SPINE, Curvature of.
The angular curvature produced by tuberculous disease of the bodies of the vertebrae is to he treated on the lines laid down in the article on Caries of the Spine or Pott's Disease.
Scoliosis or lateral curvature of long standing is always associated with some rotation of the vertebre round a vertical axis. Amongst the numerous causes of this deformity none are so important as long continued faulty attitudes and obliquity of the pelvis, which produce an unequal compression of the intervertebral discs, and this is more likely to occur in feeble, toneless individuals soon after the advent of puberty.
If the case is detected in its earliest stages when only lateral deviation exists, before the rotation has set in, correction of the faulty position promptly removes the deformity. Every deviation from the normal standard of health must be corrected ; good food, open-air life, breathing exercises, tonics like Iron, Strychnine, Quinine and Cod-Liver Oil should be administered, adenoids and enlarged tonsils should be removed so as to provide for an unobstructed air-way, and the fatigue of standing must be avoided. Myopia and errors of refraction will require suitable glasses to prevent undue flexion of the neck. The child should be taught to avoid the faulty attitude and to maintain the correct position when the body is placed with the spine straightened.
In reading and writing the desk should be so adjusted—about an angle of 45 degrees—as to prevent stooping forwards, and in sitting, a deep chair, whose seat slopes slightly downwards from front to back, should be used ; the back of the chair should slope backwards beyond a right angle with the seat, and with a slight forward curve opposite the child's lumbar region. Obliquity of the pelvis in hip-joint cases should be corrected by wearing a thick-soled or high-heeled boot.
Gymnastic exercises must be assiduously carried out for i or 2 hours daily with slowness and precision, stopping as soon as fatigue is ex perienced. Innumerable exercises have been planned, the rationale being to strengthen the muscles whose actions straighten out the curves of the spine, and to educate the patient to understand what the normal position of the spine should be and to maintain this position by a voluntary action of the muscles for as long a period as possible at each séance. One of the best routine exercises for simple lateral deviation is that so efficient for the treatment of rounded shoulders—viz., to swing from a horizontal bar
I iv the arms. Ily sloping the bar from the horizontal a better result is obtainable; thus in the treatment of lateral curvature with the convexity to the right, the left end of the bar may be raised 3 or 4 inches higher than the right. When rings attached to vertical ropes are used for swinging a similar alteration of level can be adjusted.
Dumb-bell exercises are useful. Ridlon's method consists in placing the patient upon a table hying on his back and exercising the muscles by alternately raising above the level of his head and lowering an iron bar (to to 20 lbs. in weight) whilst the elbows are kept rigidly extended, together with various flexion and extension exercises of the spine, swim ming and rotating movements and breathing exercises. The chief point in the working out of all gymnastic exercises should be by manipulation of the arms and of the spine to find out the " keynote position—viz., that in which the deformity becomes reduced to a minimum. With the spine maintained in this position as far as possible, the patient should be placed on the back on a table or couch with the body projecting well beyond the end of it, falling being prevented by an assistant forcibly holding down the legs, after which the body is alternately lowered and raised by flexion and extension at the hip-joints.
Klapp's method of treating lateral curvature consists in the practice of gymnastics carried out with the patient in the crawling position, after the manner of a quadruped, the keynote position being produced when crawling round a circle with the head inclined at each step towards the side on which the hand and knee are brought together in progression. Roth, after finding out the keynote position in each particular case, places the patient before a mirror or between two mirrors, so that he may thoroughly recognise and understand the normal posture when standing, lying and sitting. By this simple means in cases of lateral deviation the perverted muscular sense is soon restored; as the patient endeavours and succeeds in keeping the spine in the normal position by voluntary effort he soon finds that the easiest posture is the old abnormal one which he learns to avoid, and a speedy and complete cure often results.