Scoliosis Research Society (SRS)
Scoliosis Research Society (SRS)
An International Organization Dedicated to the Education, Research and Treatment of Spinal Deformity
Our Mission is to Foster Optimal Care for All Patients with Spinal Deformities
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SRS statement on Physiotherapy Scoliosis Specific Exercises

Physiotherapy Scoliosis Specific Exercises: Scoliosis Research Society

M. Timothy Hresko, MD: Chair, SRS Non-operative committee

May 19, 2014

Physiotherapy Scoliosis Specific Exercises (PSSE) have been proposed as a supplemental treatment to orthotic management of scoliosis to prevent progressive deformity in children and adolescents. PSSE have also been applied for adult patients with pain associated with scoliosis deformities. The common principles of PSSE involve auto correction, elongation, and chest wall expansion with integration of the “corrected” posture into daily life activities. Several programs have been proposed for scoliosis treatment throughout Europe. One of the initial proponents was Katharina Schroth of Germany who established a clinic for treatment of scoliosis based on a spa-like concept. The Schroth technique evolved into an intensive initial evaluation and treatment regimen to include a residential program of several weeks duration with group and individual therapy sessions followed by daily home exercises and periodic physical therapy sessions. Other “schools” of scoliosis physiotherapy have evolved from the Schroth concept including the Schroth-Barcelona School (BSPTS), where the exercises are learned in an outpatient regimen. Different approaches also developed in Europe like SEAS in Italy, Dobomed and FITS of Poland, and “side shift” of England to name a few. A therapist may incorporate principles from several of these “schools” in their treatment of the individual patient with scoliosis while working with a rehabilitation team formed by physiotherapists, orthotists and medical doctors.

Physiotherapy Scoliosis Specific Exercises have been used with spinal orthotic management in the treatment of progressive idiopathic scoliosis. The combination of the two modalities may offer advantages over more simplified treatment plans. At the present time, there is no evidence supporting PSSE to be offered in substitution of bracing in treating progressive idiopathic scoliosis.  Although some evidence has shown the superiority of some PSSE programs in comparison with non-specific exercises and/or controls, it is still too soon to make a general statement about their applicability. Most studies in the literature are based on case series of selected patients who are managed at specialized scoliosis clinics. It is uncertain if the results of treatment can be expanded to the general population. In addition, further follow up assessments are needed to ascertain if the effects of PSSE can be maintained and that the scoliosis does not deteriorate with time.  Treatment programs that emphasize the same principles of the PSSE are being investigated for their potential application in a community setting which is typical for North America.

At the present time, there is strong evidence to support the use of brace treatment for moderate scoliosis and for surgical treatment for progressive scoliosis in adolescents or painful scoliosis in adults. Early detection of scoliosis is paramount to optimize the care of patients with spinal deformities. Early detection involves physical examination of the spine for at-risk population of adolescents by all healthcare providers. Subsequently, individualized treatment programs can be established for patients who have been detected to have a deformity.

Scoliosis Research Society (SRS) and its members actively support optimal treatment for each patient which may include non-operative, operative and combined treatment methods. SRS has supported and will continue to support pilot research studies for the role of exercises in the treatment of scoliosis. SRS in conjunction with Society On Scoliosis Orthopedic & Rehabilitative Treatment (SOSORT) is in the process of development of research guidelines for the study of treatment method for scoliosis to include bracing, physiotherapeutic scoliosis exercises, and other fusion less treatments.

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