By Christopher Vara, MD; Sarah Kelly, DPT, Shriners Healthcare For Children — Twin Cities
Adolescent idiopathic scoliosis (AIS) can be a frustrating diagnosis because the cause is unknown in more than 80 percent of cases. Shriners Healthcare for Children — Twin Cities offers a non-traditional 3D treatment approach for AIS. Therapists instruct patients using scoliosis specific exercises (SSE) according to the principles of Christina Lehnert-Schroth and the Barcelona Scoliosis Physical Therapy School (BSPTS). This program targets the AIS population, but can also be used to treat juvenile idiopathic scoliosis and several sagittal plane disorders, including Scheuermann’s kyphosis.
At Shriners Healthcare for Children — Twin Cities more than 60 patients have seen improvements in postural control, pain reduction, strength and overall quality of life since inception of the SSE program two years ago. Here patients have the benefit of a low dose 3D EOS radiation imaging system, in-house orthotists for custom bracing, and expert care from pediatric orthopedic surgeons.
Various factors are considered to determine if a patient is ideal for our program, including but not limited to, Cobb angle, age, Risser score, menstruation, and other radiological findings. Research indicates that younger, skeletally immature patients with a higher Cobb angle at diagnosis correlate to a higher risk of progression and an increased need for possible bracing or surgery.
When postural asymmetries are noted and the Adam’s forward bend test is performed, the use of a scoliometer can be a very helpful tool to assess the angle of trunk rotation (ATR). The 2013 SRS recommendation for measuring ATR is 7 degrees to make a referral.
On the left: An SSE patient with AIS habitual standing posture
On the right: The same SSE patient with active stabilization in her corrected posture
The SSE program focuses on educating patients about body awareness while using sensory-motor and kinesthetic training, with a goal of creating stability around their corrected posture. The program empowers patients by providing them with an active role in their treatment.
Scoliosis Specific Exercises:
- Improve aesthetics via postural correction
- Address respiratory dysfunction
- Reduce functional limitations
- Minimize the progression of the spinal deformity
The SSE program is time intensive and requires multiple follow-up sessions over a span of time relative to the patient’s risk of progression. Patients are prescribed a daily home exercise program including education on adapting posture, and they are instructed to avoid activities that may negatively impact their spine. Successful outcomes are directly correlated to the patient’s compliance with their home exercise program.
Historically, high-quality evidence supporting physical therapy and scoliosis has been hard to find but now there is new and ongoing research regarding the impact of physical therapy on scoliosis. A recent study by Kwan et al. in 2017 in the journal Scoliosis and Spine Disorders revealed that Schroth exercise, in combination with bracing, was superior to bracing alone in improving Cobb angles, trunk rotation, and quality of life scores. Additionally, patients who were compliant with their exercise program had a higher rate of Cobb angle improvement.
Shriners Healthcare for Children — Twin Cities has two therapists certified in SSE: Sarah Kelly, DPT and Rebecca Rouse, DPT. Both are BSPTS C1 and C2 certified to treat scoliosis and have extensive knowledge of the treatment of back pain and sacroiliac joint dysfunction. Currently, these physical therapists are two out of only four in the state of Minnesota with the advanced C2 certification, allowing for the treatment of a patient who have undergone spine surgery. Primary care providers who refer will receive progress updates and are welcome to reach out for more information. Referrals may be made by phone 612-596-6105 or fax 612-596-6102.
