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Yoga therapy for scoliosis: an adult case approach

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Scoliosis
Open Access
Poster presentation
Yoga therapy for scoliosis: an adult case approach
Elise B Miller
Address: Palo Alto, California, USA
Email: Elise B Miller - ebm@yogaforscoliosis.com
Objective
To document improvement in the curvature of adolescent
idiopathic scoliosis without surgery.
Study design
An adult case report was monitored from age twenty-three
until fifty-eight years of age. Idiopathic scoliosis (right
thoracic with a Cobb angle of forty-nine degrees, with
compensatory left lumbar curve) was diagnosed at age six-
teen years, with referral to an orthopedic surgeon who rec-
ommended spinal fusion surgery. A second opinion from
Dr. Harris, orthopedic sugeon at Children's Hospital,
advised against immediate surgery and instead recom-
mended swimming, general stretching and Physical Ther-
apy. The patient became an avid swimmer and later joined
the swim team in college. She then joined the Peace Corps
in Brazil where she became more sedentary and began to
experience pain with her scoliosis.
Methods
At age twenty-three years, she began yoga therapy with
BKS Iyengar and continued to study with him over a
thirty-five year period. A multimodal physical therapy/
yoga therapy approach included deep tissue massage and
chiropractic adjustments.
Results
Stable progressive improvement in magnitude of Cobb
angle from forty-nine degrees to thirty-one degrees. Also
the improved curvature occurred in correlation with pro-
gressive improvement in posture, appearance, and mor-
phology.
Conclusion
The reduction in curvature and high quality of life as a
result compares favorably with results from surgical inter-
vention [1].
References
1. Bradford DS, Kay BKB, Hu SS: Adult scoliosis: surgical indica-
tions, operative management, complications and outcomes.
Spine 1999, 24:2617-2629.
from 4th International Conference on Conservative Management of Spinal Deformities
Boston, MA, USA. 13–16 May 2007
Published: 12 October 2007
Scoliosis 2007, 2(Suppl 1):P6 doi:10.1186/1748-7161-2-S1-P6
<supplement> <title> <p>4th International Conference on Conservative Management of Spinal Deformities</p> </title> <sponsor> <note>Publication of these abstracts has been funded by the National Scoliosis Foundation (<url>http://www.scoliosis.org</url>) and the Asklepios Katharina Schroth, Spinal Deformities Rehabilitation Centre (<url>http://www.skoliose.com</url>)</note> </sponsor> <note >Meeting abstracts – A sing le PDF containing all abst racts in this Supplement is available <a href="http:// www.biomedcentral.com/content/files/pdf/1748-7161-2-S1-full.pdf">here</a>.</note> <url>http://www.biomedcentral.com/content/pdf/1748-7161-2-S1-info.pdf</url> </supplement>
This abstract is available from: http://www.scoliosisjournal.com/content/2/S1/P6
© 2007 Miller; licensee BioMed Central Ltd.
... Unfortunately, it is lack of official reported papers. Yoga was, however, presented twice as it was an effective treatment for nonoperative treatment of scoliosis in medical conference [23,24]. In 2012, Cochrane reviews stated that they cannot evaluate Yoga because there is no randomized control or controlled prospective study or as equivalent for it [15,16]. ...
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Until now because there are many published journals with a variety of opinions so I will stratify these articles by giving weighted value on grade evaluation which depend on each institution (written author and co-authors) and external evaluate status (SCI, SCIE, impact factor) rather than the outcomes provided by each article. Consequently, before evaluating publicized papers, study quality assessment of each interesting paper should be performed by mean of gauging the quality of evidence. Reviewing these articles, a grade of medical literature was divided into the following 5 levels as level I (randomized controlled study), level II (non-randomized controlled study), level III (case-control study), level IV (case series), and level V (expert opinions). However, in present article I concluded only involved medical literatures with weighted value of level I and II evidence.
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In this section we are discussing the patient over the age of 20 years with idiopathic scoliosis, with or without superimposed degenerative changes. Many adult scoliotics seek medical treatment because of deformity, back pain, or both. Nonoperative measures for back pain include intermittent nonsteroidal anti-inflammatory drugs, physical therapy geared towards trunk strengthening and aerobic conditioning, alteration of lifestyle, and other general supportive measures. Frequently, the long term results of conservative treatment are disappointing. Bracing does not seem to have a role in altering the natural history of adult scoliosis, but may be helpful for certain patients who are not surgical candidates. Progression of the deformity to an unacceptable degree, and/or pain resistant to conservative treatments, are the usual surgical indications in the middle-aged and older adult. For the younger adult, magnitude of deformity (radiographic and clinical) are relative indications. Technical issues that must be considered by the surgeon include whether to include distal lumbar levels (the fractional curve) including L5-S1, decisions regarding combined approaches, and whether these are best done same day versus staged, and fixation to the sacrum/pelvis. Correction or maintenance of coronal and sagittal balance with long fusions (to the sacrum) is complex and critical. Complications and pseudoarthroses occur much more frequently in adults compared to the adolescent scoliosis patient. Nutritional depletion is known to be a significant problem in a high percentage of patients having combined surgery. Therefore, nutritional supplementation should be instituted in the high risk patient, and its role warrants future investigation. Evaluation of the results should include radiographic measures, as well as measures of pain relief, functional assessment, and patient satisfaction. Prospective randomized studies in this area do not exist, though retrospective reviews suggest a majority of patients feel that they have benefited from the surgery and have gained some pain relief. Basic patient assessment measures such as Oswestry or SF-36 are not disease-specific enough to evaluate surgical treatment outcomes of adult scoliosis. Future investigations should include the long term influence of a significant idiopathic deformity on degenerative lumbar disc disease. In the future, prospective use of validated instruments will hopefully shed more light on these issues.
Adult scoliosis: surgical indications, operative management, complications and outcomes
  • D S Bradford
  • Bkb Kay
  • S S Hu
  • DS Bradford