choices to employ in clinical practice. Furthermore, and perhaps even more concerning, is the distinct possibility that providers are missing an opportunity to intervene in a patient’s life and at the very least identify this serious condition which can have a dramatic impact on overall health.


A variety of non-invasive/non-surgical interventions have been employed and utilized by practitioners, yielding good results. There are a variety of exible/non-hard braces that are presently being tested as potential treatment approaches. Multiple studies, including random control trials, reveal the wide use and effectiveness of exercise and scoliosis rehab programs in preventing progression and decreasing Cobb angles.2,3,4


treatment approaches found in the academic literature utilize neuromuscular education, traction, and specic treatment procedures that aim to rehabilitate the spine and reduce scoliotic curves without the use of bracing or surgery.5,6


It is also worth noting that conservative scoliosis care is becoming more mainstream and accepted in health care professional circles. There are now international conservative care scoliosis associations, such as the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), which advocate continued use of and research for conservative management options of scoliosis conditions. Providers from varied specialties are represented here, revealing a level of conservative care provider collaboration that previously did not exist.


AIS and the complex nature of it necessitates the need for practitioners to address other underlying factors that may be causative, in addition to classic neuromusculoskeletal approaches. Due to genetic variability and the apparent genetic connection found in scoliosis conditions, it makes sense that different metabolic and physiologic factors may inuence AIS and its severity. Specically, certain neurochemicals and factors affecting neurochemistry are correlated with these scoliotic conditions and, therefore, may be important issues for practitioners to address in their whole-health treatment plans.


and countless others have revealed that removal of the pineal gland from bipedals, such as chickens, induced scoliosis.


volved in the production of melatonin. Melatonin and precursor substrates such as serotonin and 5HTP may


Pre Post The pineal gland is principally in-


Serotonin and melatonin have been long postulated to be involved in the development of scoliosis. Early studies by Thillard7


Furthermore, additional


also have similarly inuencing affect on neurochemistry, the causation and/or progression of AIS. Studies have also revealed that abnormal serotongenic activities are present when elongation of the spinal cord occurs.8


studies have found lower levels of serotonin in scoliotic patients. Because of the apparent correlations noted between scoliosis and these neurotransmitters and their intermediaries, supplementation with neurotransmitter precursors have been suggested. Companies such as Neuroscience and others may be benecial in evaluating neurotransmitter proles as well.


Interestingly, both vitamin D and omega 3 fatty acids have both been linked to serotonin up regulation.9


which is known to be a common area of deciency in the United States, has been shown to potentiate serotonin activity.10


And the DHA component of omega 3 fatty acids has also been shown to have positive affects on up-regulating serotonin. Interestingly enough, both of these have also been implicated in depression and anxiety conditions, and studies also revealed a connection between AIS and depression. Testing is widely available for both of these nutrients, allowing providers to tailor specic potential supplementation needs for patients.


Other genetic factors may be implicated in the creation or progression of AIS as well. Genetic testing, although not in its infancy, continues to evolve and become much more detailed every year. Several genetic testing options are available in the market place, such as Scolioscore, assessing the likelihood of progression of AIS. Other genetic testing attempts to identify biochemical pathways that are variant, affecting formation and progression of many conditions. For example, the now often tested MTHFR genetic test may reveal aberrations, or poly- variance in methylation, mucopolysaccharide and lipo- protein synthesis, and other pathways. Interestingly enough, it can be demonstrated that reduced serotonin levels are found in those with MTHFR mutations. Those with these genetic mutations may benet from methylated nutrient support, such as methylfolate. There are increasingly more laboratories that are offering genetic testing options which may be of benet to our scoliosis patients as well.


For the majority of AIS patients spinal curvature is just one of many maladies that they are dealing with. Many AIS patients experience depression. The fact that individuals with scoliosis have a decreased life expectancy by 14 years should be a indicator that these patients need all the help we can give them.11


need to take a multifaceted approach in addressing their myriad of potential concurrent clinical presentations. Dietary factors, deciencies, and lifestyle factors all should be addressed to direct these patients to a more optimal health status. It is encouraging that there are researched-based treatment approaches in present use that can be objectively measured, with reproducible results.


The purpose of this article is to propose a re-exploration of conservative management of scoliosis by conservative care physicians. There is a body of research that supports conservative management options for scoliosis, as an


THE ORIGINAL INTERNIST JUNE 2016


(Continued on page 93) 65


For the sake of these patients we Vitamin D, Other


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