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
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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
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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
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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
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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.
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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
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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
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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
Appointments:914-333-2403
Therapist:RebekahWallach,PT,DPT
NYP/MorganStanleyChildren’sHospital3959Broadway,5thFloorNorthNewYork,NY10032
Appointments:212-305-7674
Therapists:DeniseColeman,PT,DPT.CEIMKatieRiley,DPT,CSCS
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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).
WhattoExpect:ConservativeScoliosisCare
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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.
ColumbiaPediatricOrthopedics
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Notes
WhattoExpect:ConservativeScoliosisCare
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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
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