S erving as a chiropractic assistant is, in my opinion, the ideal occupation for people interested in beginning a career in health care. The US Bureau of Labor Statistics predicts 31% increased growth and demand for CAs from 2010 to 2020, which is higher than the expected growth for nurses. CAs receive training in hands-on patient care; exposure to medical terminology, anatomy, and physiology; and opportunities to learn more about administration and business. In addition, the position brings increased awareness and understanding of the chiropractic philosophy and the natural healing power of the body—something that no other introductory position offers. I worked as a CA for nine years before beginning my DC studies. To me, the most captivating patients were young people living with scoliosis, an abnormal sideways curvature of the spine. Scoliosis can affect the posture and appearance, resulting in feelings of dissimilarity at a time when "fitting in" with your peers means everything. The thoughts and emotions expressed by young people with scoliosis about the unique challenges they face can be both inspiring and heartbreaking. In this article, I hope to share a few of these stories and what they taught me about working with scoliosis patients as a chiropractic assistant. How to Recognize Scoliosis A mother once shared with me how she came to realize her daughter had scoliosis. Her first clue came when she began noticing that dresses would hang unevenly on her daughter's body. At the time, she did not think much of it, and simply began altering the hem of the dresses to compensate. "If only someone had told me what it meant back then," she mused. "We could have done something sooner." One of the first signs of scoliosis is a change in the symmetry of the body. People may notice their clothes fit unevenly; one shoulder may be higher than the other, or the space between the arm and the body may be greater on one side than the other. In more advanced cases, the ribs and shoulder blade on one side of the back may stick out. Due to cosmetic concerns, many young people with scoliosis will avoid tight-fitting clothes and swimwear. Sometimes they have never been told about scoliosis—they might only know that their body looks "different" in the mirror—so they may try to hide their differences, even from their parents. As a CA, you may be one of the only people in a young person's life who has a chance to identify the condition and help address it before the scoliosis progresses to severe levels. If you observe signs that suggest a patient may have scoliosis, refrain from asking the person directly, but consult the patient's file and share your concerns privately with the chiropractor if it doesn't mention scoliosis. The only way to diagnose scoliosis is by taking an x-ray; this should be done every time a case of scoliosis is suspected. Even the most skilled chiropractor and the most dedicated parents occasionally will miss the subtle signs that suggest an early, developing scoliosis, and it is always better to err on the side of caution than to risk leaving a case undiagnosed. How to Respect People who have Scoliosis "Freak, hunchback, Quasimodo," she laughed as she went down the list, but my heart was breaking for her. "I was teased quite a bit because of my scoliosis. I skipped my senior prom because I didn't like the way I looked in a dress. At first, I didn't want anyone to know I had scoliosis, not even my family. But being open with them, and my friends, was one of the best things I could have done. It really helped. I found other people who had scoliosis. Talking with them made me feel not so alone anymore." Scoliosis can have a devastating effect upon the emotions of teenagers. It is extremely important to be respectful of their appearance; many times, it is a source of insecurity to them. When examining their posture or massaging their back, remain professional by using appropriate terminology and mannerisms. Avoid using the terms "rib hump" or "deformity," as these carry negative connotations and can be hurtful to hear; instead, use the terms "rib arch," "curve," or "condition." Use a confident touch and tone, and be empathetic to how their condition makes them feel. It may reassure them to know that scoliosis is quite common, and many famous celebrities and athletes have scoliosis—people like Sarah Michelle Gellar, Isabella Rossellini, Usain Bolt, and Vanessa Williams. There is a website, www.CelebrityScoliosis.com, which lists many famous people with scoliosis, and there are several online scoliosis support groups like www.CurvyGirlsScoliosis.com, www.Scoliosis-Support. org, and www.DailyStrength.org. Share these resources with scoliosis patients, and encourage them to express themselves if they feel comfortable doing so. A little bit of kindness and empathy can be a powerful light for a young person going through a dark time. How to Assist Your DC in Scoliosis Rehab Massage can be very beneficial in cases of scoliosis. People living with scoliosis often exhibit increased muscle tension on the side of their curve (along the convexity). By focusing on relaxing that side of the spine more than the other, it can be very therapeutic for the patient, and help the adjustments that follow go smoother. After the adjustment, twisting or bending exercises performed with the aid of an elastic band can help rehabilitate the muscles on the opposite side of the curve (the concavity). One common therapy chiropractors provide to scoliosis patients is electrical muscle stimulation, or e-stim. Many chiropractors were taught to use e-stim to treat scoliosis in chiropractic college—before research was published that showed this doesn't work, and long-term use can actually cause damage to the muscles.12 If your chiropractor is instructing you to use e-stim on scoliosis patients, you may wish to bring this information to his or her attention. Another way you can add value to scoliosis care is by learning how to use a scoliometer. This simple and inexpensive tool is an effective and easy way to record changes in the rib arch and the rotation of the spine, helping to measure the effect of care.3 A scoliosis patient walks into a chiropractor's office seeking help almost three million times every year.4 Never underestimate how you can influence their health and their emotions. Asa CA, you have a unique opportunity to communicate and empathize with patients on a daily basis. You have the power to make a tremendous difference in their lives; recognize this. Respect it and celebrate it! By being aware of scoliosis and knowing the signs, you provide a very valuable skill—one that truly has the potential to alter the course of a young person's life. Research and References Lenssinck MLB, Frijlink AC, Berger MY, et al: Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Phys Ther 2005; 85:1329-1339. Kowalski IM, Szarek J, Babinska I, Wojtkiewicz J, Andrzejewska A, Lipiiiska J, Majewski M: Ultra- structural features of supraspinal muscles in rabbits after long-term transcutaneous lateral electrical surface stimulation (LESS). Folia Histochem Cytobiol. 2005;43(4):243-7. Bonagamba GH, Coelho DM, de Oliveira AS: Inter- and intra-rater reliability of the scoliometer. Rev Bras Fisioter. 2010 Oct;14(5). Christensen MG, Kerkhoff D, Kollasch MW: Job analy sis of chiropractic 2000. Greeley, Colorado: National Board of Chiropractic Examiners; 2000. Dr. A. Joshua Woggon, a 2010 Graduate of Parker College, serves as the Director of Research for the CLEAR Scoliosis Institute, aNon-Profit Organization dedicated to advancing chiropractic scoliosis care (www.clear-institute.org). He can be contacted at [email protected]
