Out of Balance!
by Dr. Matthew Schwab

Balance dysfunction has been shown to occur with scoliosis, especially those with progressive curves.  There are numerous asymmetries associated with progressive scoliosis, including muscular, ligamentous, brain stem, visual and vestibular righting reflexes, etc.  In order for balance to be optimum the human body needs constant communication and harmony between the visual, somatosensory, vestibular, and the appropriate motor commands to react to this constant feedback within its environment.  Currently CLEAR Institute is investigating this dis-harmony from a slightly different approach.  One observation noted by Dr. Dennis Woggon is a flexion malposition at the skull and first vertebrate, or atlas.  On X-ray evaluation what has been observed over repeated analysis is a flexion-malposition at the C0/C1 articulation when the scoliosis is in it’s progressive, or active state.  By progressive I mean skeletal growth is driving the progression at a faster rate than normal.  Clearing that up is important since without active intervention, scoliosis, being a dynamic condition is either getting better or getting worse, it doesn’t stay the same.  This C0/C1 anatomical area is important since there are many important spinal cord tracts at this location giving us feedback and proving crucial motor commands for postural control.

In this brief overview we would like to educate you on several stability indicators that may assist you and your health care practitioner as to what may be causing your imbalance and just why it is where it is.  First of all there are two main types of balance, static and dynamic.  An example of static balance would be trying to open your house door with 1 arm while holding onto a bag of groceries.  An example of dynamic balance would be walking on unstable terrain that moves as your heel strikes the surface.  This then is now a dynamic environment forcing a reaction of the calf and toe musculature to quickly cause a reaction from the bottom up.  How well and how fast you react is a measure of your balance capability.

Research has been done that has outlined a hierarchy of balance difficulties for varying curve patterns in individuals with scoliosis.  Interestingly, individuals with two opposing curvatures, or a double major scoliosis (DMS) often exhibit the best control of balance in both static and dynamic scenarios.  For static control of balance the individuals with curve patterns lower in the body (Lumbar scoliosis) often have the most difficult time balancing.  The next worse scenario is the curvatures that encompass both the thoracic and lumbar spine (Thoracolumbar scoliosis), preceeded by a single thoracic curve (Thoracic scoliosis), and lastly the double major curve patterns (Double major scoliosis).  In summary, from best to worst in a static balance setting, they are as follows, Double Major Scoliosis, Thoracic Scoliosis, Thoracolumbar Scoliosis, and lastly Lumbar Scoliosis.

For dynamic balancing, as mentioned earlier individuals with a double major scoliosis exhibit the least difficulty.  The next best is Lumbar scoliosis, followed by Thoracolumbar scoliosis, and lastly Thoracic scoliosis.  The interesting observation here is that individuals with the higher curvatures (Thoracic scoliosis) revealed the greatest imbalance.  The next question one might ask is, why are individuals with DMS curve patterns performing the best with regards to balance?  One key reason is the position of the head and neck.  The closer the head is positioned over the body, such as in DMS, the body’s vestibular input is more symmetrical thus enabling better balance control.  In summary, from best to worst in a dynamic balance setting are DMS, Lumbar scoliosis, Thoracolumbar Scoliosis, and lastly Thoracic Scoliosis.

Urge your doctor to check your balance in several different settings, including with eyes open and closed.  If compromised, it could be not only an indicator of scoliosis, but an explanation as to why you are having difficulty balancing and, depending upon the balance test, an indicator as to the location of the major curvature.  CLEAR methods address these balance difficulties through addressing all the curvatures of the spine, especially the head and neck.  As pointed out earlier the position of the head and neck is paramount in enabling the body to achieve optimum balance.  This is one of the reason’s why CLEAR Institute methods incorporate treatment methods to restore cervical lordosis and the reduction of forward head posture.  There are several other reasons to address this area as well.  One of them is the neck (cervical spine musculature) is a virtual warehouse of receptors that continually give us feedback about our ever changing environment.  In fact, while walking the body relies heavily on feedback from the neck.  Thus, if abnormal neck alignment is present the body has a difficult time receiving this information in a two-way communicative process during every day tasks such as walking.  Lastly, since the upper neck has been shown to commonly have misalignment at the C0/C1 area in cases of scoliosis, and this area has important spinal cord tracts for body control, this is addressed through precise adjustments verified through x-ray analysis.

In summary, it is crucial that not only balance be tested in several settings with this information applied, but the proper restoration of curves (especially head and neck) is achieved through appropriate treatment to improve inherent balance difficulties within the scoliosis population.

About the Author:
In addition to being a member of the CLEAR Institute Board of Advisors, Dr. Matt Schwab is a member of the American Academy of Spine Physicians and is also certified with the SpineCor dynamic brace.  His office specializes in advanced, non-surgical methods of treating scoliosis.