Myofascial and Articular Treatment of Adolescent Idiopathic Scoliosis

NCT ID: NCT05423509

Last Updated: 2024-06-11

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

21 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-12-01

Study Completion Date

2022-06-10

Brief Summary

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Randomized controlled trial of participants with scoliosis into standard treatment with observation/bracing and the other group will have the added treatment of dynamic myofascial manipulation for 6 months.

Detailed Description

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The purpose of this study is to conduct a pilot study of the Dynamic Myofascial and Articular Mobilization and Reorganization (DMAMR) treatment in Adolescent Idiopathic Scoliosis (AIS). The investigators propose the implementation of Dynamic Myofascial and Articular Mobilization and Reorganization (DMAMR) protocol can (a) decrease and/or reduce progression of spinal curvatures, (b) reduce degree of anatomical rib hump deformity common in AIS, (c) decrease incidence of patients requiring corrective bracing and/or corrective spinal surgery, (d) significantly reduce AIS-associated pain, and (e) improve quality of life for AIS participants.

This study will test whether DMAMR produces clinically relevant changes in progression of scoliosis curvatures and rib humps, and whether this treatment protocol improves pain scores and quality of life.

Current research has demonstrated unilateral muscle shortening in AIS. Of most importance for this research proposal, research has also identified a set of muscles, portions of which are at an angle to the spine, that are shorter on the concave side of the curvature: the quadratus lumborum, psoas major and minor, and the abdominal obliques. The researchers have suggested this is a compensatory effect of the spinal deformities seen1. The investigators agree that unilateral muscle shortening is present in AIS but the investigators suggest that this asymmetry represents differences between muscle tension on either side of the spine and results in a tethering effect on the spine itself. Supporting a finding of the importance of these muscle imbalances, research using individualized physical therapeutic exercise programs to balance these types of muscle imbalances has demonstrated effectiveness in AIS treatment.

The investigators hypothesize this asymmetrical muscle imbalance, and its resultant tethering effect on the spine, represent myofascial dysfunction. The investigators believe the forces generated by this dysfunction are sufficient to induce worsening of the AIS curvature. The myofascial factors involved in the tethering of the spine in AIS include asymmetrical muscle imbalances involving muscles at an angle to the spine, primarily iliopsoas, quadratus lumborum, abdominal obliques, latissimus dorsi, and anterior serratus muscles.

Fascia overlies and interpenetrates these muscles. At a critical point, these myofascial imbalances generate sufficient stress on the overlying fascia to create a further contractile force within the fascia itself. The investigators ask whether this contractile force is mediated not only by anatomic shortening of individual muscle groups but also by intrinsic changes in fibroblast gene expression within the fascia itself.

The investigators further hypothesize that the asymmetrical muscle imbalances observed in AIS may be part of a larger contracted fascial spiral force influencing the development and progression of deformity. Therefore, treatment of the muscles, fascia, and related articular dysfunction may contribute to the control or reduction of AIS-associated deformities including scoliotic curvatures and accompanying rib humps. Effective treatment of these imbalances and deformities may reduce or eliminate AIS-associated spinal area pain, which the investigators hypothesize is largely myofascial in nature.

Conditions

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Scoliosis Idiopathic Adolescent Treatment

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

randomized controlled trial between 2 treatment groups
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The follow-up visits were performed by an advanced practice provider that did not know which treatment arm the patient is in.

Study Groups

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Standard treatment for AIS

These are the participants with AIS that recieved the standard treatment with observation or bracing depending on the size of their curve.

Group Type OTHER

Standard AIS treatment with observation or bracing

Intervention Type OTHER

Observation with radiographs and bracing of curves greater than 20 degrees

Treatment with Dynamic Myofascial Manipulation

These are the participants that still received the standard treatment with observation or bracing depending on the size of their curve, but also had weekly treatment with a chiropractor for 6 months for dynamic myofascial manipulation

Group Type EXPERIMENTAL

Dynamic myofascial manipulation

Intervention Type OTHER

Dynamic myofascial manipulation of the muscles in the back to improve the scoliosis appearance/flexibility/rotation

Standard AIS treatment with observation or bracing

Intervention Type OTHER

Observation with radiographs and bracing of curves greater than 20 degrees

Interventions

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Dynamic myofascial manipulation

Dynamic myofascial manipulation of the muscles in the back to improve the scoliosis appearance/flexibility/rotation

Intervention Type OTHER

Standard AIS treatment with observation or bracing

Observation with radiographs and bracing of curves greater than 20 degrees

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age from 10-15
* Scoliosis curve of 15-30 degrees on cobb angle
* Risser stage of 0-2

Exclusion Criteria

* outside of age range, cobb angle or maturity level
Minimum Eligible Age

10 Years

Maximum Eligible Age

15 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

University of New Mexico

OTHER

Sponsor Role lead

Responsible Party

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Selina Silva

Associate Professor, Orthopaedic Surgerey

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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UNM Carrie Tingley Hospital

Albuquerque, New Mexico, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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Study 20-228

Identifier Type: -

Identifier Source: org_study_id

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