<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=192888919167017&amp;ev=PageView&amp;noscript=1">
Thursday, March 28, 2024
March 28, 2024

Linkedin Pinterest

Scoliosis moves beyond braces

Using exercise to treat condition gains momentum

The Columbian
Published: November 10, 2014, 12:00am
4 Photos
Trevor Johnson, 15, stands in front of a grid for evaluation of his scoliosis Oct. 6, 2014 at Empower Physical Therapy in Exton, Pa. Lisa Angioli, a physical therapist at Empower Physical Therapy, uses the Soliosis Schroth method with Johnson. (Michael S.
Trevor Johnson, 15, stands in front of a grid for evaluation of his scoliosis Oct. 6, 2014 at Empower Physical Therapy in Exton, Pa. Lisa Angioli, a physical therapist at Empower Physical Therapy, uses the Soliosis Schroth method with Johnson. (Michael S. Wirtz/Philadelphia Inquirer/MCT) Photo Gallery

PHILADELPHIA — When Trevor Johnson was 11, his growing spine took a detour from the normal straight path. Instead of stacking neatly one atop the other, his vertebrae began to drift sideways into an S-shape and his rib cage started torquing to the left.

This spinal deformity, called idiopathic adolescent scoliosis, is common, affecting nearly 6 million Americans. In its early stages, the long-accepted approach is to wait and see whether the curve worsens.

Trevor’s parents had been down this road before and were not alarmed. His older sister has scoliosis, too. By the time she finished her growth spurt, the slight swerve in her back was hardly noticeable and posed no health problems.

But Trevor would not be so lucky. Periodic X-rays showed his spine bending and twisting like a sapling surrendering to gale-force winds.

“First the curve was 11 degrees,” said his mother, Amy. “It went to 19, then 25, then 34, then panic.”

In February, the Johnsons were told Trevor needed surgery to straighten his spine so he could breathe properly and enjoy an active life. “Isn’t there anything else we can do?” they asked.

There was.

Only a few months earlier, Lisa Angioli, a physical therapist in Exton, had been trained in the Schroth method, which uses posture correction, resistance training and breathing exercises to stabilize the spine.

The method was developed in the 1920s and has been used in Europe for decades, but until three years ago, few places in the United States offered the treatment other than a small clinic in Wisconsin.

With pressure from an increasing number of parents like Trevor’s who are loath to subject their children to major back surgery, more physical therapists are training in variations of the Schroth technique and more doctors are willing to consider its merits.

“Five or six years ago, I first started hearing parents ask me about it,” said Suken Shah, the pediatric orthopedic surgeon who evaluated Trevor. As division chief of the Nemours Spine and Scoliosis Center in Wilmington, Shah said he had always encouraged patients to get exercise and stay active. Although many studies have been published in Europe about Schroth, no solid work has appeared in the top U.S. journals supporting claims that Schroth and similar therapies can help stop a scoliotic curve from progressing or actually reverse it, as many advocates claim.

That does not mean, however, the method is ineffective, Shah said.

“I’m open,” he said. “We’re interested in really good outcomes, whether that’s operative or nonoperative. And nonoperative care is not optimal right now. We may not be acting early enough. And we may not be taking advantage of things available elsewhere.”

Nearly a century ago, Katharina Schroth, a German teacher who had worn a steel brace as a teenager to straighten her spine, developed exercises to treat scoliosis. She discovered that by assessing the back in three dimensions, practicing deep breathing, strengthening weak muscles, and training herself to reposition her shoulders, hips and torso, she stood straighter and expanded her lung capacity.

She opened several clinics and began working with her daughter, Christa. After her mother’s death in 1985, Christa treated patients in Germany, then went on to join forces with a doctor in Barcelona, fine-tuning the technique.

The treatment was brought to the U.S. in 2003 by Beth Janssen, a physical therapist from Wisconsin. Janssen’s son had scoliosis and after two years in a rigid brace, still had problems with his posture and breathing. After hearing about the clinic in Barcelona, she took him there for treatment, then trained as a practitioner.

Like most physical therapists, Johan van Schalkwyk, 46, in Cherry Hill, N.J., said that in his 16 years of practice, all his training, and continuing education, no one ever suggested patients with scoliosis needed specialized care.

A few years ago, when a patient asked him about Schroth, he looked into it and was struck by its logic. Last year, he took the course at Hunter, which has now certified more than 60 therapists, said Gary Krasilovsky, chair of the physical therapy department.

Scoliosis normally starts early in puberty and occurs equally in boys and girls, although girls are eight times more likely to have a curve progress to the point that they need a brace or surgery.

The Catch-22 is that there is a higher probability of preventing a curve from getting worse when patients are braced early on, before they enter the peak of their growth spurt. But because it is impossible to predict whose curve will progress enough to require intervention, and it is impractical — and from a public-health perspective, too costly — to brace every child at the first sign of scoliosis, doctors do not recommend doing anything until the curve reaches 25 degrees.

Advocates of Schroth and similar exercises say the central question is: Why not teach patients how to strengthen their backs, correct their posture and breathe more effectively rather than passively waiting to see how far their curves progress?

“A lot of physical therapists who come to my courses tell me they’re seeing so much scoliosis and don’t know what to do with it,” said Amy Sbihli, a Schroth-certified therapist in Burlington, Mass. “There’s a world of unmet need.”

mobile phone icon
Take the news everywhere you go.
Download The Columbian app:
Download The Columbian app for Android on Google PlayDownload The Columbian app for iOS on the Apple App Store
Loading...