Scoliosis in both children and adults can be painful, unsightly, and perhaps most important, can decrease the optimal functioning of your lungs and heart.
A groundbreaking 2015 study published in the New England Journal of Medicine found that a little over one-third of the 176 children with scoliosis they assessed also had obstructive lung disease (abnormal airway function). The authors say that this type of lung dysfunction cannot be detected with diagnostic imaging (specifically, radiographs such as x-ray, CT scan, MRI, and more).
Not everyone believes this.
Forward thinking physical therapists and others are now, on a case-by-case basis and by growing a body of research, building evidence for PSSE. PSSE is an acronym for "physiotherapy scoliosis specific exercises." It refers to an exercise therapy program given to a patient in physical therapy to treat idiopathic scoliosis.
But in Europe, it thrives. The main schools of physiotherapy scoliosis specific exercise therapy are as follows.
Lyon (France)
The Lyon method is the oldest active approach to scoliosis. It started in the early 18th century when Dr. Gabriel Pravaz founded the first orthopedic physiotherapy center in the city of the same name. In Pravaz's day, treatments included auto-adjusted traction, exercise on "extension equipment" that resembled ladders (to allow the patient to do their work in an upright position—as well as to adjust the traction for themselves) and more. Over one hundred years later, casts and braces were added to the protocol, first with the Lyon brace and later with the more modern ARTbrace. The ARTbrace replaced the Lyon, and this effectively retired the use of casts.
The Lyon approach is mainly focused on the use of the brace, although the scoliosis specific exercises are still a part of the plan.
Scientific Exercises Approach to Scoliosis (Italy)
The Scientific Exercise Approach to Scoliosis (acronym SEAS) is as individually tailored as it is evidence based. It follows the Lyon method—although it got its start much later, in the 1960s—when Antonio Negrini and Nevia Verzini founded a center in Vigevano, Italy. In 2002, the center's name was changed to the Italian Scoliosis Spinal Institute.
The SEAS method focuses on active 3D self correction of the scoliosis by means of patient education (first) and then developing the patient's awareness of their deformity. The idea is that with awareness both of the deformity and the way to correct it, the patient is empowered to consciously make adjustments to the curve. These adjustments are done in every plane—horizontal, saggital, and transverse. Exercises are then given to help stabilize the spine and maintain the newly achieved corrected posture. SEAS practitioners are careful to prescribe exercises backed by the most updated medical evidence.
Schroth (Germany)
A family affair, the Schroth method got its start in 1910 when 16-year-old scoliosis patient, Katharina Schroth, took her treatment matters into her own hands. She wore a steel brace, but the properties of balloons caught her attention as a possible model for decreasing the degree of the curve on the concave side.
Schroth's idea was to breathe into the concave side while watching herself in front of a mirror. Eleven years later, Schroth started a scoliosis clinic where she used functional exercises based on her teenage explorations to treat and educate patients. By the late 1930s, the Schroth method was the most widely recognized clinic for conservative treatment of scoliosis.
After World War II, Schroth and her daughter moved to West Germany and started a clinic there, where Schroth's grandson, orthopedic surgeon Hans-Rudolph Weiss, later served as the medical director (until 2008). In 2009, Weiss branched out on his own to offer new bracing and therapy options that are based on the Schroth method. But the clinic in West Germany continues to this day.
As you will see, most of the other PSSE approaches are either based on or borrow from the Schroth method.
Barcelona Scoliosis Physical Therapy School
The Barcelona scoliosis physical therapy school is a modified version of the Schroth method (described above). Prior to around 2009, the Barcelona school was a Schroth center. It was founded in the 1960s by physiotherapist Elena Salva who met Katharina Schroth and her daughter around that time in Germany. who met Katharina Schroth and her daughter around that time in Germany.
The Schroths gave Salva a new perspective on scoliosis which she promptly took back to her native Spain. For 40 years, she practiced the Schroth method; after that, she evolved the work into a mix of cognitive, sensory-motor and kinesthetic training.
At the Barcelona Scoliosis Physical Therapy School, a human approach is taken with patients. They are taught to improve their own 3D scoliosis posture and shape using breathing and muscle activation techniques. The Barcelona school adheres to a "vicious cycle" theory which states that its the scoliosis posture that promotes progression of the curves.
DoboMed method (Poland)
The Dobomed method is a combination of the Schroth method and a mostly defunct method known as Klapp. Developed in 1940, the Klapp method was based on the observation that quadruped animals don't seem to get scoliosis, while humans, who are bipedal, do. The Klapp method worked better for spinal issues than for pelvic issues, but pelvic issues are important for postural support in scoliosis and related conditions.
Along with techniques from the Klapp method, the Dobomed method employs the use of Schroth's active asymmetrical breathing.
The Dobomed method was developed in 1979 by a Polish physician and physiotherapist named Krystyna Dobosiewicz. Within a few years, it became a regular fixture in conservative scoliosis treatment circles in Poland. The method is used both with and without bracing and has been adopted by the Department of Rehabilitation at the Medical University of Katowice, as an in-patient treatment.
Side Shift Method (London)
The Side Shift method was developed in 1984 by Dr. Min Mehta and is practiced at the Royal National Orthopaedic Hospital in London. It's currently under the guidance of Tony Betts, a physiotherapist. At first, the method was used only for treating children, but it's now given to adults as well. This method borrows from the Schroth and Dodomed breathing mechanics work. Emphasis is placed on addressing posture that deviates from the mid-line of the body. The Side Shift method treats both pre- and post-op patients.
In children, a guiding principle of the Side Shift method is that growth can be used as a corrective force in curve management. Lateral trunk shift movements are done repeatedly to oppose the curve; this increases mobility and helps re-align the spine. It also helps to integrate perception of posture. The goal of doing the lateral trunk shift movements is to affect the way the curve develops.
Core stabilization exercises are also done using isometric contractions of the lower abdominals, gluteal muscles and muscles around the shoulder blade (scapula).
In adults, the goal is more about reducing and managing pain that is caused by the posture as it migrates away from the mid-line of the body.
Functional Individual Therapy of Scoliosis (Poland)
Functional Individual Therapy of Scoliosis (FITS) was created in 2004 by Polish physiotherapist Marianna Białek and physiotherapist and osteopath Andrzej M'hango. This approach to PSSE brings together and modifies elements from other scoliosis exercise approaches. It's used in several ways: On its own for curve correction, along with bracing and as pre and post-surgery therapy. FITS is also given for other posture issues such as Scheuermann's kyphosis.
Scoliosis specific exercises are generally given in conjunction with bracing, but as you've seen from the above, this is not a hard and fast rule. It's possible, depending on the patient, the degree of the curve and the doctor, among other things, to use PSSE as the sole treatment.
Either way, scoliosis medicine requires a team approach with observation, physiotherapy, and sometimes psychotherapy and surgery making up the spectrum of potential treatment.
Sources:
F. Bruder Stapleton, MD reviewing McPhail GL et al. J Pediatr. 2015.
Lung Function Can Be Compromised by Severe Scoliosis. NEJM Journal Watch. 2015.
Kotwicki T. et al. Optimal management of idiopathic scoliosis in adolescence. Adolesc Health Med Ther. 2013.
Marti C. et al. Scoliosis Research Society members attitudes towards physical therapy and physiotherapeutic scoliosis specific exercises for adolescent idiopathic scoliosis. Scoliosis. 2015.
A groundbreaking 2015 study published in the New England Journal of Medicine found that a little over one-third of the 176 children with scoliosis they assessed also had obstructive lung disease (abnormal airway function). The authors say that this type of lung dysfunction cannot be detected with diagnostic imaging (specifically, radiographs such as x-ray, CT scan, MRI, and more).
The abnormal airway function persisted in 73 percent of the children—even after bronchodilator therapy was given.
The study found another relationship, this time between scoliosis and low lung volume. Low lung volume, also known as restrictive lung disease, is a different problem than obstructive lung disease. As the name suggests, it is characterized by reduced capacity of the lungs (which means less air volume can come in and go out of the lungs during breathing). It generally results from disease or alteration of the lung structures. What is the solution?Scoliosis Specific Exercise: Where the Spine Industry Is At
Most of the conventional medical system operates on the model that exercise, generic physical therapy sessions, and in some cases chiropractic can be helpful for pain control and balance in cases of scoliosis. Balance helps restore good physical functioning, which is useful for daily activities, but to actually straighten out the curves, the theory goes, one needs surgery.Forward thinking physical therapists and others are now, on a case-by-case basis and by growing a body of research, building evidence for PSSE. PSSE is an acronym for "physiotherapy scoliosis specific exercises." It refers to an exercise therapy program given to a patient in physical therapy to treat idiopathic scoliosis.
(Idiopathic means the cause of the scoliosis is unknown.)
A 2015 survey found that 22 percent the 263 scoliosis practitioners questioned use PSSE with their patients. Reasons include:- As an adjunct to bracing, which is a standard non-surgical scoliosis treatment, for small curves.
- To help improve aesthetics.
- To improve outcomes of surgery.
The 7 Major Schools of PSSE
There are seven main types of PSSE, and all of them originated in Europe. And while there are exceptions, exercise for scoliosis is not commonly prescribed by physiciansin the U.S. or the U.K.But in Europe, it thrives. The main schools of physiotherapy scoliosis specific exercise therapy are as follows.
The Lyon method is the oldest active approach to scoliosis. It started in the early 18th century when Dr. Gabriel Pravaz founded the first orthopedic physiotherapy center in the city of the same name. In Pravaz's day, treatments included auto-adjusted traction, exercise on "extension equipment" that resembled ladders (to allow the patient to do their work in an upright position—as well as to adjust the traction for themselves) and more. Over one hundred years later, casts and braces were added to the protocol, first with the Lyon brace and later with the more modern ARTbrace. The ARTbrace replaced the Lyon, and this effectively retired the use of casts.
The Lyon approach is mainly focused on the use of the brace, although the scoliosis specific exercises are still a part of the plan.
Scientific Exercises Approach to Scoliosis (Italy)
The Scientific Exercise Approach to Scoliosis (acronym SEAS) is as individually tailored as it is evidence based. It follows the Lyon method—although it got its start much later, in the 1960s—when Antonio Negrini and Nevia Verzini founded a center in Vigevano, Italy. In 2002, the center's name was changed to the Italian Scoliosis Spinal Institute.
The SEAS method focuses on active 3D self correction of the scoliosis by means of patient education (first) and then developing the patient's awareness of their deformity. The idea is that with awareness both of the deformity and the way to correct it, the patient is empowered to consciously make adjustments to the curve. These adjustments are done in every plane—horizontal, saggital, and transverse. Exercises are then given to help stabilize the spine and maintain the newly achieved corrected posture. SEAS practitioners are careful to prescribe exercises backed by the most updated medical evidence.
Schroth (Germany)
A family affair, the Schroth method got its start in 1910 when 16-year-old scoliosis patient, Katharina Schroth, took her treatment matters into her own hands. She wore a steel brace, but the properties of balloons caught her attention as a possible model for decreasing the degree of the curve on the concave side.
Schroth's idea was to breathe into the concave side while watching herself in front of a mirror. Eleven years later, Schroth started a scoliosis clinic where she used functional exercises based on her teenage explorations to treat and educate patients. By the late 1930s, the Schroth method was the most widely recognized clinic for conservative treatment of scoliosis.
After World War II, Schroth and her daughter moved to West Germany and started a clinic there, where Schroth's grandson, orthopedic surgeon Hans-Rudolph Weiss, later served as the medical director (until 2008). In 2009, Weiss branched out on his own to offer new bracing and therapy options that are based on the Schroth method. But the clinic in West Germany continues to this day.
As you will see, most of the other PSSE approaches are either based on or borrow from the Schroth method.
Barcelona Scoliosis Physical Therapy School
The Barcelona scoliosis physical therapy school is a modified version of the Schroth method (described above). Prior to around 2009, the Barcelona school was a Schroth center. It was founded in the 1960s by physiotherapist Elena Salva who met Katharina Schroth and her daughter around that time in Germany. who met Katharina Schroth and her daughter around that time in Germany.
The Schroths gave Salva a new perspective on scoliosis which she promptly took back to her native Spain. For 40 years, she practiced the Schroth method; after that, she evolved the work into a mix of cognitive, sensory-motor and kinesthetic training.
At the Barcelona Scoliosis Physical Therapy School, a human approach is taken with patients. They are taught to improve their own 3D scoliosis posture and shape using breathing and muscle activation techniques. The Barcelona school adheres to a "vicious cycle" theory which states that its the scoliosis posture that promotes progression of the curves.
DoboMed method (Poland)
The Dobomed method is a combination of the Schroth method and a mostly defunct method known as Klapp. Developed in 1940, the Klapp method was based on the observation that quadruped animals don't seem to get scoliosis, while humans, who are bipedal, do. The Klapp method worked better for spinal issues than for pelvic issues, but pelvic issues are important for postural support in scoliosis and related conditions.
Along with techniques from the Klapp method, the Dobomed method employs the use of Schroth's active asymmetrical breathing.
The Dobomed method was developed in 1979 by a Polish physician and physiotherapist named Krystyna Dobosiewicz. Within a few years, it became a regular fixture in conservative scoliosis treatment circles in Poland. The method is used both with and without bracing and has been adopted by the Department of Rehabilitation at the Medical University of Katowice, as an in-patient treatment.
Side Shift Method (London)
The Side Shift method was developed in 1984 by Dr. Min Mehta and is practiced at the Royal National Orthopaedic Hospital in London. It's currently under the guidance of Tony Betts, a physiotherapist. At first, the method was used only for treating children, but it's now given to adults as well. This method borrows from the Schroth and Dodomed breathing mechanics work. Emphasis is placed on addressing posture that deviates from the mid-line of the body. The Side Shift method treats both pre- and post-op patients.
In children, a guiding principle of the Side Shift method is that growth can be used as a corrective force in curve management. Lateral trunk shift movements are done repeatedly to oppose the curve; this increases mobility and helps re-align the spine. It also helps to integrate perception of posture. The goal of doing the lateral trunk shift movements is to affect the way the curve develops.
Core stabilization exercises are also done using isometric contractions of the lower abdominals, gluteal muscles and muscles around the shoulder blade (scapula).
In adults, the goal is more about reducing and managing pain that is caused by the posture as it migrates away from the mid-line of the body.
Functional Individual Therapy of Scoliosis (Poland)
Functional Individual Therapy of Scoliosis (FITS) was created in 2004 by Polish physiotherapist Marianna Białek and physiotherapist and osteopath Andrzej M'hango. This approach to PSSE brings together and modifies elements from other scoliosis exercise approaches. It's used in several ways: On its own for curve correction, along with bracing and as pre and post-surgery therapy. FITS is also given for other posture issues such as Scheuermann's kyphosis.
Understand and Appreciate the Scoliosis Specific Exercise Treatment Spectrum
Although each of the 7 PSSE approaches has the same goals—to correct the 3D scoliosis deformity by re-aligning the spine, ribs, shoulders and pelvis—most put their own stamp on the treatment.Scoliosis specific exercises are generally given in conjunction with bracing, but as you've seen from the above, this is not a hard and fast rule. It's possible, depending on the patient, the degree of the curve and the doctor, among other things, to use PSSE as the sole treatment.
Either way, scoliosis medicine requires a team approach with observation, physiotherapy, and sometimes psychotherapy and surgery making up the spectrum of potential treatment.
Sources:
F. Bruder Stapleton, MD reviewing McPhail GL et al. J Pediatr. 2015.
Lung Function Can Be Compromised by Severe Scoliosis. NEJM Journal Watch. 2015.
Kotwicki T. et al. Optimal management of idiopathic scoliosis in adolescence. Adolesc Health Med Ther. 2013.
Marti C. et al. Scoliosis Research Society members attitudes towards physical therapy and physiotherapeutic scoliosis specific exercises for adolescent idiopathic scoliosis. Scoliosis. 2015.
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