Adolescent idiopathic scoliosis: The Tethered Spine III: Is fascial spiral the key?

This article reports on an observational and treatment case series involving 22 adolescents and preadolescents treated over a 15 year period who had or appeared to be developing idiopathic scoliosis (IS). Common patterns of muscle and fascial asymmetry were observed and treated. Most of these individuals had spinal area pain and the trigger points (TrPs) apparently responsible for this pain were located in muscles at some distance from the spine, yet referred pain to locations throughout the thoracolumbar spine. Asymmetries in tension in these muscles appear to tether the spine in such a way as to contribute to scoliotic curvatures. The most common pattern of asymmetrical muscle tension found in these individuals follows a particular spiral fascial plane and as the fascia in this spiral plane tightened, the scoliotic curvature appeared to increase. Evaluation also showed that 21 of 22 of these individuals have major ligamentous laxity and this may also have contributed to the development of scoliotic curvatures. Furthermore, each of these individuals has marked overpronation of the ankles, with arches that totally collapse when weight-bearing. Based on observation during the care of these 22 subjects, it appears that asymmetry in the degree of pronation may, in some individuals, be a contributing factor in the development of the spiral body organization involved in the development of scoliosis. Common patterns of joint dysfunction were also observed in many of these individuals. There were also some findings of significant muscle weaknesses that appeared to contribute to the development of the spiraling body organization. Treatment of the tethering of the spine from myofascial asymmetries and related joint dysfunction not only resulted in elimination of pain in almost all cases but also, in many cases resulted in significant reduction of scoliotic curvatures including reductions of rib humps. In other cases, it resulted in stabilization of scoliotic curvatures, and in some cases it may have slowed the rate of progression of curvatures. Stretching and strengthening exercises appeared to contribute to the stability of treatment gains. A segment of the treated population had atypical scoliotic curvatures that did not follow the typical spiral pattern. Even in these individuals, there were significant patterns of fascial restriction and joint dysfunction accompanying the curvatures. Prior traumatic injury was a common factor in almost all of these atypical cases. Treatment of myofascial TrPs and asymmetrical fascial tension and accompanying joint dysfunction is proposed as a useful approach to treating pain in adolescents who have or who appear to be developing scoliosis and to treating and controlling and/or decreasing many scoliotic curvatures. This case series is presented as a way to illuminate possible factors in the development of scoliosis and promising treatment strategies to address these factors and to eliminate pain and stabilize or decrease curvatures so that further research can more systematically evaluate the role of these factors. An addendum of two more cases is also included, because of the information that these cases add to the discussion and to treatment approaches. Including the addendum cases, 8 of the subjects had scoliosis as documented by x-rays. The other 16 appeared to be developing scoliosis according to criteria stated below.

Idiopathic scoliosis: the tethered spine II: post-surgical pain.

The treatment of severe chronic pain in young people following surgery for the correction of curvatures of idiopathic scoliosis (IS) is presented through two case histories. Effective treatment involved release of myofascial trigger points (TrPs) known to refer pain into the spine, and treatment of related fascia and joint dysfunction. The TrPs found to be contributing to spinal area pain were located in muscles at some distance from the spine rather than in the paraspinal muscles. Referred pain from these TrPs apparently accounted for pain throughout the base of the neck and thoracolumbar spine. Exploratory surgery was considered for one patient to address pain following rod placement but the second surgery became unnecessary when the pain was controlled with treatment of the myofascial pain and joint dysfunction. The other individual had both scoliosis and hyperkyphosis, had undergone primary scoliosis surgery, and subsequently underwent a second surgery to remove hardware in an attempt to address her persistent pain following the initial surgery (and because of dislodged screws). The second surgery did not, however, reduce her pain. In both cases these individuals, with severe chronic pain following scoliosis corrective surgery, experienced a marked decrease of pain after myofascial treatment. As will be discussed below, despite the fact that a significant minority of individuals who have scoliosis corrective surgery are thought to require a second surgery, and despite the fact that pain is the most common reason leading to such revision surgery, myofascial pain syndrome (MPS) had apparently not previously been considered as a possible factor in their pain.

Adult idiopathic scoliosis: the tethered spine.

This article reports on an observational and treatment study using three case histories to describe common patterns of muscle and fascial asymmetry in adults with idiopathic scoliosis (IS) who have significant scoliotic curvatures that were not surgically corrected and who have chronic pain. Rather than being located in the paraspinal muscles, the myofascial trigger points (TrPs) apparently responsible for the pain were located at some distance from the spine, yet referred pain to locations throughout the thoracolumbar spine. Asymmetries in these muscles appear to tether the spine in such a way that they contribute to scoliotic curvatures. Evaluation also showed that each of these individuals had major ligamentous laxity and this may also have contributed to development of scoliotic curvatures. Treatment focused on release of TrPs found to refer pain into the spine, release of related fascia, and correction of related joint dysfunction. Treatment resulted in substantial relief of longstanding chronic pain. Treatment thus validated the diagnostic hypothesis that myofascial and fascial asymmetries were to some extent responsible for pain in adults with significant scoliotic curvatures. Treatment of these patterns of TrPs and muscle and fascial asymmetries and related joint dysfunction was also effective in relieving pain in each of these individuals after they were injured in auto accidents. Treatment of myofascial TrPs and asymmetrical fascial tension along with treatment of accompanying joint dysfunction is proposed as an effective approach to treating both chronic and acute pain in adults with scoliosis that has not been surgically corrected.