Any deviation of two or more consecutive vertebræ from the normal
curves of the spinal column is usually termed by the osteopath a
pathological curvature. Of the common pathological curvatures of the
spinal column there are found: (1) scoliosis or lateral curvature, (2)
kyphosis, or excurvation, an antero-posterior curve with the convexity
backward, and, (3) lordosis, or incurvation, an antero-posterior curve
with the convexity forward.
=Osteopathic Etiology.=—Of primary importance in the causation of
pathological curvatures of the spinal column, are injuries to the
spine, such as strains, falls, blows, and various physical forces,
acting directly or indirectly, as injuries to the chest, pelvis and
limbs. The osteopath in his daily work finds more curvatures, as well
as acute and chronic diseases, resulting from some simple injury to the
spine, as a slip, strain or twist, than from any other cause. The dire
effects of any violence to the spinal column cannot be overestimated.
Among =predisposing causes= may be mentioned, continued ill health,
general weakness, rapid growth, rachitis, tuberculosis, etc. Any
habitual one-sided position may result in a curvature. An injury to the
chest, adhesions from pleuritis, chronic liver disease, obliquity of
the pelvis producing unequal length of the legs, carrying heavy weights
on one side, and various morbid growths of the chest and abdomen, may
all produce curvatures. Many cases are found in school children who
are growing rapidly, and whose muscular strength and development do
not keep pace with their growth. Unilateral atrophy of the muscles,
due to central changes or overuse, may be the cause of deviations of
the spinal column. Sacro-iliac disease in some instances is a potent
factor. Thus there may be a great variety of causes productive of the
incipiency, and the spine being strained or irritated at a single point
and in a certain way gradually develops a curvature. Every spinal and
innominate lesion should be considered as a potential cause for a
curvature.
=Scoliosis.=—This is the most common spinal deformity and is
characterized by lateral deviation from the median line. In most
cases the curve is to the right in the upper dorsal region, with a
compensatory curve in the opposite direction in the lumbar region. The
curve being to the right in the majority of cases, is probably due to
the fact that most people are right-handed.
=Morbid Anatomy.=—The vertebræ in the region involved are rotated so
that their spinous processes point toward the concavity of the lateral
curve. The bodies of the vertebræ on the side next to the concavity
are thinner, due to absorption; the intervertebral discs are made thin
on the same side by pressure and absorption. The ribs are considerably
distorted, depressed on the concave side and prominent on the convex
side. The ligaments on the concave side are contracted, and stretched
on the convex side. The muscles on the concave side are more or less
contracted, and on the convex side they are stretched, causing atrophy
and fatty infiltration of their tissues.
=Kyphosis.=—This may be a slight posterior curve really amounting to
nothing, or it may be a very grave pathological condition as in Pott’s
disease. Therefore it is very necessary that one should make a most
careful diagnosis (see Pott’s disease).
The most common =causes= of kyphosis are Pott’s disease, rachitis,
occupation, general weakness, rheumatism and old age.
In Pott’s disease, the posterior curve is characterized by a sharp
angle, and by the spine being very rigid. This, taken in conjunction
with the history and other symptoms should be sufficient to enable one
to make a diagnosis. Radiographic examination should be made.
The condition of round shoulders, which in time produces marked
kyphosis, is rarely a habit as it is usually termed. In nearly every
case it indicates either a weakness of the back muscles or, what is
more apt to be the cause, a strained posterior condition of the dorsal
vertebræ, commonly of the lower dorsal region.
=Morbid Anatomy.=—In mild cases there is simply a relaxation of the
ligaments of the vertebræ and a separation of the laminæ and spinous
processes. In severe forms there may be absorption of the anterior
portion of the intervertebral discs and the bodies of the vertebræ
(Pott’s disease).
=Lordosis.=—This may be a congenital condition, especially when
occurring in the lumbar region. Anterior curves of the spine are
generally found in the lumbar or cervical regions, but occasionally
occur in the dorsal region, causing the spinal column to be more
or less straight, and thus weakening the individual. This curve is
commonly compensatory to kyphosis, hip-joint disease and congenital
dislocations of the hip.
=Treatment= of =Spinal Curvatures=.—The treatment of pathological
curves of the spinal column, by osteopathic methods, has been highly
satisfactory to both osteopath and patient. The success of the
osteopath in these cases has been due to his comprehensive and exact
knowledge of each vertebra, and of the spinal column in general. He
recognizes curvatures that the ordinary practitioner, and it is safe
to say the orthopaedic specialist, would not even notice or recognize.
On account of the highly developed sense of touch of the osteopath,
he is capable of detecting the slightest deviation of one vertebra
from another, and of the spine in general from the normal. Thus by
the uniqueness and peculiarity of his work he is capable, not only of
discovering a curvature, but also of reducing a curve when found.
The work consists of, first, relaxing any muscles that may have become
rigid over the seat of the curve. Then follows a treatment to each
vertebra involved, by attempting to replace it, and treatment to
the curve in general by springing it toward its normal position. At
each treatment effort should be made to accomplish something toward
correcting the spine; too many treatments are given in a “general”
way, and being unspecialized amount to nothing. One must become
familiar with the exact location of each vertebra involved, to attempt
a correction of a curvature intelligently. Upon this one point it is
impossible to speak too strongly, for a great many treatments have been
wasted and improvement of cases retarded by not paying enough attention
to the details of the diagnosis, either from pure slothfulness or from
an imperfect conception of osteopathy. Corrective exercises are always
of value in addition to treatment.
These remarks refer to incipient and certain moderate curvatures.
In other cases radical measures (Abbott) should be employed if age
and conditions permit. Remember, however, that the practitioner in
his daily work of adjusting the many combinations of rotation and
sidebending lesions corrects innumerable actual and impending curves.
=Lateral curvature= in the dorsal region is undoubtedly the hardest
to correct on account of the ribs, which complicate the condition.
A marked curve in the dorsal region is sure to be accompanied by a
dislocation of the vertebral end of one or more ribs. Treat each
distinct lesion separately, follow by general stretching, replacing and
molding of the tissues. A good method to stretch tissues and adjust
a moderate lateral curve is to utilize the swing, or in lieu of this
have the patient stand just at arm’s length from the wall with concave
side toward the wall with straight arm at right angles and palm resting
against the wall. Stand in front of patient whose feet are firmly on
the floor and reach around with both hands upon the spine. As the
patient sidebends toward the wall it tends to correct the deformity, so
if the operator coordinates his adjustment with that lateral movement
of the patient, precise fulcra can be obtained and a certain, definite
correction secured. The significance rests with the stretching of
tissues and the definite fulcra obtained, thereby securing a maximum
sidebending and rotation toward correction.
The =dislocation= of an =innominate= sometimes complicates matters, but
is a simple point to remedy, and should not be overlooked.
The correction of a curvature presents a special study to the
osteopath, whether it be scoliosis, kyphosis or lordosis, and special
rules cannot be laid down for treatment. Cases of rare occurrence are
what might be termed “symmetrical” curves; i. e., no vertebra presents
separately a marked lesion, the column on the whole being simply bowed.
Such cases can be treated by springing back the spinal column, and by
the use of methodical exercises. Unfortunately most curvatures are
characterized by various lesions between the vertebræ, and thus each
lesion requires special work.
In simple curves the use of braces, jackets, and the various mechanical
appliances are of very little use to the osteopath, in fact, more
harmful on the whole, than beneficial. Naturally they would apply to
a “symmetrical” curve, or where the patient is too weak to sit or
walk, but they can be of very little use to the average patient, in
place of correct osteopathic treatment. Mechanical appliances confine
the movements of the patient, interfere with the development of the
muscles, and impinge to a greater or less extent the spinal nerves.
Due attention to hygienic surroundings and diet are certainly of aid.
Proper exercises and occupation for the sufferer should be advised.
Special care should be taken in examining (radiographic) for infectious
lesions (arthritis).
=Straight Spine= is a term used particularly by osteopaths for a
condition seldom recognized by orthopedic surgeons. The following
is from H. W. Forbes[40]: Straight spine is “a departure from the
normal in the conformation of the chest; characterized anatomically
by bilateral diminution in size, decrease in the antero-posterior
diameter, relative increase in the transverse diameter and flattening
of the anterior and posterior walls; characterized clinically by
diminution of respiratory capacity, lowered lung and heart resistance,
impaired general nutrition and predisposition to neurosis.
“Of the many possible manipulations that may be used to lift and
overcome the morbid bend of the ribs I will attempt the description of
but one.
“Relax the musculature of the back and chest. Rotate, flex and extend
the dorsal spine. Examine all the ribs on each side and loosen any that
do not move freely. Having done this, the patient is prepared for the
specific treatment. Have the patient sit on a stool and lean forward
on a table. Have him separate the elbows, flex the forearms, place one
hand over the other and his forehead on the hands. Tell him to relax
all the muscles of the shoulders and arms and to breathe deeply without
using the muscles. After a few trials he is able to fully expand his
chest without contracting the muscles connecting the upper extremity
with the trunk. The physician then takes a position at side (either
side) of the patient and places the weight of his trunk on the ribs of
the side he is on, a little external to their angles. He passes his
arms around the patient’s body; the arms passing across the front of
the chest are carried around far enough to allow the hand to be placed
on the ribs just external to their angles. The other hand is placed
on the top of this one. In this position the physician’s body on one
side, and his hands on the opposite, occupy similar positions. The
patient is now told to inspire deeply and at the same time to relax
the shoulder muscles, as before instructed. As the chest expands drop
the weight of the trunk on one side and make pressure forward (forward
meaning toward the anterior surface of patient’s body) with the hands
on the other side. This lifts the ribs to a greater extent than the
patient unassisted could lift them. At the end of inspiration and
during the first third of expiration the chest is compressed laterally.
The compressing force, if applied correctly, will fix the ribs in a
position of less obliquity and will also correct the increased lateral
bending of them. The dorsal spine becomes more convex posteriorly
at the moment of lateral compression of the thorax, if correctly
made. Great force should not be used at the beginning. Repeat the
manipulation five to twenty times each treatment. Give treatment three
times a week. A similar movement may be given on the table.
“The greater number of flat chests in patients under thirty years
of age may be corrected. If the patient is above thirty, although
complete correction may not always be accomplished, the results are
satisfactory. Two to six months treatment is required.”
=A “typhoid spine”= comes as a sequel to typhoid fever. There is
constant pain, tenderness along the lumbar region and rise of
temperature. The pain is generally increased when the spine is moved
forward or sidewise. Such a condition is clearly understood by the
osteopath. There are always found distinct vertebral lesions along
the region that is tender on pressure. In fact these very lesions may
have been the predisposing cause of the attack of typhoid fever.
The treatment is rest and the indicated manipulation to correct the
derangements. It is of great interest to note that where the typhoid
patient is treated osteopathically the condition just described seldom
results. Observations by C. M. T. Hulett confirm this statement.
The =Neurotic Spine= may be the result of injury but the subject is
usually of a nervous, neurasthenic type. It occurs from the age of
puberty to adult, much more often in females than males.
The patient has dull pain in the back of the neck or in the lumbar or
sacral region, complains of a constant tired feeling and often of a
sharp neuralgic pain in certain parts of the spine. Generally there is
a drooping posture in the upper dorsal with shoulders thrown forward,
which is a sign of weakness. There is extreme tenderness along the
spine and usually the pain is confined to the sensitive places.
Treatment consists of a constitutional toning up, and increasing
muscular strength through judicious exercise. The posterior curve may
be pushed toward the median line by laying the patient on the face;
also with the knee in the back and the flat of both hands on the
sternal ends raise the ribs; or by the arms making use of the pectoral
muscles accomplish the same result. Deep breathing is also effective.
Relief can usually be given and a cure will depend upon the patient’s
general condition.
The =Hysterical Spine= is usually considered the same as the neurotic
spine, but there are many cases which have the sensitive spine without
being hysterical. There is more deformity usually present, particularly
in the lumbar region. Probably there will be a history of some injury.
The treatment is to correct the curvature and build up the general
health. These conditions are stubborn and progress is slow. In both the
neurotic and hysterical spines the ligaments of certain areas will be
found atonied and relaxed. This is especially noticed upon attempting
to spring a group of vertebræ when all of a sudden the section relaxes.
In either of these spines the lesions will irritate or obstruct nervous
courses, produce venous stagnation or arterial starvation, and disturb
lymph channels. H. F. Goetz has observed that in functional nervous
diseases the dorsal spine is flat, while in visceral displacement the
dorso-lumbar spine is posterior.
The =Spine of the Aged= wherein is found stooped shoulders and a
rigid spinal structure, can be distinctly improved by slow, cautious
traction. This tones weakened muscles, releases contractures, separates
the compressed intervertebral discs, and definitely tones the viscera.
Careful work is imperative.