Scoliosis and Its Common Impacts
October 3, 2008
Scoliosis is a common orthopedic condition affecting millions of individuals. In fact, more than a half million doctors’ visits occur each year regarding the evaluation and treatment of scoliosis.
What is scoliosis? In medical terms, it describes lateral (side to side) curvatures of the spine (aka: the mid and/or lower back).
Occurring at any age, scoliosis most commonly develops between the ages of 10 and 15. Girls are more commonly affected than boys. The condition may be inherited or the cause may be unknown. In any case, scoliosis can be puzzling and should be evaluated and monitored properly to ensure the best outcome at any age.
Our bodies have specific spinal curvatures from front to back, as well as a straight line appearance from top to bottom. Because we stand and walk on two feet, we constantly use muscle control to keep us upright, while fighting external forces such as gravity. In most cases, "normal" spinal curves allow us to move and function correctly, and allow the body to be more resistant to injury.
On the other hand, abnormal curvatures can cause problems. In some individuals, lateral (or sideways) spinal curvatures can develop, which change the "normal" straight line appearance of the spine. If the curvature is measured larger than 10 degrees (side to side), it can be called a scoliosis. Curves less than 10 degrees are not classified as a scoliosis and may just be postural compensations. Some curvatures may be accompanied by increased front to back curves (kyphosis), may involve rotation of the spinal bones (vertebrae), or even contain more than one curve. Whether from daily activities, poor posture, specific injury, or even due to genetics, any change in "normal" curvature will affect spinal movement, position and function.
In most cases, the cause is unknown. In other cases, trauma, postural problems, developmental issues, neurological diseases, or other conditions may be causally related. Some scoliosis may be related to muscle spasm, biomechanical compensation, or leg-length inequality, which can often be addressed conservatively. Other scoliosis may be more complicated and may require more invasive treatments.
How is scoliosis evaluated? A thorough history and physical examination, including a postural analysis and spinal screening, is usually the first step in evaluating a spinal curvature or diagnosing scoliosis. Only if clinically appropriate and necessary, X-ray evaluation can determine the location and degree of the curvature, as well as monitor other associated factors. Depending on each case, additional diagnostic testing and/or repeat X-rays may be necessary as often as every 3 months to as little as once every few years to monitor abnormal findings.
Symptoms differ in each person. Fortunately, 4 out of 5 people with a scoliosis have curves less than 20 degrees, which are usually not detected by the untrained eye and have no symptoms. In most small curves, pain is not an issue and progression of the curve does not occur. In severe cases, pain and limited physical activity may be evident, in addition to possible harm to internal structures.
Will the scoliosis progress? In most cases, scoliosis remains mild, does not progress, and requires little treatment, if any. In other cases, growing children may have rapidly progressive curves which require more frequent check-ups and more aggressive treatment. One group of concern will be young females who have a scoliosis greater than 25 degrees and who have not had their first menstrual period. This concern is due to rapid growth during this developmental period. In addition, adults with pain and progressive curvatures must be monitored more closely.
Successful treatment doesn’t mean reversing the curve, but it means managing it and stopping it from getting worse. Curves under 20 degrees are usually "treated" with careful observation and conservative options, since most mild scolioses don’t progress or cause physical problems. Specific therapeutic exercises and stretching, electrical stimulation and spinal manipulation have been successfully utilized in the management of scoliosis. For curves between 25 and 45 degrees, in addition to those who are not at skeletal maturity, conservative care to include bracing may also be recommended. Bracing depends on the type and site of curvature. Surgery may be an option for curves greater than 45 degrees and progressive, and/or when internal organ function is affected.
Most people with scoliosis lead normal lives without complications. Physical activity is usually well-tolerated and encouraged. Since none of these therapies alone have been shown to consistently reduce scoliosis or to make the curves worse, an integrated approach to the treatment of scoliosis using your medical doctor as well as a chiropractic physician is a proven and effective treatment option.
Dr. Todd Joachim, a chiropractic physician, practices in Marion. He specializes in the conservative treatment, rehabilitation and management of musculoskeletal injuries and conditions including scoliosis, while using non-surgical chiropractic treatment options. Questions regarding chiropractic care or health concerns can be addressed to dr_todd_dc@yahoo.com
Source: marionstar.com
Arthritis of Spine Targets Young Men
October 2, 2008
It’s a disease that affects between 150,000 and 300,000 Canadians, strikes males three times as often as females and is literally a pain in the backside.
Ankylosing spondylitis (AS) is a mouthful to say, so some people call it "poker back." Having it can wreak havoc with your golf game, and make just getting around the house difficult.
New advances in diagnosis and treatment may help catch AS early and greatly ease the negative effects of this disease.
AS is a type of arthritis that usually affects the spine. According to a recent paper by Dr. Saeed A. Shaikh of McMaster University, "ankylosing spondylitis most commonly has its onset while a patient is in their 20s, although late teenage years are also relatively common for initial symptoms."
He adds that the disease "has a predilection to affect young males." It also has a strong genetic component, with a gene called HLA-B27 showing up in 93 per cent of the patients with AS, but is seen in only six per cent of the general population.
According to Shaikh, it can still be very difficult to diagnose, and "on average, there is a seven-to-10-year delay in the diagnosis of this disease from the onset of symptoms."
It doesn’t help that, he says, "the majority of back pain sufferers do not seek care from healthcare providers. Young men tend to be the segment of the population that are the least likely to do so."
So, you young guys, being tough and sucking it up when confronted with an aching back may work against you.
Magnetic Resonance Imaging (MRI) technology can reveal the earliest signs of this disease, especially inflammation in the sacroiliac joints, long before anything would show up on a conventional X-ray. (The sacroiliac joints connect the sacrum — the wedge-shaped bone at the bottom of the spine — to the pelvic bones.)
If left unchecked, AS can cause chronic back pain, stiffness, especially in the morning, as well as fatigue and pain in the joints. There can also be consequences elsewhere in the body, including eye infections, psoriasis and inflammatory bowel disease. In advanced cases, bony spurs can grow out from the edges of the vertebrae, fusing together parts of the spine and making movement even more difficult.
The Arthritis Society of Canada has plenty of good, objective information on this disease on its website, arthritis.ca. It says treatment usually starts with a non-steroidal anti-flammatory drug, like the ones you probably have in your medicine cabinet. Corticosteroids are sometimes given by injection into the affected join to provide short-term relief. For severe cases, there are disease modifying anti-rheumatic drugs such as methotrexate and sulfasalazine. Of course any medication can have side-effects so the benefits need to be weighed against the risks.
A new class of AS treatments involves biological response modifiers, sometimes just called biologics. These drugs work by plugging up the pathway that leads to inflammation. According to the Arthritis Society, they "recently have been shown to have the potential to slow or even halt the progression of AS in some people."
You can tell there’s big money in biologics, since the company behind one of them, Remicade® (infiximab), has sponsored a very high-quality website called ihaveoptions.ca. On it, an unidentified, but very trustworthy looking guy in a white coat reviews the treatment options. While the information is medically vetted and factual, with links to other sources, it’s still useful to remember that the pharmaceutical company Schering-Plough Canada Inc. pays the bill for this website.
Most of the biologics are given by intravenous injection, at intervals of several weeks or months. Because of their cost, which the Arthritis Society estimates at $15,000 to $25,000 per year, most provincial health plans restrict them to patients whose disease cannot be controlled by conventional treatments. And because they depress the immune system, there are certainly people who should not be taking them at all.
Of course, there are some excellent non-pharmaceutical approaches to ease this disease. They range from stretching exercises to physical therapy to trying to maintain good posture. A physiotherapist can be very helpful in showing you how.
Moderate physical activity is desirable, but the Arthritis Society cautions against contact sports such as rugby or hockey, or falling down sports like skiing, because a person with AS may be at greater risk of spinal fracture.
Most experts agree that people with AS will always be aware of their disease, but advances in diagnosis and treatment can keep it under control. Famous people with AS reportedly include baseball player Rico Brogna and Mötley Crue guitarist Mick Mars.
Then again, former world chess champion Vladimir Borisovich Kramnik may be a more relevant example for most of us. The discomfort of sitting at a chessboard actually forced him out of the game.
But with medication for his AS, he was back for the 37th Chess Olympiad in June 2006. For now at least he seems to have his disease in check.
Tom Keenan, I.S.P., is an award-winning science writer, professional speaker and professor at the University of Calgary.
Source: canada.com
Watchung Chiropractor Works to Ease the Pain
October 1, 2008
Whether suffering pain from an acute injury or a chronic condition, the walking wounded come to Dr. Ron Spiaggia’s rehabilitation facility seeking the same thing: pain relief and a return of physical mobility and function.
Long before the chiropractor purchased the building in September 2001 to open his own practice, Spiaggia was familiar with the Watchung Avenue site. After earning his chiropractic degree, Spiaggia, 39, married 12 years and the father of three children, began his career in 1984 in the same building when it was the Back and Neck Care Center.
Since 2001, Spiaggia has overseen two expansions of the facility to accommodate patient volume and a business strategy to provide ""diversified, full treatment services,” he said.
The doctor said the practice sees from 80 to 100 patients a day, five days a week.
"The practice has grown 300 percent in patient volume, and the building was expanded from 1,500 square feet to its current 4,000 square feet,” Spiaggia said.
Filling all that space is a second chiropractor, Dr. Faisal Hussain, a psychiatrist; Dr. Paul Abend, a specialist in rehabilitation after nerve, muscle and bone injuries and illnesses; Andy Koser, a physical therapist; Anna Mantelli, a licensed massage therapist; and the support staff necessary to manage patients, billing and insurance companies.
"As a physiatarist, Dr. Abend provides neurodiagnostic testing and light pain management,” Spiaggia said, adding that chiropractors are not licensed to provide prescription medication.
Each specialist at Performance Rehabilitation & Sports Injury Center complements Spaiggia’s goal of providing comprehensive evaluation, treatment and maintenance following an injury.
Two new treatment therapies are available at the center: DRX 9000C Spinal Decompression Therapy and Micro Vas Therapy.
Spinal Decompression Therapy is a noninvasive course of treatment for chronic back pain, typically including herniated and bulging discs and degenerative-disc disease conditions of the neck or low back.
"I began using the DRX 9000C about 18 months ago. After getting very good results, recording less than a three percent 
exacerbation of a patient’s condition following treatments, I now have two DRX machines. I’m proud to say I’m the only center in Central Jersey that offers this particular nonsurgical treatment,” Spiaggia said.
DRX machine therapy "reduces intradiscal pressure while sending water and nutrients back into the problem disc. This allows the disc to repair itself,” Spiaggia said.
On a recent visit, Dennis Kirk of Rahway was getting suited up for a long spinal stretch on the DRX 9000C. The girdle-like brace he donned isolates the area of the spine to be treated, which first was determined through a Magnetic Resonance Imaging scan.
Kirk laid on the DRX’s padded table and was positioned into a supine position to receive a slow, calibrated stretch of his lumbar area.
"I’ve had better than a 100 percent improvement of my pain since I started this treatment plan,” Kirk said.
He also receives traditional physical therapy modalities during his visits.
Thomas Calavano of the Martinsville section of Bridgewater received Micro Vas Therapy. Referred to Performance Rehabilitation by his podiatrist, he was seeking relief from the painful symptoms of neuropathy in his feet.
"I’ve been suffering pins and needle and electric-shock sensations for three years, with no relief. Four neurologists later, and also after acupuncture treatments, I am getting some results from this,” Calavano said.
His treatments require the application of eight pads on eight leg, which, when activated, give gentle electrical stimulation for 45 minutes.
Micro Vas Therapy ""increases circulation and oxygen levels to the affected extremity,” Spiaggia said.
Growing up in Livingston, Spiaggia thought he would study to be a dentist. He turned to chiropractic after the only relief he got for a football injury was after chiropractic treatments.
"I decided then I wanted to help people suffering pain, especially someone who had been injured playing sports,” Spiaggia said.
Spiaggia still enjoys treating patients with sports injuries.
"I love dealing with athletes because they make good patients,” Spiaggia said, adding that athletes already are ""wired” to make a commitment to get excellent results from their treatment.
Even though Spiaggia has moved toward treating individuals who suffer chronic pain and who are 40-plus years old, his commitment to alleviate pain remains.
Laurie Levoy: 908-707-3118; llevoy@MyCentralJersey.com
Source: mycentraljersey.com
Pain Isn’t Just a Symptom of Arthritis
October 1, 2008
Pain is often thought to be a debilitating symptom of osteoarthritis. But new research suggests pain is more than a symptom, it’s a damaging part of the disease itself.
According to a new study, pain signals originate in arthritic joints and the biochemical processing of those signals as they reach the spinal cord actually worsen and expand arthritis. Furthermore, researchers found that nerve pathways that carry pain signals transfer inflammation from arthritic joints to the spine and back again to the joint — causing disease at both ends.
The process of pain signals being transmitted from the sight of origin to the processing centers in the spinal cord and back is called nociception — a type of “crosstalk” within the body. According to the study, it’s this crosstalk that enables joint arthritis and inflammation to be transmitted to the spinal cord and brain and consequently spread throughout the central nervous system.
Researchers have identified likely drugs that can interfere with the crosstalk of arthritis pain through inflammatory receptors on sensory nerve cells. This could be an effective new approach to treating osteoarthritis — a condition that affects 21 million Americans.
“Until relatively recently, osteoarthritis was believed to be due solely to wear and tear, and inevitable part of aging,” Stephanos Kyrkanides, D.D.S., Ph.D., associate professor of Dentistry at the University of Rochester Medical Center, was quoted as saying. “Recent studies have revealed, however, that specific biochemical changes contribute to the disease, changes that might be reversed by precision-designed drugs. Our study provides the first solid proof that some of those changes are related to pain processing, and suggests the mechanisms behind the effect.”
Researchers also believe that if joint arthritis can have an effect on neuro-inflamation, it could have a role in conditions like Alzheimer’s disease, dementia and multiple sclerosis.
SOURCE: Arthritis and Rheumatism, 2008;58:3100-3109
Source: ivanhoe.com
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