Scoliosis

PSSE, Pre-hab and Rehab, Postural Screening

A scoliosis is a three-dimensional change in the shape of the spine. The vertebrae rotate, laterally deviate and extend. There can be one curve or there can be multiple curves. Generally, there is one major curve and the secondary curves form as a compensation to keep the body upright. There are different types of scoliosis: idiopathic, congenital, neuromuscular and degenerative. Adolescent idiopathic scoliosis is the most common type and it is the type of scoliosis we treat most often. Idiopathic simply means there is no known cause.

At McGowan Physio we are trained in Physio Scoliosis Specific Exercise. There are seven different schools some of which derived from Schroth. Niamh has completed her training in Barcelona Scoliosis Physical Therapy School (BSPTS) under the guidance of Dr Manuel Rigo and International Schroth 3D scoliosis Therapy (ISST). Garett and Daniella have competed their BSPTS Level 1.

Physio Scoliosis Specific Exercise (PSSE)

There are seven different schools that satisfy the criteria set by SOSORT to be classified as being PSSE. The Schroth method is named after Katherina Schroth. Katherina had moderate scoliosis and wore a steel brace. She wished to be proactive with her care and so created a sequence of exercise that incorporates breathing techniques.

The method has been modified and adapted over the course of time and through the various schools.

To be considered PSSE the physiotherapy must include:

Patient education
3D self correction
Stabilization in self-correction
Activity of daily living training

PSSE is often used to slow down the progression of a scoliosis and in some cases it can stabilize the curve or decrease the degree of the curve. It is also used in spines that are fully developed with an aim to decrease any potential pain and imbalance that may have developed over the years. PSSE can also be used both pre and post op. As a form of pre-habilitation it will prepare your body ahead of scoliosis surgery so that you are as fit, strong and flexible as possible and so that the nervous system is prepared for the new position you will be in post-operatively.

PSSE is especially good to improve the global 3D balance of an individual and minimise the appearance of a scoliosis.

Specialist Assessment

The correct assessment of each individual is crucial. It allows for correct classification of the curve type so that the individual exercises can be tailored to each person. Following an initial assessment, the physiotherapist will teach the individual their exercises using a combination of tactile and verbal cues. This means that they use their hands to guide the movement as well as using their words to help instruct how to move.

The Exercises

The exercises are often isometric. This means a contraction of the muscles held in a stationary position. The physiotherapist will position you in a way that creates optimal length in your spine and then you strengthen your muscles to encourage your body to maintain that position from a stable and neutral pelvis. By repeating the same patterns over and over again you not only create strength but you teach your body the correct way to move. This is known as proprioception. A huge part of the method is expansion and breathe control. This is vital for core control and having a strong core helps to create a stable pelvis and support for the spine from the inside out. Expansion of flat zones in the torso helps to reduce the appearance of imbalances and will have a detorsional effect on the scoliosis itself.

At McGowan Physio we also offer strength based exercise programmes specifically targeted at patients preparing for scoliosis surgery as well as those completing their post-op rehab. It is important to have a full assessment done by a Scoliosis Specialist Physiotherapist prior to this.

We were referred to Spinal Specialist Physiotherapist Niamh McGowan
in July 2020 and can honestly say that we would not have been able to navigate our scoliosis journeys without her.

Patricia & Briain Kelly

PSSE Goals

Spinal correction
in 3D

Improved chest mobility
and respiratory function

Postural awareness
and postural changes

Cosmetic
improvements

Support for brace
treatment

At McGowan physio we also offer scoliosis and kyphosis screening as well as postural assessment.

Bracing & Scoliosis Specific Exercise

We work closely with Ciarnaid Hayes and Bianca Daly from Orthotic Solutions. Orthotic Solutions is paired with Neja in Germany. They make Rigo-System-Cheneau braces. The braces are unique and are made specifically for each individual based on the information gathered from photos, x-rays and the orthotist’s measurements. The brace is checked regularly as the individual is growing to ensure any adjustments needed are made.

From the research we know that the best conservative approach is to use the brace along with completion of Physiotherapeutic Scoliosis Specific Exercise (PSSE).

RSC brace for scoliosis and brace education book

Watch Niamh explain what scoliosis is

In the video we can see Iarla’s scoliosis. Iarla has a double curve. He has a curve in his mid back (thoracic spine) and in his lower back (lumbar spine). This is often referred to as an “S” type scoliosis. It is important to check teenager’s backs to look out for imbalances as Niamh explains in the video. Things that are commonly noticed are a shoulder that is higher than the other, a shoulder blade that sticks out, a hip that is higher than the other or a hip that sits out to the side more than expected.

Thanks again to Iarla for being our scoliosis model.