What to Expect: Conservative Scoliosis...

A guide for patients and families

Division of Pediatric Orthopedics

NewYork-Presbyterian/Morgan Stanley Children’s HospitalColumbia University Medical Center

Department of Orthopedic Surgery

Tel: 212.305.5475Fax: 212.305.8271

columbiaortho.org

What to Expect:Conservative Scoliosis Care

ColumbiaPediatricOrthopedics

JHRevised12-15-16

WelcometoColumbiaOrthopedics

DearParents&Patients,

WelcometotheCenterforConservativeSpine&ScoliosisCareatColumbiaOrthopedics.Weunderstandthatscoliosiscanbeafrighteningdiagnosisandthatyouwillhavemanyquestions.Wehavedesignedthisbooktoprovideyouwithgeneralinformationaboutscoliosisandthenon-operativetreatmentoptionsavailabletoyouatColumbia.

HereatColumbiaOrthopedicswehaveassembledagroupofscoliosisexpertswhoworktogetherwithfamiliestocreateanindividualizedcareplanforeverypatient.Wedothisbyofferingthemostup-to-date,safest,andeffectivetreatmentoptions,aswellasthesupportandguidanceofourspecialists.

ColumbiaOrthopedicsisdedicatedtoprovidingsensitive,age-appropriatecaretochildrenandtheirfamiliesthroughouttheirscoliosisjourney.Weunderstandthattheemotionalimpactofscoliosiscanbeasintenseasthephysicaldemandsandweareheretosupportyou.

Sincerely,

TheConservativeCareTeamatColumbiaOrthopedics

WhattoExpect:ConservativeScoliosisCare

1

TableofContents

OurTeam 2

ContactInformation 3

GeneralInformation 3

TheTeamApproach 4

WhatisScoliosis? 5

OrthopedicAppointmentsandImaging 8

Bracing 10

BracingAppointmentProtocol 13

BracingTips&Tricks 14

PhysiotherapeuticScoliosis-SpecificExercise(PSSE):TheSchrothMethod 15

SchrothPhysicalTherapyContacts 17

Research 18

ScoliosisResources 19

Notes 20


2

YourConservativeCareTeam

MichaelG.Vitale,MD

DavidP.Roye,MD

JoshuaE.Hyman,MD

BenjaminD.Roye,MD

JenniferHope,CPNP

AmberMizerik,PA

NikkiBainton,CPNP

JohnTunney,BOCPO

HagitBerdishevsky,DPT

PrachiBakarania,DPT

KellyGrimes,DPT


3

ContactInformation

OnlineMessaging–PatientPortal:

Youcansendmessagestotheclinicalstaffandofficeviathepatientportal.Atyournextvisitpleaseaskforaninvitetothepatientportalsothatyoucansignup.Youcannotsignuponlinewithoutaninvitationsopleasemakesuretofillouttheappropriatepaperworkatyourofficevisit.Patientsolderthan12mustsignupwiththeirownemailaddressandthenmaketheparentstheirproxy.

ClinicalQuestions:

Youmayreachamemberofourclinicalteambycalling(212)305-5475.Pleaseleaveadetailedmessagewiththeteammemberwhoanswersyourcallsothatwemightdirectyoutothemostappropriateclinician.Forschoolnotes,PTprescriptionsandx-rayrequisitionrequests:pleasehaveafaxnumberoraddressavailable.

GeneralInformation

MedicalRecords

Youmayaccesshealthinformationwemaintainaboutyouoryourchild.Youmustcompleteareleaseformgivinguspermissiontoshareprotectedhealthinformationwithotherproviders.Pleasecontactourmedicalrecordsofficesothattheycanhelpyouwithyourrequests.Theirnumberis212-305-0099.Youcanalsovisitourwebsiteatcolumbiaortho.org/patients/medical-record-informationtoobtaintheformonline.

Insurance&FinancialInformation

ColumbiaOrthopedicshaspartneredwithEastCoastOrthoticstoprovideourpatientswithbraces.Ifyouhaveaquestionaboutinsuranceauthorizationorcoverageofabrace,pleasecontactAngelaBerberichat(631)392-2237.

BillingquestionsregardinganappointmentwithoneofourprovidersshouldbedirectedtotheColumbiaOrthopedicsBillingDepartmentat(646)317-7111.

OurWebsites

PediatricOrthopedics:columbiaortho.org/specialties/peds

NewYorkPresbyterian/MorganStanleyChildren’sHospital:childrensnyp.org


4

TeamApproachtoConservativeScoliosisCare

ConservativeCareisanapproachtothetreatmentofscoliosisfocusedonavoidingsurgery.Currently,theconservativemethodsthatweusetotreatscoliosisnon-operativelyarebracingandScoliosisSpecificExercises.Bothoftheseoptionsrequireanintenseandprolongedcommitmentfromthechildandfamily,aswellasaskilledteamoforthopedicproviders,orthotists,andphysicaltherapists.

Thestudy“EffectsofBracinginAdolescentswithIdiopathicScoliosis,”publishedbyTheNewEnglandJournalofMedicinein2013,foundthatamongpatientswithcurvesrangingfrom20to40degrees,bracingwasmoreeffectivethanobservationatpreventingprogressiontosurgery.Italsofoundthatthenumberofhoursthatthechildwearsthebracematters–patientswhoworethebracemorehadagreaterlikelihoodofavoidingsurgery.However,weknowthathandingateenagerabraceandtellingthemtowearitisnoteffectivewithoutthesupportoffamilyandateamoftrainedprofessionals.

Weunderstandthatthediagnosisofscoliosisaffectstheentirefamilyandwearecommittedtosupportingandempoweringyouthroughoutthisprocess.Ourteamincludesdoctors,nursepractitioners,physicianassistants,orthotists,andphysicaltherapists.Eachteammemberbringsauniquesetofstrengthsandskillstothetreatmentprocess,andbyworkingcooperativelyweaddressallaspectsofyourcare.


5

WhatisScoliosis

Scoliosisisa3-dimensionalcurvatureofthespine.ThemostcommonformofScoliosisiscalledAdolescentIdiopathicScoliosis(AIS)–itisfirstdiagnosedbetweenages10and18.Theterm‘Idiopathic’meansthatthecauseisunknown,anddenotesthatthistypeofscoliosisisnotcausedbyanyothermedicalproblem.Scoliosiscanalsooccurinchildrenyoungerthanage10,andthisisreferredtoasEarlyOnsetScoliosis(EOS).

AISaffectsasmanyas4in100childrenandismorecommoningirls.TheredoesappeartobeageneticlinktoAISastheincidenceisgreaterinchildrenwithafamilyhistoryofscoliosisinacloserelative.ThisbookwillbediscussingAISbutmanyofthesameprinciplesandtreatmentsapplytoyoungerpatientsaswell.

Anatomyofthespine

Thespineismadeupof24mobilevertebrae:7cervical,12thoracic,and5lumbar.Thecervicalvertebraecomposetheneck,thethoracicvertebraeareattachedtotheribs,andthelumbarvertebraeareinthelowerback.The5thlumbarvertebraconnectstothesacrum,whichisinturnattachedtothepelvis.Thespinehousesandprotectsthespinalcord.Whenviewedfrombehindthespineshouldbestraightandwhenviewedfromthesideitshouldhaveanormalthoracickyphosis,orforwardcurvature,andalumbarlordosis,orbackwardscurvature.

1

1Image:cybersurgeons.net


6

Connectiontogrowth

Mostchildrenwithscoliosisarenotawarethattheyhaveit.Usually,adifferenceinthechild’sbackisfirstnoticedbyparentsorbyamedicalprofessionalduringaroutinephysicalexam.Thechildmayhavepassedroutinescoliosisscreeningsinthepast,butthenanasymmetryappearsinthechild’sshoulders,scapula,ribsorhipsoverashortperiodoftime.Thisisbecausescoliosistendstoprogressasachildgoesthroughagrowthspurt.Likewise,scoliosistendstostabilizeonceachildisfinishedgrowing.2

Howisscoliosisdiagnosed?

Thepediatricianusestheforwardbendtesttoevaluatedifferencesinthetrunk.Ifthereisaconcernaboutscoliosis,yourproviderwillsendyoutoanOrthopedistforaspinex-rayandfurtherclinicalevaluation.

Theforwardbendtest

3

TheOrthopedistordersanx-rayofthespineanddeterminesthedegreeofthescoliosisbymeasuringthecurvature.ThisisreferredtoastheCobbangle.Curveslessthan10degreesareconsideredwithinnormalrange,10to25degreesisamildscoliosis,25to45degreesisamoderatecurvesize,andgreaterthan45degreesisseverescoliosis.

Isthatan‘S’ora‘C’curve?

Thereareavarietyofcurvepatternsfoundamongpeoplewithscoliosis.Somepeoplehaveonecurve;othersmayhavetwo,three,orevenfourcurves.Havingmorecurvesdoesnotmeanthatyourscoliosisisworse.Thebodywantstomaintainbalancebykeepingyourheadcenteredoveryourpelvis.Itdoesthisbycreatingadditionalcompensatorycurves.Thesecurvesareanormalandexpectedfinding.

2Image:www.nlm.nih.gov3Image:www.choa.org


7

Whydowetreatscoliosis?

Inandofitself,ascoliosismeasuringlessthan45degreesinafully-grownpersondoesnothaveanyimpactonoverallhealthorfunctionalabilities.Thesizeofthesecurvestendstostaystablethroughoutlife.However,onceacurveis45degreesorlargeritmaycontinuetogetbiggerevenafterapersoniscompletelygrown.Verylargecurvescanbegintoimpactinternalorganssuchasthelungs,andtheymaycausebackpainandfunctionaldifficulties.

Thegoaloftreatingadolescentidiopathicscoliosisistopreventprogressiononcetreatmentisinitiatedandhelpthechildarriveatskeletalmaturitywithacurvelessthan40degrees.

Whencurvesbecomegreaterthan50degreesthereisaveryhighlikelihoodthattheywillcontinuetogetlargerovertime.Atthispoint,spinalfusionsurgeryisrecommendedtocorrectthescoliosisandhaltprogressionofthecurve.

Howwillscoliosisaffectmylife?

Beingtoldthatyouhavescoliosiscanbescary.Inallofthemostimportantwaysscoliosiswillnotchangewhoyouare.Yourpersonalitywillbethesame,youwillnotfeelsickorunhealthy,andyoucanstilldoallofthesportsandactivitiesthatyouenjoy.

However,whileyouarestillgrowingyourscoliosisneedstobecheckedbyyourOrthopedistseveraltimesperyear.Youwillmostlikelyneedtogetx-raystakenatyourappointmentstomakesurethatthecurvehasn’tprogressed.Dependingonthesizeofyourcurve,wemayrecommendaspecialtypeofphysicaltherapyoryoumaybeprescribedabackbracetowear.Livingwithabracecanbechallenging,butthisistemporary–onceyouarefinishedgrowingyouwillbefinishedwiththebrace.

Asanadult,scoliosiswillnotstopyoufromdoinganyofthethingsyoulove.Youwillbeabletohaveanactivelife,participateinsportswithoutrestriction,andhavechildren.


8

OrthopedicAppointmentsandImaging

OnceyouhavebeentoldyouhavescoliosisyourOrthopedistwillwanttoseeyouseveraltimesperyear.Thenumberofvisitswillvarybaseduponhowquicklyyouaregrowingandthetreatmentregimenwehavedeveloped.Ingeneral,youcanexpecttoseeus2or3timesperyear.Atthosevisitsyouwillbeaskedtochangeintoagownsothatwecanperformaphysicalexam,whichincludeslookingatyourbackduringtheforwardbendtest.

SpineX-rays

AtmostvisitsyourOrthopedistwillaskyoutogetaspinex-raypriortoyourappointment.WedothisinordertocompareCobbanglemeasurementsandtrackyourcurveovertime.X-raysmayalsobeusedtocheckthefitandeffectivenessofabrace.Manychildrenandparentshaveconcernsabouttherepeatedexposuretoradiationatsuchayoungage.Wetakethisconcernveryseriouslyanddoourbesttolimitthenumberofx-raysperyear.

EOS

Wehaveinstalledanextremelylow-dosex-raymachine,calledEOS,atourMorganStanleyChildren’sHospitallocation.Thismachinesimultaneouslycapturesafullbodyimagefromthefrontandsideandthenusesacomputertocombinetheimages.Thisuniqueprocesscutstheradiationexposure.Asanaddedbenefit,thistypeofx-rayismuchfaster;ittakeslessthanaminutetocomplete.InordertouseEOSthepatientmustbeabletofollowdirectionsandstandcompletelystillforabout20seconds.4

Whyahandx-ray?

Alargepartoftreatingscoliosisappropriatelyisdeterminingthechild’scurrentrateofgrowth.Todothisweconsiderseveralfactors:anyrecentincreaseinheight,pubertaldevelopment,andaspecialx-rayofyourhandcalledaboneagex-ray.Thisx-rayhelpsustodeterminewhereyouareinyourgrowth:whetheryouaregrowingsteadilyasapre-adolescent,inthemidstofyouradolescentgrowthspurt,orintheslowerfinalstagesofgrowth.Thisinformationwillhelpguideourtreatmentdecisions.Unfortunately,itdoesnottellushowtallyouwillbe!

4Image:www.eos-imaging.com


9

Whyahandx-ray?(continued)

Therearemanybonesinthehandandeachoneoftheseboneshasagrowthplatethatwecanseeonx-ray.Asachildmatures,thesegrowthplatesbegintocloseinasequentialmannerbeginningatthetipsofthefingersandproceedingdownthehanduntil,finally,thegrowthplatesofthewristclose.Atthatpointthechildisfinishedwithgrowth.WeuseagradingsystemcalledtheSandersscaletoclassifythex-rayintooneof8stages.Theadolescentrapidgrowthspurtoccursduringstages3and4,followedbyaperiodofslowergrowth.Understandingwhereyouareinyourgrowthtellsuswhentoinitiateandendtreatmentandhelpsguideusonhowfrequentlyyouneedtofollowup.

MRI

NotallscoliosisisAIS;sometimesthereareotherreasonsthatscoliosisdevelops.IfyourOrthopedistnoticesthatthecurvehasanatypicalpattern,ifthecurveisprogressingrapidlyoriftherearedifferencesinyourneurologicalexamwemayaskyoutogetanMRIofthespine.Thistestallowsustolookcloselyatthespinalcordtomakesurethatitisnotbeingaffectedbythescoliosisandthattherearenoothercausesofthescoliosis.Thistestisnon-invasiveandtakesaboutonehour;itonlyrequiresthatyouliestillonatableinsidetheMRImachine.

Weunderstandthatlyingstillcansometimesbedifficultforchildren,soatMorganStanleyChildren’sHospitalwehaveChildLifeSpecialistsonstafftoexplainthetestinadevelopmentallyappropriateway.Thereisaspecial“mock”MRImachine,whichtheChildLifeSpecialistsmayusetoallowchildrentosimulatetheexperiencethroughplay.Thishelpsthemtoprepareforthetestandunderstandwhatisgoingtohappen.WealsohavespecialglassesandheadphonesthatcanbewornintheMRImachinetowatchmoviesorlistentomusic.Ifyouareinterestedinanyoftheseoptions,pleaseletyourproviderknowandwewillconnectyouwithChildLife.

Researchandtechnology

Asamajoracademicinstitution,ColumbiaUniversityisdedicatedtoenhancingtheexistingbodyofknowledgeaboutscoliosisthroughresearchandthedevelopmentofnewtechnologies.AtavisitwithyourOrthopedistyoumaybeaskedtoparticipateinaresearchstudy.Yourinvolvementmayincludefillingoutaquestionnaire,allowingustotakeyourmeasurements,ortrialinganewappordevice.Whilethechoicetoparticipateisalwaysoptional,wehopethatyouwillseriouslyconsideranyresearchrequestbecausetheinformationwecollectimprovesthecareofallpatientswithscoliosis.AllresearchattheUniversityisunderthestrictoversightoftheInstitutionalReviewBoardandwhetherornotyouchoosetoparticipateinastudy,yourcarewillalwaysadheretostandardpractices.


10

Bracing

Bracingtreatmentistypicallyrecommendedafterthecurvehasreached25degrees,butthismayvarydependingonthechild’sage,skeletalmaturity,familyhistoryandadditionalfactors.Severaltypesofbracesexist,suchastheBostonstyleTLSO(thoracic-lumbar-sacralorthosis)brace,Charlestonbendingbrace,Providencebrace,andaRigo-Chêneaubrace.

Allbracesaredesignedtopreventprogressionofthespinalcurve.However,itisexpectedthatwhenyoutakeoffthebraceyourspinewillreturntoitspreviousshape.Bracingdoesnotcureorimprovescoliosis.

Itisimportanttorememberthatourgoalistokeepyourcurvefromchanging,eventhoughyouaregrowing.

Advancesinbracedesignhaveallowedformorecomfortablyfittingbraces.Ifyourbraceisuncomfortable,itisimportanttospeakwithyourOrthopedistaswellasyourorthotist.Theymaywanttotakeupdatedx-raystoseeifthecurvehasprogressed;evaluatewhetheryouhaveoutgrownthebrace;ormakechangestothebrace.Ifthebraceiscomfortablethenyouaremorelikelytowearitfortherecommendednumberofhours.

Typesofbraces

Inourpractice,wetypicallyusetheBostonTLSOandtheRigo-Chêneaubrace.TheBostonTLSOutilizesacustom,made-to-measuredesign.Itworksbyapplyingthree-pointpressuretothecurvatureviafoampadsplacedwithinamoldedplasticshell.Thebraceisconstructedusingaradiograph-basedblueprintdesignedbytheorthotist.

TheRigo-ChêneaubraceisdesignedtofocusoncorrectionoftheCobbangleaswellasderotationofthespine.MeasurementfortheRigo-Chêneaubraceinvolvesphotographs,measurementsinstaticanddynamicpostures,anda3Dscanofthepatient’sbody.Yourbracemeasurementsarethenuploadedintoastate-of-the-artcomputersystem.WeselecttheappropriatebracemolddesignandthenyourbraceismanufacturedbyEastCoastOrthoticsaccordingtothesespecifications.

BostonTLSO(right)Rigo-ChêneauBrace(left).EssentialdifferencesinbracedesigngiveRigo-Chêneaubracesbetterderotationalcontroloverscoliosiscurves.


11

Typesofbraces(continued)

ThederotationalpropertiesoftheRigo-Chêneaubraceallowforgreaterin-bracecurvecorrectionthantheBostonstyleTLSO.Therearecutoutsinthebracethatalignwiththeconcavitiesofyourcurvesandallowforthoracicexpansionandreshapingoftheribcage.ThesizeandshapeofaRigo-Chêneaubracevariesdependingonyourcurvepatternbecausethebraceismadespecificallyforyou.

Ourexpertorthotist,JohnTunneyBOCPO,hasyearsofexperiencewiththeRigo-ChêneaubraceandisavailableinourofficesothatyouareabletoseehimatthetimeofthevisitwithyourOrthopedist.

FormoreinformationontheRigo-Chêneaubrace,pleasevisitEastCoastOrthotic&ProstheticCorp.onthewebatwww.ec-op.com/us-rigo-cheneau-brace

Timeinthebrace

FortheTLSOandtheRigo-Chêneaubrace,itisrecommendedthatyouwearthebrace15-18hoursaday.ArecentstudypublishedintheNewEnglandjournalofMedicineandfundedbytheNIHfoundthattheeffectofbracingisdeterminedbythenumberofhoursinthebrace,aswellasbythecurvecorrectionofthebrace.

Ifyouwearthebracelessthantherecommended15-18hoursaday,itismorelikelythatyourcurveisgoingtoprogressandultimatelyrequiresurgicaltreatment.Ifthereisnocurveprogression,thebraceisusuallywornuntilanadolescentreachesskeletalmaturity,apointthatvariesamongindividuals.Weusetheboneagex-raytohelpusdeterminetherighttimetohaltbracingtreatment.


12

Themoreyouwearyourbrace,thebetteritworks!

Adaptedfrom:WeinsteinSL,DolanLA,WrightJG,DobbsMB.“EffectsofBracinginAdolescentswithIdiopathicScoliosis.”TheNewEnglandJournalofMedicine.2013Oct17;369(16):1512-21.

Bracefollowup

Onceyouhavebeenmeasuredandfitforthebrace,theorthotistwillexplainhowtoweanintothebrace.Thebraceislikeanewpairofshoes;ittakessometimetogetusedtoitandtobeabletoobtainthe15-18hoursadayatthedesiredtightness.Itwilltakeabout4to6weekstoreachthe15-18hoursaday,andatthatpointwewillhaveyoufollowupwithourNursePractitionertoobtainanx-rayinthebrace.Wetakethisx-raytomakesurethatthebraceiscorrectingthecurve.Theorthotistwillalsobepresentatthisappointmentincasethereareanychangesthatneedtobemadetothebrace.Forallofyourotherscoliosisfollowupappointments,wewillobtainx-raysoutofthebracetoseewhetherthecurvehasprogressed.Atthosevisitsyoumustbeoutofthebracefor24hourspriortothex-raytoeliminateanyeffectthebracemighthaveonthecurve.

Theseriesofappointmentscangetconfusing,sowehavecreatedtheguideonthenextpagetoassistyou.


13

BracingProtocol

Youwillhave4appointmentswithourteam.Thefirst3willoccuratNYP/MorganStanleyChildren’sHospital.Pleaserefertotheguideonthenextpagetohelpyoukeeptrackofyourappointments.

1. BraceMeasurementAppointment

1hourwithourOrthotistJohnTunneyAppointmentDate

2. BraceFittingAppointment

2hourswithourJohnTunneyAppointmentDate Note:Thisiswhenyouwillreceiveyourbrace

3. BraceCheckAppointment(andIN-BRACEx-ray)

WithJenniferHope,NP,andJohnTunneyAppointmentDate

Note:PleaseschedulethisappointmentbycallingColumbiaOrthopedics.Thisappointmentwillbescheduledfor6weeksafteryourbracefittingappointment.Youwillneedtoarrive1hourearlytomeetwithJohn.Hewillhelpyoutightenyourbracebeforegoingforthex-ray.

4. AppointmentwithYourDoctor(andOUTOFBRACEx-ray)

AppointmentDate

Note:thisappointmentwillbescheduledfor6monthsafterthein-bracex-rayDonotwearyourbracefor24hourspriortothisappointment

Questions?

Forallquestionsregardinginsuranceauthorizationsforyourbrace,ortoscheduleanappointmentwithJohnTunneyforabracemeasurementorfittingappointment,pleasecontactAngelaBerberichatEastCoastOrthotics(631)392-2237

ToscheduleanappointmentwithaColumbiaOrthopedicsprovider,pleasecontactourappointmentschedulingteamat(212)305-4565.


14

BracingTipsandTricks

1. Theundershirtyouwearunderneaththebraceisveryimportant.Somethingrelativelytightfitting,seamless,andsweatwickingareallqualitiestolookfor.Thiscangreatlyincreaseyourcomfort.

Websitesthatsellcomfortabletanktopsforunderneaththebrace:

www.hopescloset.com

www.embracedincomfort.com

2. Youcanfindsomeclothingrecommendationsinthebook“StraightTalkwithTheCurvyGirls”.Thereisawholesectionofthebookdevotedtohowtomakeiteasiertodresswithabraceon.

www.straighttalkscoliosis.com/index.html

3. Alwaysbringyourbrace,x-rays,andappropriateclothingwithyoutoyourvisitswiththeOrthopedistandtheOrthotist.Anexampleofclothingwouldbeasnugfittingt-shirtandleggings.

4. CallyourOrthotistimmediatelyifyouarehavingbracefitissues.Youdonotneedtowaittoseethedoctorfortheseissuestoberesolved.

5. Alwaysmakesurethatyourbraceisoncorrectly.Inmostbracingsystemsthewaistiswelldefinedandshouldbethelandmarkforcorrectbracewear.Ifthewaistispositionedproperlytherestofthebraceshouldfitasdesigned.PuttingontheRigo-Chêneaubracewhilelyingdowncanmakeabigdifference.

WhendoIstopwearingthebrace?

WhenyourgrowthhasslowedandyourOrthopedistdeterminesthatyouarereadytostopwearingthebrace,wewillrecommendaperiodofweaningoutofthebrace.Typically,wewillfirstweanthebracetonighttimeonlyandthenatthenextvisitifthereisnofurtherprogression,discontinuethebracealltogether.

Duringtheweaningperiodandafterthebracehasbeendiscontinued,somepatientsexperiencesomebackpain.Thisisbecauseyourcoreandbackmusclescanbecomeweakfromimmobilizationwhileinthebrace.Itisimportantthatyoutodoexercisestomaintainyourcorewhileyouarewearingthebrace.Ifyoudoexperiencebackpainafteryoudiscontinuethebrace,pleasespeakwithyourOrthopedist.Wemayprescribesomephysicaltherapytoworkonyourcoremusclesanddecreasethepain.


15

PhysiotherapeuticScoliosis-SpecificExercise(PSSE):

TheSchrothMethod

Whilethebraceprovidesapassivecorrectionofyourscoliosis,therearecertainexercisesthatyoucandotostrengthenyourbackandcoremusclestoprovideactivecorrection.Theideabehindtheseexercisesistocreateasortof“internalbrace”tobetteralignyourspinewhenyouareoutofthebrace,treatorpreventbackpain,andmaintainahealthyspineforlife.

Ourmedicalcenterisproudtoofferthisconservativeexerciseapproachtothemanagementofscoliosis,kyphosis,andotherspinalconditionscalledtheSchrothmethod.TheSchrothmethodisaformofPhysiotherapeuticScoliosis-SpecificExercise(PSSE).Schrothexercisesarefoundedontheprinciplesofself-elongationandspecificmusclecontractionindividualizedtotheshapeofeachpatient’strunk.OurtherapistsaretrainedthroughtheBarcelonaScoliosisPhysicalTherapySchool(BSPTS),arigorouscertificationcourserootedinSchrothprinciplesandasolidunderstandingofthebiomechanicsofscoliosis.

Background

TheSchrothmethodwasinventedbyKatharinaSchrothwhohadscoliosisherself.Shebelievedthatshecouldtreatherscoliosisthroughexercise.Shedevelopedasetofmaneuversbyusingamirrorandemployingtargeted,chest-expandingbreathingtoreshapehertrunkandback.Hersuccessinaddressingherownposturepromptedhertothenpursueaneducationinphysiotherapyandbegintreatingpatients.Herfamilyhascontinuedherlegacy,andnowSchrothisbeingpracticedthroughouttheworld.

Whattoexpect

Ourtherapistscareforthewholeperson,andnotsimplyapainfulbodypart.YourexperiencewithuswillbeginwithathoroughandcomprehensiveassessmentwithyourBSPTSSchroththerapist.Wewilltakeahistoryandperformanexamthatinvestigatesyourposture,function,movementpatterns,breathingpatterns,muscleperformanceandtissuetone.Youandyourtherapistwillworktogethertodevelopaplanofcarebasedonyourgoalsandtailoredtoyourindividualneeds.

Yourfirstappointment

Pleasebringaprescriptionfromyourreferringprovider,insuranceinformation,aswellasanydiagnostictestssuchasx-rays.Note:ifyouareapatientwhowasseenorreferredbyaColumbiaprovider,yourprescriptionandx-rayswillbeinoursystem,sononeedtobringthemtoyourappointment.

Bringorwearcomfortableclothesthatenableyouandyourtherapisttoobserveyourtrunkasyouperformvariousposturesandmovements.Formales,thisincludesaT-shirtandshorts.Forfemales,thisincludesasportsbraorbathingsuittopandshorts.Youcanexpecttobewithusforupto45minutesforyourinitialappointment.


16

Whataretheexerciseslike?

Theexercisesplaceastrongemphasisuponincreasingyourawarenessofyourbodyandtheposturesandmovementsthatyouhabituallyperform.Wewillalsoteachyouhowtooptimizeyourposturalmusclestoachieveamoreneutralpositionthatyoucanincorporateintosustainedpositionsandmovementsandthenintegratethisnewawarenessintoyourdailyandrecreationalactivities.Youandyourtherapistmayutilizemirrors,hands-onguidance,aswellasexternalpropstofacilitateyouroptimalposture.

HowmanysessionsshouldIattend?

Thetotaldurationofyourprogramwillvarybasedonyourindividualneeds,butusuallyaverages10-15totalsessions.TherearemultipleoptionsforfittingSchrothintoyourbusyschedule.Youcanmeetone-on-onewithatherapistonceaweek,oryoumayfinditmorehelpfultolearntheexercisesallatonceduringoneormoreintensiveclasses.Sometherapistsalsooffergroupclassesfortheexperiencedstudentwhowouldlikeextracoachingorarefresher.

Onceyoulearntheexercises,itisimportanttopracticeathomeinordertoimprove.Wegenerallyrecommendthatyoupracticeyourexercisesathomefor30minutesperday,5daysaweektoseeimprovementinyourpostureandappearance,andtoreducebackpain.TheintentionistoincorporateSchrothexercisesintoyourdailyroutinesothatyoucanmaintainyouralignmentforlife.

HowdoIfindaSchroththerapistinmyarea?

AtColumbiaDoctorswehavemanyexcellentSchroththerapistswhopracticeatseverallocations,listedonthefollowingpage.However,ifyouliveoutsideoftheNewYorkCityareayoumaycontactusforrecommendationsoftherapistswithwhomweoftenwork.Youcanalsoviewamoreexpansivelistonthewebsitesbelow.

www.hunter.cuny.edu/pt/the-schroth-method-of-management-of-scoliosis

www.scoliosiseducationseminars.com/physical-therapists-directory.html


17

SchrothPhysicalTherapyContacts

ColumbiaDoctors|Orthopedics NYP/MorganStanleyChildren’sHospital5905thAvenue 3959BroadwayFloor8North NewYork,NY,10036 NewYork,NY,10032

Appointments:212-305-4878

Therapists:HagitBerdishevskyPT,MSPT,DPT,Cert.MDTPrachiBakarania,DPT,BSPTS,C2KellyGrimes,DPT,GCS,OCS,BSPTS,C2

ColumbiaDoctors|Tarrytown155WhitePlainsRoad,Suite102Tarrytown,NY10591


Therapist:RebekahWallach,PT,DPT

NYP/MorganStanleyChildren’sHospital3959Broadway,5thFloorNorthNewYork,NY10032


Therapists:DeniseColeman,PT,DPT.CEIMKatieRiley,DPT,CSCS


18

Research

Ifyouwishtodofurtherreadingabouttheconservativeapproachtothetreatmentofscoliosis,werecommendthefollowingarticles:

WeinsteinSL,DolanLA,WrightJG,DobbsMB.“EffectsofBracinginAdolescentswithIdiopathicScoliosis.”TheNewEnglandJournalofMedicine.2013Oct17;369(16):1512-21.

SandersJO,KhouryJG,KishanS,BrowneRH,MooneyJF,ArnoldKD,etal.“Predictingscoliosisprogressionfromskeletalmaturity:asimplifiedclassificationduringadolescence.”TheJournalofBoneandJointSurgery.2008Mar;90(3):540–53.

KuruT,YeldanI,DereliEE,OZdinclerAR,DikiciF,ColakI.“Theefficacyofthree-dimensionalSchrothexercisesinadolescentidiopathicscoliosis:arandomisedcontrolledclinicaltrial.”ClinicalRehabilitation.2015;30(2):181–190.

MonticoneM,AmbrosiniE,CazzanigaD,RoccaB,FerranteS.“Activeself-correctionandtask-orientedexercisesreducespinaldeformityandimprovequalityoflifeinsubjectswithmildadolescentidiopathicscoliosis.Resultsofarandomisedcontrolledtrial.”EuropeanSpineJournal.2014;23(6):1204–1214.

SchreiberS,ParentEC,MoezEK,etal.“TheeffectofSchrothexercisesaddedtothestandardofcareonthequalityoflifeandmuscleenduranceinadolescentswithidiopathicscoliosis—anassessorandstatisticianblindedrandomizedcontrolledtrial:“SOSORT2015AwardWinner.”ScoliosisJournal2015;10(24).


19

ScoliosisResources

NationalScoliosisFoundation www.scoliosis.org

ScoliosisResearchSociety www.srs.org

SettingScoliosisStraight www.settingscoliosisstraight.org

CurvyGirls-scoliosissupportgroup www.curvygirlsscoliosis.com

SHIFT-non-profitoutreachprogram www.shiftscoliosis.org

Rigo-Chêneaubrace www.ec-op.com/us-rigo-cheneau-brace

SchrothWallBars www.infitnessequipment.com

Peachman,R.R.“HopeforanS-ShapedBack.”TheNewYorkTimes.well.blogs.nytimes.com/2014/05/12/hope-for-an-s-shaped-back/PublishedMay12,2014.


20

Notes


21

Notes

Division of Pediatric Orthopedic Surgery NewYork-Presbyterian/Morgan Stanley Children’s Hospital Columbia University Medical Center

3959 Broadway, 8 NorthNew York, NY 10032

Tel: 212.305.5475Fax: 212.305.8271

columbiaortho.org

What to Expect: Conservative Scoliosis Care

Date post:	31-Aug-2018
Category:	Documents
Upload:	phamthuan
View:	219 times
Download:	0 times

What to Expect: Conservative Scoliosis...

Documents