Scoliosis disagreement

Scoliosis disagreement

Aryeh

7/20/2001

Dear orthotists;

You know how you've been doing something successfully for a looooong
time, then someone in authority suddenly says you don't know what you're
doing and you begin to doubt yourself.....?

After providing literally hundreds of Boston-type and Milwaukee type
orthosis as a CO for a generation of clients, I am faced with having to
prove what an authentic low-profile Boston type really is to a doctor
new to me but in the practice of treating scoliosis for many years (I
suppose successfully). I lent him the manual from the Boston Brace
workshop (happens to be an old one) for this particular doctor's perusal
to show him what it's supposed to look like.

Now, just to make sure I haven't lost my mind completely, isn't it still
the standard rule that we don't attempt to put corrective forces above
the null vertebra (or the ribs leading to it) for that respective curve?
Therefore, for example, a lumbar curve with an apex L2 or below will not
exert force on the ribs on the convex side, but rather from the notorious
triangular pad on the posterior aspect on the muscle bulge? (Leave out
the issue of the anterior contralateral [apron] extension and other
pelvic pads for the moment.) The real issue to him is the lateral
superior trim lines. He seems to expect to apply corrective forces to the
entire length of the curve, and therefore there is almost no such thing
as a leaving the ribs free on the convex side.

Another related dispute re: leg length discrepancy. I am accustomed to
relying on pelvic crest height by both examining standing x-rays (both
knees straight, we hope) and palpating the crests and/or the sacral
dimples. Some folks (including this doctor) in the care process seem to
prefer the supine method of measure the leg length, which I agree with
for adults with fixed deformities, for example. However, I think this
masks pelvic obliquity secondary to muscle imbalance and allows this
obliquity to interfere with providing a level base for the lumbar spine.
Just because the young patient's muscles are used to obliquity doesn't
seem to me to be a valid reason to allow the pelvis to remain oblique.

Fortunately, at least this doctor is willing to talk about it, so I'm
looking for supporting information. Even pictures would help. I found
none on the internet

Opinions, ideas, etc.?

Thanks,
Aryeh