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scoliosis resources brisbane

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Valuable Information...

OUR PROJECTS

Our frequently asked questions

What credible information is available on scoliosis?

What are the “International guidelines for scoliosis management”?

FAQ's

What is "scoliosis-specific exercise?"

What are the different scoliosis schools and their approaches?

What is the evidence for each school?

  • “Rehabilitation schools for scoliosis” thematic series: describing the methods and results. Scoliosis 2010, 5:27

https://scoliosisjournal.biomedcentral.com/articles/10.1186/1748-7161-5-27

 

What is the “Schroth Method”?

  • Three-dimensional treatment for scoliosis. A physiotherapeutic method to improve deformities of the spine. Palo Alto, CA, The Martindale Press 2007

https://scoliosisjournal.biomedcentral.com/articles/10.1186/1748-7161-6-17

What is the best exercise for scoliosis?

Exercises specific to scoliosis are becoming an increasingly common and favoured treatment of scoliosis. Exercise therapy as per Schroth method for scoliosis is usually recommended by your physician as a first line treatment of scoliosis, sometimes in combination with a brace, or while awaiting surgery. There are many differences of scoliosis specific exercises to traditional exercises. The program design and approach, is determined by the patients age, absence/presence of symptoms, and risk of curve progression, and the quality is determined by the training and experience of the therapist/s; typically, PSSE physiotherapy is only performed by professionally trained instructors.

What is scoliosis specific exercise?

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The primary goal of scoliosis specific exercise is to influence the "progressive cycle" that occurs with structural postural conditions. The spine is designed to sit with balance: that is, the head on top of shoulders, on top of ribcage, on top of pelvis, hip and ankles. Disturbance in the balance of the system means compensations occur and the body looks at strategies to maintain upright posture in response, this can results in increased loads on certain structures of the spine.

 

For those growing, that is, a lateral spinal curvature produces asymmetrical loading of the skeletally immature spine, which in turn, causes asymmetrical growth and a progressive wedging deformity. Offloading the growth plate and opposing these forces encourages more symmetrical vertebral growth and a slowing/prevention of further changes in the scoliosis, and in some cases improvement. For adults, the goals is to prevent further asymmetrical degenerative changes and loss in ligamentous strength that leads to progression of the scoliosis with aging.

 

Scoliosis specific exercises teach the person to "hold out of their curve",/ and often including exercises that oppose the curve/ achieve maximal correction. Once able to maintain this posture, strengthening of the spinal musculature is added. Through the exercises the body is able to return to a more ‘normal’ physiological position and lessen the progressive "cycle" through improving posture and restoring muscle symmetry as well as offloading structures that may have been overloaded and contributing to pain. 

 

Stoke’s Vicious Cycle of Pathogenesis:  Adapted from, “Scoliosis and the Human Spine” by Martha C. Hawes (2002)

What is the evidence for each school?

The SOSORT states that physiotherapy and exercise therapy used for the treatment of AIS differs from nonspecific exercises and physiotherapy in that it aims at treating three-dimensional nature of scoliosis and includes the following principles; self-correction of posture and spinal strengthening of key muscle groups, and patient education on postural modifications and integration into daily activities . The frequency of PSSE physiotherapy varies from 2 to 7 days per week. 

 

The most well-known PSSE physiotherapy schools operating under the SOSORT are as follows:

  • Schroth, Germany;

  • Lyon, France;

  • SEAS (Scientific Exercise Approach to Scoliosis), Italy;

  • BSPTS (Scoliosis Physical Therapy School), Spain;

  • Side Shift, UK;

  • DoboMed, Poland; and

  • FITS (Functional Individual Therapy of Scoliosis), Poland

Supporting research exists for each of these methods, and therapists often use a number of methods for their patients (Marchese et al), thus, there has been a move in recent years toward collectively naming the exercises from each of these schools as "scoliosis specific exercise".

  • “Rehabilitation schools for scoliosis” thematic series: describing the methods and results. Scoliosis 2010, 5:27

https://scoliosisjournal.biomedcentral.com/articles/10.1186/1748-7161-5-27

 

 

What is the “Schroth Method”?

The Schroth Method is a specialised form of exercise therapy specific to the 3D nature of Scoliosis - considering the flattening of usual curves in sagittal plane, the side bending in the frontal plane, and the rotations in the transverse plane. It was developed by Katerina Schroth, a Physiotherapist in Germany, and is the oldest, most widely used and most researched method of physical therapy/ exercise in the treatment of Scoliosis with various studies supporting its use. 

  • Three-dimensional treatment for scoliosis. A physiotherapeutic method to improve deformities of the spine. Palo Alto, CA, The Martindale Press 2007

https://scoliosisjournal.biomedcentral.com/articles/10.1186/1748-7161-6-17

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What is the best bracing for scoliosis?

Brace treatment is the most common noninvasive treatment in adolescent idiopathic scoliosis (AIS); bracing for scoliosis is usually recommended by your physician with a plastic brace which covers the trunk or part of the trunk and is usually worn full-time (16-23hrs).Bracing success is defined by preventing the curvatures from progressing and is used in growing spines where there is progression or high risk of curve progression. There are many brace types that differ in design and approach, often the brace success is determined by the expertise of the team and therapists involved in the brace design, make and fit.

 

Symmetrical, asymmetrical or side-bending braces?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Symmetric braces such as Boston Brace, Milwaukee and Wilmington are designed to hug and hold the trunk and use a compression squeezing effect to elongate the spine This brace style is worn 18–23 hours per day. Thi brace does not address the rotation or flat back affects of scoliosis (Weiss & Turnbull 2020b). Of these symmetrical braces, the Boston brace is most commonly used and is 70-72% effective  (Nachemson & Peterson 1995, (Weinstein et al. 2013).

Asymmetric back braces such as the Cheneau-style brace have a unique curve pattern and 3D design to addresses all three planes, considering the flattening of usual curves in sagittal plane, the side bending in the frontal plane, and the rotations in the transverse plane. There are areas of increased pressure to move the curvature into correction and voids/expansions for allowing the ribs and spine to migrate into the corrective directions, and for easier breathing. These braces strive for best possible in brace correction which aims to improve the curve (when possible), this brace is able to reach curves >40degrees in Cobb with good effect (Weiss et al 2017).  Each Cheneau-Gensingen is Schroth method compatible. These braces have shown to be up to 92% effective in preventing progression of scoliosis with just >13 hours of brace wear.

  • "Brace technology" thematic series - the Gensingen brace™ 

https://scoliosisjournal.biomedcentral.com/articles/10.1186/1748-7161-5-22

Night-time side-bending braces such as Charleston or Providence brace, are as effective as full time symmetrical braces with 78% success rate, Unfortunately these are not yet used in Australia, however asymmetrical braces could offer a similar effect without creating any compensations above or below. Night-time braces are usually worn for 8h overnight (Davis et al. 2019; Simony et al. 2019), and is used for milder curves on the cusp of a bracing recommendation or where full time bracing is being refused.

3D Scoliosis Brace for major thoracic curve 
3D Scoliosis Brace for major lumbar curve "C curve"
3D Scoliosis Brace for thoracic and lumbar curve "S curve"
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Do soft braces or off the counter braces help?

Soft braces such as SpineCor and the Scoliosis Activity Suit have become available as an alternative more comfortable option to the standard back brace for scoliosis. Most physicians do not advocate soft back braces for growing kids/ teenagers with scoliosis and research in this area is very limited. Studies have shown the SpineCor brace (soft brace) when compared to a hard brace was associated with increased curve progression and increased risk of requiring surgery (Gutman et al 2016, Wong et al. and Guo et al).  Over-the-counter braces or brace purchased online are not an effective management strategy for those with scoliosis, as they are not not customised enough to the patient or their curves.

 

Night time, part time or full time, which is best?

Rigid full-time brace wear (16-23hrs/day) has the best success rate of 73.2% (61–86%) for symmetrical braces and up to 92% for asymmetrical braces (Weiss et al). Night-time braces worn (8hrs/day) have a success rate of 78.7% (72–85%) (D’Amato, Griggs & McCoy 2001, Price et al 1990). Increased brace wear has been linked with improved success rate, therefore we recommend the brace be as much as possible, part-time or night bracing might be recommended in some cases as a first-point of treatment with potential to move to full time bracing if the curve continue to progress. 

Why is it important to do specialised exercise therapy alongside brace wearing?

​Exercises as per Schroth method have shown to be superior to preventing progression in scoliosis through growth (and helping with improvement in the Cobb) than bracing alone (Kwan et al 2017) .Clients wearing an asymmetrical brace are encouraged to perform their scoliosis specific exercise program, throughout their bracing, and especially during brace weaning to avoid regression of the curvature once the brace is removed (Zaina et al 2009).

Other common questions

What is an EOS Scan, is it safe?

An EOS scan is a low dose radiation scan of the spine that provides a full spine image with important postural information relevant to your scoliosis or postural condition. These scans can be done at regularly intervals to assess for any progression of scoliosis throughout growth, usually 4-6monthly, and allow for multiple scans with minimal radiation which is better for overall health and reduced risk of cancers. The scan is also performed in-brace to assess for brace-effectiveness and inform the orthotist of necessary adjustments that may need to be made to improve brace-effect.

  • The EOS™ imaging system and its uses in daily orthopaedic practice, Int Orthop. 2012 Jul; 36(7): 1325–1331.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385897/

  • A systematic review of the clinical effectiveness of EOS 2D/3D X-ray imaging system, Eur Spine J. 2013 Feb; 22(2): 296–304.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555608/

What is involved in the assessment of scoliosis?

- Low-radiation EOS radiograph which is required to measure the angle of the curve known as Cobb Angle and rotation, as well as other postural measures, and,

- MRI is sometimes used to rule out brain or spinal cord causes for scoliosis

- Back strength testing 

- Measurement of trunk inclination using a device called a Scoliometer/Inclinometer 

- Postural photos/ 3D scanning of the trunk shape

- Questionnaire's for quality of life, pain, appearance and function

  • ​ Radiographic assessment, trunk deformity and back asymmetry. Physiotherapy theory and practice 2011, 27 (1):7-25. doi:10.3109/09593985.2010.503990

https://pubmed.ncbi.nlm.nih.gov/21198403/

  • Validity and Reliability Testing of the Scoliometer® Physical Therapy, 1990; 70 (2):108–117,

https://academic.oup.com/ptj/article-abstract/70/2/108/2728658

 

Is joint hyper-mobility linked to scoliosis? 

YES!, there is a higher incidence of hypermobility in those with scoliosis, and often this is the reason for pain with scoliosis as the postural muscles must work harder to maintain erect postures under the effect of gravity, which can cause an increase in the muscle tone over the outside of the curve and often muscle pains.

 

Does postural stability differ between adolescents with idiopathic scoliosis and typically developed?

Yes! those with scoliosis have increased postural sway in all planes, meaning there is a disturbance in the body's ability to find its point of balance/ support, that is why specialised physiotherapy works to improve spinal balance. 

Does pregnancy increase curve progression in women with scoliosis treated without surgery?

 

No! pregnancy has not been linked to an increased risk of scoliosis progression

exercise
RESEARCH

Research articles

What is the evidence for Kyphosis Specific Exercise & bracing in managing Scheuermann's ?

Effect of Intensive Rehabilitation on Pain in Patients with Scheuermann’s Disease

The Effect of Schroth Therapy on Thoracic Kyphotic Curve and Quality of Life in Scheuermann’s Patients: A Randomized Controlled Trial

Brace treatment for patients with Scheuermann's disease - a review of the literature and first experiences with a new brace design

Kyphosis Specific Exercise in managing Scheuermann's
scoliosis exercises for children

What is the evidence for Scoliosis Specific Exercise in managing scoliosis for children & teens?

  • Physical exercises in treatment of adolescent idiopathic Scoliosis:

updated systematic review. Physiotherapy theory and practice 2011, 27 (1): 80-114 https://pubmed.ncbi.nlm.nih.gov/21198407/

 

  • ​The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial. Clin Rehabil. 2016 Feb;30(2):181-90.

https://pubmed.ncbi.nlm.nih.gov/25780260/

  • The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial:

"SOSORT 2015 Award Winner” https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-015-0048-5

  • SEAS exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis.

Results of a randomised controlled trial, Eur Spine J. 2014 Jun;23(6):1204-14. https://pubmed.ncbi.nlm.nih.gov/24682356/

 

  • Scoliosis intensive out-patient rehabilitation based on Rigo-Concept, Studies Health Tech&Info, 135,  208-227

​      https://pubmed.ncbi.nlm.nih.gov/18401092/

  • Effects of Specific Exercise Therapy on Adolescent Patients With Idiopathic Scoliosis- A Prospective Controlled Cohort Study, SPINE:

August 1, 2020 - Volume 45 - Issue 15 - p 1039-1046 https://journals.lww.com/spinejournal/Fulltext/2020/08010/Effects_of_Specific_Exercise_Therapy_on_Adolescent.10.aspx

  • Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil 2003, 6(3-4):209-214.

https://pubmed.ncbi.nlm.nih.gov/14713587/​​

What is the evidence for Scoliosis Specific Exercise in managing scoliosis for adults?

 

 

  • Rehabilitation in adult spinal deformity. Turk J Phys Med Rehabil. 2020 Sep; 66(3): 231–243.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557622/

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bracing

Bracing for Scoliosis

What evidence exists for Physiotherapeutic exercises during bracing in children/teens?

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What evidence is there for exercises during brace weaning?

  • Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients: Winner of SOSORT's 2008 Award for Best Clinical Paper Scoliosis 2009 Apr 7;4:8. doi: 10.1186/1748-7161-4-8 https://pubmed.ncbi.nlm.nih.gov/19351395/

Is bracing effective in teens?

  • Effects of Bracing in Adolescents with Idiopathic Scoliosis.

​    https://www.nejm.org/doi/full/10.1056/NEJMoa1307337#t=article

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156678/

  • A Prospective Cohort Study of AIS Patients with 40° and More Treated with a Gensingen Brace (GBW): Preliminary Results

​    https://pubmed.ncbi.nlm.nih.gov/29399229/

  • First end-result of a prospective cohort with AIS treated with a Gensingen CAD Chêneau style brace

​     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893157/

  • Combined effect of Schroth method and Gensingen brace on Cobb's angle in adolescent idiopathic scoliosis: a prospective, single blinded randomized controlled trial

     https://pubmed.ncbi.nlm.nih.gov/36930467/


Is bracing effective in adults?

  • Non - specific chronic low back pain in patients with scoliosis—an overview of the literature on patients undergoing brace treatment. J Phys Ther Sci. 2019 Nov; 31(11): 960–964.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879412/

Pre & Post Rehab Evidence

Is there evidence for pre-hab in children/teens?

  • Effect of a preoperative protocol of aerobic physical therapy on the quality of life of patients with adolescent idiopathic scoliosis: a randomized clinical study. Am J Orthop (Belle Mead NJ). 2014 Jun; 43(6):E112-6.

https://pubmed.ncbi.nlm.nih.gov/24945482/

Is there evidence for post-operative rehabilitation in children/teens?

  • Rehabilitation of scoliosis patients with pain after surgery. Stud Health Technol Inform. 2002;88:250-3. PMID: 1545604

https://pubmed.ncbi.nlm.nih.gov/15456044/

Is there evidence for post-operative rehabilitation in adults?

  • The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review; J Neurosurg Spine 26:694–704, 2017

https://pubmed.ncbi.nlm.nih.gov/28291412/

What outcomes can I expect after surgery?

  • The effect of spinal fusion on the long-term outcome of idiopathic scoliosis.

https://scoliosisjournal.biomedcentral.com/track/pdf/10.1186/s13013-018-0157-z.pdf

  • What are the timeframes for return to school and sport after surgery?

https://publications.aap.org/aapgrandrounds/article-abstract/32/5/55/90889/Regaining-Functional-Activity-After-Spinal-Fusion?redirectedFrom=fulltext

POST-OP

Our projects

  • Prowse A, Aslaksen B, Kierkegaard M, Furness J, Gerdhem P, Abbott A. Reliability & Validity in the Measurement of Postural Asymmetry in Three Anatomical Planes for patients with Adolescent Idiopathic Scoliosis. World J Orthopedics,

  • Jan 2017

    • ​doi: 10.5312/wjo.v8.i1.68 - The purpose of this study is to assess the reliability and validity of the Baseline Scoliometer in the assessment of three-dimensional postural asymmetry in patients with adolescent idiopathic scoliosis 

  • Prowse A, Pope R, Gerdhem P & Abbott A (2015) Reliability and validity of inexpensive and easily administered anthropometric clinical evaluation methods of postural asymmetry measurement in adolescent idiopathic scoliosis: a systematic review. Eur Spine J,

  • April 2015

    • doi10.1007/s00586-015-3961-7 - The purpose of this review was to review the current literature in the assessment of postural asymmetry in adolescent idiopathic scoliosis using manual anthropometric measures.​

  • CONTRAIS: CONservative TReatment for Adolescent Idiopathic Scoliosis: a randomised controlled trial protocol,BMC Musculoskelet Disord.5;14:261.

  • Sept 2013 - 2023

    • doi: 10.1186/1471-2474-14-261- The purpose of this study is to improve the evidence base regarding the effectiveness of conservative treatments for preventing curve progression in idiopathic scoliosis.

  • CURENT PROJECTS

  • Our clinic is assisting with RECRUITMENT to studies in ADOLESCENTS WITH AND WITHOUT IDIOPATHIC SCOLIOSIS through University of Queensland 2023-2024 alongside Dr Labrom and the research team - CONTACT US for more information 

OUR PROJECTS
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