Scoliosis Blog

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.