CUSTOMIZED REHABILITATION CLINIC AND HOME PROTOCOL CLEAR INSTITUTE ST. CLOUD CHIROPRACTIC AND SCOLIOSIS CLINIC DENNIS WOGGON, D.C. for ROSEMARIE STALLWORTH-CLARK A-TYPICAL SCOLIOSIS

Pre-Intervention

Rosemarie (retired professor, age 65—at the end of healthy days) presented for Two Weeks of Intensive Treatments for continued scoliosis care with Dr. Dennis Woggon and Dr. SuYen Chong at the St. Cloud Chiropractic and Scoliosis Clinic in St.Cloud, Minnesota, on March 30, 2009.  Her X-rays on March 30, 2009 revealed the following:  1)  lateral cervical kyphotic lordotic S curve with 264% loss of curve indicating 23 pounds of apparent head weight with 1.3 inches of forward head posture, dysfunction of cervical vertebra C0, 1,2,3,4,5, and 6;   2)  lateral lumbar x-ray reveals a 189% loss of curve/loss of lordosis;  3) right cervicodorsal COB angle from T3 to T6--10 degrees;  4)  left thoracic COB angle from T7 to T10--40 degrees;  5)  right lumbodorsal COB angle T11 to L3-- 65 degrees. 

Doctors’ Diagnosis:  Cervical dorsal lumbosacral pelvic subluxation syndrome. Intersegmental dysfunction. Chronic sprain. Muscle guarding.  TMJ.  Bilateral shoulder and rib strain/sprain=A-Typical Scoliosis

Intervention (2 Week Intensive Treatment at St. Cloud Chiropractic and Scoliosis Center)

Two weeks of Dr. Dennis Woggon and Dr. SuYen Chong’s Intensive Treatments included comprehensive exercises involving cervical traction; vibration therapy; customized chiropractic Pettibon adjusting procedures and spinal rehabilitation; neuromuscular training exercises with spinal weighting; therapeutic massage (once weekly); nutritional assessment and recommendations; and home exercise protocols. (See below). 

Neuromuscular re-education is for the movement, balance, coordination, kinesthetic sense, posture and proprioception, as well as mechanical traction, to create a degree of tension of soft tissues and allow for separation between joint surfaces. The exercises are designed to be therapeutic and to assist in developing strength, endurance, range of motion, and flexibility.  Morning and Afternoon Protocol during the two weeks at the St. Cloud Chiropractic Clinic included:  1)  Wobble chair warm up exercises;  2)  Standing Cervical Spinal Traction with right knee bending;  3)  Cervical Vibrating Traction with Spinalator;  4)  Lumbar Vibrating Traction with cervical drop traction; 5)  Eckard Mechanical Traction Table (30 minutes) with mirror image positioning and scoliosis strapping;  6)  Massage therapy (Deep Tissue and Trigger Point Therapy) with therapist findings and recommended massage treatment plan (once weekly);  7)  Chiropractic Adjustments using Pettibon adjusting procedures and spinal rehabilitation;  8)  Ball exercises with whole body vibration supine;  9)  Standing Strap Stretch Exercises with vibration therapy;  10)  Rotary Twist exercises with vibration therapy and spinal weighting;  11)  Pneumex Gait Training with limited vision horizon glasses and lumbar traction—involving walking (to improve rhythm and speed);  12)  Sitting in the Scoliosis Traction Chair for 30 minutes each session; 13) Tightrope Gait Training with spinal weighting on hips and head for proprioception with limited vision horizon glasses;  and 14)  Vibrating Platform for proprioceptive neuromuscular re-education with cervical traction.

The Scoliosis Traction Chair

The Scoliosis Traction Chair for cervical, thoracic, and lumbar traction and vibration therapy.
(Rosemarie sat in the STC twice daily, 30 minutes each.)

Customized Directions for assembling and sitting in the STC—for
“a-typical” scoliosis.

Follow directions for assembling the STC.  The ARM RESTS should be positioned and tightened at a level that will provide as much traction to the torso as possible, without unnecessarily impairing the circulation in the arms.  Place a small stool in front of the chair so as to keep the legs at right angle to torso.

Plan to sit in STC 30 minutes twice daily (with vibration) and 20 pounds cervical traction attached to head halter. 

STRAPS AND SITTING POSTIONS FOR ROSEMARIE

THE ARM RESTS:    The RIGHT ARM REST should be raised two inches higher than my left arm rest. (My RIGHT shoulder is lower than my left shoulder. This will help to raise my RIGHT shoulder.)
SITTING POSITION:  SCOLIOSIS TRACTION CHAIR
THE BACK REST:  Position the BACK REST at the level of my back rib arch, with the middle of the back rest corresponding to the vertebral level of the apex of my thoracic Cobb angle.  Rotate the back rest into the side of the convexity (toward my left side) approximately thirty degrees.
THE ARM RESTS:    The RIGHT ARM REST should be raised two inches higher than my left arm rest. (My RIGHT shoulder is lower than my left shoulder. This will help to raise my RIGHT shoulder.)

THE AIR CUSHION:  Place the air cushion in the seat of the STC.  I will sit as far back on the cushion as possible so as to maintain the lumbar lordosis and to maximize the exercises. I will practice while sitting in the chair.

THE STRAPS/BELTS

(1)  THE UPPER STABILIZATION STRAP:  The upper stabilization strap does not have a corresponding ratchet.  To position, hold the buckle close to myself and wrap the other end around myself, back to front. This stabilization strap should be positioned under my right arm, as high as possible, wrapped around the LEFT arm rest and around for maximum correction in addressing the top cervico-dorsal COB angle, and also prevents me from being shifted while I am sitting in the chair.
(2)  THE LEGS STABILIZATION STRAP:  The legs stabilization strap does not have a corresponding ratchet.  This strap is wrapped around my legs and my legs are pulled toward the RIGHT (the side of the lumbar scoliosis).  This will aid in de-rotating my spine.  When the legs strap is tightened, my hips should be rotated as little as possible as my legs are pulled to the side.
(3) THE SEAT BELT STRAP: is placed around the back and underneath of the chair around my waist to prevent rotation of my hips pulling my left hip back as that is my anterior hip
(4) THE THORACIC TRACTION STRAP:  This is done to pull the spine and decrease the thoracic COB angle from my left to right.  Position the top ratchet on my LEFT arm pole with handle toward the back so that my upper torso is rotated toward the right posterior when tightened. Thread the rectangular pad onto this upper, thoracic corrective strap.  Wrap this thoracic corrective strap around the backrest (to further assist in de-rotation).  When seated, make sure that the rectangular pad is positioned at the ribs under my left arm.  Once the stabilization and the legs strap are in place, this thoracic traction ratchet strap should be tightened fully.
(5) THE LUMBAR LATERAL TRACTION STRAP:  The Bottom ratchet should be positioned with the handle towards the front, rotating my spine toward my RIGHT anterior when tightened.  Thread the hourglass-shaped pad onto this lower, lumbar corrective strap.  Do NOT wrap this lumbar strap around the back rest so as to create a purely lateral pull. When seated, make sure that the hourglass-shaped pad is positioned between my ribs and iliac crest.  Place a foam block between the arm rest and my right hip so as to keep my hips in a central position.  Once the stabilization (shoulder), legs, and thoracic traction straps are in place, this lumbar lateral traction ratchet strap should be tightened fully. The lumbar strap should be as tight as possible.

THE TRACTION POST:   After all straps are positioned correctly and tightened, rotate the traction post to pull my chin away from the Cobb Angle (away from the side of my low/LEFT shoulder—to the RIGHT!).  Maintain this head direction throughout the duration of my Scoliosis Traction Chair therapy (look to the right).  This assists in de-rotation of the spinal column, and also helps to correct the Cervico-Dorsal angle.  My chin should be raised slightly to maintain the cervical lordosis.  I should use some time of mouthguard and a pad under my chin to enhance my comfort. 

THE HEAD HALTER:  Place the head halter under the back of my head, then under my chin, and fasten the Velcro straps.  Hold the head halter with one hand while I do this so as not to release the weight on the cervical traction before the halter is in place.

THE CERVICAL TRACTION WEIGHT:  Release the weight of the cervical traction (20 pounds of water in plastic bag.) Cervical  traction reduces the forward head posture in regard to neuromuscular re-education concerning movement, balance, coordination and kinesthetic sense, posture and/or proprioception.

THE VIBRATORY COMPONENT:  Turn on the vibratory component for 30 minutes.  The vibrating platform provides motion for proprioceptive neuromuscular re-education; and thus, enhancement for the cervical traction.

EXERCISES WHILE SITTING IN THE SCOLIOSIS TRACTION CHAIR:   (Repeat this series throughout the treatment)

1. Lateral Hip Movement Exercise:  Using torso muscles, move hips from side to side in the “x” dimension, 30 times.
2. Arch and Relax Exercise:  Using torso muscles, arch and relax back muscles (similar to the Lumbar Extension exercise), extending for two seconds and relaxing for two seconds, 30 times.
3. Isometric Torso Rotation Exercise:  Using torso muscles, rotate to the LEFT against the back rest.  Hold for 5 seconds, relax for 5 seconds, then repeat 5 times.

PRESCRIBED HOME EXERCISE PROTOCOL (TWICE DAILY)

On the first day of treatment, Dr. Woggon and Dr. Chong assigned an intensive home protocol of exercises for Rosemarie.  Rosemarie arranged her home exercise protocol from sitting to standing to lying…(21 Exercises to be performed twice daily)

Sitting…

1. Spinal Rotation Exercise  (first thing in the morning and before lying on spinal support prior to sleeping)
2. Cervical Extension Exercise
3. Lumbar Extension Exercise
4. Chest Expander Exercise (leaning to the right)
5. Cervico-Dorsal Exercise (right side with chin level)
6. Axis Spinous Exercise (right side)
7. Sitting Strap Exercise (leaning to the right)

Standing…

1. Cervical Traction
2. Toe Raiser Exercises (lift up on the right foot)
3. PSOAS Stretch (kneel on left knee with right knee up)
4. Head Weighting Procedures (with limited vision glasses, 3# head weight and hip weights (left front/anterior, right back/posterior)—My plan is to wear the glasses and hip weights while I walk on my treadmill without holding onto the hand rails.)
5. Praying Mantis Exercise

In Crawling Position…

1. Leg Extension Exercise (left leg only…add extension of right arm when ready)

Lying Supine…

1. Leg Pump Exercise (right leg only)
2. Straight Leg Weighting Exercise with ankle weight( right leg only)
3. Leg Raise Exercise (right side up)
4. QL Low Back Exercise (while lying with left side against wall, neck roll but no low back roll, cross left ankle over the right ankle, block the right hip high and the left hip low, fold arms over chest, push legs against the wall.  The legs should NOT move.  Hold for ten seconds, 10 times, twice daily)
5. Low Back Ball Exercise (to de-rotate the low back and pelvis)…Holding the ball with feet and thighs, slowly lower the feet to the LEFT towards the floor and back to the middle.)
6. Cervical Flexion Exercise (can be done while lying on spinal supports)
7. Lying On Spinal Supports (for minimum of 20 to 30 minutes each day before sleeping…cervical flexion exercise can be done while lying on spinal supports)

Lying Prone…

1. Flexion/Extension Prone Exercise (to work the cervical flexor (front) and extensor (back) muscles…can be done just prior to lying on spinal supports)

Post Treatment Findings

After two weeks of intensive treatment at the St. Cloud Chiropractic and Scoliosis Center, on April 10, 2009, Rosemarie’s final x-rays and comprehensive assessments revealed the following:

1. lateral cervical stress x-ray with 2# headweights and limited vision horizon glasses reveal a lordotic curve with 65% loss of curve indicating 11 pounds of apparent head weight with 0.1 inches of forward head posture, dysfunction of cervical vertebra C2,3,4 and 5.
2. right cervicodorsal COB angle from T3 to T6  3 degrees; 
3. left thoracic COB angle from T7 to T10 27 degrees; 
4. right lumbodorsal COB angle T11 to L3 48 degrees. 

Pre	Post	Pre	Post	Pre	Post

Rosemarie’s thoracic “hump” is visibly decreased; her pain is substantially lessened; and her optimism for a healthy remainder of her life is greatly increased.  She will go back to work soon!

Conclusion

Fifty-five years after Rosemarie’s scoliosis was diagnosed (at age 10), Rosemarie left the St. Cloud Chiropractic and Scoliosis Center in St. Cloud, Minnesota with renewed strength and courage to continue her battle against the crippling effects of “idiopathic adolescent scoliosis,” having finally found help for her debilitating disorder/syndrome.  She realized that the cost of the treatment was incidental compared to the benefit of a straighter, stronger, healthier spine.  She cannot sing the praises loud enough for Dr. Woggon, Dr. SuYen Chong, and the other St. Cloud Chiropractic Scoliosis Center staff—Margie, Ashley, Emily, Rachel.  Let the dance begin!  Rosemarie’s back is soon to be (with diligent exercises, patience, and care)…..a normally curved spine.  Who could have imagined such a miracle!...........Dr. Dennis Woggon, that’s who.  Thank you, Dr. Woggon!    I love you!

Love, peace, much success,

Rosemarie