Scoliosis and Chiropractic Care
The average reduction of thoraco-lumbar scoliosis was 17.2° and was maintained for 24 months.
Function improved 70% and pain was reduced by 60%.
A report on the scientific literature
BY Mark Studin DC, FASBE(C), DAAPM, DAAMLP
According to the Mayo Clinic (2009), " Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Most cases of scoliosis are mild, but severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to straighten severe cases of scoliosis" (http://www.mayoclinic.com/health/scoliosis/DS00194). They go on to say that signs and symptoms of scoliosis may include, uneven shoulders, "Signs and symptoms of scoliosis may include: uneven shoulders, one shoulder blade that appears more prominent than the other, uneven waist, [and] one hip higher than the other" (Mayo Clinic Staff, 2009, http://www.mayoclinic.com/health/scoliosis/ DS00194/ DSECTION=symptoms).
"If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis can cause back pain and difficulty breathing. Go to your doctor if you notice signs or symptoms of scoliosis in your child. Mild curves can develop without the parent or child knowing it because they appear gradually and usually don't cause pain" (Mayo Clinic Staff, 2009, http://www.mayoclinic.com/health/ scoliosis/DS00194/ DSECTION=symptoms).
According to Lou et al. in 2010, three-dimensional lateral curvatures of the spine affect 2-3% of the adolescent population. According to ACT Youth who utilizes the 2000 US Census Bureau statistics, the number of adolescents in the United States is 41,747, 962. Averaging 2.5% of all adolescents having scoliosis equates to 1,043, 699 children facing issues as result of scoliosis. Lou et al. (2010) continue, "Brace (orthotic) treatment is recommended for growing children with curves of 25–45° Cobb angle. Surgery is the final treatment option for curves greater than 45° and its goals are to obtain safe correction, to produce a solid spinal fusion of the curve region, and to bring the spine and body into a more balanced position (p. 292). However, they conclude, " Although brace treatment for scoliosis has been used for more than fifty years, its effectiveness is still debatable... Most studies used the amount of curve progression (as measured by the Cobb angle) to determine the effectiveness of brace treatment. Some defined success as 5° or less curve progression" (Lou et al., 2010, p. 292).
While allopathic medicine is still entrenched in the debatable practice of bracing and eventually surgery with the eventual progression of scoliosis, there are proven solutions. Morningstar concluded in 2011 that as a result of chiropractic spinal adjusting and chiropractic spinal manipulation, a thoracolumbar curvature (scoliosis) averaged a 17.2° reduction that was maintained for 24 months, the length of the study. Across all spinal groups, an average of 10° reduction was realized that persisted for 24 months, again the length of the study. Morningstar also concluded that pain scales reduced by 60% at 24 months and function improved by 70% while respiratory capacity increased 7%. Although this was a limited study with 28 patients, it is the first scientific conclusion that documents and reflects the results of what chiropractors have been realizing in their offices for over a 100 years.
The real issue is that if adolescents have their curvatures reduced by 10°-17.2°, then bracing and surgery are not an option because they will not be indicated. As bracing has been deemed "highly questionable" in the literature and now the literature reflects chiropractic as a highly effective modality, the standard of care across professions should be chiropractic care for scoliosis as first line treatment and should be standardized in every discipline.
Headaches and Migraines:
Chiropractic Saves Federal and Private Insurers $13,680,000,000
and Resolves Many Issues Facing Emergency Rooms Today
A report on the scientific literature
by Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Published in Dynamic Chiropractic, Volume 29, Issue 22
It was reported by Doheny in 2006 that migraine headaches cost U.S. employers more than $24 billion annually, including direct health care costs and indirect expenses such as absenteeism. Doheny goes on to report that according to Michael Staufacker, director of program development for StayWell Health Management in St. Paul, Minnesota, "The programs are so few and far between because many companies ‘don't perceive it as a priority’" (p. 10).
Much of the public perceive headaches and migraines as normal occurrences. For example, a patient will enter a doctor's office and report they get normal headaches, not realizing that pain is never a normal occurrence. Symons, Shinde and Gilles (2008) highlighted a statement from http://www.iasp-pain.org saying that pain is "'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage'" (p. 277). As a result of the public not taking many types of headaches as potential serious problems, they let the condition linger and that can lead to negative sequella.
According to Munakata, Hazard, Serrano, Klingman, Rupnow, Tierce, Reed and Lipton (2009) "...neuroimaging studies have provided compelling evidence that suggests progressive brain changes in persons with migraines...migraine frequency is associated with posterior circulation infarcts and diffuse white-matter lesions...Welch et al. showed that impairments in iron homeostasis in periaqueductal grey areas that were associated with migraine duration and chronic daily headache" (Munakata et al., 2009, p. 499).
Munakata et al. also reported that the economic impact of migraines in both direct healthcare costs and indirect costs of absenteeism is a huge economic burden. The direct cost of migraines ranges from $127 to $7,089 per and the indirect cost due to absenteeism ranges from $709 to $4,453 per victim, making migraines an economic burden to the individual, the insurer, the employer with absenteeism and increased benefits paid and local, state and federal entities who will experience a lowered tax base from lost wages. It was also reported that between 2005 and 2006 there were 1,729,555 physician office visits, 186,603 advanced imaging procedures, 59,589 other diagnostic procedures, and 22,168 hospital days with a primary diagnosis of migraine or headache; all of which are paid by private or public insurers or out of the pockets of individuals. In short, the costs are staggering and a burden to the economy.
Friedman, Feldon, Holloway and Fisher (2009) reported that acute headaches account for 5% of emergency department (ED) visits in hospitals. In addition, they also reported that "…the ED environment that may also contribute to unsatisfactory treatment response include limited physician contact time that may preclude a detailed history, overuse of ED by patients with substance abuse problems, the need for rapid triage, the competing distraction of patients with life-threatening conditions, and directives (or lack thereof) for care dictated by the referring physician…Thus, the treatment of migraine patients in the ED appears to be suboptimal and the high rate of recurrent headache may be attributed to underutilization of relatively ‘migraine specific’ treatment" (Friedman et al., 2009, p. 1164).
Nelson, Suter, Casha, du Plessis and Hurlbert (1998) reported on randomized clinical trials that took place over an 8-week course. The results showed there was minor statistical differences in outcomes for improvement during the trial period for chiropractic care and for amatriptyline and over-the-counter medications for treating migraine headaches. It was also reported that there was no statistical benefit in combining therapies. However, the major factor is that in the post-treatment follow-up period, chiropractic was 57% more effective in the reduction of headaches than drug therapy. In addition, it was reported that, with the drug group, "...58% experienced medication side effects important enough to report them. In the amatriptyline group, 10% of the subjects had to withdraw from the study because of intolerable side effects. Side effects in the SMT (Spinal Manipulative Therapy) group were much more benign, infrequent, mild and transitory. None required withdrawal from the study (Nelson et al., 1998, p. 511). Although this study was conducted 13 years ago, a more current study by Chaibi, Tuchin and Russell (2011) reported that that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine, supporting the previous findings. Although more research is desperately needed, the above conclusions give the public clear directions with migraines and headaches.
Using the 57% increased effectiveness that chiropractic has over drug therapy (leaving out the overlap that chiropractic could help without drugs) and the $24,000,000,000 ($24 billion) Americans pay for headaches and migraines, the savings would result in $13,680,000,000. back in the insurers, the public's and the government's pockets. In addition, if chiropractic reduced the necessity for emergency room visits by 57%, then the ED doctors could focus on what their primary purpose is, to save lives in urgent scenarios.
Chiropractic offers solutions to the federal government, local government, public and private insurance companies, eases the burden on emergency rooms and prevents unnecessary side effects of drugs that are not clinically indicated, with a more viable and proven drugless solution. Although much more research is desperately needed to explore the benefits of chiropractic with migraines and headaches, the research that is available clearly reports that chiropractic offers immediate solutions. These solutions will add to the economy of local, state and federal governments by increasing the tax base and productivity in the marketplace as a result of keeping workers at work and circulating money into local economies with increased paychecks at the end of the year and productivity avoiding absenteeism. The research is conclusive and chiropractic has solutions to many of the economic and societal problems in the United States and worldwide.
1. Doheny, K. (2006). Recognizing the financial pain of migraines. Workforce Management, 85(16), 10-12.
2. Symons, F. J., Shinde, S. K., & Gilles, E. (2008). Perspectives on pain and intellectual disability. Journal of Intellectual Disability Research, 52(Pt 4), 275-286.
3. Munakata, J., Hazard, E., Serrano, D., Klingman, D., Rupnow, M. F. T., Tierce, J., Reed, M., & Lipton, R. (2009). Economic burden of transformed migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache, 49(4), 498-508.
4. Friedman, D., Feldon, S., Holloway, R., & Fisher, S. (2009). Utilization, diagnosis, treatment and cost of migraine treatment in the emergency department. Headache, 49(8),1163-1173.
5. Nelson, C. F., Bronfort, G., Evans, R., Boline, P., Goldsmith, C., & Anderson, A. V. (1998). The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. Journal of Manipulative & Physiological Therapeutics, 21(8), 511-519.
6. Chaibi, A., Tuchin, P. J., & Russell, M.B. (2011). Manual therapies for migraine: A systematic review. The Journal of Headache and Pain, 12(2), 127-133.
Children and Chiropractic Care:
Birth to 18 Years
Conditions cared for and side effects
A report on the scientific literature
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
Chiropractic has been successfully caring for children for various conditions for over a millennium. The main issues are what conditions are cared for by chiropractors, what is the reported success rate and what is the incidence of side effects. Over time, research has started to catch up on what individual chiropractors have been realizing in their private practices and this article will outline the current state of literature.
Marchand (2012) reported that an extensive European study was performed revealing that 8.1% of chiropractic practices were children between the ages of 0-18 (this is lower than the 17.1% of pediatric case loads of American Chiropractors.) This was based upon 921 doctors of chiropractic participating and reporting 19,821 pediatric visits, thereby certifying a valid cross-section of patients to conclude results.
The conditions that were reported to be cared for by chiropractors were the following:
Miller and Benfield (2008) conducted a study of children younger than 3 years old to determine the adverse effects of chiropractic care in that age group, arguably the most susceptible to injury based upon the fragility of that age group. The study was based upon 5,242 chiropractic adjustments and if the results were extrapolated to the wider infant/toddler population that receives chiropractic treatment, the adverse reaction rate is expected to be 1 out of every 1300 chiropractic adjustments. There was less than 1% of patients experiencing negative side effects and all of these adverse reactions to care were mild in nature; transient and required no medical care with serious complications. The typical reaction was transient crying.
The “Practical Application” reported by Miller and Benfield was that chiropractic adjustments were safe for young children and adolescents.
Marchand (2012) also reported the negative side effects of chiropractic care in children to be less then 1% (0.23%,) which is consistent with what Miller and Benfield reported 4 years prior in an independent study. However, Marchand went further to categorize the negative side effects into mild, moderate and severe. A 1 year study of 237,857 pediatric patients, there was a reported 534 mild side effects (0.2%) and on 23 (0.009%)moderate side effects with 0 (zero) reporting any severe side effects.
To render perspective on the safety of chiropractic care and children, Le, Nguyen, Law and Hodding (2006) reported "The incidence of adverse drug reactions among hospitalized children in the United States has not been well studied. Because clinical trials involving neonates, infants, children, and adolescents are limited, the safety and tolerability of many pharmacologic agents are not well established. Often the pharmacologic actions of drugs in neonates, infants, and children are not similar to those identified for adults; therefore, information obtained from research with adults cannot be applied directly. On the basis of a meta-analysis of 17 prospective studies conducted in the United States and Europe, the incidence of ADRs among hospitalized children was 9.5%, with severe reactions accounting for 12% of the total (pg. 557.)
The above study indicates that side effects need more researched conclusions in many sects of health care, but comparatively speaking, chiropractic is a much safer choice than alternative options.
Over time, research will continue to render more outcome statistics on the efficacy of chiropractic care. However based upon the current statistical conclusions, chiropractic is being utilized to help an array of maladies worldwide in the pediatric population with minimal to no side effects.