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Adolescent Idiopathic Scoliosis

For teens and adolescents with scoliosis, a new study demonstrates how specialized physical therapy exercises, known as the Schroth Method, can improve the curve of the spine, muscle endurance and quality of life.1 Author recommendations include adding this type of treatment to the standard of care for patients.

Scoliosis is abnormal, side-to-side curvature of the spine.  Adolescent idiopathic scoliosis (AIS) is the most common (84%-89%) form of scoliosis, occurring in less than 5% of the general adolescent population and mainly affects females.3,4  The most common signs of scoliosis include trunk and pelvis asymmetry, a rib and a lumbar “hump”, as well as a prominent shoulder and/or hip. As scoliosis progresses, symptoms such as back pain, problems breathing, osteoarthritis, psychological concerns, and a decreased quality of life become more apparent.

Most commonly, adolescents and teens diagnosed with scoliosis are either monitored for progression, treated with a brace, or, in severe cases, offered surgery. However, this study demonstrated that 88 percent of patients who performed the Schroth physical therapy scoliosis-specific exercises showed improvements or prevented progression in their scoliosis curves over six months compared to 60 percent of those adolescents in the group receiving only standard care.

The randomized control trial studied 50 adolescents with scoliosis,  aged 10 to 18 years with curves of 10 to 45 degrees (Cobb Angle). After six months of Schroth physical therapy, (30-45 minutes of daily home program and weekly supervised sessions), 88 percent of patients either had improving curves or remained within 5 degrees of their baseline curve magnitude. On the other hand, the average curve in the group receiving standard care deteriorated by 2.3 degrees.

These short term results are clinically significant and show that Schroth physical therapy exercises has the potential to help many patients with scoliosis if this type of conservative management is routinely added to the standard of care.

What are Schroth Method exercises like?  The exercises approach the body in three dimensions to to elongate the trunk and correct imbalances of the spine. The goal is to develop the inner muscles of the rib cage to help change the shape of the upper trunk and to correct spinal abnormalities. The exercises are complex and curve-specific, and a Schroth Method-certified physical therapist prescribes exercises targeted to straighten, centralize and de-rotate the spine with corrective breathing techniques.

PhysioPartners physical therapist, Stephanie Penny, is an advanced certified Schroth Method Practitioner.  “I’ve worked with many teens and adults who have experienced pain improvement and feel better overall with Schroth exercises.  The Schroth method teaches them how to stand, sit, walk, and do other daily activities in corrected posture so that they can reinforce their best posture. In adolescents the current standard of care of ‘wait and see’ for smaller curves can be frustrating for parents and patients who would like to take a more proactive approach. Instead, we like to encourage patients to ‘try and see'”, says Dr. Penny.  “Slowing the curve from progressing or reducing the curve size as demonstrated in this study is exciting.   I take pictures or record the exercises and corrections and they can view them on their phone or computer, and the small group sessions I teach allow Schroth graduates and current participants to work on their exercises together and take control of their curve.”

The study also demonstrated positive effects of the Schroth on pain, body image and muscle endurance. The Schroth group improved muscle endurance with increased average holding time by 32.3 seconds after three months, while the non-exercise group increased by only 4.8 seconds.

The sample patient demonstrates a scoliosis patient’s back before and after six months of Schroth physical therapy scoliosis-specific exercises.2

sample-patient

CREDIT

University of Alberta

For more information on the Schroth Method for Scoliosis, schedule a complimentary screening with Stephanie Penny, PT, DPT or Erin Buenger, PT, DPT. 

References:

  1. Schreiber S, Parent EC, Khodayari Moez E, Hedden DM, Hill DL, Moreau M, et al. (2016) Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis – an Assessor and Statistician Blinded Randomized Controlled Trial. PLoS ONE 11(12): e0168746. doi:10.1371/journal.pone.0168746

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168746

  1. This is a scoliosis patient’s back before and after six months of Schroth physical therapy scoliosis-specific exercises. Photo credit: University of Alberta. https://www.eurekalert.org/pub_releases/2017-01/uoa-spt012417.php#.WIkJVAVyJ4Y.facebook
  2. Schlösser TPC, van der Heijden GJMG, Versteeg AL, Castelein RM. How “idiopathic” is adolescent idiopathic scoliosis? A systematic review on associated abnormalities. PLoS ONE. 2014;9(5):e97461. doi: 10.1371/journal.pone.0097461. pmid:24820478
  3. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013 Feb;7(1):3–9. doi: 10.1007/s11832-012-0457-4. pmid:24432052
  4. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth http://www.physiopartners.com/media/file/362192/2016%20SOSORT%20guidelines.pdf
  5. SOSORT 2017 Award Winner http://www.physiopartners.com/media/file/362192/SOSORT%202017%20Award%20Winner.pdf
  6. SOSORT 2017 Award Winner  http://www.physiopartners.com/media/file/362192/SOSORT%202015%20Award%20Winner.pdf
  7. Cobb Angle Reduction in a Nearly Skeletally Mature Adolescent (Risser 4) After Pattern-Specific Scoliosis Rehabilitation (PSSR) http://www.physiopartners.com/media/file/362192/Cobb%20Angle%20Reduction.pdf
  8. Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis http://www.physiopartners.com/media/file/362192/Effects%20of%20Schroth%20Exercise.pdf
  9. Observational retrospective study on socio‑economic and quality of life outcomes in 41 patients with adolescent idiopathic scoliosis 5 years after bracing combined with physiotherapeutic scoliosis‑specifc exercises (PSSE) http://www.physiopartners.com/media/file/362192/Observational%20retrospective%20study.pdf
Sample