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Modern Scoliosis Treatment

Conservative Treatment for Scoliosis from Physical Therapist Hagit Berdishevsky’s Perspective

I have been a physical therapist for more than ten years. My interest in scoliosis therapy started when I was a volunteer for an organization in Ghana that treated people of all ages who had severe, complex spinal deformities (scoliosis and kyphosis). The organization was called FOCOS, for “Foundation of Orthopedics and Complex Spine.” Since then I have been learning a specialized method—the Schroth method—and traveling around the world to see how other countries conservatively treat their patients with Physical-therapy Scoliosis-Specific Exercises (PSSE).

I have been treating patients using the Schroth method for more than eight years, and now I am one of only a few instructors teaching this  method via the Barcelona Scoliosis Physical Therapy School (BSPTS) in the United States.

Having treated prior scoliosis patients using general exercises, I now recommend scoliosis-specific exercises (SSE) as a first step to limit curve progression and maintain function. Bracing is recommended when SSEs are unable to prevent progression, and surgical fusion is the unavoidable treatment when scoliosis is causing symptoms, conservative treatment has failed, and a well-informed patient requests fusion (Weinstein et al, 2008).

 

Scoliosis-Specific Therapy vs. General Physical Therapy

The difference between PSSE and general physical therapy (GPT) is that PSSE consists of individually adapted exercises taught to patients in centers that are totally dedicated to scoliosis treatment. Patients learn an exercise protocol that is personalized according to medical and physical therapy evaluation. GPT, on the other hand, is more generic, usually consisting of low-impact stretching and strengthening activities that are not curve-specific and are based on an old conception that patients with scoliosis need to stretch the short muscles in the concave (collapsed) side and to strengthen the tight muscles that are on the convex (curve) side. However, this last has been proven not to be the case with scoliosis. Therapists, physicians, and patients should understand that scoliosis is a three-dimensional problem, and highly specific to the patient’s curve type.

 

About the Schroth Method

The Schroth Method is a therapy plan of cognitive, sensory-­motor, and kinesthetic training that teaches the patient to improve her/his scoliosis posture and soft tissue imbalance, assuming that scoliosis posture and soft tissue imbalance promote curve progression. Through specific exercises and corrective breathing techniques, the method aims to elongate the trunk and correct the imbalances of the body. By developing the inner muscles of the rib cage, the method aims to change the shape of the thorax. Schroth therapists recognize the importance of a multidisciplinary team approach to treating scoliosis; the team should include a medical doctor, a physiotherapist, an orthotist, and a psychologist.

Scoliosis has both a structural and a non-structural component. The structural component is related to the bone deformity that occurs over time as a result of asymmetrical loading (Stokes et al, 2006). The non-­structural component involves both a default posture (which can be reduced by self-­correction in a moment) and a soft-tissue component. The asymmetry of the soft tissues is partially fixed, but changeable by (1) exercises to increase flexibility and (2) manual therapy intervention in a relatively short time of intensive physical therapy.

 

What the Exercises Are Like

The exercises are determined by the curve patterns and severity, as well as the patient’s age and level of function and fitness. They are designed to create awareness of posture and alignment through proper positioning and repetition. The patient is taught certain positions that will allow expansion of the flattened chest and back areas. Many scoliosis patients have flattening of their backs, prominence of the ribs, lumbar, or pelvic areas as a result of the curvature. We encourage exercises that improve the flat back, restore the alignment of the pelvis, and reduce the protruded areas of the trunk.

Once the patient becomes familiar with his or her individual curve pattern and the principles of the corrections, the method offers many positions that will apply all of the concepts in the same manner, making the program easy to follow.

The exercises can be performed while sitting on a ball, lying face down, lying face up, or on one’s side, as well as in different standing postures using poles or bars that have been secured to a wall.

 

What Is a Treatment Session Like?

The Schroth therapist guides patients with tactile stimulus so that they may get a sense of where they need to breathe into their collapsed areas, and where they need to elongate and tense their muscles to create muscle activation in the direction of the corrections.

By visualizing and feeling the parts of their bodies respond to their breath, patients learn a new way to breathe and align their body. Working with mirrors, patients receive new visual information and are asked to remember how the alignment and corrections feel. Following detailed vocal guides from the therapist, patients are then able to maintain the correct posture and practice it in various positions and their daily activities.

In my opinion, the best scoliosis care for adolescents combines the Schroth method with the Rigo-Chêneau brace. This combination enables the patient to be supported both during Schroth training and in the many hours between sessions.

 

Research Results

Results of the classical Schroth method have been widely published and summarized in several papers. Improvement of breathing function, pain, back asymmetry, posture, muscular imbalance, and the Cobb angle in the short term have been shown (Weiss, 2011). Specificity of the exercises has been shown by the Barcelona Scoliosis Physical Therapy School (Jelacic et al, 2011). However, no research-­based paper has shown that specific exercises following Schroth principles, or any other physical therapy principle, can  prevent curve progression in rapidly progressive scoliosis during the acceleration phase of the pubertal spurt, before the peak of growth and maintained through until reaching maturation. Yet, Schroth method PT remains a very good option for maintaining and even improving function of those with scoliosis throughout the years.

 

References

Rigo M, Quera-­Salvá G, Villagrasa M, et al: Scoliosis intensive out-­patient rehabilitation based on Schroth method. Studies in Health Technology and informatics 2008, 135: 208-­227

Stokes IA, Burwell RG, Dangerfield PH: Biomechanical growth modulation and progressive adolescent scoliosis of an electronic focus group debate of the IBSE. Scoliosis 2006, 1:16

Legaye J, Orban C: Evolution of scoliosis by optical scanner I.S.I.S. Studies in Helat Technology and Informatics 1995, 15: 415-­421

Rigo M, Villagrasa M, Gallo D: A specific classification correlating with brace treatment: description and reliability.  Scoliosis 2010 5:1 (27 January 2010)

Jelacic M, Villagrasa M, Pou E, et al: Barcelona Scoliosis Physical Therapy School BSPTS-­ Based on classical Schroth principles: short term effects on back asymmetry in idiopathic scoliosis. Annual meeting, 8th International Conference on Conservative Management of Spinal Deformities. Barcelona, May 19-­21

Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis.  Lancet 2008X371(9623):1527+37.

 

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  • Cara July 8, 2018 at 8:09 am

    Very informative. My scoliosis wasn’t recognized until after a car accident, which made it worsen. I was told then, it can also cause COPD in smokers? True or not – I am not certain. This is a great article as so much has changed. Not only in Tx but in myself and my body. I do only certain YOGA moves and not others to help my posture. I can visibly see my shoulders are off much more than 5 years ago when accident happened. TY for giving back here, we can all use the extra help and accurate info!!!!

    Reply