(Chest. 2001;120:672-674.)
© 2001
American College of Chest Physicians
Improved Chest Expansion in Idiopathic Scoliosis After Intensive, Multiple-Modality, Nonsurgical Treatment in an Adult*
Martha C. Hawes, PhD and
William J. Brooks, DO
*
From the Department of Plant Pathology (Dr. Hawes), University of Arizona, Tucson AZ; and the Restorative Care Foundation (Dr. Brooks), Kansas City, MO.
Correspondence to: William J. Brooks, DO, 9204 NW 80th Terrace, Kansas City, MO 64152; e-mail: wjbdo{at}wjbrooksdo.com
 |
Abstract
|
|---|
This case report documents a substantial increase in chest wall
expansion in a middle-aged woman with stable right thoracic spinal
curvature due to idiopathic scoliosis. Treatment involved intensive
psychological and mobilization therapies, including comprehensive
manipulative medicine treatments and daily manual traction. Over an
8-year period, a 6-cm increase in resting chest circumference (in the
absence of weight gain) and a 7.5-cm increase in chest expansion were
correlated with a substantial reduction of incidence of respiratory
infections.
Key Words: hypothyroidism • idiopathic scoliosis • manipulative medicine • mitral valve prolapse • pectus excavatum
|
Introduction
|
|---|
The
most serious complication of thoracic scoliosis, compromised
cardiopulmonary function due to reduced chest wall expansion, can be
fatal when curvatures are severe and is present even in mild idiopathic
scoliosis (IS).1
2
Chest expansion increases of > 1 cm,
and improved vital capacity (VC), have been achieved in children and
young adults with IS during a 6-week hospitalization regime using
physical therapies.3
Traction was used to achieve improved
pulmonary function in a middle aged patient with severe scoliosis due
to infantile poliomyelitis.4
In the current study, the use
of physical methods including comprehensive manipulative medicine (CMM)
and daily manual traction was correlated with a progressive increase in
chest expansion, a stable improvement in torso morphology, and a
reduced incidence of respiratory infections.
|
Case Report
|
|---|
The patient was a 48-year-old woman in whom a prominent rib
hump, scapular and torso asymmetry, thoracic lordosis, and forward
rotation of the right shoulder were detected at age 11 years.
Radiographic analysis revealed a right thoracic curvature of 43° with
lesser curvatures in the cervical and lumbar spine. Pectus excavatum
and mitral valve prolapse also were present. An orthopedic surgeon
recommended spinal fusion, which was declined. Daily torso
strengthening and conditioning exercises were carried out through
February 1992. Hypothyroidism was diagnosed in 1971 and was treated
with thyroid extract (3 grains daily). The patient described a chronic
susceptibility, from infancy through April 1992, to upper and lower
respiratory tract infections, averaging four or more a year, each
lasting up to 6 weeks, commonly with temperatures > 102° F and
requiring medical intervention.
|
Methods and Results
|
|---|
In February 1992, the patient suffered psychological
decompensation with emergent incapacitating multiregional physical pain
and began outpatient psychological therapy (therapists Diane Breier,
MSW, and Nancy Skocy, MSW; Tucson, AZ), which continued through
September 1994. No psychopharmacologic or analgesic medications were
employed. All strengthening and conditioning exercises were
discontinued in February 1992. In April 1992 a spontaneous
reduction in the forward rotation of the right shoulder occurred (not
shown). From January 1993, one of the authors (WJB) provided
instruction, support, and evaluation of posture and movement. Sustained
pressure applied directly to muscle spasms, or manual traction to
stretch the torso, was used by the patient to relieve pain as needed
(
4 h daily through 1997). These methods were supplemented with
massage therapy monthly in 1993 and 1994.
CMM was performed by one of the authors (WJB) on four occasions during
the period 1993 to 1998 and on seven occasions in 1999 to 2000.
Manipulative interventions were dictated by a diagnostic methodology
employing a systems analysis of whole-body biomechanics (posture and
movement). Specifically, techniques and dosages were applied to the
proportionately most severe deficiencies of available motion (W.
J. Brooks, DO; unpublished data; 2001). Techniques employed
included thrusting, muscle energy, articulation, myofascial release,
and counterstrain.
Chest expansion increased from 2.5 to 10 cm (Fig 1
), with 33% of the change occurring in correlation with intensive CMM
in 1999 to 2000 (Fig 1
, arrow). This change was associated with an
increase in the mean (± SD) resting circumference of the chest
from 76 ± 0.5 to 82 ± 0.3 cm, together with stable changes in the
morphology of the upper back (Fig 2 ,
top left, A, and top right,
B), the anterior chest (Fig 2 , middle left,
C, and middle right, D), and thoracic
lordosis (Fig 2
, bottom left, E, and bottom
right, F). Radiographically, the thoracic curvature
remained moderately severe (not shown). In November 1992, the signs and
symptoms of hypothyroidism normalized, and thyroid medication was
discontinued. Between 1992 and 2000, the patient experienced four
respiratory infections, all of which resolved in 3 to 5 days. Daily
severe pain continued through 1997, then decreased progressively to
current levels of two to three episodes per month.
View larger version (9K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1. Increase in chest expansion, 1992 to 2000. The
values for chest expansion are derived by subtracting the circumference
(measured just below the breasts) during maximum exhalation from the
circumference during maximum inhalation, and represent the means and
SDs from the number of measurements taken by the patient at different
times of the day over several days (1992, 10 measurements; 1995, 7
measurements; 1999, 20 measurements; and 2000, 29 measurements). Hip
circumference (107 ± 0.5 cm) and weight (133 ± 3 lb) were stable
during the test period. The arrow denotes the beginning of a year of
intensive manipulative treatments.
|
|
View larger version (111K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2. Stable morphologic changes occurring in
correlation with increased chest expansion. The photographs are of the
patient’s back while in a relaxed standing position and show an
apparent increase in the breadth of the upper back in January 1993
(top left, A) and November 1995
(top right, B). Casual photographs show
morphologic changes in the anterior chest in July 1995 (middle
left, C) and July 1998 (middle
right, D). Photographs of the patient’s back
while in a relaxed standing position in November 1995 (bottom
left, E) and November 1999 (bottom
right, F) show a visual improvement in the
appearance of thoracic lordosis.
|
|
|
Discussion
|
|---|
When compared with control subjects, patients with IS exhibit a
significantly smaller mean chest circumference and restricted chest
mobility.2
3
5
A chest expansion capacity of < 3.8 cm in
IS patients is strongly correlated with diminished VC.5
Pulmonary symptoms characteristic of IS can be duplicated in control
subjects by inhibiting chest expansion with corsets or
taping.1
Reduced VC is associated with increased
susceptibility to respiratory infection.6
In the current report, the achievement of a significant increase in
chest expansion in correlation with the near-elimination of respiratory
illness is consistent with a previous study showing that even in middle
age, functional defects associated with thoracic scoliosis can be
reversed measurably using physical methods.4
The increased
rate of improvement during the last year of the study suggests that CMM
played a significant role in improving chest wall expansion. Mechanisms
of improved chest wall expansion probably include altered muscle tonus
through neuroreflexive mechanisms (ie, CMM) and plastic
tissue changes from directly applied forces (ie, CMM, manual
traction, and deep massage) and, over time, self-stretching through
deeper breathing. The relief of pain was temporally correlated as an
effect, rather than the cause, of the gradually improved physiology.
|
Acknowledgements
|
|---|
The first author (MCH) is the patient in the study.
The authors thank John Galgiani, MD, John B. Schousboe, MD, and David
Van Wyck, MD, for critical reading of the manuscript.
|
Footnotes
|
|---|
Abbreviations:
CMM = comprehensive manipulative medicine; IS = idiopathic
scoliosis; VC = vital capacity
Received for publication September 25, 2000.
Accepted for publication January 4, 2001.
|
References
|
|---|
-
Lonstein, JE, Bradford, DS, Winter, RB, et al (1995) Moe’s textbook of scoliosis, and other spinal deformities 3rd ed. ,572-581 WB Saunders Philadelphia, PA.
-
Leong, JCY, Lu, WW, Luk, KDK (1999) Kinematics of the chest cage and spine during breathing in healthy individuals and in patients with AIS. Spine 24,1310-1317[CrossRef][ISI][Medline]
-
Weiss, HR (1991) The effect of an exercise program on vital capacity and rib mobility in patients with idiopathic scoliosis. Spine 16,88-93[CrossRef][ISI][Medline]
-
Block, AJ, Wexler, J, McDonnell, EJ (1970) Cardiopulmonary failure of the hunchback: a possible therapeutic approach. JAMA 212,1520-1522[CrossRef][Medline]
-
Collis, DK, Ponseti, IV (1969) Long term follow-up of patients with idiopathic scoliosis not treated surgically. J Bone Joint Surg 51-A,425-445[Abstract/Free Full Text]
-
Murray, JF, Nadel, JA (2000) Textbook of respiratory medicine 3rd ed. ,2357-2376 WB Saunders Philadelphia., PA.
This article has been cited by other articles:
|
|
|
|
 
M. C. Hawes
Improved Chest Expansion in Idiopathic Scoliosis
Psychosom Med,
November 1, 2001;
63(6):
994 - 995.
[Full Text]
[PDF]
|
|
|
TOP
Abstract
Introduction
