Adolescent scoliosis is a curvature of the spine (seen from side-to-side in a frontal x-ray) diagnosed between the ages of 10 and 18. About 80% of cases are considered idiopathic (no known cause) and commonly referred to as adolescent idiopathic scoliosis, or AIS for short. The remaining 20% of cases can be neuromuscular, congenital (present at birth) or syndromic (i.e. associated with other conditions such as EDS, connective tissue disorders, etc.).
Scoliosis is often first detected through a simple clinical test known as the Adam’s bend test during school screening or pediatric examination. A full spinal x-ray is required for an official diagnosis which may occur at any stage – mild, moderate or severe. The Cobb angle, as measured on x-ray, quantifies the degree/severity of scoliosis and is an important clinical marker for tracking scoliosis throughout adolescence and into adulthood.
Despite the value of the Cobb angle measurement, it is important to realize that scoliosis is a 3-dimensional condition. With scoliosis, the spine is asymmetric not only in the frontal plane, but also in the sagittal and transverse planes. The Scoliosis 3DC® program is a comprehensive management program that addresses all three planes of scoliosis with the goal of interrupting the vicious cycle and preventing curve progression.
While adolescent scoliosis treatment typically depends on age, growth potential and curve severity, significant postural imbalance and family history also play a role. At Scoliosis 3DC®, we emphasize early intervention whenever possible. Our conservative, proactive approach to adolescent scoliosis treatment differs from the status quo ‘wait and see’ advice that parents often receive.
Schroth Method for Adolescent Scoliosis
Adolescent scoliosis is a lifelong condition that will not improve on its own and should be actively managed for the best outcome. Kids need to live in their bodies for a long time and before skeletal maturity is the only time to make a significant difference with the right treatment approach.
Once a curve reaches 15º or more in a growing adolescent, we recommend beginning instruction in Schroth protocols to learn how to counteract asymmetric loading and curve progression. The goal of this is to unload the spinal joints and allow the spine and trunk to grow more normally.
Our program is based on Schroth Best Practice® (SBP), the newest evolution of the Schroth method which is designed to be simpler and easier to incorporate into daily life. Our multifaceted program includes:
- ADL instruction (modified postures for activities of daily living)
- Physiologic® exercises (sagittal plane exercises exclusive to SBP)
- Mobilizations (to keep the spine as flexible as possible)
- 3D Made Easy exercises (simple 3D Schroth exercises to incorporate throughout the day)
- Power Schroth exercises (Schroth exercises designed to unload the spine and improve core muscles)
- Customized video and instructional binder to refer to after program completion
Spinal education is the foundation of our treatment philosophy. Our programs are always individually tailored and structured so that adolescents gain complete understanding of their unique curve pattern. A core component repeated throughout the program is ADL training, during which patients learn how to modify habitual scoliotic postures and self-correct to create a more balanced position. Not only do patients learn a personalized scoliosis-specific exercise routine, they also learn the hows and whys of their newly modified postures, so that they know how to avoid feeding into their curve(s) when encountering new activities.
In the interest of efficiency and experiential learning, we prefer to use intensive training (over the course of five days) whenever possible. This allows patients to gain a clearer understanding and have an immersive therapy experience with structure and repetition. Due to the nature of scoliosis and the potential for progression during growth, it’s important for patients to gain the necessary skills and put them to use right away, rather than prolonging instruction over the course of weeks or months. This is why our outpatient program is designed to parallel much of the original German Schroth experience, but with modern day improvements.
Most adolescent patients complete either a 12-hour or 17-hour program (individual sessions may range from 1.5-3 hours at a time). Program recommendations will vary according to individual circumstance and based on Dr. Marc’s assessment during examination appointment (for local patients) or phone consultation (for long-distance patients: please send x-rays, photos and detailed scoliosis history to email@example.com).
Potential Benefits/Goals of the Schroth Method for Adolescents
- Lifetime management skills
- Empowerment over scoliosis
- Increased strength and flexibility
- Improved breathing and lung capacity
- Improved bracing results
- Improved body awareness and body mechanics
- Postural improvement – When you think about it, it’s not your child’s x-ray that people see when they walk down the street – it’s their postural appearance. Our scoliosis exercise protocols focus on helping teens attain a more balanced, symmetrical appearance.
- Prevent curve progression (i.e. stop scoliosis from getting worse)
- *Improve Cobb angle – *This is a goal for adolescent patients but is not guaranteed and depends on individual factors. Improvement requires consistent application and is more readily achievable in immature, flexible spines.
In addition to scoliosis exercise, we offer patients the option for a fully compatible, technologically advanced, asymmetric 3D brace. We are the only US location to offer this combination treatment in one location.
Scoliosis Brace for Adolescents
For patients that require a scoliosis brace and/or may otherwise benefit from bracing, we offer the Chêneau-style Gensingen brace. This TLSO is designed to correct scoliosis in 3 dimensions and is 100% Schroth compatible. Each brace is designed by Dr. Hans-Rudolf Weiss, the grandson of Katharina Schroth and son of Christa Lehnert-Schroth.
Bracing can be done alone or in conjunction with a Schroth exercise program but we find that patients that combine both treatment options typically have the best outcome! While the majority of our patients wear the Gensingen brace full-time, it can also be designed for nighttime only wear (depending on Dr. Marc’s recommendations and individual factors).
The primary goals of Gensingen bracing are for curve stabilization and/or reduction and postural improvement. The Gensingen brace differs significantly from traditional scoliosis braces due to its asymmetric style – designed to induce a mirror image of the patient’s scoliosis. The goal of this is overcorrection (dependent on curve severity and spinal flexibility). Each brace is designed according to individual curve pattern and strategically placed openings allow for derotational breathing – similar to a Schroth exercise!
Another bonus is that whereas most braces close in the back, the Gensingen brace has front closures which allow for greater independence. Patients who have switched from other scoliosis braces often remark that the Gensingen brace is easier to wear and that it ‘feels different.’ That’s because the Gensingen brace doesn’t just squeeze, it shifts!
With this newer German technology, we are able to brace curves ranging from the upper mild range to severe curves, including those who may have been recommended for surgery. Many patients who have been told they are not eligible for other braces have achieved curve reduction after wearing the Gensingen brace and using our Schroth exercise protocols. Check out our Results or our Facebook Page. We are proud to say that some of our patients have attained results that the medical profession says are impossible!
Surgery for Adolescent Scoliosis
We don’t need to tell you that spinal fusion surgery for adolescents is a serious and lasting procedure. We encourage parents to consider our proactive approach before opting for surgery. Surgery may help straighten the spine with hardware, but limits mobility and is far from a ‘quick easy fix.’
Rather than a lasting solution, for some, surgery may be the beginning of a new set of circumstances, some of which are far worse than living with scoliosis. This isn’t always the case at first, but we’ve spoken with many patients who regret their decision to have surgery, months, a year or many years later. Parents should understand that for many patients, surgery is a choice and not the requirement it is often presented as. We are not in favor of scoliosis surgery except in the most extreme cases. Please refer to our Research section for papers on the topic.
The very few patients we’ve had who eventually opted for surgery after treating in our office (mostly cases involving neuromuscular scoliosis, congenital scoliosis, and connective tissue disorders) have reported that their surgeons were pleased with recovery times and had outcomes that exceeded expectations. That said, we’ve had many adolescent scoliosis patients who were previously recommended for surgery who have been able to avoid surgery¹ by using our Schroth program and/or the Chêneau-Gensingen brace.
Post-surgical Scoliosis Treatment
It is important to realize and accept that scoliosis is a lifelong condition that may require maintenance even after surgery. After spinal fusion surgery, the spine can sometimes buckle above and below fusion sites (i.e. causing compensatory curves to progress). Pain levels can also increase in adulthood. In these cases, post-surgical patients may be candidates for our Schroth program and/or part-time bracing to help mitigate post-surgical symptoms. To participate in our program after surgery, patients must be 1-year post-operation with recent PA and lateral x-rays indicating stable hardware. Clearance from an orthopedic surgeon may also be required.
Whether you’re looking to help your adolescent child avoid scoliosis surgery, or are seeking post-surgical treatment, please contact us with more details.
¹ Moramarco M, Moramarco K, Fadzan M. Cobb Angle Reduction in a Nearly Skeletally Mature Adolescent (Risser 4) After Pattern-Specific Scoliosis Rehabilitation (PSSR). The Open Orthopaedics Journal. 2017;11:1490-1499. doi:10.2174/1874325001711011490.