Happy 2012.  2011 was a life changing year. I hope that all readers of this blog have a happy and healthy 2012.

We recently received our first letter from a scoliosis surgeon. The letter was written in response to a patient that I had seen and although this particular case falls into the domain of possible conservative management, I still felt it essential that the scoliosis surgeon is involved in the early stages of the case.

Although the surgeon was not supportive of Schroth, at least he wrote back, which is a start.  He wrote that although some early positive work had come out of the schroth clinic in Germany, it had not been able to be reproduced outside of Germany.  I suspect it will take a long time to "convince" these surgeons of the work that we do. It also seems that the publications coming out of Italy regarding the effectiveness of SEAS is not filtering down to the local Australian scoliosis surgeons.

I did however receive the following email

"Just letting you know that the last x-ray that R had on 25th October 2010 showed that R's curve went from about 45 degrees to 25 degrees. Her hand x ray showed that she is nearly at the end of her growth, we will find out in February if she has stopped growing. We have been doing your exercises every day, but now that we are seeing R she changed exercises because her curve has changed. Her next appointment at the Royal Children's is at the end of February. I will keep you informed about her progress after her next scan. Thanks for you help this year, R really pushed herself to do the exercises and we can see an amazing change. Dr T couldn't believe the results. We told Dr T about the schroth method exercises and that we are seeing a Chiropractor weekly. He didn't seem keen on the idea but then told us to keep doing what we are doing."

I cannot push the scoliosis surgeons into believing what we do as sceptics cannot be convinced with pure information. (I am the same). Sceptics are only convinced through experience and hopefully as we continue with our work they will come around. There has also been some new conservative management clinics opening up in Sydney.  I guess I am like the scoliosis surgeons who am very concerned that these people are treating scoliosis without the necessary scientific evidence and that they have the potential to create real damage.

We have also seen some Very large adult curves or post fusion curves in adults. These adults have been told that that although their curves are large, the surgeons are not yet willing to commence or re-do surgery. They present complaining of significant pain. It has been very interesting working with them and rewarding to be of help

I will be leaving in 3 weeks time to meet up with Dr Rigo again in Wisconsin.  Scoliosis Rehab is hosting an advanced course in Scoliosis treatment and although I will not be looking forward to the weather will look forward to "drinking at the feet of the master". I have a pile of x-rays that I will be taking up with me to go through them with Dr Rigo.

Hello again...

The lives of a group of physio's dealing with scoliosis continues to progress. These last few months have been quite busy, and the world, it seems, has gone mad. There is turmoil all over the place and everyone seems to be very unsettled. Quite a long time ago I was chatting to an elderly patient and happened to mention "that the world had gone mad", my patient who had survived WW2 looked up at me and clarified that the world had always been mad and that I was just lucky enough to be born at a time when things were quite stable.  Schroth technique is underpinned by need for a stable base / pelvis.... may we all merit stability in our lives!!

Following our course in Milan in May we were told that we would be given an exam to complete. The exam was duly given and duly completed.Its funny how a few weeks of intensive reading and sleepless nights can be summerised into the one preceeding sentence.  I now have my level 1 certification in SEAS (specific scientific exercises approach to scoliosis exercises) technique. As mentioned previously SEAS seems quite similar to Schroth and the ISICO group in Milan have recently published a very good article in the Spine Journal; (article here). I will try and locate the full article for the blog.  I wonder why Schroth seems so much more popular than SEAS? We are presently using aspects of both techniques in our scoliosis treatments and they are very complimentary.  

Shana-Lee has been seeing some of my old scoliosis patients as well as new patients. We sometimes get caught up with our own treatments and our own patients.  Watching Shana-Lee work is very special. I can see the focus and caring attitude of Beth and Patty (the head physio's at Scoliosis Rehab Inc. who trained Shana-Lee in Wisconsin) coming through in her treatments.

Below is a patients' email about her treatment with Shana-Lee;

I am 47 years old and developed scoliosis in my teens.  I have just learned that i have a four curve scoliosis, the biggest curve being 37 degrees.I have tried everything over the last 30 years to find pain relief and solutions to my scoliosis.  I mean everything.  I have been told all kinds of things, ranging from "it's just a beauty spot, don't worry about it"  to "I'll give you a bikini figure in 6 weeks".  By far the worst thing i have been repeatedly told is "I'm not going to try and straighten you up, i'm just going to make you comfortable".   Embedded in these words is the whole idea that being curved is 'normal' for you, so we won't try and tamper with it.  After 10 hours of Schroth, i realise just how misguided that idea is.I would urge anyone, at any age suffering from scoliosis to learn the Schroth Method.  For the first time in my life i feel that i am in control of my scoliosis.  People are saying to me, "You look different, you look really happy".  I'm not saying it is a picnic.  It's very challenging to go against the patterns of your body, but with a skilled teacher  you can learn.   More than anything it requires a high level of concentration, but every new day my body told me, "this is what i want."  I am so grateful to Shana-Lee for her fantastic care, her encouragement and compassion as well as the sophisticated understanding of the Schroth Method that she was able to impart.

Last week I met up with Charles Smuts who is the chief radiographer at Dalecross Adventist Hospital. I was given an overview of their new EOS x-ray imager.  The details of the machine are here. It is a very impressive machine and although its quite a trip from Bondi Junction I would definitely recommend my patients utilise it.  During our meeting (Jeb joined me), we met up with a scoliosis surgeon by the name of Dr Davor Saravanja (website). We had a very productive talk about what we are trying to do with regard to conservative management and I look forward to working with Dr Saravanja.

Physiotherapy has no role in the management of scoliosis – Or does it ?

There is something comforting  yet daunting in taking a long journey into the unknown. We hope that our past experiences and knowledge will prepare us for the task ahead.  I initially embarked on a journey into the world of scoliosis a few years ago and now find myself sitting on a plane to attend the world meeting (conference) of conservative scoliosis practitioners (SOSORT).  

The conference is in Barcelona, home of Dr Manuel Rigo – my first scoliosis teacher, and will be preceded by a course providing insight into the different “schools” of conservative scoliosis treatment (physiotherapy and bracing) and followed by a certification course (in Milan ) in the SEAS approach to conservative scoliosis management.  The SEAS approach is conducted by ISICO (Italian Spine Scientific Institute).

The SOSORT meeting  will be attended by the world’s leading experts in scoliosis and will be attended by exactly ONE Australian physiotherapist - myself.  Australia is supposed to be one of the world’s leading physiotherapy countries and our physiotherapists are in demand globally. Yet, the question remains why we have no leading scoliotic practitioners who have entered into the world of Scoliosis.

The heading above might be reason...  The prevalence of scoliotic curves above 20 degrees is about 0.29% of the population.  Therefore;  can there be 20 000 Australians who have been told that they should not attend physio as part of their management for their scoliotic curves?  Am I embarking on a very expensive learning curve which is doomed to failure and are the surgeons in our country correct.?  Are our patients destined to live an adolescent life waiting for their curves to finally progress sufficiently till they need surgery to correct their curves or should they be operated “in case their curves progress”.   The answer to the question must be very complex....  I will try to be as objective as possible. Everyone has a conflict of interest!!!  In the words of Tim Ferris, we need to be skeptical but need to differentiate between pro-active and defensive skepticism.

Once again I find myself sitting on a plane.. this time on the way home. I need to clarify the paragraph above in that although I was the only physiotherapist from Australia , the conference was also attended by an Australian sports physician by the name of Dr Mel Cusi with whom I have worked with in the past. Although never in the field of scoliosis.  Additionally, Dr Jeb McAviney  (chiropractor and Bracing specialist) attended the pre-conference course, the SOSORT meeting as well as the post conference certification course at ISICO in Milan.

Although  SOSORT is supposedly a group of conservative scoliosis practitioners it was reassuring to meet up with many spinal surgeons who are highly regarded in the conservative management as well. The keynote address was by Dr. R. McCarthy  who is the most recent past-president of the SRS (Spinal Research Society).  Interestingly the SRS group in Australia state on their website that they do not endorse any “alternative” form of scoliosis treatment, apart from bracing and surgery.

Having Dr McCarthy and colleagues publicly discuss conservative management, bracing and surgery in an open forum with very good science and logic was paradigm shifting.  I have always thought that Australia has been backward in its available treatment options with regard to scoliosis. However... just like unmodernised Africa has been able to “leapfrog” into modern technology I sincerely believe that we in Australia will be able to “leapfrog” into cutting edge scoliosis treatment.

Does physiotherapy have a place in scoliosis treatment...  initially I would always answer it depends but now I am more confident in responding, Yes.  However – it has to be the correct physiotherapy treatment.  We know that most physiotherapy approaches are not able to positively affect scoliosis

There appears to be be 4 main approaches to scoliosis treatment accepted within SOSORT: 

• Schroth therapy and its slight variation coming out the Barcelona school directed by Dr Rigo.
• Dobo method from Poland: based on a 4 point kneeling position
• FITS from Poland: fascinating in its integration of muscle energy, very specific massage and mobilisation and myofascial plane techniques
• Dr Weiss’s new “power schroth” and its variations
• SEAS from the ISICO clinic in Milan.

We were introduced to all the different methods in the pre-conference course and experienced the personalities behind the methods.  The ISICO school ran a post conference course in the certification in SEAS which both Jeb and I completed.

ISICO is run by a physical medicine specialist by the name of Dr Stefano Negrini. I was able to have a great informal chat where he told me that he was introduced to scoliosis treatment by his physiotherapist father at the age of 10. Dr Negrini then spent many years with a specialist called Dr Sibilla and the foundation of his approach to scoliosis was based on the work on Dr Sibilla.

ISICO’s approach to scoliosis has similar “flavours” to Schroth and Schroth certification certainly helped in grasping the technique a lot quicker. Dr Negrini is the clinical director who decides on bracing options as well as physiotherapy directions however the real “craftsman” of the treatment is a physiotherapist, Michele  Romano, who was the lead instructor on our course.  We had many theoretical  lectures as well as practical lectures.  Watching Michele  work is like watching a master craftsman work.  Dr Rigo once told me that a good therapist is someone who can anticipate the response of the patient to any musculoskeletal movement and is able to respond the behaviour.  Michaeli definitely  shows this unique ability. 

Dr Rigo has a hobby of playing the cello. When we did our course in Wisconsin he would take some time every afternoon to practice in one of the rooms. Michele’s hobby is drawing satirical cartoons. He has promised to email me some which I will put up on the blog.

ISICO is a unique clinic in that they are very active in the publishing their data and continually refine their approach according to their research results. They have a very un-Schrothlike treatment protocol. Only one or two 90 minute to 2 hour sessions and then again in 3-6 months. This seems very little treatment when compared to Schroth. We are currently using 5 sessions of 2 hours each whilst Germany and London use a full time month and Barcelona and Wisconsin use a protocol involving four hours daily for a fortnight.   I think one of the major changes we will have in the clinic is that we will open opportunities for a more accelerated scoliotic correction program.

Hi All,

I am off to Barcelona and Milan for the SOSORT conference and to spend some time in the clinic of Stefano Negrini in Milan. Their group use a method called SEAS to treat scoliosis.  I will write something from the course...  however, in the interim...

I asked my colleague Shana-Lee to write something about her recent trip to Wisconsin...

After Larry returned from the USA in November 2009, I was intrigued and inspired at all he had learnt and wanted to hop on the next plane to do the Schroth course. Little did I know that after  travelling with my husband for 5 months around the globe, I’d get an email from Larry in my last week of travels to say “don’t put your passport away” and I was to leave 2 weeks after returning from my relaxing time away.

I unpacked one bag, only to pack another but this time the bikinis were left behind and the warm winter coats, scarves and boots were packed. A snow storm hit the middle of the USA just in time for my and many other course participants arrival. So after a 50 hour journey with many itinerary changes and no sleep, I arrived in Wisconsin, USA….with no luggage.  Due to the storm the first day of the course was cancelled and hence what was meant to be a 10 day course to learn the Schroth Based Method of treating Scoliosis, became 9 very long days.

Scoliosis was always one condition I questioned. Was there a cure? What treatments were best? Could you stop the progression of the curves? And could we help pain? None of which I knew how to answer fully until I attended the Schroth course. Learning about the Schroth method and the theory behind all the exercises was interesting and exciting knowing that now I could now finally answer most of the questions I had all along and most importantly…now I could truly help patients with a method that works!

The most amazing part of the course was seeing the patients performing the exercises and watching their faces glow as they realized their potential to improve not only their “curvy” posture, but their confidence and self esteem.

Like most physical conditions, scoliosis is coupled with many emotions from both the patients and their parents. We were lucky enough to have a physiotherapist attending the course who in fact had scoliosis herself, as well as 2 other physiotherapists who were mothers of teenage girls who both suffered with scoliosis. Seeing the emotions that came through from both the patients and the parents was amazing. The 4 teenage girls truly went from 4 shy girls with hunched shoulders to hide from their curves, to 4 confident and bubbly girls who stood up straight and proud.

Both the girls and the parents were inspired by each other and were so grateful to have others to talk to who knew what they were going through. It really made me realise the importance of having a support system for patients and their parents to be able to discuss their condition, the pain they feel both physically and mentally, and of course the big question for some is the possibility of surgery and possible outcomes.

In America there is a support group called “The Curvy Girls” which I think is an amazing idea and would be welcomed in Australia. For more information go to www.curvygirlsscoliosis.com.