Scoliosis 3DC℠, Not Wait and See…
It is our mantra for good reason. Every case of mild scoliosis as a result of adolescent idiopathic scoliosis we have treated has halted or reduced. Here’s an example: Schroth method results.
Unfortunately, we don’t see as many mild curves as we would like – if we did, our job would be much easier. In fact, we are confident that the incidence of scoliosis progression, brace wearing and surgery could and would decline if only more parents adopted our early intervention methodology for their children.
What is Mild Scoliosis?
By definition, mild scoliosis is a spinal curvature with a Cobb angle measurement of 10º – 24º.
Why are about 90+% of the cases we see moderate and severe scoliosis curves and not mild?Well, for starters, not all kids are diagnosed when scoliosis is in the mild phase. If your child has been then you have an opportunity to respond. Although your physician or pediatrician will probably tell you there is nothing to be done at this point, other than take an x-ray in a few months, we disagree with that philosophy.
“Early structural scoliosis is more amenable to conservative treatment owing to residual growth potential of the spine.(1)”
The Argument for Early Intervention for Mild Scoliosis
As a parent, Dr. Moramarco didn’t have an opportunity to address scoliosis at the mild phase, nor do many others who have brought their children to Scoliosis 3DC℠ for scoliosis-specific exercise instruction and/or Chêneau bracing. Many kids we treat have curves that were not discovered until the moderate or moderate/severe stage. However, others coming to us have larger Cobb angles which began in the mild stages and although under a doctor’s watch, their scoliosis progressed with each semi-annual or quarterly x-ray.
If you have a child whose scoliosis has been detected early and is currently in the mild range, consider yourself fortunate if you are willing to take the appropriate steps. Clinical experience has shown us that scoliosis can be controlled non-surgically. Depending on where a curvature falls on the spectrum of mild to moderate, and the stage of growth, there are decisions to be made and interventions that can positively affect scoliosis Cobb angle outcomes at skeletal maturity – with management and compliance.
We consider ‘watch and wait’ or ‘do nothing’ inadvisable in most instances. We know this advice is probably in direct contrast to your orthopedic surgeon’s advice. Certainly, if a child is ten, eleven or twelve years old and has a curvature below 15º then it is not cause for alarm. However, if a child has significant growth potential, waiting six months for the next x-ray may be too long – we’ve seen this documented on x-ray – especially if a major growth spurt occurs during this time span.
When a child has a 15 – 20º Cobb angle and has significant growth potential, then there are simple interventions we teach older children, pre-teens and teens that can and do help the compliant patient. It is not our full program, but a short program to introduce postural education, instruction in scoliosis ADLs, physiologic® exercise (Schroth Best Practice®) and perhaps a 3D Made Easy® exercise (also Schroth Best Practice®) or two. This is not a full program, but it is education, knowledge and tools a pre-teen can incorporate easily in everyday life to counteract the curve and empower themselves.
When a curve is over 20º and the child has significant growth potential, exercises in addition to those listed above will be introduced and perhaps our Chêneau-Gensingen® brace (Schroth compatible). Treatment using exercise for scoliosis, or bracing, depends on age, skeletal maturity (Risser sign) and growth potential. In-brace corrections are more easily achievable when a child’s spine is still flexible. This is demonstrated on an x-ray indicating a correction, in-brace, of 20º to 5º on a girl, just about to turn ten years old.
From our vantage point, the ‘wait and see’ way of thinking puts children that do not need to be at risk. Parents should know there is opportunity to slow, stop or reverse progression and manage scoliosis to a more successful outcome rather than following the ‘watch and wait’ scenario. If a curve is above 20º and risk of progression is not high (for example, a patient in their mid-teens with a higher Risser sign) then pattern-specific exercise alone can very possibly prevent the need for bracing altogether and prevent progression.
Parents should react when scoliosis threatens. Critics say this is over treatment and provide the argument that not all scoliosis curves progress. You should understand that surgeons are the gatekeepers of scoliosis treatment and they are not trained in physical rehabilitation methods. In fact, they have spent the previous several decades denying that exercise methods can be helpful – to learn more about this Scoliosis and the Human Spine, by Dr. Martha C. Hawes. Beyond that, general physical therapy is not enough; scoliosis rehabilitation must be curve-pattern specific to be effective. Moreover, there are few qualified physicians or therapists in the U.S. who are trained specifically in Schroth methodology and very few who are certified in Schroth Best Practice®. Best Practice makes the load-altering methods of Katharina and Christa Lehnert-Schroth easier to learn and apply and they are the newest developments of this scoliosis-specific technique.
Depending on how much growth potential a child has and his/her risk of progression, we equate our proactive approach for mild scoliosis to an insurance policy as opposed to gambling with a child’s health. Untreated, maybe your child’s scoliosis will progress – maybe it won’t, but is it worth taking a chance with your child’s health?
Finally, according to Weinstein’s natural history, curves held to 30º or lower are less likely to progress into adulthood. A few months of watching and waiting may end up being a big mistake. There is a small window of opportunity to treat and manage scoliosis conservatively. It is our firm belief that hesitation can potentially be a costly mistake.
It comes down to a matter of philosophy. Dr. Moramarco has two adult children with spinal curves, one who was in the severe range at its highest point before he discovered the existence of the Schroth method and used it to help her reverse her thoracic curvature by about 10º and her lumbar by 15º. Treating scoliosis conservatively and effectively became his mission because of the insights he acquired on his journey to help his daughter. You don’t want to go there if you can help it.
The problem with adolescent idiopathic scoliosis is that no one has yet to determine whose curve will progress and whose will not. If you have a family history of scoliosis, then obviously the likelihood is greater.
If your child is diagnosed with scoliosis in the mild stage, Schroth Best Practice® methodology provides management techniques that can help stabilize the spine. You have the opportunity to respond and make a difference for your child if they are willing to be a compliant patient.
When a patient’s scoliosis progresses into the moderate stage, parents and patients are often confused about the most appropriate next step in scoliosis treatment. Curve progression can be scary, and treatment recommendations are sometimes confusing. Those on the smaller Cobb angle end of moderate scoliosis are usually advised to brace their child (if they still have a significant amount of growth potential), while those on the larger Cobb angle end of moderate scoliosis are often told it is too late to brace and that they might be a “candidate for surgery.” At Scoliosis 3DC℠, it is our goal to help patients avoid scoliosis surgery via our Schroth Best Practice® exercise rehabilitation program and the Chêneau-Gensingen® brace (which addresses moderate and even severe curves).
What is Moderate Scoliosis?
By definition, moderate scoliosis is a spinal curvature with a 25º – 49º degree Cobb angle measurement.
My child has moderate scoliosis, do they need to wear a brace?
Bracing can be a very helpful tool in halting progression of scoliosis or reducing curvature. Refer to our research studies page if you are interested in reading about the benefits of bracing. When it comes to bracing, if the child is an adolescent with significant potential for growth, generally we say the earlier the better. Bracing which starts early is most effective. Unlike many other types of braces, the Chêneau-Gensingen® is made to address moderate to severe curves (even 40º and 50º+).
I have back pain and moderate scoliosis. Can the Schroth method help me?
Yes! One of the goals of our exercise rehabilitation program is to relieve pain associated with scoliosis.
What’s the best way to manage a moderate scoliosis?
We believe our two-pronged approach to scoliosis management using the Chêneau-Gensingen® brace and our immersion approach where patients learn several curve-pattern specific exercise techniques according to Schroth Best Practice® are the most effective way to manage scoliosis – anywhere. For compliant patients our results have been consistent and effective. The earlier a family becomes proactive when scoliosis is diagnosed, the better!
What is Severe Scoliosis?
By definition, severe scoliosis (referred to as third degree scoliosis in some countries) is a spinal curvature (Cobb angle) at or above 50º.
I have severe scoliosis. Do I need spinal fusion surgery?
Every individual is different, but at Scoliosis3DC℠ we only endorse surgical intervention in very extreme cases, and we aren’t referring to those with 60º or even 70º curves. The reason for this is it has been determined that individuals with scoliosis can live a long, healthy life without treatment (2) (we don’t recommend that, we recommend taking a proactive stance). In fact, it has been determined by two prominent scoliosis surgeons that evidence is lacking for scoliosis surgery (3). Finally, it’s important to know the many risks and unknowns when it comes to surgery, both in the mid- and long-term (4).
At Scoliosis 3DC, we’ve treated patients with very severe scoliosis successfully in terms of helping some achieve curve reduction, improve pain and/or increase vital capacity. (Please see our Schroth Method Results page for a few results).
For adolescent idiopathic scoliosis (AIS), we encourage parents to bring their adolescents for Schroth Best Practice® instruction as early as possible in the process after a diagnosis. When scoliosis is severe, we recommend our intensive Schroth immersion program and the Chêneau-Gensingen® Brace because it’s the best scoliosis brace to successfully manage curves with Cobb angles of 50º, 60º and higher.
Other than surgery, what can be done for severe scoliosis?
Scoliosis surgery is usually done for cosmetic reasons and to prevent further progression, but Schroth exercises and/or bracing can help with both of those as well. Our patients improve postural appearance, stimulate spinal stabilization and improve muscle imbalances without surgery. Patients are taught how to avoid curve-stimulating behaviors on their own. Practice can help improve vital capacity and reduce pain. It’s important to know that the the foremost natural history study on scoliosis (2) states that the incidence of back pain for people with scoliosis is only somewhat greater than the general population. Patients who gain the skills we teach learn how to help alleviate pain and progression, without surgery.
(1) Aulisa L, Lupparelli S, Pola E, Aulisa AG, Mastantuoni B, Pitta L. Biomechanics of the conservative treatment of idiopathic scoliotic curves in surgical “grey area”. Stud Health Technol Inform. 2002;91:412-8.
(3) Westrick ER, Ward WT. Adolescent idiopathic scoliosis: 5 year to 20-year evidence-based surgical results. J Pediatr Orthop. 2011;31(1 Suppl):S61–S68.
(4) Mueller FJ, Gluch H. Cotrel-dubousset instrumentation for the correction of adolescent idiopathic scoliosis. Long-term results with an unexpected high revision rate. Scoliosis. 2012;7(1):13. doi: 10.1186/1748-7161-7-13.