Case Report: Deep Oscillation and Acupuncture in Scheuermann’s Disease

by Chris Boynes, Consultant Chartered Sports & Spinal Physiotherapist

Introduction

Scheuermann’s disease (SD) is referred to as a rigid hyper-kyphosis secondary to vertebral wedging occurring during adolescence. Its incidence ranges between 1 and 8% in the general population. The main complaints are back pain and poor posture associated with unacceptable cosmesis. There are two types of SD according to the apex of the kyphotic deformity, type-1 with the apex at the midthoracic level and type-2 with the apex at the thoracolumbar junction. Operative treatment is indicated in the presence of neurological symptoms and failure of non-operative treatment, including physiotherapy and brace in symptomatic patients. A meticulous selection of fusion levels, avoidance of overcorrection, and the use of neuromonitoring are needed to prevent complications. [1]

Background

Patient is a 54-year-old male with a very long history of painful and restrictive arthritis in the neck and spine continuously suffering from a nasty painful, type 1 Scheuermann’s disease.

Decreased sleep for years
On-going pains for years
No therapy has helped or done much over the years
Posturally, due to Scheuermann’s, certain spine areas take more loading than others.
Lack of Th/Spine Ext/Rot leads to increased lower back loading, and his mid-spine curvature loads more to his right pelvic side.
The C/Spine has reduced ROM in all directions but more so rotation and extension.
Poor hip ROM, both actively and passively, with no hip extension ROM and strength, has led to more loading with the lower back over time.
Other PMH includes a slow-growing aneurysm on his main aorta, which is regularly monitored.
Due to pain, hardly any productive exercise is carried out.
A stooped and slow-moving gait.

Treatment Aim: Reduce pain

Treatment Protocol

During the last 6 x 45 mins sessions, I have covered the following.

Initially, it was the neck and shoulders, with referred pains underneath the right armpit area, sweeping further down the back.

In most sessions, IMS was used first, then Deep Oscillation afterwards, but vice versa also shows how softening the tissue pre-needling helps [2]

DEEP OSCILLATION: 20 mins (or more) sweeping from 200 Hz to 85 Hz, 60 Hz to 41 Hz, 25 Hz – 9 Hz

IMS to c/spine and shoulder girdle: Points used included upper traps, Levator scapulae, Rhomboids, Infraspinatus, Anterior and Posterior Deltoids, and Thoracic Spine Extensors /Rotators.

Traditional Chinese Medicine Acupuncture points include Shenmen, GB 20, GB21, LI4.11, DU20, GB34, St36, BL60, Kid3, St44.

I use IMS and TCM points together, utilising both approaches to affect pain and movement. Please note here the use of both Deep IMS - Chan Gunn [3] and Superficial needling - Peter Baldry [4,5] approaches for pain changes.

IMS Thoracic points and Lower Back points included – please see photos above of Spinal Points at iliocostalis Thoracis and Spinalis Thoracis, plus the right Quadratus Lumborum. Picture 5723.

Such was the strong ‘biting’ effect of the deep needles that I used superficial needling next session for further pain changes. See pictures attached 5915 and 5914.

Picture 5820 – shows 3 needles @ L3/4 and L/5 plus BL26.

In addition, basic exercises for ROM and regular use of warmth in all areas

Results

Over the six sessions, patient has stated his neck/shoulder pains are 70% better, but his lower back/right-sided pelvic has only reduced by 10-15%. But his initial flexed walking pattern has changed to a more ‘normal’ upright posture.

Patient has stated that the pain is reduced after the DOT, and he moves better. It may take him 2-3 days to feel easier, and after some 5-6 sessions, he is improving with pain reduction and better movement.

Observations

Two things may happen when using Deep Oscillation for pain [6-15] on more ‘chronic’ presentations:-

1. Under 50 years of age – individuals feel much better more quickly.

2. Over 50 years and 65 + the positive effects take longer to come through from the treatment.

It appears the ‘older’ tissue sensitivity is felt more than the younger pt. It also depends on the dosage and frequency I use. There are advisable parameters to work with in Deep Oscillation, but what is wonderful about this method, is the variability it can be used with, and depending on the clinic's individual presentation, it is most successful in the majority of presentations in reducing pain.

Future Plan

Auricular acupuncture points to supplement all the above changes and pain management.

About DEEP OSCILLATION® THERAPY (also known as HIVAMAT® therapy)

DEEP OSCILLATION® is an internationally patented, proven technology based on the effects of creating an electrostatic field in the tissue of the patient.

Easy application is from therapist to patient/client via hygienic, vinyl gloved hands; utilizing all normal massage movements or via circular movements over the tissue with a handheld applicator. The handheld applicator also enables self-treatment. The special structure of DEEP OSCILLATION® allows the creation of biologically effective oscillations in the treated tissue using electrostatic attraction and friction. In contrast to other therapies, these pleasant oscillations have a gentle and deep-acting effect on all tissue components to an 8 cm depth (through skin, connective tissue, subcutaneous fat, muscles, blood and lymph vessels). Because of the non-invasive, non-traumatic, gentle nature of this therapy, very early possibilities of application are possible following injury and from Day One post operatively. Chronic conditions can also be worked upon with effective results. http://www.physiopod.co.uk/

Watch video 'Overview of Deep Oscillation with special focus on scars', Watch video of 'The Effect of Deep Oscillation on the Lymphatic System'

About Chris Boynes

Chris is a very proactive and experienced chartered sports and spinal musculo-skeletal physiotherapist with a previous degree in Physical Education. He has worked with elite athletes across a wide range of sports for many years, including Club Physiotherapist at London Irish for 6 years. He has toured with the England U-19’s football team and worked with GB athletes in disciplines as varied as gymnastics, weightlifting, boxing, field and track athletics and badminton. He still works with professional dancers. He has presented at various conferences on such topics as Sports Injury rehabilitation and Diagnostic Taping, Spinal Injury and rehabilitation and movement dysfunction. He has worked closely with Mr Martin Knight and the Spinal Foundation for the past 17 years.

Chris holds clinics in Fakenham and Ebchester

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