Background: The effectiveness of conservative management of Scoliosis in the adolescent population continues to require further investigation. A study by Stefano Negrini et al (1). supports that the combination of bracing and Schroth based exercises reduced patients scoliosis curve progressions. The aim of this case report is to further increase the literature available to support these findings.
Subject: The subject in this case report was a 10 year old female who was diagnosed with idiopathic scoliosis on 5/16/12. Her initial Cobb angles were measured to be 32° right thoracic curve, with a 19° left lumbar prominence. Axial trunk rotation through the thoracic spine was defined by Raimonde of 14°. She was a 0-1 on the Risser scale. Schroth classification was a right thoracic 4-curve pattern. The subject is active with karate, basketball, and volleyball. She has not undergone any other treatments for scoliosis prior to our initial evaluation. She is highly motivated, with a great support system from her family.
Methods: This is a retrospective case report, single subject. The subject began the Schroth based method of physical therapy for her scoliosis on 6/11/12. Our initial plan of care entailed 2 visits per week for 6 weeks. All clinic sessions were 1 hour in duration. This plan included a total of 12 visits from 6/11/12 through 8/8/12. Her home exercise program (HEP) consisted of 15 minutes of Schroth based exercises per day, 6 days per week. The subject was fit for a 23 hour Rosenberger brace on 6/28/12. The subject's in brace x-ray revealed a 12° correction of her thoracic curve. Her scoliosis curve improved from 32° to 20° in brace.
Phase 2: After her original plan of care was completed, we decreased her frequency of visits to 1x/week for 10 weeks from 9/5/12-12/27/12. Frequency of visits was decreased due to her increased independence in technique efficiency and accuracy. At this time, HEP was continued 15 minutes/day for 6 days/week. The subject had her first follow-up x-ray at the end of this second phase plan of care. Her thoracic Cobb angle improved from 32° to 21°, her lumbar curve remained at 19° and her degrees of rotation improved from 14° to 11°.
Phase 3: The third phase of treatment included a plan of care consisting of 1 visit every other week for 20 weeks. This phase was carried out from 1/7/13-6/20/13, and consisted of 10 visits. At this time, patient and her mother reported full independence with the HEP, but patient was highly motivated by clinic exercise sessions and new challenges. During this time, Schroth based method postures were progressed and accessory exercises for core and total body strengthening were further progressed. Follow-up x-rays were taken on 6/20/13, upon completion of phase 3 plan of care. Her thoracic Cobb angle had improved to 17° and her lumbar curvature improved to 15°. The patient is currently wearing her brace 23 hours/day, and continues her home exercise program only. Follow-up phone calls are used for tracking progress.
Results: The subject participated in the Schroth based method of physical therapy program from 6/11/12 to 6/20/13. She had a total of 32 visits during this 1-year span. Her and her family report great compliance with her 15 minute/day, 6 days/week HEP. She also reports great compliance with her Rosenberger brace 23 hours/day regimen. Since beginning her conservative treatments for scoliosis management, the subject's thoracic Cobb angle has improved from 32° to 17°. Her Lumbar curve has improved from 19° to 15°. Her thoracic rotation classified by Raimonde has improved from 14° to 11°. The numbers observed in this case suggest that conservative treatments were successful in significantly reducing Cobb angles.
Conclusion: The combination of Schroth based physical therapy method and 23-hour bracing were found to be successful in significantly reducing Cobb angles in this case. This suggests that in the case of mild to moderate idiopathic scoliosis, good compliance with conservative treatments can be effective in reducing curvatures.
William Block, DPT, is a PT at FYZICAL Naperville. His education at Midwestern University has incorporated the skills and knowledge to bring forth new and innovative treatment approaches for patients. William has special interest in both orthopedic sports rehabilitation and outpatient neurological rehabilitation cases.
"The human body and how it works has always fascinated me. Becoming a physical therapist has given me the lifelong reward of having the ability to understand an individual's physical limitations and help correct it. It is a good feeling at the end of the day to know that I have helped a patient progress towards a better quality of life. I am excited to be the newest member of the physical therapy team at FYZICAL Naperville."