Professor Dr. Karski, Lublin, Poland<br />
How does the so-called idiopathic scoliosis develop? Biomechanical Etiology. General/Essential/Elementary information about so-called idiopathic scoliosis.
See also lectures in http://www.karski.lublin.pl/en
 Biomechanical etiology – connection with hips – explanation of development of spine deformity:
A/ In every child with scoliosis – there exists asymmetry of movement of right and left hips. This asymmetry is in connection with “Syndrom of contractures in newborns and babies” – Prof. Hans Mau (Tubingen/Germany) “Siebener [Kontrakturen] Syndrom” What kinds of movements are limited? See below.
B/ In children with scoliosis there exists a limitation of adduction of the right hip or even exists “abduction contracture of the right hip” – important – examination in extension [straight position] of the joint (Karski) – [it is equal with what was described by Prof. Hans Mau as “Haltungsschwache”].
Often (and always in I epg – “S” double curve scoliosis and in III epg group – “I” scoliosis – see down) is also limited internal rotation (!), often also limited extension of the right hip.
C/ Because of this asymmetry of movements, there exist biomechanical influences on the pelvis and the spine during gait (!).
 The importance of gait (!) “Gait in scoliosis” & “standing ‘at ease’ in scoliosis.
In Mongolia/Asia no scoliosis, because the children mostly ride on horses – information from Professor Josef HYANEK – (biochemical doctor & pediatrician) in Prague / Czech Republic who was in Mongolia 2 years. Information is given – during Orthopaedic Symposium, October, 2006. Organizer of the Symposium – Professor Ivo Marik.
There is also no scoliosis in blind children. Why? After discussion (letters) with Professor Veikko Avikainen from Finland (Kauppakatu 23 A 17, 40100 Jyvaskyla, Suomi/Finland) and Professor Jacques Boulot (pediatric and adult scoliosis, spinal reconstructive surgery) from 31-400 Toulouse, Rue des Buchers, France – Polyclinique du Parc (discussion on International Orthopaedic Congress in Cairo – 4-9.12.2006) – now I can answer – blind children walk differently than children who see normally and because of this – they do not have scoliosis (see the LECTURE from IRSSD Meeting Liverpool, 2008).
Blind children walk without “eye control” but with the big “thinking-muscles control”, with careful every step, which changes “the manner of walking”. Their walk is with short steps, slowly and with “great caution”. So, even in case / in situation of “abduction contracture and external rotation contracture of right hip” it is no scoliosis, because – no “biomechanical influences” occurring during walking/gait. Please, make your own observation on this topic (Karski, December 2006 / January 2007).
 Farther explanation of development of scoliosis on the example of “S”- shaped double scoliosis (I-st etiopathological group [epg] of scoliosis. There are important significance of “gait” and “standing position ‘at ease’ of the right leg” for many years (see up and below – next points):
1/ The limitation / contracture of the right hip leads to movements asymmetry of both hips, next to transmitting asymmetrical loading from the “missing” (restricted) movements of the right hip to the pelvis and to the spine during gait,
2/ This produces rotational deformity of the spine with stiffness and in some children a lordotic deformity (see computer gait analysis in other chapters of this Web Site) of the thoracic spine, making the anterior spinal column longer than the posterior spinal column (first stages in Ist epg – etiopathological group [epg] “S” double curves scoliosis – [3D Deformation] Karski 2001). Some cases in I epg group are “lordoscoliosis”. See also the chapter “FOTOS/PHOTOS/WYKŁADY/LECTURES” and next “Badanie/Examination/LECTURES [Pl & Eng]” and here “Computer Gait Analysis” (click on the link on the left).
 The importance of “standing ‘at ease’ in scoliosis. Every child with scoliosis has a permanent habit of standing “at ease” only on the right leg (!) Click for slide presentation
“Standing” is the main cause for “C” scoliosis (II/A etiopathological group – see next chapter) and is also the cause for “S” scoliosis (II/B epg “S” scoliosis) as special sub-type.
In this “S” IInd/B epg – sub-type scoliosis, the thoracic right convex curve is the secondary deformation. This II/B epg “S” sub-types scoliosis – is without “stiffness of spine” and without gibbus costalis (or with very small), what is typical for “S” in Ist epg scoliosis – [Karski – 2001 – 2004/2006]. Some cases from II/B epg are “kyphoscoliosis”.
The standing “at ease” on the left leg, or on ‘the crossed legs’, or in the position “uchi hachi ji dachi” or “kiba dachi” (terms from Karate) are safe for the spine and protect from/before scoliosis.
 Scoliosis – is the secondary – not genetic (!) deformity of spine and body (T.Karski – 1995 – 2004/2006/2007).
 Short about new classification of so-called idiopathic scoliosis – general observation and explanation. Observations for approximately 20 years – from a large sample of clinical cases of children (N – 1300 – now 1450 july 2008) with scoliosis in all types.
Here (in this chapter) are presented / explained only connections with “gait” and “standing position ‘at ease’ on the right leg” and type of scoliosis:
I epg – “S” double curve scoliosis with stiffness of spine and with gibbous costalis, both curves develop at the same time. Influences: “gait” & standing “at ease” only on the right leg. Some cases from I-epg are described as “lordoscoliosis”. Progression.
II/A epg – “C” one curve scoliosis. Influences: standing “at ease” only on the right leg since first years of life. No progression or slight.
II/B epg – “S” scoliosis, lumbar curve primary, thoracic curve secondary, without stiffness of spine and without gibbous costalis (or with very small). Influences: standing “at ease” only on the right leg since first years of life, laxity of joints, “wrong”/harmful exercises. Some cases from II/B-epg are described as “kyphoscoliosis”. No progression or slight.
III epg – “I” scoliosis without curves, without gibbous costalis (or small) but with “stiffness of spine”. Influences: gait. No progression.
There are obviously / of course “mixed cases”. More in page [click of left]”(3) “Types of scoliosis” and in many LECTURES.
1. The aetiology of so-called idiopathic scoliosis is strictly biomechanical based on asymmetrical movements of the hips. The groups of scoliosis in this new classification (2001 – 2004 / 2006) are determined in connection with “model of hips movements” (2006).
2. Development of scoliosis is connected with function – “gait” and “standing position ‘at ease’ – only or mostly on right leg”. In the absence of “gait” and “permanent standing on the right leg” – this both factors, the AIS would not develop.
3. The abduction contracture of the right hip is connected with the “syndrome of contractures” of newborns and babies described precisely by professor Hans Mau from Tűbingen and also by many authors – Dega, Tylman, Gardner, Sevastik, Normelli, Burwell, Stokes, Saji&Leong, Willner, Wynne-Davies, Green&Griffin, McMaster, Komprda, Magoun, Karski & Tarczyńska & Karska).
4. Children in age of 2-4-6 years old should be examined to discover whether there is a difference of adduction movement of the hips and the shape of the spine in flexion (Adams test or Lublin test – side bending test for scoliosis). If there is asymmetry of adduction and the child is in the habit of standing “at ease” position on the right leg they should undergo periodical precise spine examination and should make simple, flexion exercises for spine.
5. Radiographic asymmetry of the pelvis of babies (in DDH screening) should be later remembered as a risk for spine development at children 3-4 years old and later.
7. In the new classification there are three etiopathological (epg) groups of so-called idiopathic scoliosis. The first group (I epg) – double “S” scoliosis with rib hump – is connected with asymmetry while walking, asymmetry in loading and growth of spine. The lumbar and thoracic curves appear at the same time, sometimes very early at the age of 4 – 6 years. In small children a curve even of 5 degrees (X-ray) and “stiff spine” should be recognized by doctors as an “important actual sign of the scoliosis problem”.
8. In I epg – the first sign is rotation deformity (Burwell) which causes “stiffness” of spine with three stages:
a/ disappearance of processi spinosi Th6-Th12 [35, 12] (Karski);
b/ flat back and flattening of the lumbar spine [41, 40, 11] (Tomaschewski&Popp, Palacios-Carvajal, Vlach et al.., Karski);
c/ lordotic deformity in the thoracic part of the spine (Adams, Meyer). This type of scoliosis is progressive. Because of severe rotation deformity, some cases in this group are called “lordoscoliosis”.
9. The second group – II/A epg – “C” scoliosis or II/B epg – “S” scoliosis – is connected only with the habit of “permanent stand position ‘at ease’ on the right leg” since the first years of life. In this group (II/A epg) the first and the only scoliosis is the lumbar or sacro-lumbar or lumbar-thoracic left convex scoliosis. Among these children we do not see rotation deformity with essential stiffness of the spine, nor any thoracic curve, nor rib hump and if any, these are mostly not important clinically. In II/B epg “S” scoliosis, the lumbar curve is the first, the thoracic the second. Some cases in this group have “kyphoscoliosis”.
10. There are also patients from the III epg group. In this group of scoliosis we note only “spinal stiffness” and in adult patients “back pain”. This type of scoliosis involves very small if any curves or rib hump.
11. The II/A epg, II/B epg and III epg groups of scoliosis are non-progressive.
12. All at-risk children should be included in an early program of “prophylactics”: sit physiologically, never straight up; sleep in foetus position and stand “at ease” on the left leg or on both legs. Early prophylactic programs should also include such exercises as: karate, kung fu, taek-woondo, tai chi, aikido, yoga etc.
13. Neo-prophylaxis is possible and is effective – but it should be started very early in small children in kindergartens and in the first year of primary school. It is “important program” especially in last year of “Bone and Joint Decade 2000 – 2010”.
More about “aetiology of scoliosis” about screening, about new exercises – everybody can find in this Web Site in subchapter FOTOS / PHOTOS / WYKLADY / LECTURES
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