Adolescent Idiopathic Scoliosis Linked to Gravity Drive Pronation

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Scoliosis in patients between 10 and 18 years of age is termed adolescent scoliosis The most common type scoliosis in this age group is one in which the cause is unknown, and is still referred to as Adolescent Idiopathic Scoliosis (AIS).

I have long suspected a link between abnormal (Gravity Drive) pronation and the development of abnormal scoliotic curves in the spinal cord. A study I published in 2006 statistically linked the unleveling of the pelvis, which forms the base support of the spine, to gravity drive pronation. It is only logical to suspect that if the base of the spine is unlevelled, it could also unlevel the entire spine.

This was my motivation that led to this study (published 2013). The outcome of this preliminary statistical study suggests that the development of scoliosis is linked to gravity drive pronation:

• Gravity drive pronation pattern right > left was linked to a right thoracic scoliotic curve
• Gravity drive pronation pattern left > right was linked to a left thoracic scoliotic curve

As compelling as this study was, it needs to repeated using a larger statistical blinded investigation.


Rothbart BA 2006. Relationship of Functional Leg-Length Discrepancy to Abnormal Pronation. Journal American Podiatric Medical Association;96(6):499-507
Rothbart BA 2013. Preliminary Study: Adolescent Idiopathic Scoliosis Linked to Abnormal Foot Pronation. Podiatry Review Vol 72, No 2:8-11.

 

In 2006 I published my findings in the JAPMA linking gravity drive pronation to an anterior rotation of the innominate which results in a functional short leg syndrome. At that time, on this forum, my paper elicited a great deal of derision and sarcasm. Several senior members even stated that my research study was flawed and unscientific and should never have been published. However since that time the link between innominate rotation and leg length pattern has been duplicated by other research teams including:

Khamis S, Dar G et.al. 2015. The Relationship Between Foot and Pelvic Alignment While Standing. Journal Human Kinetics.
Betsch M, Wild M, et.al. 2012. The effect of simulating leg length inequality on spinal posture and pelvic position: a dynamic rasterstereographic analysis. Journal European Spine.
Kwon YJ SongM et.al. 2015. The effect of stimulating a leg length discrepancy on pelvic position and spinal posture. Journal Physical and Therapeutics Science.

The link between gravity drive pronation and scoliosis can now be expatiated:

• Gravity drive pronation (commonly resulting from either the PreClinical Clubfoot Deformity or the Primus Metatarsus Supinatus foot structure) drives the innominate bones anteriorly (sagittal plane rotation). The more anteriorly rotated innominate bone (referred to as pelvic torsion) being ipsilateral to the more pronated foot.
• Bilateral anterior innominate rotation functionally shortens both legs, the shortest leg being ipsilateral to the more anteriorly rotated innominate bone.
• This unlevel the pelvis and resuls in a pelvic tilt (frontal plane rotation) towards the leg functioning the shortest
• Unleveling of the pelvis results in scoliotic curves

I suggest the term Adolescent Idiopathic Scoliosis should be changed to Gravity Drive Adolescent Scoliosis

The above postural model assumes one is dealing with a pure ascending postural distortion pattern. If there is a descending component (e.g., malocclusion), one foot typically will be pronated and the other supinated while standing. This can modulate the scoliotic curve.