Scoliosis

[angel76]

Please let me know the conservative management for correction of scoliosis by Physiotherapy,with main emphasis on a thoraco - lumbar curve.

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[asha]

More details are neccessary. How old is the patient. Is it a congenital scoliosis?

[angel76]

More details are neccessary. How old is the patient. Is it a congenital scoliosis?

The case is an adoloscent female.she has Right Thoracic and left lumbar Curve.I would like to know how to proceed with the exercise program for this patient as it is a double curve/

Thanks.

[tea]

Hi

Try to find out about Katharina Shroth method (german method). (Try google). It's very successfull exercise programe that works on correction of rib rotation and activating weak muscles. Patients learn how to correct posture themself and have to continue with those exercise at home to keep the corrction.
Hope this helps.

Cheers

[charlize29]

Hi there,

I have inquired about this method thru email and unfortunately there is no method offered in australia and asia.

However, they have had patients from US, Canada, Australia, Saudi Arabia, Tanzania, Nigeria and New Zealand.

If you want further information you can contact Erika thru this email:
[email protected]

UK Katrina Schroth Centre:
Scoliosis SOS Ltd. Rehabilitation Centre
Top Street
Martlesham
Suffolk
IP12 4RB
England
(00 44) 1394 383 258
Email: [email protected]

and in the US:

Scoliosis Rehab, Inc.
1201A Water Street
Stevens Point, WI 54481
Email: [email protected]
Phone: 715.295.9820
Fax: 715.295.9821
Toll Free: 877.REHAB.220 (877.734.2220)

Goodluck to you!

Regards,
charlize29

[asha]

How long has she been with this scoliosis. Have you ruled any pathology behind this? Does her scoliosis disappear on flexion or elongation of the spine? This would require an extensive work up in her bony alignment & musculoskeletal system. Iam presently working on a patient & there's enough +ve results seen. The patient is 72 years. Red flags has been ruled out before taking up the patient. You will have to first assess to see if anything can be done at our level. Then proceed to assess which is the primary curve & which one is secondary.

[Peaky]

I would like some advice for expectations and treatment methods following a scoliosis correction if anybody is willing to share! I have had my first patient who has had this procedure recently and I am struggling to think of different methods due to the amount of fixed vertebrae.

My patient is a 15 year old girl and had fixation from T4 to L4 and a couple of lower left ribs removed around 2 months ago. Her scoliosis developed as she grew and surgery was decided when her pain and breathing became the priority. Her pain is pretty much radiating throughout her whole spine and scapulae. She is quite a slim girl with poor musculator in general. I have started work on basic core stability and dissociation (lower limbs for now) and scapula work to make a start and avoiding prolonged positioning. Her main functional problems are that she reports not being able to walk for longer than 5 minutes or sit for 5 minutes before pain limits her (though she can sit through a 30 minute appointment with me with little complaint or obvious pain behaviours). This is a big concern for her schooling as she is about to enter an important year at school for standard GCSE qualifications. According to the patient's mother, pre-surgery the school had little sympathy for the patient, sent her home frequently and gave the impression they thought she was 'making it up'.

I realise that I need to liaise with the school on this patient's needs to ensure she gets the best shot at this important year. It is simply that I have not come across this before and wonder how these usually turn out (if there is a common prognosis) and how I can help her. Thanks in advance!

[Judith Mollet]

For the Katharina Schroth method try this website, it has instructions in english as well that seem fairly detailed: Willkommen auf der Homepage von Christa Lehnert-Schroth...
Click on th union jack flag for english.
regards

[estherderu]

dear everybody,

In the course of information gathering for a scoliosis workshop I am giving and I have been reading a lot about scoliosis lately.
Scoliosis treatment varies per country,
what I suggest you do is READ too .... go to
Scoliosis World and (patient and professional)
Scoliosis Research Society (SRS) for a lot of information.

The SIR- Scoliosis Intensive Rehabilitation programmes includes Schroth and is practised in various countries in Europe and in the USA. To learn as much as fast as possible I suggest you definitely have to go to Scoliosis. The free access journal of the Society on Spinal Orthopaedic and Rehabilitation Treatment (SOSORT)


You will have to see what the possibilities are in your countries. Try to get the orthopaedic surgeons or rehab specialists involved and interested.

There is a lot of knowledge out there and things are changing fast. The SOSORT guidelines look good to me. They include the latest ideas of good management and therapy possibilities including normal physiotherapy and the SIR.

Good luck

Esther de Ru

[estherderu]

dear Peaky,

I must say that my first answer was aimed at the people wanting to know more about the "Scroth method" and having read your thread again I thought I should answer your questions as well.
THE big problem with progressing scoliosis is that breathing (+ pain) becomes a problem. I expect that that was the reason that your patient had this big operation.

In your case, I would try to get hold of the specialists treating her. Pain after surgery does tend to happen a lot and can even be a sign that something is wrong. There is quite some literature about surgery going wrong or post-op problems. I would say you have to be very sure that that is not the case first.
If you can team up with her specialist, it is his/her responsibility as well, you may be able to do much more.
Then, yes, take her problems very seriously, she has her whole life ahead of her. I would certainly give her the names of all the scoliosis sites you can find because being able to communicate with peers with the same problems might help a little.

If I were not certain that I could give her the best treatment, I would try to get her to a colleague that does, or at least visit one for a second opinion.

Good luck for you both

Esther

[Peaky]

Thank you for all of the information and advice you offered. I have taken it all onboard. I think a big problem is her surgeon who is known to be quite anti-physio. When my patient expressed her concerns on the pain he apparently simply answered that he could always just take out the metalwork, which the patient is not keen for. I will work on this. Thanks again

[estherderu]

dear Peaky,
I know the problem. think we all have to deal with this type of problem at one stage or another. But every doctor is a human being, no more, no less.
I have found it quite rewarding to keep trying.
There must be a reason why this specialist is anti-physio.
Lets try and make him/her change his/ her opinion.

Good luck... the more you know before you meet , the better of course.

Esther

[linbin]

hi
couple of months back i read an article about scroth's techniques in physical therapy journal of 80's.i agree with the biochemical aspects of scoliosis she projected.scoliosis is a 3 dimensional deformity,so the correction also should be 3 dimensional
i tried rotational breathing technique described by her in 2-3 patients with functional scoliosis and the results was extremely good.

[estherderu]

dear linbin,

Is this the article you were talking about?
if not, this one does describe the method well.

http://www.easyvigour.net.nz/pilates...2Treatment.pdf

esther

[linbin]

hi ester
i just flipped thru the pages of the pdf you attached.i will read and let you know whether its the same one.
it was kind of you to put such a wonderful article here.i firmly believe that hundreds of people will be infleunced by it

[linbin]

hi ester
i read the pdf file.its the same one which i read.
to physiomembers,
i am extremely sorry all for quoting the wrong journal and year.
i find her principles extremely useful
please put forward comments after reading the pdf file

[Peaky]

Thanks for sharing that article. I will study that and take it on board for my recent influx of patients with scoliosis. I went from zero to four within about two weeks!

[estherderu]

a little information on bracing.....

we all know the old Milwaukee and Boston Brace. The last few years three new players have entered the ring and they really look promising.

The SpineCor Brace ... SpineCorporation Home Page Elastic Strapping Orthosis for Adolescent Idiopathic Scoliosis: A Preliminary Report and Initial Clinical Observations - Journal of Prosthetics and Orthotics, 2002 | American Academy of Orthotists & Prosthetists
The [B]ScoliOlogiC Chêneau light Brace [/BCorrection effects of the ScoliOlogiC Chêneau light brace in patients with scoliosis Hans-Rudolf Weiss et al Open Access artikel 26-01-2007 Scoliosis | Full text | Correction effects of the ScoliOlogiC(R)Cheneau light" brace in patients with scoliosis [B]]About me

The TriaC Brace [/B]Clinical effect of continuous corrective force delivery in the non-operative treatment of idiopathic scoliosis: a prospective cohort study of the triac-brace Eur.Spine J 2008 february 17(2);231-239 , Med Eng Phys. 2002 Apr;24(3):209-18. A new orthotic device in the non-operative treatment of idiopathic scoliosis. Veldhuizen AG, Cheung J, Bulthuis GJ, Nijenbanning G.

I do not have any experience with them I´m afraid. The Chêneau brace has been around the longest, has been modified a number of times and allows breathing and rib movement in the area you want it. With the SpineCor brace you can even do your gymnastics and with the TriaC brace movement in all planes is possible because of a flexible coupling. Patient can bend forward,backward and sideways with corrective forces maintained. It is suitable for most curves.

Maybe it is time for us physiotherapists to get more involved with the orthopaedic surgeons in finding the best brace solution for our patients. We have the knowledge and right to ask questions about the braces that are being supplied to our patients.

Good luck
Esther de Ru

[estherderu]

dear everybody,

a few interesting articles on scoliosis managment are:

in the online free access journal Scoliosis the following review on surgery has just been published.
Scoliosis | Full text | Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature
In the European Journal of physical and rehabilitation medicine June 2008 2008;44:177-193 The treatment of adolescent ideopathic scoliosis (AIS) according to present evidence. A systematic review H-R Weiss & D. Goodall.

and a little older but interesting.... The natural history of scoliosis in spastic cerebral palsy. Naoto Saito et al in The Lancet Vol 351 june 6 1998

kind regards

Esther

[neuromuscular]

Dear angel76,

Have you tried a pelvic angles assessment with hip abduction directly lateral in the coronal plane? See my posting Trial of a test and the one on APAS.

I find that most patients with a scoliotic patterning have two pelvic angles that increase in difference as the hip abduction proceeds. Correcting the pelvic angles to anatomical neutral brings excellent results. If you would like the most common contributing factors from pelvic angle difference to scoliosis, I would be glad to forward these to you.

Hope you find this helpful.

Best regards,

Neuromuscualr.

[linbin]

hi neuromuscular
if you upload the articles,it will be useful for us

[neuromuscular]

hi neuromuscular
if you upload the articles,it will be useful for us

Unfortunately there are no articles as this is a new direction of assessment.

The OGI is doing a trial of the idea that pelvic angles are the most objective information on the patient's condtion. The person pursuing it will be pubishing a research paper.

However, I have tried to find similar information and there appears to be none.

I have used the test for over 15 years and with over 1,000 patients.

the difference of pelvic angles works its way up to the lumbar and higher.

The most common muscles in scoliosis are the serraus posterior inferior on the right and the QL on the left which are attempting to anchor a problematic right psoas which in turn is being activated by a left adductor longus.

try the tests as indicated and see what your results are as this is a new direction and there is little in the way of corroberating evidence.

An international magazine in the UK is interested in the paper and so is the conference in Holland in 2009. Be ahead of everyone by trying the test.

Hope that tish is helpful.

Best regards,

Neuromusclar.

[estherderu]

dear neuromuscular,

you are talking about scoliotic patterning being either a pain scoliosis or a a postural scoliosis I presume.
Not a "real scoliosis" as measured in cobb angle and risser scales etc?

Esther

[neuromuscular]

Can be either.

If the deviation is only a small amount the Cobbs angle may not show it.

However, the scoliotic patterning is due to pelvic angle differnces in many patients. The adductor longus activates a response in the contrlateral psoas. The psoas will put a torsion rto the spinal column ant the QL on the contralteral side to the psoas and the serratus pos inf on the ipsilateral side will try to counter the rotoscoliosis that the psoas would create.

The proprioceptive sense will try to maintain face forward or torso and lower extremity alignement.

The most common lateral deviation of the lumbar to the left is thus accomplished.

Presently I have a patient who had a major scoliosis that was to be treated by Harrington Rod Implant, but the opeation will not be needed and the scoliosis is correcting to a more neutral pattern. Radiographic assessmentt is set for November.

Little research has been done on the pelvic angles factor. This is being done by the OGI after I presented my information to them.

Look for the research paper in about 6 months or earlier.

Best regards,
Nueromuscular.

[estherderu]

dear neuromuscular,

Do you know the free access site of the SOSORT.....
I suggest you go to Scoliosis and see if they are interested in what you have to say.

esther