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Physical Therapy for Pediatric Scoliosis
Nicole Viverito PT, DPT discusses what Pediatric Scoliosis is, what a Scoliosis-Specific Exercise program based on Schroth principles is, and current research and outcomes associated with this method.
Featuring:
Nicole Viverito, PT, DPT
Nicole Viverito, PT, DPT graduated from Midwestern University with a Doctor of Physical Therapy in 2013. After graduation, she was a physical therapist in outpatient orthopedics, where she worked with people of all ages with a variety of orthopedic conditions. Nicole has worked at Shriners Hospitals for Children – Chicago since 2013. At Shriners, she has provided physical therapy treatment to the pediatric population ages birth to 21 years old with a variety of orthopedic, neurological, and genetic conditions on an inpatient and outpatient basis. She has provided physical therapy based on Schroth principles for scoliosis since she earned her beginner C1 certification in 2015 for the BSPTS 3-D Treatment of Scoliosis based on Schroth principles and co-developed and implemented an outpatient program at Shriners. She earned her C2 advanced level certification in 2017. Nicole has participated in research data collection for the study, “Outcomes of a Scoliosis-Specific Exercise Program: A Pilot Study”; and is working to develop a multi-center study on short and long term outcomes of the scoliosis-specific exercise program with other Shriners units. Nicole has presented 2 poster case studies on scoliosis-specific exercises and a poster called “Short-term Outcomes of a Scoliosis-Specific Exercise Program” at physical therapy conferences. From 2016-2019, Nicole also worked in education as an instructor at Triton College’s College of Continuing Education; and since 2017, she has worked as adjunct faculty at Midwestern University Physical Therapy program assisting with the pediatric evaluation and treatment in labs and lectures. Transcription:
Melanie Cole (Host): Today we’re talking about the Schroth method which is a physical therapy approach to scoliosis treatment. My guest is Nicole Viverito. She’s a Physical Therapist with Shriners Hospitals for Children in Chicago. Nicole, what a pleasure to have you with us today. Tell us a little bit scoliosis specific exercise programs based on the Schroth principles. What is this method? Tell us about it.
Nicole Viverito, PT, DPT (Guest): This scoliosis specific exercises based on the Schroth method was initially developed in Germany in the 1920s and is a method that includes postural balancing exercises for scoliosis. These postural balancing type exercises have been widely used in Europe for a number of decades. And the approach was brought to the US in the past 20 years or so. And has evolved with continued learning and research into what it is today.
So, idiopathic scoliosis, just a little background, is a three dimensional deformity of the spine that occurs with periods of rapid growth. Scoliosis can result in significant postural impairments, muscle imbalances, pain, breathing impairments and functional limitations. And that can limit the person’s participation in their daily activities, negatively impact their quality of life overall.
The purpose of the scoliosis specific exercises based on the Schroth method are to provide individualized exercises to patients with idiopathic scoliosis in order to address that 3-D dimensional component of the scoliosis to improve their overall postural alignment.
Host: How can physical therapy help patients who have scoliosis?
Nicole: So, the overall goals of the scoliosis specific exercise program are to improve their postural alignment, including improving their postural awareness overall, improving their strength and endurance, improving breathing and lung capacity and ultimately, preventing curve progression. Often, those who practice the scoliosis specific exercises, also experience decreased pain symptoms.
And typically with scoliosis, people who have scoliosis present with asymmetries in their shoulders, their should blades, their low back and their pelvis and with the scoliosis specific exercise program, we teach postural correction in various positions with the ultimate goal of retraining the brain with lots and lots of practice to hold the body into a more optimal alignment. So, eventually that optimal alignment feels more normal to them versus when they first come in, they have all of these asymmetries, that feels normal to them. So, there’s a shift with practice, where that symmetrical central position feels better.
Host: How you therapists decide what exercises may help?
Nicole: Therapists us the information that we see in their medical history, their age, the level of skeletal maturity and our examination findings. And we look at the radiographs of the curve to formulate individual comprehensive exercise programs for each person. In Chicago, we have two physical therapists who have advanced level training to provide scoliosis specific exercises based on the Schroth principles through the Barcelona Scoliosis Physical Therapy School.
Host: Wow, that was an excellent description of what it is for people that don’t know. So, are there some people for whom this is not really an option? Who is appropriate for this type of exercise method?
Nicole: At Shriners, kids and adolescents with idiopathic scoliosis are appropriate. Adults can also benefit from this program too but since I’m coming from Shriners; we see kids from birth to 21. So, my range is kids and adolescents with idiopathic scoliosis for this approach and idiopathic scoliosis means that there’s no known cause for the scoliosis. So, it’s not secondary to other conditions. And those are the kids that can really benefit from the Schroth or scoliosis specific exercise program. So, other conditions could be like spinal cord injury or cerebral palsy or muscular dystrophy or any other number of musculoskeletal or neuromuscular type conditions and that type of scoliosis is called neuromuscular scoliosis.
Sometimes we’ll use the elements of the Schroth principles in our treatment with kids who have some of these neuromuscular type conditions but in and of itself, the true Schroth program is specifically for those with idiopathic scoliosis.
Host: What else should families know about this therapy?
Nicole: Another thing that’s really important with somebody who thinks that they want to participate in this type of program is that they have to be really committed to participating in the program and need to be compliant with their home exercise program. So, if somebody goes through our program, and they learn all the exercises but then they don’t carry over the exercises at home; then their results aren’t as good as somebody who would regularly practice the exercises, come to therapy, really learn the exercises and then put them to use in everyday life.
Host: So, tell us a little bit about how it’s working for you. What are you seeing? Discuss a little bit of the current research and outcomes that you’ve seen for patients that do this and do their home training as well.
Nicole: So, currently, there’s not a huge body of research that exists on the Schroth method or scoliosis specific exercises. It seems to be growing. I just learned of another article that came out recently. So, that’s very positive for us but the research that has been conducted, show promising results for this type of approach in preventing curve progression including some random control trials. And at Shriners, we have found that kids and adolescents that are compliant with the program and their home exercise program have had really good results including preventing curve progression especially with those higher risk kids that are still growing.help with pain
So, the curve is most likely to progress if a child is still growing. We’ve seen improvements in posture, core strength, quality of life with kids’ participation in PE class, sports and other activities. And as I mentioned before, it can also help with pain.
Host: Tell us about the ongoing research for this method at your hospital.
Nicole: At Shriners in Chicago, we recently completed a pilot study on the long-term outcomes of a scoliosis specific exercise program, and we’ve been able to report these results. Our plan in the upcoming year is actually to apply for a grant to allow us to research long-term outcomes of the scoliosis specific exercise program in the form of a multicenter study with multiple Shriners units participating. I’m pretty excited about that.
Host: Well that is so exciting. So, what are the exercises like and what are they like for the patient?
Nicole: So, the exercises are very individualized as I said. And we take the patient through different positions. So, standing up, sitting down, laying down on their backs, laying down – or more like a kneeling position on their stomach, laying on their side and during movement as well, working on these postural corrections. We use different props like rectangular pads and wedges, yoga blocks, we use different belts, TheraBand’s if we want to add some resistance and we use something called a wall bar so it’s like stall bars that – there’s basically like a really wide ladder, spaced out maybe like four inches between each rung.
Host: How does the equipment help with the therapy?
Nicole: We use our different props to set the patient up and we teach them how to manage the muscle asymmetries. So, somebody with scoliosis has areas on their body, their trunk in particular that are more collapsed where the muscles have shortened and areas where the muscles and bony structure looks more prominent on the convex side of the curve.
So, on the concave side of the curve, it looks more collapsed and then on the convex side it looks more expanded. And so, we teach kids how to use their breathing. We have a special breathing technique that we teach, and they use that breathing technique and kind of just that brain body connection to expand those areas of collapse and contain the area of where their structure has become more prominent to try to make their posture more symmetrical.
Host: Wow, isn’t that so interesting? Will they be straight after the Schroth method? You said it becomes their new normal if they were a little bit different before, now this is their new normal. Are they straighter? Does it help the scoliosis in the long run?
Nicole: Our study hasn’t looked at the – we call it the cobb angle which is the level of the degree of the curve. However, we’ve seen – we take before and after pictures and we take different measurements as well with some of our physical therapy tools. And we’ve seen improvements in posture overall. So, improvements in symmetry and improvements – sometimes we’ll get a little extra height in them too because they are standing up taller. A lot of times, kids with scoliosis and adults too without scoliosis have slouchy posture and so, we really, really teach having better posture and more upright posture. So, between being up taller, using their muscle strength to improve their postural alignment overall, and then working into some of those areas of collapse and improving the symmetry of the shoulders and the pelvis; we’ve seen improvements in back symmetry between sides.
Host: Tell us a little bit as we wrap up here. What’s the process for participating in a scoliosis specific exercise program with a physical therapist from Shriners Hospital?
Nicole: So, in order to receive physical therapy at Shriners Hospital, the child or the adolescent must first make an appointment with one of our spinal orthopedic physicians. And at the visit, the physician can help determine whether that child is appropriate for the program. And then at the visit as well, our therapists staff the orthopedic clinics and so they can also have an opportunity to chat with a physical therapist about the program, the family can chat with the physical therapist about the program. And they are thought to be appropriate for the scoliosis specific exercise program, a wait list for the physical therapy services can be started and then as soon as an appointment time is available, that child can be started at Shriners.
Host: How often do patients need the therapy?
Nicole: In Chicago, we provide scoliosis specific exercise treatment through two different approaches. So, we either do a one time a week for 12 weeks approach or two to three hours a day for one week, so a more intensive type approach. And we have found that the more intensive one week approach has been more effective at helping kids and adolescents learn the program and they are better able to carry over the techniques to home. However, we realize that not every family is able to commit to a one week intensive program so those who participate in the one time per week for 12 weeks approach are also very successful. And regardless if it’s the one time a week or the one week intensive, we encourage the parents to be active participants in the learning process so that they are able to facilitate those postural corrections in the home setting when the child or adolescent is performing their home exercise program.
Host: Wow, that is such great information. What an amazing program Nicole. Do you have any final thoughts you’d like parents to know who have children with scoliosis and what you’d like them to know about what you can do for them there?
Nicole: There are many, many kids our there with scoliosis. Sometimes we find that families who just learn of the diagnosis, so the family and the child feel kind of isolated like nobody at my school has scoliosis and their self-esteem really takes a hit to learning something like that especially if they have to wear a brace which can be very helpful. So, if there’s anybody out there listening who does wear a brace, make sure you wear your brace at the level that the doctor tells you to. Because between the brace and Schroth exercises; that is the best conservative way that we can help to prevent curve progression. And so, for families that have a child with scoliosis or have just received a diagnosis of scoliosis; know that these options are out there, that there are conservative options our there and we’re happy to help if we can.
Host: Thank you so much Nicole. What an interesting topic and thank you so much for all the great work that you’re doing. That concludes today’s episode of Pediatric Specialty Care Spotlight with Shriners Hospital for Children in Chicago. Please visit our website at www.shrinerschicago.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Shriners Hospital for Children in Chicago podcasts. You can follow more health tips and updates on the latest medical advancements and breakthroughs, follow us on Facebook and Twitter. Please share on your social media and that way we can all learn from the experts at Shriners Hospital together. I’m Melanie Cole.
Melanie Cole (Host): Today we’re talking about the Schroth method which is a physical therapy approach to scoliosis treatment. My guest is Nicole Viverito. She’s a Physical Therapist with Shriners Hospitals for Children in Chicago. Nicole, what a pleasure to have you with us today. Tell us a little bit scoliosis specific exercise programs based on the Schroth principles. What is this method? Tell us about it.
Nicole Viverito, PT, DPT (Guest): This scoliosis specific exercises based on the Schroth method was initially developed in Germany in the 1920s and is a method that includes postural balancing exercises for scoliosis. These postural balancing type exercises have been widely used in Europe for a number of decades. And the approach was brought to the US in the past 20 years or so. And has evolved with continued learning and research into what it is today.
So, idiopathic scoliosis, just a little background, is a three dimensional deformity of the spine that occurs with periods of rapid growth. Scoliosis can result in significant postural impairments, muscle imbalances, pain, breathing impairments and functional limitations. And that can limit the person’s participation in their daily activities, negatively impact their quality of life overall.
The purpose of the scoliosis specific exercises based on the Schroth method are to provide individualized exercises to patients with idiopathic scoliosis in order to address that 3-D dimensional component of the scoliosis to improve their overall postural alignment.
Host: How can physical therapy help patients who have scoliosis?
Nicole: So, the overall goals of the scoliosis specific exercise program are to improve their postural alignment, including improving their postural awareness overall, improving their strength and endurance, improving breathing and lung capacity and ultimately, preventing curve progression. Often, those who practice the scoliosis specific exercises, also experience decreased pain symptoms.
And typically with scoliosis, people who have scoliosis present with asymmetries in their shoulders, their should blades, their low back and their pelvis and with the scoliosis specific exercise program, we teach postural correction in various positions with the ultimate goal of retraining the brain with lots and lots of practice to hold the body into a more optimal alignment. So, eventually that optimal alignment feels more normal to them versus when they first come in, they have all of these asymmetries, that feels normal to them. So, there’s a shift with practice, where that symmetrical central position feels better.
Host: How you therapists decide what exercises may help?
Nicole: Therapists us the information that we see in their medical history, their age, the level of skeletal maturity and our examination findings. And we look at the radiographs of the curve to formulate individual comprehensive exercise programs for each person. In Chicago, we have two physical therapists who have advanced level training to provide scoliosis specific exercises based on the Schroth principles through the Barcelona Scoliosis Physical Therapy School.
Host: Wow, that was an excellent description of what it is for people that don’t know. So, are there some people for whom this is not really an option? Who is appropriate for this type of exercise method?
Nicole: At Shriners, kids and adolescents with idiopathic scoliosis are appropriate. Adults can also benefit from this program too but since I’m coming from Shriners; we see kids from birth to 21. So, my range is kids and adolescents with idiopathic scoliosis for this approach and idiopathic scoliosis means that there’s no known cause for the scoliosis. So, it’s not secondary to other conditions. And those are the kids that can really benefit from the Schroth or scoliosis specific exercise program. So, other conditions could be like spinal cord injury or cerebral palsy or muscular dystrophy or any other number of musculoskeletal or neuromuscular type conditions and that type of scoliosis is called neuromuscular scoliosis.
Sometimes we’ll use the elements of the Schroth principles in our treatment with kids who have some of these neuromuscular type conditions but in and of itself, the true Schroth program is specifically for those with idiopathic scoliosis.
Host: What else should families know about this therapy?
Nicole: Another thing that’s really important with somebody who thinks that they want to participate in this type of program is that they have to be really committed to participating in the program and need to be compliant with their home exercise program. So, if somebody goes through our program, and they learn all the exercises but then they don’t carry over the exercises at home; then their results aren’t as good as somebody who would regularly practice the exercises, come to therapy, really learn the exercises and then put them to use in everyday life.
Host: So, tell us a little bit about how it’s working for you. What are you seeing? Discuss a little bit of the current research and outcomes that you’ve seen for patients that do this and do their home training as well.
Nicole: So, currently, there’s not a huge body of research that exists on the Schroth method or scoliosis specific exercises. It seems to be growing. I just learned of another article that came out recently. So, that’s very positive for us but the research that has been conducted, show promising results for this type of approach in preventing curve progression including some random control trials. And at Shriners, we have found that kids and adolescents that are compliant with the program and their home exercise program have had really good results including preventing curve progression especially with those higher risk kids that are still growing.help with pain
So, the curve is most likely to progress if a child is still growing. We’ve seen improvements in posture, core strength, quality of life with kids’ participation in PE class, sports and other activities. And as I mentioned before, it can also help with pain.
Host: Tell us about the ongoing research for this method at your hospital.
Nicole: At Shriners in Chicago, we recently completed a pilot study on the long-term outcomes of a scoliosis specific exercise program, and we’ve been able to report these results. Our plan in the upcoming year is actually to apply for a grant to allow us to research long-term outcomes of the scoliosis specific exercise program in the form of a multicenter study with multiple Shriners units participating. I’m pretty excited about that.
Host: Well that is so exciting. So, what are the exercises like and what are they like for the patient?
Nicole: So, the exercises are very individualized as I said. And we take the patient through different positions. So, standing up, sitting down, laying down on their backs, laying down – or more like a kneeling position on their stomach, laying on their side and during movement as well, working on these postural corrections. We use different props like rectangular pads and wedges, yoga blocks, we use different belts, TheraBand’s if we want to add some resistance and we use something called a wall bar so it’s like stall bars that – there’s basically like a really wide ladder, spaced out maybe like four inches between each rung.
Host: How does the equipment help with the therapy?
Nicole: We use our different props to set the patient up and we teach them how to manage the muscle asymmetries. So, somebody with scoliosis has areas on their body, their trunk in particular that are more collapsed where the muscles have shortened and areas where the muscles and bony structure looks more prominent on the convex side of the curve.
So, on the concave side of the curve, it looks more collapsed and then on the convex side it looks more expanded. And so, we teach kids how to use their breathing. We have a special breathing technique that we teach, and they use that breathing technique and kind of just that brain body connection to expand those areas of collapse and contain the area of where their structure has become more prominent to try to make their posture more symmetrical.
Host: Wow, isn’t that so interesting? Will they be straight after the Schroth method? You said it becomes their new normal if they were a little bit different before, now this is their new normal. Are they straighter? Does it help the scoliosis in the long run?
Nicole: Our study hasn’t looked at the – we call it the cobb angle which is the level of the degree of the curve. However, we’ve seen – we take before and after pictures and we take different measurements as well with some of our physical therapy tools. And we’ve seen improvements in posture overall. So, improvements in symmetry and improvements – sometimes we’ll get a little extra height in them too because they are standing up taller. A lot of times, kids with scoliosis and adults too without scoliosis have slouchy posture and so, we really, really teach having better posture and more upright posture. So, between being up taller, using their muscle strength to improve their postural alignment overall, and then working into some of those areas of collapse and improving the symmetry of the shoulders and the pelvis; we’ve seen improvements in back symmetry between sides.
Host: Tell us a little bit as we wrap up here. What’s the process for participating in a scoliosis specific exercise program with a physical therapist from Shriners Hospital?
Nicole: So, in order to receive physical therapy at Shriners Hospital, the child or the adolescent must first make an appointment with one of our spinal orthopedic physicians. And at the visit, the physician can help determine whether that child is appropriate for the program. And then at the visit as well, our therapists staff the orthopedic clinics and so they can also have an opportunity to chat with a physical therapist about the program, the family can chat with the physical therapist about the program. And they are thought to be appropriate for the scoliosis specific exercise program, a wait list for the physical therapy services can be started and then as soon as an appointment time is available, that child can be started at Shriners.
Host: How often do patients need the therapy?
Nicole: In Chicago, we provide scoliosis specific exercise treatment through two different approaches. So, we either do a one time a week for 12 weeks approach or two to three hours a day for one week, so a more intensive type approach. And we have found that the more intensive one week approach has been more effective at helping kids and adolescents learn the program and they are better able to carry over the techniques to home. However, we realize that not every family is able to commit to a one week intensive program so those who participate in the one time per week for 12 weeks approach are also very successful. And regardless if it’s the one time a week or the one week intensive, we encourage the parents to be active participants in the learning process so that they are able to facilitate those postural corrections in the home setting when the child or adolescent is performing their home exercise program.
Host: Wow, that is such great information. What an amazing program Nicole. Do you have any final thoughts you’d like parents to know who have children with scoliosis and what you’d like them to know about what you can do for them there?
Nicole: There are many, many kids our there with scoliosis. Sometimes we find that families who just learn of the diagnosis, so the family and the child feel kind of isolated like nobody at my school has scoliosis and their self-esteem really takes a hit to learning something like that especially if they have to wear a brace which can be very helpful. So, if there’s anybody out there listening who does wear a brace, make sure you wear your brace at the level that the doctor tells you to. Because between the brace and Schroth exercises; that is the best conservative way that we can help to prevent curve progression. And so, for families that have a child with scoliosis or have just received a diagnosis of scoliosis; know that these options are out there, that there are conservative options our there and we’re happy to help if we can.
Host: Thank you so much Nicole. What an interesting topic and thank you so much for all the great work that you’re doing. That concludes today’s episode of Pediatric Specialty Care Spotlight with Shriners Hospital for Children in Chicago. Please visit our website at www.shrinerschicago.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Shriners Hospital for Children in Chicago podcasts. You can follow more health tips and updates on the latest medical advancements and breakthroughs, follow us on Facebook and Twitter. Please share on your social media and that way we can all learn from the experts at Shriners Hospital together. I’m Melanie Cole.