Myofascial and Articular Treatment of Adolescent Idiopathic Scoliosis

Study Overview
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Brief Summary
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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
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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.

Official Title
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Dynamic Myofascial and Articular Mobilization and Reorganization (DMAMR) Treatment in Adolescent Idiopathic Scoliosis (AIS)

Conditions
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Scoliosis Idiopathic Adolescent Treatment

Intervention / Treatment
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* Other: Dynamic myofascial manipulation
* Other: Standard AIS treatment with observation or bracing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age from 10-15 Scoliosis curve of 15-30 degrees on cobb angle Risser stage of 0-2 Exclusion Criteria: outside of age range, cobb angle or maturity level

Ages Eligible for Study
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Minimum Age: 10 Years
Maximum Age: 15 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: randomized controlled trial between 2 treatment groups
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Standard treatment for AIS<br>These are the participants with AIS that recieved the standard treatment with observation or bracing depending on the size of their curve. | Other: Standard AIS treatment with observation or bracing<br>* Observation with radiographs and bracing of curves greater than 20 degrees<br>|
| Experimental: Treatment with Dynamic Myofascial Manipulation<br>These are the participants that still received the standard treatment with observation or bracing depending on the size of their curve, but also had weekly treatment with a chiropractor for 6 months for dynamic myofascial manipulation | Other: Dynamic myofascial manipulation<br>* Dynamic myofascial manipulation of the muscles in the back to improve the scoliosis appearance/flexibility/rotation<br>Other: Standard AIS treatment with observation or bracing<br>* Observation with radiographs and bracing of curves greater than 20 degrees<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cobb angle | Cobb angle as measured on x-ray | At time of enrollment | 
| Cobb angle | Cobb angle as measured on x-ray | 6 months from time of enrollment | 
| Scoliometer degree | The degree of rotation measured clinically with a scoliometer | At time of enrollment | 
| Scoliometer degree | The degree of rotation measured clinically with a scoliometer | 6 months from time of enrollment | 
| SRS-22 | Functional survey for the patient to fill out on their scoliosis. This survey has been validated in the literature. It is a 22 question survey on the functional status and pain that a patient experiences. Created by the scoliosis research society. There is a scoring rubric that goes with the survey. | At time of enrollment | 
| SRS-22 | Functional survey for the patient to fill out on their scoliosis. This survey has been validated in the literature. It is a 22 question survey on the functional status and pain that a patient experiences. Created by the scoliosis research society. There is a scoring rubric that goes with the survey. | 6 months from time of enrollment | 
| Pain scale | 4 questions about their pain level using a visual analog scale of 0-10. Zero is no pain and 10 is the worst pain they have ever felt. | At time of enrollment | 
| Pain scale | 4 questions about their pain level using a visual analog scale of 0-10. Zero is no pain and 10 is the worst pain they have ever felt. | 6 months from time of enrollment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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scoliosis, adolescent, chiropractor, myofascial, idiopathic