Adolescent idiopathic scoliosis (AIS) remains the most common deforming orthopaedic

condition in the adolescent age group. Increasingly, both adults and children are seeking
alternative therapy, including chiropractic treatment, for this condition (Rowe et al., 2006).
The typical model for treatment is observation in early stages, bracing between 20 to 40
degrees curve progression, and surgical intervention for curves greater than 40 degrees
("Adolescent Idiopathic Scoliosis | Scoliosis Research Society", 2020). However, each case
presents differently and more aspects such as psychologic effects on the presenting patient
must also be considered (Romano & Negrini, 2008).

As a third-year university student at Central Queensland University, AIS is a condition which

we have touched on in relation to observation and assessment, as well as treatment. This
condition is also something that I can relate to, as I was personally diagnosed with AIS when
I was 14 years old. I was also seeing a chiropractor at the time and was assessed and treated
by her as well as further referred to a spinal surgeon for assessment. In regard to AIS, the
issue that I have identified this semester is that my primary concern is treating my patients
with the best health care possible. In order to do this, I need to further understand how to
accurately advise the patient in regard to treatment and potential surgical referral, as well
as the overall effectiveness of chiropractic treatment.

To begin my journey, relevant literature was sourced from various journals. There have
been a few studies done on the effectiveness of chiropractic treatment in patients with AIS.
A study published by Dale E Rowe in 2006 compared two treatment options: medical care
(observation or brace treatment) and standard medical care plus chiropractic manipulation.
For the medical care treatment, presenting Cobb angles of 20-25 degrees are carefully
observed and radiographic exams are performed twice a year. Curves between 20-40
degrees are potentially braced and undertake x-rays. Curves 40 degrees and above were
surgical candidates (Rowe et al., 2006). Alternatively, for the chiropractic treatment, the
Diversified technique is used with prone, side posture and supine adjustments. These are
performed in conjunction with manual soft tissue therapy to the overlying tissues (Rowe et
al., 2006). Treatment consisted of three sessions per week for the first month, two per week
for the second month, one per week for the third and fourth months, followed by a
maintenance program of two treatments per month for the fifth and sixth months (Rowe et
al., 2006). Outcomes were measured by Cobb angle and psychosocial measure was Scoliosis
Quality of Life Index. The standard medical care plus chiropractic manipulation group had
68% of patients who reported a clinically important improvement in the moods and feelings
domain and the global score (Rowe et al., 2006). A similar study was done by M.
Morningstar in 2011, which consisted of a 6-month chiropractic treatment plan. A cohort of
28 adult scoliosis patients reported improvements in pain, Cobb angle, and disability
immediately following the conclusion of treatment and 24 months later (Morningstar,
2011). This is further supported in a study done by K. Chang-Chen in 2008, where a
chiropractic treatment trial was put in place after 6 months of conventional medical
treatment had failed to stop progression of the curve. The trial revealed that chiropractic
treatment was associated with a reduction in the degree of curvature. These results are
suggestive that chiropractic treatment can potentially help to reduce symptoms and may
decrease the need for surgery (Chen & Chiu, 2008). The literature did however, reveal that
the success of patient outcome is dependent on not only practitioner’s knowledge of the
condition and applied adjustments, but also patient cooperation and compliance. This was
evident in a study published in 2008 by M. Romano, where only 28% of patients were
completely compliant with bracing and scheduled visits.

In order for me to develop my knowledge and understanding on my role as a chiropractor in

the management and treatment of AIS, I do not believe a team approach is necessary.
However, conducting this research has so far given me greater understanding and
confidence towards the effectiveness of treatment for AIS from a Chiropractic model.
Forward thinking into the future when I have AIS cases present in clinic, I will follow a similar
model to the trial done by Dale E Rowe in 2006. Effectiveness of treatment and
management can be measured by Cobb angle and psychosocial measure with the Scoliosis
Quality of Life Index. This will be combined with effective patient communication on the
importance of compliance. Moreover, this will give me measurable data to assess whether I
am addressing the initial presenting issue of understanding my role in treating AIS as a
chiropractor, and ensure I am delivering the best health care possible.

My patients expect me to have the knowledge and awareness of presenting musculoskeletal

conditions, and therefore treat and manage their presenting case effectively. Having a
measurable way to assess the effectiveness of my treatment, coinciding with my continual
personal research will best ensure I can meet this expectation. This therefore, is benefiting
both the patient’s health journey and myself as a chiropractic professional.
References

Adolescent Idiopathic Scoliosis | Scoliosis Research Society. (2020). Retrieved 17 September

2020, from https://www.srs.org/patients-and-families/conditions-and-
treatments/parents/scoliosis/adolescent-idiopathic-scoliosis

Chen, K., & Chiu, E. (2008). Adolescent Idiopathic Scoliosis Treated by Spinal Manipulation: A
Case Study. The Journal Of Alternative And Complementary Medicine, 14(6), 749-751. doi:
10.1089/acm.2008.0054

Morningstar, M. (2011). Outcomes for adult scoliosis patients receiving chiropractic

rehabilitation: a 24-month retrospective analysis. Journal Of Chiropractic Medicine, 10(3),
179-184. doi: 10.1016/j.jcm.2011.01.006

Romano, M., & Negrini, S. (2008). Manual therapy as a conservative treatment for
adolescent idiopathic scoliosis: a systematic review. Scoliosis, 3(1). doi: 10.1186/1748-7161-
3-2

Rowe, D., Feise, R., Crowther, E., Grod, J., Menke, J., & Goldsmith, C. et al.
(2006). Chiropractic & Osteopathy, 14(1), 15. doi: 10.1186/1746-1340-14-15