Explanation in Points of the Aetiology of the So-Called Idiopathic Scoliosis (Adolescent Idiopathic Scoliosis [AIS])

In the years 1984 to 2007 was described the biomechanical aetiology on the So-Called Idiopathic Scoliosis (Adolescent Idiopathic Scoliosis [AIS] [1-29]. The “biomechanical aetiology” explain asymmetries of movement of the right and the left hip, next asymmetries of standing right: left leg mostly on right and also connection with gait. Why gait explanation the maximally absent movements of right hip during every step are transmitted as “compensatory movement” to the pelvis and to the spine causing the deformity rotation deformity. They are three group and four types of etiopathogenesis (epg) of scoliosis depending of three “model of hips movement” [7].


Introduction
To understand the presented theory of aetiology of the so-called idiopathic scoliosis is necessary to use the new tests in examination. Important is to check the hips movements -adduction in straight position of joints to understand the biomechanical influences "permanent standing 'at ease' on the right leg" and "gait".

Material
In the years 1984-2019 in Lublin research were examined 2500 patients with scoliosis. The control group was 340 children -presented by parents with the suspecting of scoliosis. In examination of these children it was full and symmetrical movement of hips and all tests no found the spine deformity. A.
1 st epg -"S" scoliosis -3D -two curves, stiff spine, gibbous on the right side of thorax. Connection with gait and with permanent standing 'at ease' on the right leg.
The first symptoms of oncoming scoliosis are rotation deformity especially in the region of Th6-Th12 and beginning of stiffness.
(2b) 2 nd /B "S" scoliosis -1 or 2D -two curves. Connection with permanent standing 'at ease' on the right leg -plus laxity of joints and wrong and harmful previous treatment (!). In this both types the spine is flexible. D. 3 rd epg "I" scoliosis -1/2D -small curves or any, small gibbous or any -only stiffness of the spine. The 3 rd epg scoliosis is connected only with gait. Deformity appears after walking.
See-the children in Mongolia have no scoliosis (Prof. Jozsef Hyanek, Czech Republic-personally information), they mostly ride horses, exist -no or rare influence of "standing" and "walking". Does a "primary curve" or "secondary curve" exist?: In "S" 1 st epg -both curves -lumbar left convex and thoracic -right convex appears et the same time. In "S" 2 nd /B epg scoliosis the thoracic right convex curve appeared as secondary curve.
Why is there a rapid progression of scoliosis in the acceleration period of a child's growth?: Child's bone growth, the contracted soft tissue on the lateral side of the right hip does not grow and because of this the influence on development of the spine deformity is bigger.

Which type of scoliosis progresses?:
The progression is especially in the "S" 1 st epg scoliosis.
Which type of scoliosis does not progress?: The scoliosis "C" in 2 nd /A type and "S" 2 nd /B epg, does not progress or not significantly. In scoliosis 3 rd epg, patients get to know about the problem in adulthood, because of pain.
What is meant by the worldwide use of the term "the natural history of scoliosis"?: Incorrect therapy -in result progression of scoliosis. Please -pay attention -in past -the etiology was not discovered -and the result because of wrong and improper therapy not good. Such bad result was described as "the natural history of scoliosis". "Laxity of the joints".
All these additions cause make easy oncoming scoliosis and enlarged the deformity.

What kind of therapy-conservative or operative-should be used in treatment?:
Only conservative treatment is proper if we start in proper time, its mean in child's age 5-6 years. The proper therapy -are stretching exercise to receive full and symmetrical movement of hips and spine. Very beneficial exercise is all "Far East Sport Arts" like karate, taekwondo, aikido, kun fu.

Are extension exercises correct?:
No-such exercises are wrong. They produce "iatrogenic deformity" -bigger curves, bigger rip hump, stiffer spine.

What kinds of rehabilitation exercises should be applied?:
Only stretching exercises, giving the symmetry of movements and next the symmetry of the growth and development of the pelvis and the spine are proper. In the first instance, we should receive the "full symmetry of all movement of the hips" especially adduction in the straight position of the right hip joint. Next we should receive also the symmetry in "activity of the trunk muscles". For this aim are proper only stretching exercises.  f) The children should make especially important and proper sport arts like karate, taekwondo, aikido, kung fu, yoga and other similarly. 2. The etiology is strictly biomechanical. The important role in oncoming of scoliosis play "gait" and "standing 'at ease' on the right leg".
3. There are three groups and four types of scoliosis: a) "S" scoliosis -3D -two curves, gibbous, stiff spine. Cause: gait and standing on the right leg.

c)
"S" scoliosis -1D or 2D -two curves -flexible spine. Cause: standing on the right leg plus laxity. d) "I" scoliosis -2D or 3D -no curve or slight, no gibbous or minimal -stiff spine. Cause: gait. 4. In some children in etiology there are present additional causes such as:

a)
Wrong and incorrect therapy / exercises,

b)
Existing of primary extension contracture of the trunk, anterior tilt of pelvis and laxity of joints -symptoms of MBD.

Causal prophylaxis is possible and very easy.
Recommendations in points: a/ physiotherapy -kinesiotherapy for receiving full and symmetrical movement of hips and proper position of pelvis, b/ standing 'at ease' on the left leg, c/ sitting relax, d/ sleeping in embryo position, e/ performing sport -especially beneficial are -karate, taekwondo, aikido, kung fu, yoga.