Address Your Back Pain and Postural Concerns with the Right Physical Therapy Here!

At In Line Physical Therapy, I am committed to providing personalized and effective spine treatment for all spinal conditions including scoliosis, hyperkyphosis, Flat-back Syndrome and Scheuermann disease. I am a Schroth and SEAS certified physical therapist who will assess and guide your individualized therapy to ensure compassionate and comprehensive care, addressing a wide range of spinal disorders. In the pages below, I will delve into each specialty individually.

Understanding Spinal Conditions

People suffer from back pain for diverse reasons. The most common reason is due to a change in the natural shape of one’s spinal curves from prolonged positioning in poor postures. A healthy spine with its natural curves, absorbs the stress and forces caused by physical movements and gravity. When one’s natural curves are increased or decreased, these forces are exaggerated in certain areas, resulting in pain. Healthcare practitioners and physical therapists recognize these postural abnormalities as spinal disorders.

Scoliosis is a spinal condition where there is a curvature of the spine, often seen with what may appear as an “S” or “C” shape. This can originate in childhood or adolescence and may continue into adulthood. It also is common to begin in adulthood, as we see an increase in a forward bent posture and a resultant gravity induced spinal curvature. One can see visible symptoms including uneven shoulders, waistlines and hips, the head not being centered directly above the pelvis, rib cages are different sizes and a side leaning of the body. Scoliosis in adults can cause extreme pain and disability depending on its severity, location of the curve, and many individual factors.

Typical Course of Action in Spinal Disorders

Healthcare professionals conduct physical examinations, X-rays, CT scans or MRIs, and other various curve measurements to diagnose this condition precisely. They recommend treatment comprising of follow up visits, physical therapy, bracing and surgery for severe cases. However, individuals can significantly improve all spinal conditions by using a Physical Therapy Scoliosis Specific Exercise (PSSE) program under a certified PSSE practitioner.

Personalized Physical Therapy under Schroth and SEAS Methods

Schroth and SEAS are relatively new in North America and are growing in popularity as the first effective non-invasive spinal disorder treatment approaches. These approaches help reduce ones spinal mal-alignments, and therefore their pain and disability, and drastically improve their return to normal functional activities. This requires a solid understanding of the biomechanics of the spine in order to best optimize the health of each person's spine and movement system throughout their lifespan. The focus is on specific exercises to improve their spinal alignment and stability. These methods help them learn about their particular spine’s behavior and how to use the correlating muscles, therefore restoring their spinal alignment. However, they differ in philosophy, focus, and application.

The Schroth Method 
addresses muscular imbalances and postural deviations by correcting each vertebrae’s three-dimensional movements; forward and backward bending, side bending and rotating. Elongation of the spine results in decompression of the asymmetric loading that occurs with mal-alignments.  Once all three planes of motion have been restored to their best alignment, this is one's best spinal stability and an orthopedic breathing technique is then performed. This Rotational Angular Breathing, or Expansion Breathing improves the recruitment of the inhibited musculature at each individual curve. Corrective exercises challenge and strengthen these deepest core muscles and drastically reduce muscular imbalance, improve posture and respiratory function, and reduce curve progression and pain.

Scientific Exercises Approach to Scoliosis (SEAS) emphasizes an “Active Self-Correction” approach, to attain one's best postural alignment with the reduction or elimination of their curves, to achieve trunk and spine stabilization. SEAS teaches individuals to recruit inhibited trunk musculature weakened by their curve pattern, by using neuromuscular training with an Active Self-Correction. This Active Self-Correction can then be incorporated anytime during their regular activities of daily living, recreational activities, school and work environments. This approach is quickly learned and easily reproduced to improve symmetry and trunk stability, decompress spinal forces, and to prevent or halt curve progression.

Our Offerings

At In Line Physical Therapy, we employ a tailored approach, combining the Schroth and SEAS methods based on each individual spinal condition. We adapt the exercises with these methods to address all spinal conditions, including hyperkyphosis (hunchback), hyperlordosis (excessive arched back) and Flat-back Syndrome. Both the Schroth and SEAS methods are most effective when started early in the progression of all spinal conditions. Consulting a certified Schroth or SEAS physical therapist for a tailored treatment plan is crucial for these conditions.

Contact us today for more information and timely expert intervention.

TREATING ALL SPINAL CONDITIONS

Did you know that much of your back pain is due to adapted positioning over time, and a lack of understanding of how to return your spine to it's best postural alignment? This knowledge can give you control over your pain and result in a calming of the overstretched, irritated and angry soft tissue structures. The Schroth and SEAS methods will help you learn about your particular spine's behavior and teach you how to use your own muscles to actively reposition your spine. These approaches reveal your inefficient and compensatory muscle activity, giving you the opportunity to rebalance these muscles' firing patterns and restore their symmetry throughout your day. With these approaches, you will have the chance to regain your spinal health and decrease your pain. SPINAL DISORDERS AND THEIR TREATMENTS ARE FURTHER DESCRIBED BELOW.

ADOLESCENT-IDIOPATHIC SCOLIOSIS

While "watching and waiting" may feel like your only option, there is good news! The Schroth Method to treat scoliosis is a proactive alternative that offers muscle retraining to awaken the weak and inhibited muscles in your child's curve. The goal is to stop the vicious cycle of asymmetrical loading through the vertebrae, causing asymmetrical growth of the vertebrae, then causing an increase of the spinal curve or curves. The Schroth and SEAS Methods are used to avoid surgery, by assuring the most effective neuromuscular retraining for learning and maintaining optimal spinal alignment. They are also used as tools pre-surgically, post-surgically, and in conjunction with brace wearing to best adapt the soft tissues and to invest in the best outcome. ADOLESCENT-IDIOPATHIC SCOLIOSIS AND IT'S TREATMENTS ARE FURTHER DESCRIBED BELOW.

ADULT-ONSET SCOLIOSIS

Adult scoliosis IS treatable! You may have been told that there is little that you can do about your back pain, however, you can slow or stop a postural mal-alignment or a scoliotic curve progression, improve your lung capacity, restore your height and postural symmetry, and decrease your pain. You will learn how to align your vertebrae, expand your rib cage and re-educate and strengthen your breathing musculature and deep core musculature that are closest to your spine. When these muscles function correctly, they de-rotate and pull your vertebrae back toward midline into a neutral postural alignment, decompressing your vertebrae, optimizing the air volume your lungs, all while allowing a calming of the angry, irritated soft tissues that are causing your pain. ADULT-ONSET SCOLIOSIS AND IT'S TREATMENTS ARE FURTHER DESCRIBED BELOW.

SPINAL DISORDERS
From all walks of life, people struggle with spinal health conditions. Over time, people develop abnormal curvatures of their spine because of prolonged positioning in poor posture and because of the effects of gravity on progressive core weakness as we age.
Some conditions that affect the curvature of the spine are scoliosis, hyperkyphosis, Sheuermann disease and Flat Back Syndrome. If these spinal conditions are left unaddressed, the patient can experience excruciating back pain, muscle spasms, and eventual loss of work and quality of life, particularly when the curvature inevitably progresses.

Adult scoliosis is often a continuation of adolescent scoliosis, but in some cases, scoliosis can first develop in adulthood. When that happens, if not caused by some sort of traumatic injury, it’s usually the result of disc degeneration, and/or diminished bone density and muscle strength. Loss of height (caused by spinal degeneration), postural changes, and pain are all signs & symptoms that scoliosis may be present or progressing.

Staying active can help mitigate the effects of scoliosis such as muscle imbalances, spine fatigue and postural collapse.

Kyphosis describes a normal thoracic curve that appears in one's upper back, naturally bending in a forward direction. A kyphosis can be exaggerated due to weakness or pathology, or to counter an instability of the neck and lower back, and is referred to as a hyperkyphosis.

Our goal is to achieve muscle symmetry in a more neutral alignment.

ADOLSCENT-IDIOPATHIC SCOLIOSIS
The most common form of scoliosis is called Adolescent Idiopathic Scoliosis (AIS). It is first diagnosed between ages 10 and 18.
The term ‘idiopathic’ means that the causes are unknown and denote that this type of scoliosis is not caused by any other medical condition.
Scoliosis can also occur in children younger than 10, and this is referred to as early onset scoliosis. (EOS).
AIS affects as many as 4 in 100 children and is more common in girls than boys. There does appear to be a genetic link to AIS, as the incidence is greater in children with a family history of scoliosis in a close relative. Most children with scoliosis are not aware that they have it until an asymmetry is noticed in the child’s shoulders, scapula, ribs, or hips during or after a growth spurt.

Unfortunately, as a child with scoliosis grows, their brain learns to lay down bone and grow in the same asymmetrical manner as the scoliotic curve, which then perpetuates the curve.
This is best explained by Dr. Ian Stokes’ “Vicious Cycle”. This cycle becomes a set pattern of asymmetrical growth until we intervene at the point of asymmetrical loading and teach the child to live outside of their curve, offering a more symmetrical weightbearing through their spine and stopping the curve progression.

The goal of treating AIS is to prevent progression.

Our best treatment is a non-operative care approach combining Physiotherapy Scoliosis Specific Exercise (PSSE), and bracing.

Let's review each one independently.
PHYSIOTHERAPY SCOLIOSIS SPECIFIC EXERCISE (PSSE)
We are proud to offer this unique physical therapy approach called Physiotherapy Scoliosis Specific Exercise (PSSE). PSSE focuses on the management of scoliosis, kyphosis, and other spinal conditions.  The goal is to slow, stop and stabilize a progressive scoliotic or posturally exaggerated curve. These exercises always first correct the three planes of vertebral motion: forward/backward bending, side bending, and rotation.  
We recommend beginning PSSE when a curve measures 10 - 15º in a growing adolescent, to learn how to counteract asymmetric loading and curve progression. The goal is to unload the spinal joints and allow the spine and trunk to learn to grow more normally.
Spinal education is the basis of our treatment philosophy. Each program is individually designed and structured so that adolescents gain complete understanding of their unique curve pattern. A maiin component is teaching the adolescent how to modify habitual scoliotic postures and self-correct to create a more balanced position. Not only do patients learn a personalized scoliosis-specific exercise routine, but they also learn how to use their newly modified postures in everyday life, so that they know how to avoid feeding into their curve(s) when encountering new activities.
This non-operative care becomes very serious when a curve becomes greater than 50°, as it is likely to become larger overtime and require a stabilization surgery.

Below are 2 PSSE approaches offered 
here at In Line Physical Therapy.
SCHROTH PSSE
The Schroth method was originated by Katharina Schroth and her daughter, Crista Lehnert-Schroth, in the early to mid 1900s. It is rooted in a solid understanding of the biomechanics of the spine in order to best optimize one’s spinal health and one’s movement system throughout their lifespan. This training uses exercises specific to each individual curve to achieve the most stable, centered, and balanced position of each individual’s unique trunk shape. After correcting each plane of motion, therefore reducing and/or eliminating the postural malalignment, the focus then becomes on learning a deep breathing exercise established by Katharina Schroth called Orthopedic Breathing or Rotational Angular Breathing (RAB). This unique breathing method educates the weakened and inhibited respiratory musculature that controls the movement of the vertebrae. After educating and training these respiratory muscles to become more involved in maintaining one’s posture outside of their mal-alignment, challenges continue to increase and diversify to eventually be incorporated into one’s functional daily activities.

POTENTIAL BENEFITS OF SCHROTH PSSE FOR ADOLESCENTS;
*Prevents curve progression (i.e. stop scoliosis from getting worse)
*Improves body awareness and body mechanics
*Increases strength and flexibility *Empowerment over scoliosis
*Improves breathing and lung capacity *Improves bracing results
*Postural improvement- (helping teens attain a more balanced, symmetrical appearance.)
Scientific Exercise Approach to Scoliosis (SEAS) PSSE
The primary goal of the SEAS PSSE is restoring one’s natural spinal posture by increasing one’s awareness of their spinal positioning and postural alignment. Once awareness is in place, the patient learns an “Active Self-Correction” where they are trying to find the best possible alignment of their spine and trunk in all three dimensions. The SEAS Method then focuses on achieving trunk and spine stabilization through individualized exercises and incorporation of the active self-correction into daily activities. This method is unique in that it uses own’s own trunk musculature to hold oneself out of their curve instead of any external props and is easy to implement in everyday life. The SEAS Method enhances one’s functional capabilities, alleviates pain, manages symptoms, achieves long-lasting spinal stability, and deters further curve progression.

POTENTIAL BENEFITS OF SEAS PSSE;
*Prevent curve progression (i.e. stop scoliosis from getting worse)
*Improves body awareness and body mechanics
*Increases strength and flexibility
*Empowerment over scoliosis
*Improves breathing and lung capacity
*Improves bracing results
*Postural improvements (It’s not your child’s curve on an x-ray that is most worrisome for teens, but their postural appearance. PSSE at In Line Physical Therapy focuses on helping teens attain a more balanced, symmetrical appearance.)
*Improves Cobb angle (not the best or most important predictor of success, not guaranteed and depends on individual factors).
Scoliosis Bracing for Adolescents
Bracing treatment is typically recommended after the curve has reached 25°, but this may vary depending on the child’s age, skeletal maturity, family history, and additional factors. Several braces exist, such as the Boston style TLSO (thoracic-lumbar-sacral orthosis) brace, Charleston bending brace, Providence brace, the Whisper brace and a Rigo-Cheneau brace.

All braces are designed to slow and stop the
progression of the spinal curve during phases of accelerated growth. However, it is expected that when you take off the brace, your spine will return to its previous shape. Bracing does not cure or improve scoliosis; it prevents the curve progression.

Bracing is done alone or in conjunction with a Schroth or SEAS exercise program but we find that patients that combine both treatment options typically have the best outcome! It is important to remember that the goal is to keep your curve from changing, even though you are growing. Some braces are worn only at night and recommended for 9 to 12 hours, and some are recommended to be worn for 15 to 18 hours a day.

This study “Effects of Bracing in Adolescence with Idiopathic Scoliosis”, published by The New England Journal of Medicine in 2013, found that among patients with curves ranging from 20 to 40°, bracing was more effective than observation at preventing progression to surgery.
ADULT-ONSET SCOLIOSIS
Another common form of scoliosis is Adult-Onset Scoliosis or De Novo Scoliosis, which is linked to spinal deterioration, due to chronic asymmetric loading, gravity, and aging.  The combination of these factors lead to the spine losing its ability to maintain a normal shape and it begins to deteriorate.

We work with adults to take a proactive approach in not letting the condition become a hindrance to their daily activities.

In upcoming pages, we’ll look at the treatment options adults have with degenerative scoliosis, in order to ensure an improved quality of life.

Best treatment for Adult-Onset Scoliosis at In Line Physical Therapy treating adult-onset scoliosis usually hinges on several factors; the severity of the tri-planar curvature (front to back positioning, side bending, and rotational planes); the age of the patient; and the stability of the scoliosis both presently and potentially in the future.

There are several best treatments for adult scoliosis, which include Observation, Physiotherapy Scoliosis Specific Exercises through the Schroth physical therapy and SEAS (Scientific Exercise Approach to Scoliosis) methods, Bracing, and Surgery (when the scoliosis is rapidly progressing and impacting the health of internal organs).

Let's take a look at each one below.
BEST TREATMENT FOR ADULT SCOLIOSIS
1. Observation: If someone has a mild curve and it is not progressing or getting worse over time, orthopedists will typically recommend observing and monitoring only. This means they advise the patient to return for checkups at different intervals depending on the doctor and curve.

2. Physiotherapy Scoliosis-Specific Exercise (PSSE): PSSE is a form of physical therapy aimed to slow, stop and stabilize a progressive scoliotic or posturally exaggerated curve. This non-invasive approach is perfect for individuals with an active lifestyle who wants to learn how to manage their scoliosis. It empowers patients to take control of their condition at any stage of the condition. With this remarkable treatment method, degenerative scoliosis shouldn’t be a hindrance in carrying out a normal daily routine.

3. Bracing: Functional bracing is used when a surgeon believes that the curvature of the spine is progressing, is unstable and may cause organ compression or other complications. In children, this may be recommended when the curve has reached 25° depending on the child’s age, skeletal maturity, and additional factors. In adults, this may be recommended when the curve exceeds 50° and is progressing, causing back pain, functional difficulties, and when there is increased risk of impacting internal organ such as lungs.

4. Surgery: When scoliotic curves exceed 50 degrees or are likely to cause complications in the future, surgical intervention may be necessary to stabilize the curve.