Scoliosis Blog

Once again i am sitting on a plane travelling overseas.. i have worked out  that  this is my 9th trip in 3 years.  SOSORT is meeting in Milan this year. There is once again a 2 day pre-meeting course on 'all'  the established conservative  management techniques, followed by a 3 day conference, and then the level 2 SEAS course. Before I left, Chani (new receptionist) and  Tim (physio) were joking that I should enjoy my holiday. This is certainly not the case... The emotional, financial and social expense is really quite significant. I have many  friends who travel frequently for work and now appreciate what they go through.  It will be an interesting conference as there will be a 'debate' with the  head of the SRS about conservative vs. surgical treatment of  scoliosis, which I guess is what it's all about. I am still concerned that some of the  patients we are seeing should definitely be undergoing surgical management. 

Well the SOSORT COURSE and conference is over. The course was a repeat of last year and although I had already attended most of the sessions it was good to see them again. It was also good to spend time with experts from around the world and these 2 days provided me with time to discuss cases with them. I got co-opted (coerced) into the SOSORT education committee. This committee deals with the pre-conference SOSORT course as well as the educational accreditation of the different SOSORT treatment methods. I have taken on the secretary roll and will have to see what this entails.

The conference  was especially good. The standard seemed to be higher than last year and the discussions with the SRS representatives was enlightening. There were 2 'controversial sessions' scheduled. One with Dr Nigel Price (the current head of the conservative management committee of the SRS) who presented a talk confirming that there is a lack of good quality research validating the role of exercises in the management of scoliosis. There is no doubt that this evidence is lacking but the outcome from the conference is that good quality research will only be accepted when a large cohort prospective randomised controlled trial is conducted. These studies called RCTs involve some patients attending a therapist who randomly assigns them to a treatment or non treatment group which is almost impossible in a private clinical setting. I had some good talks with Dr Price who did part of his surgical training in Adelaide. He appeared very open to "not rushing" into surgery and although wasn't convinced that SSE's (scoliosis specific exercise) could play a huge roll in the management of scoliosis he was very open to what we do.  I discussed quite a few of my more "difficult" cases with him and wish we had a surgeon like him in Sydney.

I had some very itense discussions with Steve Bunce who is the physiotherapy head of North Bristol hospital. Steve is involved as clinical advisor to a NHS project to try to set up a study like this. Prof Eric Parent of Alberta Canada is also trying to research this topic. However, and this is where a problem arises, it seems that scoliosis specific exercises need to be taught by expert therapists who not only have the theoretical knowledge, but also the practical experience and teaching abillity. I worry that the RCT programs will not have access to the quality of therapist to achieve a true outcome. Lindsay Dolan who is co-ordinating the very large BRAIST trial in America on bracing reported that the trial which was originally an RCT has changed as their patients want to choose their treatment options.

The second 'controversial topic' was with Dr. B Stephen Richards who is the current head of the SRS. A series of cases were presented to the conference and Dr's Richards and Negrini presented their management approaches.  There was strong agreement with all the cases presented. I think that it was quite a relief to see that the two organisations could work so easily on these cases.  I suspect that in a few years SRS and SOSORT will be even closer.   There was also a presentation from an Eastern European country on the use of bracing for early onset scoliosis. Quite a few of us in the audience were concerned that these children were not getting the correct treatment and the SOSORT advisory board will take up the case with the presenter.

The last 2 days of the conference was devoted to the level 2 SEAS course. We spent this time with Micheli Romano and Alessandra Negrini who are the head physiotherapists of ISICO in Milan. I cannot say the that the educational component was very high but each participant was asked to present 2 cases for the group to discuss. Garikoitz Aristegui of Spain was very passionate about a method of treatment called global postural re-education (RPG) and how it can help with scoliosis.  Its amazing how things turn around. After completing my Egoscue training I spent some time exploring a technique of postural correction developed by Mersiers in France. This later became RPG through the work of another Frenchman named Souchard.  Anyway it was good to see someone blending techniques.  Gary was looking at some of my case photo's and we immediately "clicked"  on how I was trying to integrate some of the Egoscue pelvic positioning techniques into Scoliosis treatment.

I met another artist - Monica Vilegrasa in Dr Rigo's head physiotherapist in Barcelona. She is a sculptor. She was explaining that their unit now has a 4 week scoliosis program for English speakers (in a group) which runs every July. Although we have treated heaps of patients on an individual level I still haven't done groups yet..... I somehow sense another trip coming up.