CLEAR Scoliosis: Case Study
by Dennis Woggon, DC, B.Sc.
THE PATIENT PRESENTED in 2008 with a 48 degree right thoracic Cobb angle. It was initially diagnosed in 2005 at 25 degrees. The patient had a history of birth trauma. The scoliosis previously was treated with traditional Chiropractic Care. The standard CLEAR Scoliosis examination was performed. Her X-rays revealed a loss of the cervical lordosis and forward head posture (FHP) with left alar ligament damage. There was a primary right thoracic Cobb angle of 48 degrees, with compensatory left cervical dorsal Cobb angle of 35 degrees and a left lumbodorsal Cobb angle of 24 degrees. When the addition of the “compensatory” Cobb angles is larger than the primary Cobb angle (35 + 24 = 59), the scoliosis will advance. Treatment consisted of CLEAR protocols with 11 visits. The Mix, Fix, Set procedures consisted of warm-ups, adjustments and rehabilitation. The Mix phase consisted of cervical traction to improve the cervical lordosis and decrease forward head posture and vibrating traction (VT) to improve the cervical and lumbar lordosis. This mechanical traction (VT) allowed relaxationof soft tissue, specifically ligaments and discs to allow for separation between joint surfaces. Cervical drop traction was used to reduce the forward head posture and increase normal lordosis. The Spinalator allowed mechanical traction to decrease the degree of tension in the soft tissues and also allowed for more separation between joint surfaces. The Eckard Table created mechanical traction with mirror image positioning of the patient's X-ray configuration. The Eckard Table provided motion as well as traction for therapeutic exercises and decreased disc wedging. The Fix or adjusting phase consisted of specific spinal adjustments based on 8 precision X-rays and the supine neurological leg check. They included anterior thoracic adjustments, lumbodorsal pelvic side posture and drop adjustments, cervical dorsal adjustments using the Arthrostim, long axis traction adjustments, as well as extremity adjustments to the shoulders, 1st ribs and TMJ. To correct the scoliosis, the upper and lower cervical angles must be corrected and the legs must be balanced. The Set phase teaches the spine to stay in position. This included the: LD ball exercise, ball twist exercise, standing strap stretch exercise and vibration therapy and rotatory twist exercise. These exercises are therapeutic and assist in developing strength, endurance, range of motion and flexibilit. Pneumex gait training with spinal weighting is a style of walking including rhythm and speed. The patient also used the Scoliosis Traction Chair (STC), which is a combination of traction and whole body vibration (WBV), with a mirror image placement of the patient and tension straps utilized to pull rather than push the spine towards normal alignment. Tightrope exercises were utilized for gait training with spinal weighting. Next, The VibeTM was used with head, shoulder and hip weighting. This is a vibrating platform for proprioceptive neuromuscular re-education with cervical traction. Spinal weighting with WBV causes the spine to “react” to the unbalanced forces returning the spine to a normal position. The patient’s re-evaluation revealed an improvement of the scoliosis. The right thoracic Cobb angle of 48 degrees decreased to 34 degrees, the left cervical dorsal Cobb angle of 35 degrees decreased to 18 degrees and the left lumbo-dorsal Cobb angle of 24 degrees decreased to 11 degrees. More importantly, the forward head posture (FHP) returned to normal. The patient showed significant improvements in the cervical and lumbar lordosis, correction of the upper and lower angles as well as other spinal units, stabilization of the alar ligament, and a balanced neurological leg check. Lastly, the patient was instructed to continue with home protocols including head weights with limited vision glasses (to improve the cervical and lumbar lordosis, decrease forward head posture, and improve neuromuscular re-education for movement, balance, coordination, kinesthetic sense, posture and proprioception), specific spinal isometric exercises and scoliosis stretching exercises (to develop strength, endurance, range of motion and flexibility), cervical traction, and the Scoliosis Traction Chair (STC), as well as continued chiropractic care and a follow up evaluation every three months. Discussion: The scoliotic spine does not follow what we would consider normal spinal biomechanics. Therefore, normal chiropractic procedures may not be effective in some cases. This patient did benefit from previous chiropractic care symptomatically, but not structurally. The CLEAR hypothesis is that Adolescent Idiopathic Scoliosis (AIS) is caused by a combination of neurological (subluxation) and biomechanical deficits, FHP and a loss of normal spinal lever arms. Additional follow up and research is necessary to improve upon the chiropractic profession’s understanding of the scoliotic spine.