February 13, 2015

Neuro-Orthopedic Spinal Therapy; A novel approach to managing Scoliosis. PART 1

Have you wondered how conventional scoliosis methods came to be?

I often find myself pondering the origins of things, the origin of man, the origin of the universe, I’m especially perplexed by the origins of behavior. When we think about a conventional treatment in medicine, its nothing more than a behavior that is widely accepted and practiced and in not unchangeable.

So how did we get to the conventional behavior of managing scoliosis with surgery alone? 

In 50 years we haven’t reliably sustained reduction in the amount of scoliosis surgeries, and continue to fuse the spines of young women with little concern about the longitudinal health of the individual. I work with many women with scoliosis, I always say my patients are usually either 13 year old girls or they’re 63 year old girls. Both have needs that are not being addressed by current conventional behaviors of their doctors.

Hormonal Effects of Scoliosis

I had a patient yesterday in Tampa, who will remain nameless, who has had an irregular menstrual cycle of the past year. She also of course has a scoliosis that is progressive. I asked the mom to please have some blood work done so we could potentially identify why her hormones were imbalanced. Scoliosis is related to hormones after all, it typically presents at puberty and tends to progress with increases in growth hormone exposure.  The patient in being co-managed by an Orthopedist who would clearly prefer he were managing it alone, and a pediatrician.  The Pediatrician said its “normal” to have an irregular menses the first year, and the Orthopedist says they’re in nothing that can be done other than surgery. These two recommendations are an example of how conventional methods may be potentially glossing over clinical findings that may now or later have a profound affect on the resulting deformity of the bone. Keep in mind, genetics have been shown to give us Scoliosis, but it the environmental stressors that lead to progression and worsening of the deformity.

Scoliosis Is A Multi-System Condition

Scoliosis is a unique condition that involves just about every system of the body including the skeletal system the muscle system, the nervous system, the hormonal system, the motor system, the oculomotor system, the gravi-ceptive (gravity sensing) systems, and the Sensory systems just to name a few. Its interesting to me that we have doctors for everyone of these systems, but when a patient has a curvature in their spine which we call “scoliosis”, our behavior is to revert back to a long ago decided method with origins long prior to our current knowledge of today.

The descriptions of Scoliosis date back to ancient times. Early Priest -Physicians thought it was an infestation by a demon leading to the hallmark curvature of the spine. Over time our understanding changed and so did our behavior. Undoubtedly the understanding changed long before the behavior did. This is of course how things evolve and we have to recognize where we are in any moment in time in contrast to a timeline that is much larger than our everyday thoughts admit to. Do you think we will  be treating scoliosis the same way in 100 years from now? I hope not.

Over the past decade or so I have been immersed in clinical practice treating patients with scoliosis and hyperkyphosis. I happen to have hyperkyphosis myself and have a personal interest in what I do. I’m working on my posture right along side my patients, lucky them (tongue in cheek). I also fractured my spine when I was in my late twenties.  My road to recovery was long and painful. I eventually, after about 5 years have found ways to move that don’t aggravate my pain and I continue to recreate with the best of them. Getting back to my point, over the past decade I’ve learned that the more you know, the less you know you know, and the more you want to know.

So my behavior has been changing over the past decade in regards to the conventions I choose to treat my patients, this is a direct consequence of changes in my understandings.

Neuro-Skeletal Impact on Scoliosis

For instance, the field of Neuro-skeletal Biology was first described in 2014. This branch of science investigates the relationship of the nervous system to the skeletal system. Now remember above I mentioned these two systems as being part of the many systems involved in the condition of scoliosis. This is all easily researched at pubmed.com, just put the keywords; neuro-skeletal biology. One study outlined the exact mechanism, to the best of their current knowledge and understanding of course, of how cells are activated to create the asymmetry associated with the spinal bones in scoliosis.

This is of course a new understanding and ultimately will change the behavior of those that are in the know.  These studies identified divisions of the nervous system as being directly responsible for bony deformity in scoliosis. This changes everything, slowly. In our clinics we changed our behaviors immediately to include evaluation of the nervous system to identify if and when the nervous imbalance occurred.

Therapeutic Approaches To Diminish Neurological Imbalances Affecting Bone Growth

Our Conventions changed to include Heart Rate Variability monitoring and blood chemistry testing to name a few. We honed our focus in on methods designed to improve neuronal system balance and ultimately have developed a protocol that needs a name, and needs to be taught at the post graduate level to doctors with the necessary depth of knowledge in as many systems as they can, and then our Conventions will be one step closer to the reality.

I’ll be announcing a new seminar series in the coming months that will be for Doctors of Chiropractic exclusively.  Our Neuro-orthopedic approach utilizes alternative methods to current conventional protocols. Your other physicians may or may not agree with our methods. Please invite to contact me directly, having your doctors start a conversation on your behalf can only benefit you.

For those of you practitioners interested in learning about our future scoliosis treatments Click on This Link to learn more.

November 9, 2014

Should my child participate in Sports if they have scoliosis?

I recently interviewed a new patient and her family to find out her parents were encouraging her to join sports because she had recently been diagnosed with scoliosis. This is not uncommon in my practice, nor is the exact opposite, parents and doctors recommending no sports when curvatures become progressive. So which is it? Should children with scoliosis participate in sport or not? The first question that should come to mind is, what makes scoliosis curvatures progress?  This is very important to understand; genetics cause the disease, and the environment is responsible for its progression. For our purposes, the “environment” is both internal (metabolism) and external (movement).

With that being said, here are few things to consider, firstly not all movement is created equal.  If you think about “movement” as a large circle, then exercise is a smaller circle within that. Poor movement as well as poor postures have the potential to aggravate scoliosis, and to the contrary, movement can also be therapeutic, as is the case with good posture. Exercise is really no different, if the movements associated with the exercise are therapeutic or helpful then exercise is great, if the movements are imbalanced, limited,or  unstable, then the exercise may aggravate the condition.  We spend between 10 and 30 hours working on movement education with our patients. “Movement”includes exercising, as well as walking, running, stepping, sitting, standing, breathing, leaning, chewing, sitting, kneeling, lying etc.

Furthermore, exercise activates the sympathetic nervous system. Anytime you move, your sympathetic system has to dominate to bring blood to the muscles doing the work. When the sympathetics are dominating, the adrenal glands release cortisol, the heart rate becomes less variable, and digestion shuts down. Normally, the sympathetics are opposed by the parasympathic division of the autonomic nervous system, and the body returns to a state of resting and digesting. If a patient has a dominant sympathetic nervous system, it may be turned off after exercise, and lead to problems falling asleep at night (insomnia), they may be anxious, have tachycardia, have increased sweating, and decreased digestion to name a few. This is a major concern for scoliosis patients. Here’s why.

New research has identified a pathway responsible for asymmetrical bone growth related to increased sympathetic nervous system activity. Most of us are familiar with the sympathetic nervous system as the “fight or flight” division of the autonomic nervous system. Studies have shown scoliosis patients have a loss of brain influence over the sympathetics, allowing it to dominate even at rest.  One way we can measure this is through the Heart Rate Variability.

Heart Rate Variability (HRV) is a measure of the balance of the sympathetic and parasympathetic influences over the heart. When the sympathetic system is dominating, the heart beat becomes less variable, meaning its rhythm becomes like clock work. This may sound good, but it’s actually not desirable because it makes the heart more susceptible to mis-beat.  Studies show when athletes over train their HRV diminishes.  Heart rate monitor technology allows us to easily measure the HRV allowing us to recommend rest days when exercise is leading to over training.

November 9, 2014

Hypothalamic Amenorrhea in Scoliosis

What is Hypothalamic Amenorrhea and how does it affect Scoliosis?

Studies confirm prolonged onset of the menstrual cycle is a risk factor for scoliosis progression. Termed Hypothalamic Amenorrhea, abnormal menses or lack menses can be caused by a lack of adequate body fat. This may be due to genetic predisposition, or due to either excessive exercise or low caloric intake. It’s important to understand why this happens. To put it simply, if the brain (hypothalamus) does not detect enough fat storage (Leptin signaling), it won’t waste energy on preparing the body for pregnancy.  This can prolong the pubertal growth making these patients more susceptible to asymmetrical bone growth.   Dietary and lifestyle changes should be considered in these cases. Supplementation that supports proper hormone function may reduce physiological dysfunctions associated with this condition.