While this has the effect of reducing the tension on the spinal cord by allowing the cord to travel through the inside part of the curvature, but has the negative effect of creating a massive amounts torque in the spinal curvature. This has a tremendously negative effect on the curvature and dramatically increases the “coil down” effect and curve progression.
So is the cause of scoliosis neurological or biomechanical? It seems early stage scoliosis (0-19 degrees) is rooted in a neurological mis-interpretation of gravity, however biomechanical factors involving spine torque (driven by a need to relieve adverse mechanical tension on the spinal cord) seem to be the driving force behind curve progression in spinal curvatures 20 degrees or greater.
“Exercises” in the form of neurological re-education and biomechanically specific exercise can have an positive effect on the signs and symptoms of scoliosis, but it must be applied in a very specific manner, by a trained and skilled physician.
Clayton J. Stitzel DC
Co-director, CLEAR Institute