Scoliosis Blog

Normally I really look forward to getting on board these flights. I look forward to the time I have to write. I sit back start typing and ramble on… This flight is a bit different. We are almost at the end of the first leg to Singapore, landing in an hour, and this is the first time I am putting some words down. It’s off to SOSORT again, this time in Wiesbaden, Germany. This will be my fourth time at SOSORT and my first time as not only an observer but will be presenting my initial data on Friday. I have spent the last few weeks working on the slides and rehearsing the talk. I would like to say that I am confident speaking in large crowds but I am realistic to say that “not yet”. There is a lot of data to get through and a short time to get it through. The first few hours of the flight have been spent revising and culling the presentation again. There is still some culling to do though… Gulp.

I enjoy listening to TED talks when I have the time and purchased a book entitled Talk like TED at the airport. I think I will have to revise the talk and presentation again to reflect some of the points recommended. The first chapter is all about “passion”. The presenter needs to have passion about the topic and relate how this toping “what makes my heart sing?”. I will have to work on answering this more closely.

I have used my trusty android tablet for the last few years, with a very clunky and slow keyboard. I took the plunge and purchased a new (refurbished) ultrabook for the next phase of my life. At least I can type now with a more trusty instrument and able to work on all the software that I need to. Whenever I attend surgical conferences, the surgeons seem to have all the latest toys to work with and play with. There really needs to be more health dollars in the non-surgical world. For research, for treatment and dare I say it for remuneration of us poor bastards who travel round the world trying to make it a better place. Or at least trying to make the people who live in it a bit more comfortable.

When walking with my kids on Saturday I came up with a new slogan. Negative split your life. I will get some t-shirts made and give them out (if I can). The runners who read this (if anyone does) will understand. When ever any endurance athlete does any race the race can be divided into two halves and the general idea is to try and complete the second half at a faster pace than the first. So maybe the same thing should be done for life. Ahhh, I hear you say. But you don’t know how long you’ll live. Exactly! So you need to live every day at faster “pace” than the day before. The pace can mean anything but it needs to be done with meaning and intensity.

Athletes spend time and money on training to be efficient and effective. Spinal balance is no different and we need to maintain an efficient system to minimise energy wastage. How do I bring in principles of energy utilisation into a 6 minute talk on adult spine deformity. I am not sure but will need to work it out.

The first afternoon will consist a visit to the Schroth clinic in Bad Sonnenhem. There are no longer any Schroth family there so I think it might be a bit empty. But should be interesting anyway. I wonder if there are any regrets. The clinic has been around for a long long time. There must have been some good cases and some bad cases. Is it all worth it. When I see an adolescent case in surgical range, what is the balance of risk and outcome. Still don’t know.. there is no answer and each case must be handled on an individualised basis.

The next few days are the conference days. I am looking forward to it but apprehensive about the presentation. And then the following few days will consist of a scientific meeting on surface topography hosted by DIERS who have supplied our formetric that I am finding highly beneficial.

Sleep, ahh sleep that elusive ghost that comes fleetingly to visit the multitudes of travellers ensconced in these long haul flights. There is lots of comment saying how important sleep is for spine deformity patients. I think I once wrote that Dr Stefano Negrini once said that sleep is the enemy of AIS in that the spine grows at night but daytime is the enemy of the adult as that’s were gravity is active. My on board baggage looks more and more interesting as I take more and more flights. The lumbar roll for the lordotic spine, the kidney shaped neck pillow for the cervical spine, the extra socks for the potentially cold feet. One day I might turn left on board ;-)

Ok, day 4, Sunday back on a plane. This time from Frankfurt to Berlin. I will be returning back to the surface topography session in Frankfurt this evening. One of the most well respected Endocrinologists in Australia suggested I visit Berlin, so here I am. He is an expert in Osteoporosis and I tried for some time to meet up with him to discuss my thoughts on spine deformity in the ageing and osteoporotic population. It didn’t work out for quite a long time and then the world decided it was time for us to meet and we did. My wife’s family is originally from Berlin and my people’s history have been impacted so profoundly from this place that it is hard to describe my thoughts regarding my expectations of being in Berlin. Ok, had very interesting time in Berlin. Will need to write about it more later on.. but Berlin was very interesting and I was able to visit the Otto Bock research facility. We use some of their braces in the clinic but the R&D facility is open to both the public and therapists. There was a VERY clever training system to balance dysfunction that should not be too hard to implement in the clinic one day.

Well the talk went ok. The TED book (I haven’t finished it yet) says to speak with passion, engagement, personality and use novel ideas and techniques. The YouTube tutorials say to use the slides as background and engage the audience personally. The truth is once I got on stage and went through the first slide… it was all nerves, stress, tension and terror. Or so I thought. I cannot think how many times I started the first lines – “Saggital balance describes the vertical alignment of the trunk over the pelvis”. I rehearsed and rehearsed and rehearsed. Part of my recent marathon training was going through the lines of my talk, over and over, as I ran and ran. I listened to the video playback of the talk and it didn’t sound as bad as when I was up there giving it.

So, just like postural training, if you spend long and hard enough training then I think it is possible to achieve reasonable outcomes.

Back to SOSORT, I really think we are getting there. It was good to engage with Dr Steven Glassman again and I really think he was open to what the rest of the world has to offer with regard to conservative scoliosis. I did eventually put his paper up in my presentation and I think some of the audience “got it”. I have been asked by a few people for copies of the presentation so I guess that makes it worthwhile.

The good news is that there was another Australian at the conference. Another bracing specialist for Sydney. Jeb couldn’t be there due to family commitments and I also heard that the bracing specialist I had met in Sydney last year had gone to BUPA to spend time with Dr Rigo and had even spent some time with Dr Rigo in his clinic. It seems that things are getting there with regard to non operative care of scoliosis.

i got to meet up with Christa Schroth and we had quite a few "talks". I hope I did not give her too much of a hard time.

My colleague and friend Lou-Ann Rivett won the SOSORT award for the best paper. I am glad that I got to see the study in action many years ago and it was well deserved. It confirms that the RSC brace in the right hands is a very effective tool and it confirms that the psychoemotional capacity of the child and her parents are essential in conservative management.

We had the opportunity of hearing a keynote address from the famed Dr Jurgens Harms. He is the lead editor of a famous textbook called the the Harms study group. The book, apart from being one of the most expensive items in my library. I will write more on the plane back.

When Helmut Diers came to Sydney last year he asked that I stay behind after SOSORT to attend the Diers business and science meeting. I got to see firsthand the power and research that has gone into the design and build of the formetric that we have. I was able to spend lots of time with the DIERS clinical specialists as well as to see how their specialists use surface topography and measured motion mechanics to identify and treat a multitude of clinical cases. Spine and scoliosis is only a small part of its power.  BUT and it’s a big BUT, the devices are only tools to identify and quantify issues, but the clinician needs to interpret the results otherwise its just a waste.

Cindy Marty, who is an American Schroth therapist in Minneapolis was at Sosort and has been elected onto the SOSORT board. She published on Linked In today a link to the New York Times article on scoliosis. I will insert the link. Take it with you to give it to your doctor.

Prof Patrick Knott from Chicago presented some current studies that are currently underway with some of the world’s to spine surgeons. I have asked Patrick to give me a copy of the protocols so we can begin to mimic these studies performed globally. I will then be able to see if the results we are getting with the formetric are consistent with global results.  I have often been chastised by my more business minded friends for not using social media effectively to promote what we do.  Apart from this Blog, which is a passive, long winded ramble, I do not commit much to publicity. Anyway, I mentioned Friday’s talk on LinkedIn and got some humerous replies about wearing a suite. The Diers company were exhibiting one of their higher spec’d machines at the research event. I have often seen examples of subject data but this time decided to volunteer myself to be a subject. This reminded me of physio school when we had to strip down in class for practical sessions. I have spent the last few days analysing the data from the Diers examination and am enjoying seeing the power of the tests performed.

I detoured to Johannesburg on the way back from Frankfurt and am writing this on the plane back to Sydney. I spent some time with Gary at Ergotherapy who continues to explore saggital profile in seating. I was introduced to the mother of a young girl who has recently been diagnosed with scoliosis and has gone into a brace. Her physio is Lou-Anne Rivett and bracing specialist is Rowan Berkowtiz. I was able to tell this mother that Lou-Anne won the international paper of the SOSORT conference and that her daughter was in good hands. I look forward to being able to have a similar level of confidence with our own Sydney based treatment. We have everything in place…..   I think the time is nearing that we (read I) need to get out there more and start  

click here to see NY times article

OMG!! As my daughter Gabrielle would say. I really need to schedule time to write more often. I was looking forward to getting on this plane so that I could get time to put something down on 'paper'. I am on the way to the SRS meeting (conference) in Brisbane. SRS stands for Scoliosis Research Society or as some of the more militant groupies on my side of the operating room call Scoliosis Rod Society. The SRS is an American based global group who run meetings in different cities of the world and this year it’s in Brisbane. They are joining with the SSA Spine Society of Australia meeting so it’s back into the territory of the non-believers. I have a lot to say...

But first... Day 5: last session of Intensive week of Schroth sessions. Patient X's mother says 'So what's the use of doing all of this?' 16 year old Patient X was referred by her interstate physiotherapist for an interesting curve that her surgeon was reluctant to operate on. Patient X was experiencing mild pain, was unsure of the aesthetics of her posture and had a very good intense week learning and working on her corrective routine. Her pain had resolved and she was much more comfortable with the aesthetics. I discussed with her mother that she would still need to be monitored as her curve could progress and one day she might still need or elect to undergo surgery.

Our intake forms state our position, we discuss this on day one and through the program but patient x's mom only 'got it' on day 5. Surgery is a big thing, pain is a big thing and body image perception is a big thing. I think a sense of powerlessness makes all these factors a lot worse. Patient X was empowered through knowledge and muscle activity and she left the clinic in a much better place than when she came in.   Her physio interstate sent the following response.

Thank you for your report re xxx. She is doing really well. She has started coming in twice a week now and does her Schroth exercises on 1 day and more of her "pilates" exercises on the other. XXX is still reporting much reduced pain levels. I am doing my best to supervise her exercises even though I dont as yet have any Schroth training. It is on my list to do at some stage.

Back at the airport after a very interesting course. I've now seen the same faces at these meetings for quite a few years. I am glad Rebecca Harding was able to attend. Jeb was there as well. The SRS international delegates included Dr Steven Glassman and Dr Jon Dimar. Dr Glassman is the lead author of a famous paper stating that conservative management has no role in the treatment of adult scoliosis. I really know this paper and I really know the main review paper he quotes in his paper. The spine surgeon from Brisbane who 2.5 years ago at the Medtronic seminar gave one of the first talks. He once again ridiculed conservative management in this talk, maybe with less ridicule, or maybe I am just getting used to the message and the delivery. He did at least mention the Braist study confirming the efficacy of bracing in adolescent scoliosis. It seems that the surgeons are not entirely convinced that the compliance rates are that good. I think they are. But I still think that the brace systems available to the average patient in Australia is well below international standards. IF YOU ARE A PARENT READING THIS THEN YOU HAVE A RIGHT TO DEMAND THAT YOUR HEALTH DOLLARS ARE USED TO EDUCATE THE BRACING SPECIALISTS IN AUSTRALIA TO THE LEVEL OF THE WORLD LEADERS INTERNATIONALLY.   Your surgeon has travelled overseas to learn, let them send their bracing specialist overseas to learn too. Rebecca and I had a chat to a spine surgeon from Melbourne and I was very vocal in saying that it is preposterous to expect braced kids to not be able to take their brace on and off independently. Most public hospital braces are made with the opening at the back which requires the kids to have help to remove and put on the brace!

Anyway, I approached Dr Glassman to enquire about some of the details of his study. He started straight up saying that there were weaknesses in the study with regard to the choice and delivery of some of the conservative management techniques. He then repeated the often repeated statement that there is no credible data on conservative management in the literature. He then asked, which surprised me, if I had heard of SOSORT and said that he will be at SOSORT in Germany in May. I said I will be there too. I didn’t say that I will be presenting a paper on sagittal balance at this conference but it will be quite daunting speaking in front of such an eminent individual. I found out later that Dr Glassman is the current president of the SRS and that is why he will be there. I think he was open to some treatment of scoliosis but is not sure what it should look like. I agree that we need to do more research.

The other news is that I have been accepted into the PhD program at Sydney University. I am still finalizing the protocol with my supervisors but it will involve assessment, measurement and intervention of postural asymmetry.

Next time to write will be on the plane to Germany!!

Oh yes.. another Marathon down. I think it will be a long time before the next one.

2013 is almost over and life continues. I am progressing with my discussions with Sydney University and hopefully will have a formalised project starting next year. 

Unfortunately last month, one of our adult scoliosis patients passed away (from an unrelated illness). I was asked to see her by her neice (who is a friend) and only met up with her once. It is always distressing to learn that some patients pass on as we spend quality time deconstructing these curves. 

Last week I received a pleasant email from a case we saw a year ago. Our adult patient decided to recheck her curve by having  xrays and this is the report

 We dont normally recommend annual x-rays for adult monitoring but our patient and her doctor wanted to check on progress. She is feeling encouraged to continue with her exercise program. 

Its been a strange year in that I have realised that I have only travelled overseas twice to attend conferences. Does that mean that I am starting to get my head around these curves... I hope so. However, we are in process of scheduling to attend SRS course in April and SOSORT in May. 

Wow, time has flown.  Its already October. I have been meaning to put something down in the blog but have been so incredibly busy its been hard to find the time. August flew by with the Medtronic spinal surgery conference. Its the same group as last year but this time the focus was on adult spinal deformity. Many of the surgeons treated kids as well. I am thankful to Medtronic for extending an invitation to Mr Helmut Diers from Germany. Helmut is the founder and owner of the company that built the new formetric machine we have. He flew into to Sydney to test the machine (to make sure we assembled it correctly) and to conduct some training. I think it was also good for him to see the direction that that the surgeons are  heading in. We fortunately or unfortunately did not have any discussion on the efficacy of conservative managemet in spinal deformity.

I received the decision regarding my research submission to the Australian Physiotherapy Assoc conference. REJECTED!! I will have to continue with the research and resubmit next year. I have also been having some interesting discussions with Sydney University so hopefully will be able to formalise a more thorough project. 

The clinical treatments continue though.. I had the pleasure working with a special young man referred to my his amazing physiotherapist (Millie Shield) in Tasmania. He came to Sydney to visit with a spinal surgeon. He had already had a fusion a few years ago and the surgeon was reluctant to operate again. This was Millie's reply and she's heading over to Barcelona next year to complete Dr Rigo's course.

"Thank you for your invaluable work with XXX. I've seen him a few times since and he now remembers all the exercises without using the notes. We have been working on releasing right cervical tightness and his ability to correct his asymmetries is nothing short of astounding. XXX hasn't had pain since Sydney and has worked full time hours - he was previously using a day of sick leave every fortnight or so. A terrific result."

l had a another case last week where a mother brought in her young (12 year old) daughter. The daughter had been diagnosed with a 20 degree curve at aged 10 and told to leave it. the mother was worried that her daughter had progressed and came into our clinic. I arranged for another scan and unfortunately the mother's suspicion was correct and her daughter's curve had progressed well into surgical range.  This was one of those cases where I think that Schroth therapy is not indicated at this stage. This young girl needs to see and surgeon and a good bracing specialist and to determine which the better option is. If she is braced then Schroth would definately be necessary.

Last week an ex-physiotherapy student of mine was in Sydney. Gary Arenson has designed an ergonomic chair and asked me to help him launch it into the Australian market. The chair is manufactured in South Africa and it is especially supportive of the saggital posture of the spine. This ties in well with what we are doing.

It's about 4 years since my first introduction into the Schroth world of spinal deformity management. A lot longer since my time at the Egoscue clinic in San Diego and many, many more years since I was a little kid growing up and training in the gymnastics halls and diving pools of Johannesburg. 

In 1990, whilst a 3rd year physiotherapy student, I conducted a research project titled "The effect of sound biofeedback on balance when testing on a tilt board". It was a cute little project and one of my best friends, Joel, an electrical engineer selflessly built an electronic timing device and helped me hack together a crude balance tilt board. The literature review included a section on posture, balance and a measure of balance called stabilometry. 

23 years later, we took delivery of one of the most advanced posture and balance measuring systems in the world.  Our Formetric 4D system with integrated stabilometry force plate has arrived and I am testing it out on patients. I have seen a few of them in operation around the world but now I can really play!!! There is quite a steep learning curve in the interpretation of the data and the tests, but I am really enjoying the process. I have realised that I've done 20 years of preparation for this.

I am really lucky to have the team behind me in the clinic. Carol, our Irish Leprechaun, worked really hard to get the TGA approval and decided today to have a ribbon cutting ceremony for the device. Strawberry's, Champagne, Cookies, and even white gloves (thanks to Tim) to cut the ribbon. 

I think sometimes we get lost in the intensity of the work to step back and take a breather. Which brings me to 2 cases I saw last week. 2 young adult cases, both post fusion and both referred by their doctors. They haven't come from their surgeons but from their GP's. We spent time going through their curves and the surgical corrections and some general exercises that they can integrate into ther regular exercise programs. The most important message that I had for these cases, was... to step back from the intensity of the scoliosis process and get on with life. 

I finally managed to complete the analysis of the data on adult spinal deformity and compensations. I submitted the proposal to the Australian Physiotherapy Association Conference and am still awaiting their decision. I met with an esteemed Professor of Endocrinolgy as I have some intersting ideas about low bone density and spinal deformity. We had a really interesting discussion and it was enlightening to find a intellectual sparring partner, who when shouts out, show me the data....  I have it right there.

July!! its been a busy month. Next month its back to the Medtronic spinal deformity meeting!!!  Thank you Medtronic - I think.  

Another flight. its been a few months since my last one.

This time it's to Chicago. SOSORT which is the international society of conservative treatment for spinal deformity has its conference there. Its constitution requires the conference to be held every 3rd year in the USA and the other years in Europe. This will be my first SOSORT conference in the USA. who knows... one day we might even have it in Australia.

I was really hoping to have something to present at this conference but life is just too crazy to sit and research and collate the huge amount of data that needs to researched and analysed using the requisite statistical methods. Its really hard to reverse engineer these projects but I am slowly getting my head around a formal project on our patients.

This weeks email question was from a concerned mother, whose 12 year old girl has recently been diagnosed with scoliosis and is on the wait and watch program. I need to add some detail to my webpage as I had to ask for a follow up email to provide me some more background.. she has a 30 degree double curve. I dont know what her growth status is (yet) but will find out as its paramount to the management decision making process. If she still has heaps to grow then bracing might be indicated but it appears that the surgeon involved has suggested bracing would not be appropriate in this case. We will wait and see. I did suggest that the mother chat to Jeb as he should be able to provide a better opinion regarding bracing.

I must admit that I am a bit disappointed in the public bracing that I have seen. I wrote earlier that I met up with a bracing specialist from the local childrens hospital. He was aware of SOSORT and the conference and was hoping to go. I hope he is there and I will write about it on my return. This bracing specialist works with the surgeons and at least we are slowly getting into their world. I really think that the parents and families need to demand more out of the surgeons when it comes to bracing and to pressure them to recognise that their bracing specialists need to trained up and experienced to do great work; and then to monitor and demand that the braces do their jobs effectively.

When I was in Barcelona I saw Dr Rigo remake a few braces that he felt could do a better job. I havent seen much of this attention to detail in Australia. Its time to demand it!!

The email question had 2 other points.. is there any proof that Schroth works and why is the treatment program so expensive.

I explained that there is not yet any level 1 evidence that Schroth works. This means a well designed randomised double blinded study published in a very good peer reviewed journal. I cannot wait for this to occur but am worried that it will be too hard. I explained that there are currently 3 studies underway (1 in England, 1 in Canada and one in Sweden). The problem is that no therapist is alike and I do not know how they apply and teach the method. This thing is an art and requires an artist who can work in or on all the physical and non-physical facets of our patients.

Back on the plane travelling to Sydney. My brother- in- law who travels a lot for work has a joke whenever we talk about our travels. He always asks if I turned right or left. The most common curve in scoliosis is a right thoracic curve- I turn right. He turns left.

Deciding to go to these events is always difficult from a financial, family and energy level. Is there such a thing as "travellers remorse" ? I suspect there is as this time I have none (yet..) There were some particularly good papers and good discussions. The experience of the leaders of the field is being spread around and the discussion and thoughts of the group is deepening. The first few years I would just sit and watch but now its good to able to follow and contribute but I am still not able to pre-emt and forsee.

I took the time to for a run this morning -it was freezing and windy!! Sometimes the solitude of the run allows me to think through some aspects that I wish I was able to voice when we have some of our discussions. It will come.

Unfortunately Dr Rigo was unable to attend Chicago and neithere was Dr Weiss from Germany (Katarina Schroth's grandson). Rebecca Harding was there from Melbourne and it was great to see her mind swimming in the ocean of the discussion. We had a good chat to the President of SOSORT, who is also the president of the American Scoliosis Foundation. 

Dr Kamal Ibrahim,the head of the SRS was there again to present the keynote address. The relationship between the global surgeons and SOSORT bodies is improving. The chair of the SRS conservative body was there as well and was a very impressive person. Finally, there will be a half day co-meeting of SOSORT and SRS at the SRS meeting in Lyon in September 2013. This time the SOSORT leaders will present to the SRS members. Hopefully this will lead to a positive outcome as the previous experience of attending a spinal surgeon present conservative management data was very distressing to experience.

I was able to spend some time with Dr Eric Parent who is leading the Canadian randomised pilot into Scroth therapy. He presented his preliminary data which is showing effectiveness of the method in preventing the natural progression of the curve. Eric advised that once the randomised control group finish the treatment program (they had no treatment for 6 months) and will enter treatment now then he will publish his data to expand the trial into a multi center large cohort (sample size) trial.

Luke Stikeleather is bracing specialist who uses Rigo principles in his Cheneau braces. Many years ago he made a brace for a girl who had contacted me from Melbourne. She had the brace made in the states and she did her Schroth treatment in Canada.

Scoliosis page. Braist study.. dont let your surgeon prevent you from bracing because he doesnt believe in its effectiveness.
We had our half day session on research methods for SOSORT members. Last year i was secretary of the educatinional comitee but but time have agreed to liase with the research committee to faciliate the the research course at the next SOSORT meeting in Wiesbaden Germany.

Speaking of Germany I met up with Helmut Diers. The engineer who invetented the Formetric. We finally got permision from TGA to import the machine and we had some very interesting discusion on collaborating research, especially in the saggital plane. I cannot wait.. but its a very expensive piece of equipment.

Shana-Lee has returned back (part time) from maternity leave. It's wonderful to have her back and see how she works with our patients.  We had an intersting case this month. We shared the treatment in that Shana-Lee worked with our patient in the morning and I did the afternoon session. I think the patient involved (a very complex case) really got a lot out of 2 sets of eyes and hands (and the brain in between).  I sure did. 

Anyway, back to Shana-Lee, her 1 year old son Jake has been spending time in the clinic and has access to our "toys". Anyway, he was in last week and I happened to notice the doodle-sketch pad on the floor next to him.  We have had a few scoli's in over the last few weeks and I have no clue who left this message..... but I think its important to recognise the non-physical aspect of scoliosis and the impact it has on our patients. 

 If I did know who wrote this, I would enrourage them to work with our friends over at Curvy Girls. I haven't met Hayley but have had some correspondence from her family. She seems a wonderful person and I am sure is doing a great job in Perth.  I met Nina Cecylia in Milan last year. She is from Curvy Girls and presented a research poster at the SOSORT conference. 

This year the SOSORT conference in Chicago and I will be leaving next week. I was hoping to present some research but time and data got away from me. It will be very interesting and I am looking forward to diving into the large pool of knowledge. 

Rebecca Harding from Melbourne will be there and hopefully a bracing orthotist from Sydney childrens hospital.  I will no doubt write more from Chicago. 

My friend Jonathan accosted me few days ago... he asked where the most recent Rant was. Sorry, I have been remiss in posting. Here is my ramble from December January..

Another flight. another time to write. Its been a long time since I have been away with the family. My 9 year old daughter commented that she cannot remember the last time she had been on a flight with me. Most of the time I tend to meet the family after they have arrived at a particular location, and then I leave before them. This ramble of a JOURNEY into the world of scoliosis has taken me a long time and a lot of time has been without the family.

Dr Rigo often comments that he struggles to find time to be with his family and cannot fathom the workload he is under. It is hard finding time....

About 4 years ago, I started this journey in livingroom of Lior Neuhuaus in a small town in Israel. I am heading back to Israel, back to Lior and her mom Tamar (who was one of the original physio's on SOSORT). I have also planned to spend some time playing with a very special machine called a Formetric. It is a very accurate postural measuring camera. DIERS is one of the few companies who exhibit at the SOSORT conferences and this is their machine. It is shocking to see how much money is invested into the surgical exhibitions appended to spinal deformity conferences compared to conservative management strategies. Anyway, most the the centres around the world are monitorng their patients using a formetric system. It is supposedly
way more accurate than the manual measurements I am curently taking. It is non-radiation emitting and can be used as a screen for progression and also for saggital curve imbalances.

I have been speaking to DIERS for a few months now and have am awaiting approval from TGA to order a machine. There are few machines available and the one they have in Israel is one of the most modern. It is used in a clinic owned by a global private medical aid, who have been convinced that exercising in a posture modifying shoe can delay and prevent knee and hip surgery. This sounds familiar .... Maybe we wil one day have a global medical aid encouraging their members to try exercising in a brace to delay or prevent surgery.

Last week I saw another case.. a young mother with 3 kids had been refused employment because of her scoliosis curve. She has no history of pain and kept fit and active by exercising including kayaking. Many years ago I worked for a rehabilitation consultancy and did multiple pre-employment screens like this. It is tragic that some therapist can decide the fate and future employment of an individual without full knowledge of the underlying condition and its behavior. I once went to a conference on back pain, an expert stood up on stage and asked the audience for a show of hands 'who does not experience back pain' he thanked those who raised their hands and accused the non responders of lying. This caused a quick chuckle in the audience as we all know the statistics . 80% of the population will experience back pain. When scoliotics experience back pain how do we know if they are any different from the general population? The truth is that we dont know for sure. There is some evidence that scoliotics experience slightly greater incidence of back pain than the general population. They may
(but not always) experience slightly greater severity of back pain than the general population
with back pain. BUT.... if a young at heart fit healthy person with no back pain arrives at
your doorstep then I dont think that a history of scoliois is sufficient to prevent them from
employment. Besides the psycho-social-emotional background has been shown to be a greater
predictor of employment problems.

I am back on a plane again. back to Sydney. I got to spend quality time with the family. Got to spend time with the formetric machine and met up with a cousin who was distressed that her daughter has recently been diagnosed with scoliosis. 4 years ago I was only a beginner in this game but now could confidently contribute to the managment of my cousin's daughter. I met up with Tamar and Lior who commenced treatement of my cousin and we sat down and reviewed mutual cases.

Hi all,

OK. listen up!!!

We know all about scoliosis. The internet is full of information and there is more than enough "stuff" to educate till  confusion but at some stage we have to make a decision to do something. I don't remember if it was Dr Rigo of Spain or Dr Negrini in Italy who said, you can't do nothing!!

I am planning on going to Chicago next year, to the next SOSORT meeting.  It's my third year of attending and I think it's time to present something. I have heaps of data but very little of the data involves our most applicable cases. I enjoy working with all my patients but the patients most in need of therapy are delaying treatment till its almost too late.  I would love to present a large series of pre-menarche AIS cases in treatment. That means scoliotic kids BEFORE their major growth curves.   Unfortunately this is not the case, we are seeing large curve cases in almost fully grown kids. I wish we could get to these cases earlier.

I have also witnessed the unintentional mis-management of some cases by both our surgical and non-surgical colleagues.  It astounds me that some of the surgeons are running round the world learning the most modern surgical technique when the orthotist down the hall is still supposed to use 50 year old bracing knowledge and devices. The surgeon is then "disappointed  that the bracing didnt work but it's not really that unexpected.  But dont worry, we can fix it surgically!".

so...  My talk will go something like this, We have seen a large amount of scoliosis cases but unfortunately not many of them are best practice appropriate, so I will be discussing the conservative management of progressive adult scoliosis with reference to osteoporosis and pelvic incidence.

I am sure that this mouthful will change but the title of this blog is a ramble.. or maybe tonight it should be Rant!

I have put some photo's of some x-rays together of the last few week's cases.  Gratefully, some of them didn't even need treatment!