Spinometric analysis of patient affected by scoliosis, treated with acupressure

Introduction Much has been written about how the Traditional Chinese Medicine Meridians (TCMs) are closely related to Myofascial Chains (MCs) and then, as a logic consequence, to the Posture. However, there are still few studies that operatively verify these concepts by performing acupressure treatments (like Shiatsu) on subjects groups, of which is performed a postural analysis, before and after. The aim of the present work is to promote these studies, starting from a pilot one and analyzing results thereof. Materials and Methods The study, intended as a case report, enrolled a single, 12 year-old, female subject affected by double curve, low degree scoliosis for just a clinic conrmation, for 10 consecutive modules spaced about a week (range 5-10 days) from each other and consisting of a postural analysis before and after an acupressure treatment (Shiatsu) without time gaps between analysis and treatment. The analysis was made with a DIERS Formetric 4D. and


Introduction
Over the past twenty years, several Authors made articles that even more con rm the closely relation and inter-dependence between Traditional Chinese Medicine Meridian (MTCs) and Myofascial Chains (CMs), as cited by renowned works of Langevin in 2002 [1][2], Dorsher in 2009 [3], Stecco C. in 2010 [4], Myers in 2016 [5], Stecco L. in 2017 [6] and Bianco in 2019 [7], effectively building a bond between the Posture and the Meridians.
A strong support for this thesis could be nd, in a completely aseptic way, already in 1977 in the writings of Masunaga [8], in 2004 in those of Berensford-Cook [9] and in 2017 of Ricciotti [10].
However, there are not many studies that, starting from this literature, document its effective results, applying its principles on a group of subjects.
The aim of this work is to fond preliminary supports that can promote a scienti c study on the effectiveness of acupressure techniques, in the ameliorating of the Posture in subject affected by deformities of vertebral column, like scoliosis.

Materials And Methods
The criteria of inclusion selected to enroll subjects adapted to participate in the present study were the following: -age < 18 years-old -presence of untreated scoliosis (low degree, Cobb's angle <25°) -no concomitant orthodontic treatment, that is concluded for at least 6 months -no further declared or remarkable pathology upon the enrollment.
The criteria of exclusion were uniquely identi ed in the non-compliance with one or more criteria of inclusion.
The enrollment was de ned on voluntary bases, without rewards for the candidates, in any form and exempt from charges against them, except for the arriving, in autonomous manner, at the place wherein measurements and treatments would be performed.
The participation in the study was made o cial by means of a xing signature on purposely-made informed consents, also considering the involvement of not of age subjects, for both the adhesion to the study and the acupressure treatment and the processing of personal data in compliance with applicable laws (UE's Regulations 2016/679).
Based on above cited, it enrolled a single female, subject, BE00 of 12 years old affected by low degree scoliosis for just a clinic con rmation, with double right thoracic and left lumbar curve.
The study was structured in 10 identical modules, with weekly frequency (range 5-10 days), each consisted of a starting postural analysis, followed by the acupressure treatment, performed by a Professional Operator con rmed by the Federazione Italiana Shiatsu Insegnanti e Operatori (FISIEO), at the end of which it was performed a new postural analysis, equal to the starting one. Each single module was studied and organized in order to completely cancel the "pre/post-treatment postural analysis" and "post-treatment postural analysis/treatment" latency times, by performing the treatments in the same equipped room for the postural analysis.
Generally, the acupressure treatment was conducted according to the teachings of Masunaga School, to which it is allowed, as unique exception, to have structured the treatment always on the postural meridians (Bladder, Gallbladder and Stomach). The treatment was integrated with a work, aimed to relaxing, on hands, feet and face. The postural analysis system was identi ed based on its ability to completely and concurrently meet some fundamental requirements, such as the non-invasiveness, the availability, the fast execution time and the validation in the current eld of literature.
The full-spine X-ray was rstly discarded due to his invasiveness as sustained by the articles on the matter [11][12][13][14][15]. The analysis of the literature, in particular [16][17][18][19][20][21][22][23][24][25][26], has therefore lead to choose as the postural analysis system for this study the DIERS Formetric 4D provided with the measuring protocol 4D Average able to perform a dynamic analysis capable to compensate for possible unintended movements of the subject, taking 12 pictures in 6 s.
Multiple parameters are detected from this system. Therefore, it's been needed a selection of the most useful of them for the study.
In order to describe the posture of the examined subject in the three planes of space in an easy, but reliable, manner and considering the indications provided on the matter, from the above cited researches in literature, it has come to be considered the parameters, graphically shown in gs. 1-6, ( gures processed from material kindly provided by Hakomed Italia) and described in table 1. Instead, the table 2 shows a legend of references used in gs. 1-6. Finally, table 3 shows the accuracy limit of the Diers Formetric system (data kindly offered by Hakomed Italia): The data obtained from the postural analyses were derived and directly stored by the system DIERS Formetric, while the data relating to the acupressure treatments were collected with proper form wherein it was also written the value of VAS (Visual Analogue Scale), shown in Fig. 7, in a wider version to adapt it to the needs of the study, whereby the subject was asked to evaluate his own perception of the psychophysique condition, before and after each single treatment, to complement the obtained instrumental data.

Results
The study was conducted since September 2018 until to December 2018.
The subject completed the expected cycle of 10 modules with the expected frequencies.
Graphs in g. 8 show the trend of each single parameter across 10 modules, with the comparison between the pre-and post-treatment value.
Instead, another series of graphs, shown in gg. 9-10, shows the trend of all parameter in the context of every single module, with the comparison between the pre-and post-treatment value, the comparison between the start and the end of treatments and between the start of treatments and 2 months after their end.
Finally, the following graph shows the comparison among VAS' values (scale adapted to the needs of the study) relating to before and after treatment in each of 10 modules consisting the study.

Discussion
The parameters that can be considered in a postural analysis are multiple, especially when integrated by digital systems like that used in this study. It results a non-unique determination of a unique pool of parameters to be considered in the analysis itself, able to characterize it in a complete and exhaustive manner, with related ranges of physiology.
It should be also considered that the used parameters are linked with each other and consequently the detriment of one of these doesn't necessarily imply a negative aspect, because it can correspond to the improvement of another one.
Maybe, also for these reasons, there are not many available article in literature for helping in this sense.
One of the few found is thanks to Guigui et al. [27] which in their study in 2003 indicated the range of most common values for some parameters of postural analysis, one of which (angle of pelvic anteroretroversion) was selected in this studio as well, but insu cient for an acceptable evaluation of obtained results.
For these reasons, the present discussion will be based on generic consideration that can be derived from the comparison of above presented graphs.
Firstly, it is highlighted how, generally, at 2 months from the end of the last treatment, the value of each parameter tends to redirect itself towards the starting value before the 1st treatment.
Further, it is evident how at least one third of the considered parameters has a considerable variation, approximately >10% in the pre-/post-treatment comparison.
In particular, relating to the graph that compares the values of pre-1st treatment and post-10th treatment parameters, it is possible to concretely suppose a re-harmonization of the posture on the sagittal plane, with reduction of cervical lordosis, increase of lumbar lordosis and net reduction of antero-posterior exion.
Indirectly, it is important to observe that, in each module, the subject indicates a post-treatment VAS value corresponding to a perception of his own psycho-physique wellness, an important component in the determination of the postural asset, better than that declared pre-treatment. This aspect takes a particularly important meaning if it is understood that the pre-treatment values indicate that the subject presents himself with an already good, and often also very good, perception of his own state, but that in every case the treatment can still improve.
Finally, it's important highlight one consideration about the study, as a whole, Being understood the non-referential nature of the study, it still further highlighted the close bond between Posture and Acupressure, because, at the end of each treatment, at least one of the detected postural parameters becomes changed.

Conclusions
The conducted study, although within the limits of its design, reasonably permits to a rm that an acupressure treatment (like the Shiatsu treatment) is able to in uence the posture of the receiving subject, by basically re-harmonizing it, by acting on both physical and, even more often and e ciently, psychoemotional aspects that contribute to determine it and this brings to sustain the idea of encourage the development and the implementation of bigger studies with the use of Fascial Neuromodulation, to bring to clinically useful results.
Declarations Acknowledgement I really feel to thank Gianluca Bianco MD, Master Degree in Posturology, for his constant and precious scienti c and experience support.

Con icts of Interest
The Author declare to have no con icts of interest A positive value indicates that the right iliac wing is placed before the left one, while a negative value indicates that the left iliac wing is placed before the right one