by Johanna Mee – Exercise Physiologist at The ScoliCare Clinic, Melbourne
When you hear ‘scoliosis rehabilitation’ you might think of typical physiotherapy exercises involving strength and stretching. However they are much more than that. You may have heard people tell you that exercise and stretching are of no use in the treatment scoliosis. This may be true of ‘general exercise’ however scoliosis specific exercise is a specialised approach to scoliosis that extends beyond the basics that you might come across in a gym class or personal training session. Advances in research in the area of exercise for scoliosis now point toward scoliosis specific exercise being beneficial in reducing the risk of progression for different types of curves.
There are several recognised approaches to scoliosis rehabilitation such as DoboMed, Lyon, SpineCor, Schroth, Scientific Exercises Approach to Scoliosis (SEAS) and Side Shift. At this point in time, Schroth and SEAS are the most widely used and researched. These approaches work explicitly on the spinal muscles and the postural control systems that are tailored specifically to each patient. The Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) suggest that a scoliosis rehabilitation program should incorporate a 3-dimensional auto-correction, stabilisation of the corrected posture, training in activities of daily living, along with patient education.
I will discuss the two most common scoliosis specific exercise approaches, what they involve, and the associated benefits when used in the management of scoliosis.
Scientific Exercise Approach to Scoliosis (SEAS)
SEAS is an acronym for the Scientific Exercise Approach to Scoliosis. The SEAS approach uses the concept of active self-correction. The patient is taught to actively move their body into a posture that is more balanced and symmetrical. This corrected posture is then reinforced with specific functional exercises. Through repetition, the SEAS exercises strengthen the neuromotor pathways associated with normal postural alignment, making it easier for a patient to adopt and maintain a more ideal posture during their daily activities.
The SEAS approach is well researched and is consistently reviewed and updated in response to the latest evidence. The goal of the SEAS approach is to establish a home program that is performed for 20 minutes each day. Minimal equipment is required, although using a mirror for visual feedback when performing the exercises is highly recommended. The active self-correction is performed in a neutral position and uses no over-corrective properties.
The Schroth method was created by Katharina Schroth in Germany in 1894 when she underwent treatment for her own scoliosis. The Schroth method uses the patient’s own muscular contraction, along with asymmetric breathing exercises to mirror image the scoliosis and postural deformity. The treatment has evolved over time to incorporate activities of daily living in the corrected posture.
Like the SEAS approach, the patient is taught to adopt a corrected 3-dimensional position specific to their curve profile by breathing into the concavities of the curve. This corrected body position is then challenged with muscular contractions held in various static postures. The Schroth method makes use of props and external aids to enhance the correction. The Schroth method is typically performed for long intensive sessions over several days.
So what are the benefits of scoliosis specific exercises?
There are many benefits of scoliosis specific exercises! The main goals include: improving the outcome of brace treatment; improvinge spinal mobility; improving brace compliance; reducing pain; improving quality of life and function; and, improving respiratory function.
Scoliosis specific exercises are clinically indicated during various stages of treatment for scoliosis. They can be prescribed prior, during, or after brace treatment, during the brace weaning period, or in isolation for patients with mild progressive or non-progressive curves.
What are the current recommendations for exercise treatment?
SOSORT recommends that scoliosis specific exercises be performed regularly throughout treatment to achieve the best treatment outcomes. Being more complex than normal gym-based exercises, it can take several sessions to learn the self-corrected posture. Patients will therefore require frequent visits to the clinic when first learning these types of exercises. It is recommended that patients are supervised in clinic until they are performing the exercises correctly and to sufficient standard that they will be effective when they are performing them at home. Quality is valued over quantity in this sense.
SOSORT strongly advises that the exercises are only prescribed and guided by health professionals trained in the method they use. Treatment decisions should always be individualised due to the complex factors involved (curve progression, curve magnitude, skeletal maturity, and age). SOSORT and the SEAS method favour a holistic approach whereby the patient, bracing technician and rehabilitation facilitator are all included in the management process.
What approach does ScoliCare use?
At ScoliCare, we use the best of the best! Fundamentally this involves implementing the SEAS active self-correction after a thorough functional assessment and curve classification. Depending on the patient and their curve type, we implement Schroth based techniques where necessary and also during advanced stages of treatment. As with our own 3D bracing system, we incorporate over-corrective principles in all exercises. Additional exercises and the use of a spinal orthotic aid called a ScoliRoll are used to improve the flexibility in the stiffer areas of the patient’s spine. We use a multidisciplinary approach incorporating the clinician, rehabilitation facilitator, patient and family to achieve the best outcome for the patient – physically and psychologically.
ScoliCare is known for our expertise, and our clinicians and Exercise Physiologists that are accredited in the SEAS Level 1 & 2 and are trained in the Schroth method of Scoliosis rehabilitation. These are the most known and researched scoliosis specific exercises and the only modalities proven to improve Cobb angles in mild scoliosis and complement brace treatment in moderate to severe curves.
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