Scoliosis
a yet to be publication of the National Women's Health Network		 table of contents
Supplemental Treatments

Why call them "supplemental" and not "alternative" treatments?
We chose to use the term "supplemental" in order to avoid the negative ideas that some people associate with the word "alternative." This does not mean that all the supplemental treatments we talk about in this section are necessarily good. But we believe it is important to give you information with as little bias as possible so that you can make your own informed choice. While learning about supplemental treatments it is important to remember that they are treatments that are generally not accepted by doctors as a way to treat your scoliosis. It is best to consider these treatments in addition to traditional medical treatments.

Why aren’t supplemental treatments accepted by most doctors?
In the medical community only certain studies are accepted as proof that a treatment works. These studies often involve randomly assigning patients to different treatments. Randomly assigned means that patients are assigned to conditions of an experiment such that all persons have the same chance of being in a particular treatment. Random assignment helps scientists infer cause and effect. A control group is the group in an experiment which is not exposed to the treatment being tested. The result of the group being exposed to treatment is compared to the result of the control group to determine effects of the treatment. If possible, the studies are also double blind, which means that both patients and care providers are unaware of which treatment the patients received. Most doctors do not support supplemental treatments because there are no studies of this kind that prove that the treatment is effective. As a result, there are people who support these treatments and people who do not. If you choose to investigate or try these treatments, it is important that you do not neglect traditional treatment. (These traditional treatments are described in the section above.) Make sure that you at least continue to monitor your curve. Also, most supplemental treatments are not covered by insurance. To find out more about this you should call your insurance company.

How can I protect myself from unsafe/unproven/ineffective supplemental treatments?
Many individuals who have tried different supplemental treatments have found them to be ineffective and occasionally harmful. Others, of course, argue just the opposite. It is important, however, to have some measure of efficacy and quality, in order to compare different treatments. The treatments listed below make claims about how well they work, yet do not have evidence to support these claims. This is why they are listed in the "supplemental treatment" section, rather than the medically accepted "treatment" section. One individual with scoliosis cautions:

    One should be very careful when purchasing alternative therapies that make unsubstantiated claims. There are three main reasons to be careful: (1) efficiacy and safety. (2) physiology and (3) ethics.

    1. Safety and efficacy. When you purchase a car, you can usually assume that the car will work and will be safe. Consumer protection laws in the United States invoke large penalties against companies that fraudulently sell products or sell faulty products, and liability lawsuits provide strong incentive for companies to ensure that their products are safe.

    Scientific testing gets wrapped in very technical terms, but it's just the same as testing that a car works and that it's safe. Shouldn't you demand comparable testing for treatments that you use for your precious body? Many times, promoters of alternative therapies sell their bottles of treatments with no scientific evidence about whether their treatment works, and no evidence to show that it's safe. Furthermore, they resist efforts to test their treatments scientifically - it's a threat to their profit.

    2. Physiology. Engineers design a car to run and to be safe. That is, they work to understand how the individual parts of a car work together and design them to work better - reliable starters, seat belts and special reinforcement for safety. Sometimes they make mistakes, and then they study them and make the next car better. Similarly, scientific medicine works to understand in extraordinary detail how the body works. However, in many cases, alternative therapies resist the examination of how their treatment works, basing their treatments on fanciful systems such as energy flow that are fairy tales. Or, alternative therapies cobble together bits and pieces of scientific buzzwords that are the same as fairy tales. Many times, these theories directly contradict rudimentary understanding of the body. Purchasing alternative medicine based on fairy tales is like purchasing a car where the manufacturer says that it's safe because it's blessed by descendants of Indian medicine men who originally inhabited Detroit.

    3. Ethics. Consider the ethics of purchasing alternative medicine. On one side of the purchase, you, the person with (some) money, are suffering. On the other side of the transaction, someone has something to sell you. Is it ethical for the seller of the treatment to make claims that something will help you, when there's no scientific testing to show that the treatment can work? Maybe the seller really believes that the treatment can work. Maybe the treatment just feels good, but has no relation to the disease you have. Or maybe they're really just trying to con you. How do you tell the difference? You look at the scientific papers. If there's no scientific evidence, you have to consider the possibility that the treatment is a con.

CHIROPRACTIC

What is chiropractic?
Chiropractic is a system of treatment based on the idea that a person’s health is determined largely by structural alignment of the spine and other skeletal structures. Chiropractors believe that disturbances in alignment can interfere with normal functions and lower resistance to disease. Chiropractors treat patients mainly by using their hands to adjust parts of the body, especially the spine.

Can chiropractors treat scoliosis?
Some chiropractors claim to be able to correct minor spinal curves (under 20 degrees) or prevent further progression of a curve. There are case studies (stories of one patient and their treatment) in which chiropractors claim that they have not only stopped the progression of a scoliosis curve, but have reversed the curve a little. Other people, including some chiropractors disagree with these claims. Some ex-patients of chiropractors tell stories of curves worsening under chiropractic care.

BIOFEEDBACK

Biofeedback is a technique of making certain unconscious or involuntary bodily processes perceptible to the senses in order to learn how to consciously control them. Biofeedback is taught by a professional who uses special machines which immediately indicate when you have successfully made a desired change. Once the technique is mastered, it can be practiced without the use of the machine. There is some evidence that biofeedback might be useful in correcting curvature or maintaining correction after bracing.

COPES FOUNDATION

What is the Copes Foundation?
The Copes Foundation was created by Arthur L. Copes, Orthodist, Ph.D. It is a for-profit organization dedicated to the detection and treatment of idiopathic scoliosis. The foundation has two locations, one in Baton Rouge, Louisiana and the other in San Diego, California. The foundation claims that its treatment can not only stop spinal curvature but correct the curvature. They also claim that their treatment can eliminate the need for an surgery in some cases. The only proof offered to support this claim are stories of individual patients.

What is the treatment?
The program includes seven different elements: a brace, muscle therapy, exercise, chiropractic care, "ocular vestibular therapy,", nutritional therapy, and hydrotherapy. This information comes from the Copes Foundation site on the Web. The following is a summary of some of what was written.

Copes Scoliosis Brace: The brace is skin-tight, 5 millimeters thick, and has small pockets that are inflated with air. The air is injected every four to six weeks and is supposed to provide enough pressure to correct the curve in the spine. This brace is custom made for each patient by the Copes Laboratories and weighs approximately 2 and 1/2 pounds. It has a foam lining on the inside and is flexible enough to allow lifting and stooping activity. A patient generally wears the brace almost 24 hours a day for about 14 to 18 months. Afterwards, the brace is often worn for part of the day or for night time only. Natural growth or correction of the spine and ribs makes a new brace necessary. The brace costs $3,700 plus 3% Louisiana sales tax ($111), which makes a total of $3,811. This includes brace fabrication, fitting of brace, and installation of air. This fee does not include initial casting, orthotic training, follow-up visits, and x-ray evaluations.

Scoliosis Muscle Stimulation Therapy: The muscles of the back and torso are stimulated with electricity. The 8 or more specific spots to be stimulated are determined for each patient through X-rays and other tests. It seems that this is supposed to train the muscles to behave correctly.

3-Phase Exercise Therapy: Phase one consists of 13 exercises designed to regain a patient’s normal range of motion. Phase two consists of 12 exercises designed to increase a patient’s strength. Phase three involves body-building exercises designed to increase a patient’s "overall system strength."

Chiropractic Care: Chiropractic care (manual manipulation of the spine) is administered 2-3 times per week during the first 12 months of Copes treatment. After that it is reduced according to individual patient needs.

Ocular Vestibular Therapy: The word "ocular" means: of or relating to the eye. The word "vestibular" refers to a system in you inner ear that provides information to your brain about the force of gravity on your body and the motion of your head. There are connections between the cells of the vestibular system and the cells of your eye muscles. A "vestibuloocular reflex" is a quick response that adjusts the eye to a change in head position. The therapy is administered 1-3 times a week.

Nutritional Therapy: Supplements (pills) are used to make sure that patients are receiving enough minerals such as calcium, copper, magnesium, selenium, iron, and zinc. Dietary advice and vitamin supplements are used to make sure patients are receiving all the nutrients that their body needs.

Hydrotherapy: Patients spend 20 minutes a day in a hot bath with 2 tablespoons of baking soda and bath oil. The Copes Foundation claims that this corrects the chemical balance in cells. The bath oil also moisturizes the skin. This bath is also supposed to have a psychological benefit by providing a relaxing environment outside the brace on a daily basis.

How long this treatment lasts depends upon the severity of the scoliosis and the patient’s age (most patients are between 9 and 25). It generally ranges from 18-36 months.

How can I get more information on the Copes treatment?
For more information on the Copes Scoliosis Treatment Recovery System you can call 1-800-726-8869. Or you can write:

ELECTRICAL STIMULATION

Electrical stimulation for the treatment of progressive idiopathic scoliosis has received attention over the last decade. The way the treatment works is to apply an electrical stimulation and contract muscles near the scoliotic curve. With this muscle contraction, it is thought that the spine can be induced to temporarily straighten, halting progression of the adolescent idiopathic curve and possibly achieve correction. The treatment either requires a surgically implanted stimulator or carbon rubber electrodes placed on the skin. Small amounts of pulsating current are generated by a battery operated device and passed into the muscles through these electrodes, usually while the individual is asleep.

Unfortunately, electrical stimulation has been shown in several studies to be the same as doing nothing for your scoliosis, and for this reason is not recommended by MD physicians as treatment for progressive idiopathic curves.

EXERCISE

Can exercise straighten my curve?
There are some exercise programs that attempt to correct spine curvature. Some people believe that muscle activity involved in some movements, postures, and stretches can force the spine to become straighter. Some programs also include breathing exercises. These are intended both to help correct the curve and to increase the amount of air you can take into your lungs. (Sometimes people with scoliosis have reduction lung capacity.)

Some short term reduction of curve angles (by several degrees) and minor improvements in lung capacity have been observed for small groups of people with scoliosis who have undergone exercise programs. It is not known if these improvements were lasting or make a difference in how patients looked or how they moved. However, other scoliosis patients were not helped, and some were noted to have curve progression during their exercise program.

Do doctors prescribe exercise programs?
Some doctors prescribe exercise programs that are designed to improve the results of bracing. But studies have found that bracing alone is as effective as bracing combined with exercise. Because of these results, therapeutic exercise programs are not always recommended by scoliosis doctors. When prescribed, exercise programs are usually initiated in addition to, and not instead of bracing treatment. Careful monitoring of curve angles remains essential.

Some doctors still prescribe exercise for scoliosis patients who wear braces. They are not intended to correct the curve. They are supposed to help people adapt to the brace and to help keep their back muscles strong. On the other hand, exercise programs have often been prescribed in combination with corrective scoliosis braces. These programs are intended to help the wearer adapt to the brace, to encourage the active correction of the spinal deformity, and to maintain the trunk musculature during the bracing program. Most exercise are taught by physical therapist and then performed at home several times a day.

If my doctor does not prescribe it, is it still safe to exercise?
Exercise does not worsen scoliosis. It is usually appropriate for all scoliosis patients, even for patients who have had surgery. Some patients who have had surgery very low in their spine may need to be a little careful. If you have questions, ask your doctor. Exercise has many well-known benefits including: improved heart and lung conditioning, improved strength and flexibility of muscles and joints, and lessened risk of osteoporosis in women. (Osteoporosis is a condition of decreased bone mass and density, and increased bone fragility.) Exercise also can reduce stress and improve your sense of well-being. In addition, regular recreational exercise can help people with scoliosis remember that they are still "normal" and healthy. Exercise can also help people by reminding people to interact positively with their body and appreciate all that it can do instead of focusing on things about it they may be unhappy with.

Many people with scoliosis participate in sports and other recreational activities. Also, your doctor or a physical therapist can help you design an exercise program. There are also a number of exercise activities that scoliosis patients have mentioned as having been helpful to them. These activities include: yoga, tai chi, and Feldenkrais. There are also many other exercise activities that you can engage in that won’t be mentioned here.

What is yoga?
Yoga is an ancient physical, mental and spiritual practice designed to cultivate inner peace, an open heart, a calm mind, and a strong, relaxed body. Yoga is the practice of physical postures, breathing techniques, and relaxation. In the West yoga is most commonly associated with the branch of yoga known as hatha yoga.

What are the physical benefits of yoga?
Yoga postures can help you lengthen and strengthen the muscles that support the spine in order to relieve tightness and pain. It can also help you strengthen your legs, which enables them to carry the weight of your body (as opposed to your spine carrying all this weight.) Postures also improve flexibility in the legs and hips which helps create more mobility and strength and can improve posture. Yoga can also help stretch the muscles between your ribs and in this way create more lung capacity as well as more evenness of the sides of the body.

Some people also report that yoga has helped to decrease their back pain. Probably part of the reason why this occurs is because yoga can increase self-awareness which can enable you to take early corrective action (such as a short rest or a postural adjustment) after a mild discomfort has been recognized. In this way, more severe problems are prevented.

What are the mental and emotional benefits of yoga?
Karel Nespor, MD has published an article in which she discusses a number of mental and emotional benefits which she believes come from practicing yoga. These include: improved self-awareness, greater relaxation, decreased depression, anxiety, and irritability, easier regeneration after psychologically-induced stress and tension, deeper self-understanding, more relaxed approach to various problems, higher energy levels, reduce alienation, and improved imagination. Another study showed that mindful meditation? and yoga improved self esteem as well as general physical and mental health. Some people have reported dramatic changes in attitudes, beliefs, habits, and behaviors.

Can yoga change my curve?
Some yoga practitioners claim that yoga can improve curves. There are no studies supporting this claim.

How can I find more information on yoga?
There are descriptions and pictures of yoga poses in the Appendix. You can check your local library or bookstore for books on yoga. Also, you can call a local community center to ask about classes or look in the yellow pages. You can also contact:

You can find an On-line Yoga Teacher Directory at: http://www.yogasite.com/teachers.html

TAI CHI or TAI CHI CHEN

What is tai chi?
Tai Chi is a martial art that is designed to help practitioners improve health, tranquillity, and temperament. There are six characteristics of Tai Chi movements: they are calm, relaxed, circular, with continuous transitions between different types of movements, and movements are performed with intent and energy. Every movement in tai chi is circular so that all parts of the body travel along circular paths.

What are the benefits of tai chi?
Tai chi practitioners also claim that tai chi can improve circulation, improve breathing, improve organ functioning, aid digestion, help prevent disease, strengthen the central nervous system, and promote general physique. Some people also mention that the practice of tai chi can provide mental and emotional benefits such as improved tranquillity of mind, improved disposition and temperament, increased focus and concentration, better handling of stress and challenges, and increased inner peace.

How can I find out more about tai chi?
You can check your local library bookstore, community center, and yellow pages. You can also contact:

FELDENKRAIS

What is Feldenkrais?
Feldenkrais is a method of movement re-education, named after the man who developed it, Dr. Moshe Feldenkrais, D.Sc. Dr. Feldenkrais (1904-1984) was a Russian born physicist, judo expert, mechanical engineer and educator. The Feldenkrais Method uses gentle movement and directed attention to improve movement and enhance human functioning. Feldenkrais is done in two ways. The first way is through group classes called: Awareness Through Movement. In these classes the teacher verbally leads student through a sequence of movements in basic positions: sitting or lying on the floor, standing or sitting on a chair. Many of the movements are based on ordinary activities (reaching, standing, lying to sitting, looking behind yourself, etc.) and some are more abstract. The movements vary in complexity and difficulty. These classes last between 30 and 60 minutes. The second way to learn Feldenkrais is through private lessons called: Functional Integration. These are sequences of movement tailored to each students needs. The teacher guides the students movements through touch. Various props (pillow, rollers, blankets) are used to support the body or facilitate certain movements. These lessons typically last about 45 minutes.

What are the benefits of Feldenkrais?
According to Feldenkrais teachers, Feldenkrais can increase your ease and range of motion, improve your flexibility and coordination, and make your movement more graceful and efficient. Teachers also claim that these improvements will often generalize to enhance functioning in other aspects of your life. Some people have found Feldenkrais helpful in lessening their back pain. Teachers can figure out how you are moving, how this may relate to the pain that you are experiencing, and how you could move differently enough so the pain would lessen.

Can Feldenkrais change my curve?
Some practitioners claim that Feldenkrais can improve scoliosis. There are no studies to support this claim. Some other practitioners say that this claim false and that Feldenkrais is not a treatment for any kind of medically diagnosable problem.

How can I find out more about Feldenkrais?
To find a Feldenkrais practitioner near you or to find out more information about Feldenkrais you can contact the Feldenkrais Guild. A directory of practitioners can also be found on-line at www.feldenkrais.com

    Feldenkrais Guild of North America (FGNA)
    524 Ellsworth St. SW
    PO Box 489
    Albany, OR 97321
    Phone: 1-800-775-2118
    OR 1-541-926-0981
    Fax: 1-541-926-0572
    Email: feldngld@peak.org