Myofascial and Articular Treatment of Adolescent Idiopathic Scoliosis
Condition: Scoliosis Idiopathic Adolescent Treatment
MeSH terms: Scoliosis
Study type: Interventional

Summary: 
      Randomized controlled trial of participants with scoliosis into standard treatment with
      observation/bracing and the other group will have the added treatment of dynamic myofascial
      manipulation for 6 months.
    

Detailed description: 
      The purpose of this study is to conduct a pilot study of the Dynamic Myofascial and Articular
      Mobilization and Reorganization (DMAMR) treatment in Adolescent Idiopathic Scoliosis (AIS).
      The investigators propose the implementation of Dynamic Myofascial and Articular Mobilization
      and Reorganization (DMAMR) protocol can (a) decrease and/or reduce progression of spinal
      curvatures, (b) reduce degree of anatomical rib hump deformity common in AIS, (c) decrease
      incidence of patients requiring corrective bracing and/or corrective spinal surgery, (d)
      significantly reduce AIS-associated pain, and (e) improve quality of life for AIS
      participants.

      This study will test whether DMAMR produces clinically relevant changes in progression of
      scoliosis curvatures and rib humps, and whether this treatment protocol improves pain scores
      and quality of life.

      Current research has demonstrated unilateral muscle shortening in AIS. Of most importance for
      this research proposal, research has also identified a set of muscles, portions of which are
      at an angle to the spine, that are shorter on the concave side of the curvature: the
      quadratus lumborum, psoas major and minor, and the abdominal obliques. The researchers have
      suggested this is a compensatory effect of the spinal deformities seen1. The investigators
      agree that unilateral muscle shortening is present in AIS but the investigators suggest that
      this asymmetry represents differences between muscle tension on either side of the spine and
      results in a tethering effect on the spine itself. Supporting a finding of the importance of
      these muscle imbalances, research using individualized physical therapeutic exercise programs
      to balance these types of muscle imbalances has demonstrated effectiveness in AIS treatment.

      The investigators hypothesize this asymmetrical muscle imbalance, and its resultant tethering
      effect on the spine, represent myofascial dysfunction. The investigators believe the forces
      generated by this dysfunction are sufficient to induce worsening of the AIS curvature. The
      myofascial factors involved in the tethering of the spine in AIS include asymmetrical muscle
      imbalances involving muscles at an angle to the spine, primarily iliopsoas, quadratus
      lumborum, abdominal obliques, latissimus dorsi, and anterior serratus muscles.

      Fascia overlies and interpenetrates these muscles. At a critical point, these myofascial
      imbalances generate sufficient stress on the overlying fascia to create a further contractile
      force within the fascia itself. The investigators ask whether this contractile force is
      mediated not only by anatomic shortening of individual muscle groups but also by intrinsic
      changes in fibroblast gene expression within the fascia itself.

      The investigators further hypothesize that the asymmetrical muscle imbalances observed in AIS
      may be part of a larger contracted fascial spiral force influencing the development and
      progression of deformity. Therefore, treatment of the muscles, fascia, and related articular
      dysfunction may contribute to the control or reduction of AIS-associated deformities
      including scoliotic curvatures and accompanying rib humps. Effective treatment of these
      imbalances and deformities may reduce or eliminate AIS-associated spinal area pain, which the
      investigators hypothesize is largely myofascial in nature.
    

Intervention name(s): Dynamic myofascial manipulation; Standard AIS treatment with observation or bracing
Intervention type(s): Other; Other
Intervention description(s): Dynamic myofascial manipulation of the muscles in the back to improve the scoliosis appearance/flexibility/rotation; Observation with radiographs and bracing of curves greater than 20 degrees
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized controlled trial between 2 treatment groups
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: scoliosis; adolescent; chiropractor; myofascial; idiopathic