We make use of apparatus which produces passive and active over co•rection separately; they are simple and cheap and therefore very suitable for home use. The principle underlying such apparatus may be briefly presented.
The only force which one can employ to bend a scoliotie spine over to the opposite side is the erector spime muscle on the convex side.
This muscle is always too long, no matter upon what basis a scoliosis has developed, and therefore not quite adapted to the task of bending back a scoliotic spine. This muscle must, therefore, be strengthened uni laterally. This can be accomplished with the aid of simple resistance, i.e., gymnastics. Suppose we arc dealing with a case of total scoliosis with convexity toward the right. The patient is seated and asked to actively curve his spine so as to produce a convexity on the left side (Fig. 90). In attempting now to lift a weight (c) which is attached to his body by means of a strap (a) and a connecting cord running over a pulley (b), he must contract the right erector spline powerfully on the convex side. Palpation of the patient easily reveals this contraction.
The amount of work performed may be gradually increased by adding to the weight and increasing the number of exercises.
I term this method active overcorrection of scoliosis.
The task of the erector spina: is a difficult one, not so much on account of the muscle's own exceptional length but due more to the shortening of the ligaments and muscles on the concave side.
The second step in a rational treatment of scoliosis is to overcome the resistance as much as possible by stretching the soft tissues.
This is accomplished with the passive overcorrection of scolsosis.
I employ for this purpose a simple strap apparatus. Suppose, again, we are dealing with a case of total scoliosis convex to the right. The patient lies with the stomach on an upholstered board (Figs. 91, 92).
The left side of the neck and pelvis are lightly pressed against the upholstered pegs (a and b). Traction upon strap, which is fastened at c and passes over the costal hump and through the slit underneath the upholstered board, will bend the spine as much as its laxity permits from a convex curvature to the right over to a convex curvature to the left (Fig. 92).
To avoid an increase of torsion due to the traction, a wedge-shaped cushion is shoved between strap and body. Thu base of the wedge is located next to the spine of the convex side and the narrow edge of the cushion along the side of the thorax.
According to my experience this strap apparatus permits bringing great force to bear on the accomplishment of the passive overcorrection. Although working very energetically the patients stand the strain so well that they may remain in it daily from one to two hours.
In double curvature two straps are employed (Fig. 93). During recent years I have also made use of reclining boards which allow of a correction in the recumbent position. An example of its use in a convex
scoliosis to the right is reproduced in Fig. 94. Such reclining appa ratus has greater advantage, because the patients prefer the recumbent position to a position forcing them to lie on the stomach, and because they can apply the straps themselves. Naturally, the treatment is not so easy In practice as it appears to be on paper. For example, the height and position of the shoulders, incipient compensatory curvatures, and other special points must be carefully considered.
We have purposely mentioned the gymnastic exercises first, because of their overwhelming importance in the treatment of seoliosis. But orthopedic apparatus cannot be entirely dispensed with. In certain cases of seoliosis, chiefly those of rachitic origin, the plaster-of-Paris bed or the celluloid and steel wire bed is employed. The technic of the plaster bed has been already de scribed on page 1.37.
To correct a scoliosis the plaster bed must exert pressure upon the convex side from behind as well as from the side. This may be accom plished by the addition of a cushion after the bed has been fully pre pared. A more accurate correction can be made with the aid of cellu loid and steel wire beds, but the cooperation of an orthopaedic spe cialist is essential.
During the first years of life massage of the muscles of the back and daily manual reduction of the dorsal hump must be given in ad dition to the plaster-bed treatment; but as soon as a child becomes six years old gymnastic exercises occupy first place in the treatment. How ever, in all cases of scoliosis reducing beds made of celluloid and steel wire may be employed during the night at any age.
Opinions differ greatly as to the benefit of corsets. Formerly it was deemed absolutely necessary for a patient to wear a well-fitting ortho paedic corset after a diagnosis of scoliosis was confirmed. Now all specialists concur in the opinion that a corset without gymnastic exercises is quite insufficient. The correcting influence of an orthopaedic corset is trifling, while the damage done to the muscular tissue and often also to the function of the internal organs by the pressure of the corset is undoubtedly very great. We advise, therefore, restriction in the use of corsets. In mild cases of scoliosis we employ corsets as described on page 147 for about six hours daily, during the time of school attendance, to overcome the detrimental influence of faulty school benches and to guard the children against fatigue. But in marked cases of rigid scoliosis a real orthopfedic corset may be desirable when the muscular strength appears insufficient to prevent further bending of the trunk to the convex side and when intercostal neuralgias occur. The fitting of such corsets must be left to the skill of a specialist. However, a gymnastic treatment must always be combined with the former. The use of "corsets without exercise" is a scientific error.