Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

This is our third Medical Monday post on scoliosis (read Part 1 and Part 2), a common musculoskeletal condition often not recognized until midlife or later. I have asked Dr. Hagit Berdishevsky, who has a Master’s degree in physical therapy from CUNY and who, in 2013, received a clinical Doctorate degree specializing in sports rehabilitation, to provide her perspective on physical therapy for scoliosis.

Our series was prompted by a question I hear often from patients in my practice:

Carla, who was 60, had noticed that her clothes no longer fit properly. She wrote that she exercised, was fit and maintained the same weight she had always been as an adult. She learned from her tailor that she seemed to have a slight curve in her spine that was affecting sleeve length on one side. In addition, her waist was no longer at the same height due to the shoulder and hip on one side being higher than the other. Carla saw a spine specialist who confirmed the tailor’s suspicion: scoliosis. Carla questioned why she had been unaware of this development before and wanted to know how it happened. She also asked what she could do to prevent the mild scoliosis from becoming worse.

I explained that scoliosis diagnosed in an adult for the first time is nearly always subtle early on. Patients may complain of back pain and the diagnosis of scoliosis may be made as part of the evaluation. Other patients may not have pain but the diagnosis is determined by a physical exam. Muscle spasm and poor ergonomic design of how we sit at work may, over time, affect the shape of the spine as we do the kind of work so many of us do: interviewing people, taking meetings, slaving over the computer, often with legs crossed and not sitting back on the tailbone the way we should. When I examine patients, I include an exam of the spine and often discover exactly what Carla described: one side of the body will have an elevation in a shoulder and hip with subsequent alteration in waist and over time, a change in rib cage anatomy and even a tummy pooch that is not related to fat.

No woman wants to have a deformity in her spine that with aging is often associated with pain, loss of height, change in the shape of the spine, chest, waist and abdomen.  All physicians who do physical exams on women should include measurement of height, compare it over time and evaluate the spine and general posture of each patient. This allows a conversation about early changes noticed in spinal anatomy or posture and offers the physician the opportunity to share information about ways to improve and prevent observed abnormalities.

Physical therapy (PT) uses specialized methods and exercise-based treatments to treat scoliosis. In my opinion, physical therapy is the single most important non-operative treatment provided for those with scoliosis.  The foundation, principles, and goals of PT include, but are not limited to, the following:

1. The correction of faulty postures and faulty movement patterns.
2. The correction of muscular imbalances (stretching tight muscle and strengthening weak muscles).
3. Utilization of exercise on a daily basis to improve the patient’s overall fitness.

These principles are routinely applied in the field of physiatry and PT to accomplish key goals for the patient—restoration of mobility and independence.  These principles can be applied to scoliosis and many other musculoskeletal conditions.

When Dr. James Wyss, the physiatrist on our Medical Advisory Board, sees a patient who needs PT, he explains why PT is necessary for his or her condition and what the goal(s) of PT will be. Then he writes a detailed PT prescription that shares with the therapist his thoughts and recommendations, which generally  include:

1. A specific diagnosis and list of problems that need to be addressed.
2. Recommendations regarding the frequency and duration of treatment.
3. Medical precautions that may need to be considered.
4. Types of exercises, manual therapies, and other treatment modalities (ex: moist heat) that will benefit the patient.

Finally, his office staff will recommend facilities and specific therapists that might be best for the patient’s condition. He has worked with Dr. Berdishevsky for many years, first at the Hospital for Special Therapy and later referring patients to her private clinic. Many of my patients have benefited from her thorough evaluation and exacting treatment program.
I hope that you will keep these three posts saved for future reference and share with friends who may need this advice. Prevention is the best cure!

Dr. Pat