Scoliosis: Children and Adults

At Advance Physical Therapy we have spent many years developing expertise in effectively managing curvature of the spine over the lifespan. We use an overall approach aimed at teaching the patient to move their body away from their curvatures with specific exercises, activities, position, movement and breathing awareness.

Scoliosis or curvature of the spine can have many variations. Although there are general categories for curvatures, each is unique. An exercise designed to balance a curvature should take into account the uniqueness of the curvature of that person.

However, there are certain common features. First and foremost is the presence of asymmetry. Because we are 3-dimensional beings, asymmetries occur in 3 dimensions. When we look at a person that would be: 1) Front to Back (sagittal plane), 2) Side to Side (frontal plane) and 3) Rotational movements (transverse plane).

In the front to back or sagittal plane, exaggerated curvatures are described as 1) lordosis – most commonly increased arching in the low back, or 2) kyphosis – most commonly increased rounding in the upper back. In the side to side or frontal plane curvatures are most often in a C-shape or an S-shape. The C-shape is often (but not always) a 3-curve in Schroth terminology. The S-shape is often (but not always) a 4-curve. Rotational or transverse plane curvature can be seen when the person bends forward, and one side of the back is more pronounced, the other side is more concave, often in the front one ribcage is more protruding than the other.

According to the Schroth Method and to Postural Restoration, all 3 aspects of the curvature must be addressed to effectively balance the asymmetry. The sequencing of activity begins with sagittal plane correction, then frontal plane. Transverse plane correction is facilitated by the other two. Here is an example of a patient applying an excellent understanding of a standing postural correction for a common type of scoliosis seen in teenagers:

There are several tools to accomplish scoliosis specific exercises. Precise exercise positions place the body in such a way that muscles, previously underused, are activated. Muscles targeted are different on the right and on the left depending on the curve pattern. Passive assists for correct positioning and specific muscle activation can include for example: wedges or towel rolls specifically placed. Bolsters, stools, poles, bars, balls, to name a few, are all employed to give sensory input and to guide muscle activity. Once a corrected position has been achieved, specific breathing techniques are taught to direct air into the concave areas. Breathing is a very powerful tool for repositioning the spine and ribcage. Here are some examples:

Scoliosis exercises are progressed as the person gains mastery of the position and breathing technique. The Schroth Method outlines basic Principles of Correction that include mental focus on changing the body’s habits.

These activities are truly challenging. At the same time, they are tremendously empowering and can give the person a deep and enduring sensitive connection with themselves, with their body and with their breathing.

We integrate Postural Restoration Institute principles for managing asymmetry in the spine with Schroth-based Scoliosis Rehabilitation activities in conjunction with Postural Restoration Institute activities. For more about our approach read our chapter in “Innovations in Spinal Deformities and Postural Disorders” Postural Restoration: A Tri-Planar Asymmetrical Framework for Understanding, Assessing, and Treating Scoliosis and Other Spinal Dysfunctions.

We absolutely do not advocate the “watch and wait” approach as we find curves often progress in the “waiting” period. We have witnessed significant success in curve reductions with treatment and feel strongly that early intervention leads to better outcomes, however older patients with more established curves also report significant benefit related to pain and curve management.

As soon as your child is diagnosed with scoliosis, please consult guidelines provided by The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Within the document is a chart (on page 8) that provides minimum and maximum levels treatment based on your child’s age, growth and degree of curvature. You are the best advocate for your child. There are support organizations like: National Scoliosis Foundation and Curvy Girls Scoliosis Support Group that can help guide you through the process of addressing the first signs of scoliosis. We also encourage you to contact us at Advance Physical Therapy (919) 932-7266, to find out more about our conservative approach to managing scoliosis and to schedule an appointment for a detailed scoliosis evaluation and treatment recommendations.

Learn More from the Video Series: Scoliosis and Hypermobility with Neal Hallinan

Part 1: A Conversation about Childhood and Juvenile Scoliosis with Lisa Mangino

Part 2: A Conversation about Idiopathic Scoliosis with Lisa Mangino

Adolescent Idiopathic Scoliosis: Basic Curve Types and Implications on the Body with Jean Masse

Part 1: Scoliosis: Precautions and Program Considerations with Susan Henning

Part 2: Scoliosis: Precautions and Program Considerations with Susan Henning

The Compression Plank Exercise for Hypermobile and Non-Hypermobile Populations with Molly Miller

Testimonial

Reese’s Scoliosis Journey

— Reese's Mom, Charlotte, NC

Reese started having shoulder pain in April 2018. As her mom, who has been an occupational therapist/certified hand therapist for almost 20 years, I was sure it was due to her playing tennis many hours a day for many years. I assumed her rotator cuff was inflamed and that she would need a break from tennis, as well as therapy to rehab her back. After 3 months of rest and therapy with no improvement, I knew something else must be happening.

In June of 2018, Reese was seen for her well visit and her pediatrician suggested we x-ray her back due to some unevenness observed when she bent over. I remember sneaking a peak as she was getting her x-ray a week later and my heart sank. There it was, clear as day. Scoliosis. The visible curve was large enough that my mind was racing as we walked back to the car. How could this curve be this big without me noticing it? How did I not attribute that to being a possible cause of her chronic shoulder pain?

Immediately I started googling and diving into Orthopedic and Physical Therapy Journals, using my own credentials to gain access. All that research pointed me to two conservative treatment options with promising results: Schroth Physical Therapy and Rigo Cheneau bracing. There was hope.

In Charlotte at that time there were no Physical Therapists certified in Schroth PT. The closest was Advance Physical Therapy in Chapel Hill, NC (www.advance-physicaltherapy.com) and I made an appointment with Lisa Mangino PT, DPT, PCS,C/NDT,PRC, SBC-2. Reese and I spent 3 days in June of 2018 learning Schroth and PRI (Postural Restoration Institute) exercises. It was a lot to take in. Four months prior Reese was playing competitive tennis pain free, and she was ranked 15 th in the nation for her age group. Now we were doing breathing exercises and discussing the need for full time scoliosis bracing. I wondered how my daughter could play a sport at such a high level with Scoliosis?

When Reese arrived for her first appointment with Lisa, she was in chronic shoulder pain and had not picked up a racket since April. When we left Lisa three days later, Reese was reporting it no longer hurt to put her hair up or wash her hair in the shower. We texted her coach on the way home, and he suggested we meet the next morning to see if she can play. She has been playing tennis pain free ever since.

The next part of the equation was to schedule an appointment with Luke Stikeleather, the Chief Orthotist and founder of National Scoliosis Center (www.nationalscoliosiscenter.com). The former president of SOSORT (Society on Scoliosis Orthopedic and Rehabilitation Treatment), Luke has been specializing in scoliosis and making the Rigo Cheneau brace for almost 30 years. I knew I was lucky enough to have him within driving distance. The experience was welcoming and positive. He allows the kids to have input on so much of the process, even offering different patterns for their brace. I suggested to Reese the pink heart print, but she settled in on what I am calling the “tattoo graffiti” print. I am hoping this is not a foreshadow into her future tattoos!

Luke emphasized that compliance with wearing the brace, in conjunction with Schroth Physical Therapy, would give her the best chance of stopping curve progression and maximizing the potential for the curve to permanently reduce. He suggested wearing the brace for 18-22 hours a day. Reese was 11 years old, Risser 0 (skeletally immature with a lot of growth left) with curves of 25/25. Her potential for curve progression was high, nearly 100%, with no intervention. Due to the lightness of this brace Reese weaned into it the first week and built up to full time wear within a few weeks. Today, she reports it no longer feels like she is even wearing a brace. She has no issues wearing it for 20 hours a day, removing it only for tennis and showering (and an occasional pool day). We talk about this brace not being forever, just a moment in time to prevent surgery.

I knew I had to bring Schroth PT to Charlotte. Brittany Hunt is the Director of PT at UBYLEE Healthcare Group (www.ubylee.com) where we both work. Brittany agreed this was a program we needed to bring to Charlotte. In December of 2018 Brittany become certified in Schroth PT as a C1 therapist. A year later she was certified as a C2 Schroth PT, and she has been helping many kids in our area prevent further progression of their curves. She has been working with Reese for over a year and a half now and is a major part of her success.

Reese was diagnosed at 4’11” and has been on this protocol for 2 years. She is now 5’6” with curves of 20/15. Seven inches of growth with only improvements! I remember back to the day she was first diagnosed and how my heart sank, for a multitude of reasons. Many healthcare professionals will say Scoliosis is a “wait and see” diagnosis. Their approach is to simply wait to see if surgery will be necessary. That is not always the case. We used a “try and see” approach, and Reese’s results have been amazing. Her journey with Scoliosis is not over, maybe it never will be. I know for today her body is healthier, stronger and pain free. I know this is a result of the Schroth PT, Postural Restoration Institute Methodology and her Rigo Cheneau brace.