Abstract: Introduction: Recent studies have demonstrated there are genetic and epigenetic underlying causes for adolescent idiopathic scoliosis (AIS). Apparently a genetic defect causing ciliary pathology in the neural canal can affect CSF flow and can result in scoliosis. A review of this emerging evidence demonstrates the need to reevaluate the scoliosis-cerebral spinal fluid (CSF) relationship. Compelling studies have illustrated, as well, the dominant role played by epigenetic modifiers over the expression of genetic code. One fascinating study, in particular, has demonstrated definitively that scoliosis in zebra fish can be corrected through epigenetics.
Methods: The goal of this study was to revisit the current and newly published studies concerning scoliosis, epigenetics, as well as evaluating the currently available therapeutic alternatives for scoliosis treatment. The intent was to shed light on breakthrough studies and apply these finding to the chiropractic clinical practice.
Results: The position of chiropractic in this new arena of scoliosis and epigenetics is unfolding. These studies that were reviewed have demonstrated that chiropractic care can affect epigenetic mechanisms through five different avenues: environmental influences, methylation processes, elongating DNA telomeres, emotional stress reduction, and reducing chromosomal oxidative stress. Chiropractic management of scoliosis can be an effective tool for care, with minimal negative secondary effects. Recent studies are finding ineffectiveness of scoliosis bracing along with poor outcomes and serious secondary effects from surgical interventions for scoliosis treatment.
Conclusion: Therefore from a conservative, effective, low risk perspective chiropractic care appears to be an important consideration for scoliosis patients. Further study into this novel emerging field of care for scoliosis patients is indicated.
During 43 years of practicing chiropractic, observing, studying, and treating patients with scoliosis, its relation to temporomandibular dysfunction (TMD) and therefore cranial dysfunction, the focus was always on the restoration of cerebrospinal fluid (CSF) flow interrupted by the spinal/cranial distortions as a key in maintenance of health. Utilising Sacro Occipital Technique (SOT) including cranial manipulation both SOT and Osteopathic (Upledger), Applied Kinesiology (AK), Feldenkrais Technique, Alexander Technique, Shiatsu, dental interventions, and foot orthotics all utilized attempting to seek structural balance. Always with the focus of believing in the importance of reestablishing the CSF flow disrupted by the scoliotic distortions. Following the science has always meant early on practicing with a structural interpretation of DD Palmer’s ‘Green Book’ principles. As the years rolled on and science appeared to ‘catch up’ to chiropractic philosophy, there was a shifting to a neurological interpretation. In the past few years, it has become very clear that chiropractic’s basis; ‘The Three Ts of Subluxation: Toxins, Traumas, and Thoughts’ do in fact have a great impact on our body systems; and now new studies help us to understand how they even impact our genetic health. It is our hope, that what is presented, will spark curiosity and stimulate further questioning and serve as a clarion call to action.
So, let us follow the science. The science is positioning chiropractic at the forefront in care for scoliosis, and perhaps other chronic conditions which have been linked to genetic predisposition.
Science has also demonstrated that the conventional interventions offer poor outcomes with devastating and debilitating complications; further shinning the light on chiropractic as a primary choice of care as its side effects are negligible. (61, 62, 63) The most common side-effect of chiropractic scoliosis care reported in a medical study, who’s initial intent was to discourage
chiropractic care for scoliosis, was muscle soreness (accounting for 35.2 % of all side effects). The next common most side-effects were neck pain (13.6 % of side effects), back pain (12.0 %), headache (10.6 %), stiffness (7.8 %), and discomfort from the adjusting instrument (7.1 %). (64) Chiropractic care has been found to be superior to bracing and possibly surgery. (65) This study found, ‘Chiropractic treatment was associated with a reduction in the degree of curvature of adolescent idiopathic scoliosis in this case, after half a year of conventional medical treatment had
Asia-Pacific Chiropractic Journal Weiner & Blum, 6 failed to stop curve progression. This suggests that in at least some severe and progressive cases of scoliosis, chiropractic treatment including spinal manipulation may decrease the need for surgery.’ The possible secondary reactions to chiropractic care pale when compared with side effects of surgery which include, the syndrome of inappropriate antidiuretic hormone, pancreatitis, superior mesenteric artery syndrome, ileus, pneumothorax, hemothorax, chylothorax, fat embolism, urinary tract infections, wound infection, hardware failure, and death. (66) 21st century science has demonstrated what BJ Palmer stated over 100 years ago, ‘We never know how far reaching something we may think, say or do today is, or how it will affect the lives of millions tomorrow’.
The concept of the Vertebral Subluxation Complex has been made evident over and over again. Our 3 T’s (thoughts, toxins, trauma) have been validated and illustrated to affect even cellular and
chromosomal changes. (67) The medical research has begun to discuss the phenomenon of subluxation, but by renaming it ‘dysponesis’ as not to lend any credibility to chiropractic. (68, 69)
We now know that chiropractic can create profound changes in the body, not only neurological and structural, but epigenetic changes that will affect not only how our bodies function, but how
the bodies of our children and our children’s children will function. Scoliosis is estimated to affect up to 5.2% of the general population. (70) Keep in mind that in typical year all cancers affect 4.39% of the population. (71) The average scoliosis patient will suffer a 14-year reduction in their average life expectancy, this is unacceptable, this is a problem of epidemic proportion if considering CDC statistic standards for epidemic. Chiropractic must step up and assume the leadership in scoliosis treatment understanding that as Dr. Harrington himself stated, ‘scoliosis is a condition involving much more than the spinal column’. Right now, the average chiropractic patient is a 39-year-old female. (72) This is wonderful, but does this position allow us to make the impact on health care in our communities, in our countries, in the world that we have an obligation to make?
I challenge our profession to come forward and care for not only the patient in your office, but their children, families, and affect people for generations to come. Let us embrace how science of
the 21st century is validating our chiropractic principles. We must throw off the self-imposed shackles of being narrowly defined as mechanical pain-based care and embrace our roots as health-based care. Like the enormous adult elephant, restrained by a thin rope and a small wooden peg in the ground. Held there in place only by the conditioning of the small pup not having the strength to free itself. The enormous adult elephant has learned not even to try to free himself, not even recognizing the power that it wields. Our power now comes from the science. There has been so much discussion of expanding our scope of practice. We should be concentrating on expanding our scope of demography.
Therefore, from a conservative, effective, low risk perspective chiropractic care appears to be the primary consideration for scoliosis patients. Further study into this novel emerging field of care for scoliosis patients as well as the importance of chiropractic care for children and overall health for the general population is indicated.
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