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Schroth physical therapy - know anyone?

Started by smileybuyer on 08/16/2010 3:39pm

We're interested in trying Schroth-method physical therapy for our kid's scoliosis. Does anyone know of anyone who does this other than Scoliosis Rehab in Steven's Point, Wisconsin & Phoenix, Arizona? They charge $676 an hour, which is kind of expensive when you need quite a few hours of therapy and they're not in our insurance network! Places on the East Coast preferred. Also, we'd rather not see a chiropractor - we would rather see some other kind of medical professional (or even a pilates instructor who's had training in Schroth).

Thanks for any help!

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I am a physical therapist and very interest in this treatment. There was one trial with outcomes performed in Turkey. I contacted the authors. They showed x-ray changes that were interesting. It requries a lot of work on the part of the patient and several hours/day of exercise. The $676/hour is ridiculous!

You should contract:
Beth Janssen P.T.

Scoliosis Rehab

www.scoliosisrehab.com

She can point you to resources in the US (they are actually training 10 therapists at their clinic thsi month.

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The ladder type apparatus used in the Schroth Method is very similar to the ladder barrel apparatus in Pilates. I know of many Pilates Instructors who have had tremendous success with their clients with scoliosis. I would suggest you seek out an instructor who can show you proven success with The Pilates Method. Those certiifed by PoleStar have training in physical therapy techniques and are qualified to work with someone like your daughter.

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Pilates is not a standardized approach. The only peer reviewed research article I am aware of was based on a modified Pilates approach. There results were underwhelming. When 75 year old patients come in to my clinic and tell me that they are doing Pilates, I have no idea what they are talking about. I know of only a few article published in English about Schroth method but they had objective measures of their results. I am aware that there are more studies that were performed in Germany that have not been translated.

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Hi, Herb. I am in the process of seeking out the information you requested. I am originally trained by physical therapists (Polestar of Miami) in the Pilates Method of Body Conditioning. There is not only the fitness aspect but also the physical therapy aspect in effecting postural distortions and deviations. There is plenty of empirical evidence out there, some of which I have first hand. All one has to do is google Pilates and scoliosis to see that it is a viable methodology.

I have consulted my mentors for statistical information and will keep you updated.

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Dear SmileBuyer. I just finished an intensive international 2-year mentorship program with Pilates elder Lolita San Miguel in which one of my colleagues presented her case study on how the Pilates Methodology has improved her scoliotic client 's condition. The client was present and demonstrated techniques developed by my colleague.

I currently work for a studio that also has clients with scoliosis. By performing breathing into one lung, for instance, we can lengthen that particular side of the body. This type of breathing is standard to the Pilates repertoire. This is just one aspect of our training. To detail an entire program here is just not possible.

Please let me know where you live so that I can consult my colleagues as to who would be your best choice.

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Concerning PIlates, case studies, etc. I wish they would fund some blinded research with real measures of change rather than anecdotes. Based on research studies, I find it real difficult to assume that exercise can change the progression of scoliosis outside of a multiple hour exercise routine on a daily basis. Just to make a change is bone density with exercise requires considerable time and effort and the research there is not conclusive. I hope Pilates or Schroth or braces would work. It would be a real service to everyone if we make sure and state what is our opinion and what can be supported by objective independent research. Right now (especially when some is charging an outrageous amount that I think borders on the unethical) it is important to point out when their is research support for an intervention and when you think it might help. Either way, I just think it is important to state the difference and I look forward to any research.

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Any adults having success with pilates type exercises? Any chance to HOLD a curve from progressing as an older adult?! I'd like to find someone in the Tampa/ St Pete FL area familiar with the Schroth Method or at least scoliosis to coach me. I'm now 62 ...I had a 43 degree curve at age 13 and wore a brace for 2 yrs and that's all. No surgery. It improved, then slipped back but held for years. But now it's 65 degrees and I'm told it will keep progressing and eventually debilitate me and to have fusion. But it's hard to consider as I'm pain free and actve physically (singles tennis and regular exercises) and feel great. Advice appreciated!

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The questions about Pilates and Schroth's methods. Schroth's has some peer-reviewed research on Scoliosis in English. Apparently, there is much more in German. The Schroth's methods have been used in Germany for many decades. There is absolutely no peer reviewed research on Pilates and either adult or childhood scoliosis--it is all anecdotal. There may be variations of Pilates that would not be damaging for an adult with scoliosis but I can say unequivocally that the compressive forces on the lumbar and thoracic spine with traditional Pilates would be contraindicated based on considerable research by McGill among others. Reciprocal type exercises are generally recommended, so swimming is often suggested. To perform exercises to counter the curve in the adult spine would take sophisticated analysis--that is what Shroth's is supposed to do.

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Dear Herb, forgive me, but I don't believe you understand the educated approach to the Pilates Method. And by the way, we're not talking about mat Pilates. While there are many untrained Pilates instructors out there, we are also a highly trained group of individuals who understand movement and movement analysis. I am not suggesting we work outside the scope of our practice, but we can be VERY instrumental in relieving pain and improving postural distortions. Please consult a qualified instructor before you disqualify our Method. Perhaps you'll consider contacting the physical therapist under which I originally trained: Brent Anderson at Polestar of Miami.

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Please also consult Dr. Suzanne Martin. Trywww.pilatestherapeutics.com

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I don't think there needs to be a debate here but I am very familiar with Pilates and Polestar. There is not a single reference to any peer reviewed articles on scoliosis. When someone is asking about a 60 degree curve and they are going to be charged a lot of money for the intervention, someone needs to say "it is my opinion that this will help but there are no scientific studies to support this." I say that several times a day everyday in my practice--I make sure my clients know what is my opinion and what is based on research (and in fact, only 20% of all of medical interventions are supported by scientific research so no one, including Pilates instructors, should feel any shame that certain interventions are not supported by research). And, just to point out a TERRIBLE misinterpretation I hear all day long about Pilates and "core strengthening" can be found on your referenced website..."If you have or are concerned about lower back pain, pelvic pain or knee problems, or if you are recovering from pregnancy, improving your Core Strength can be of tremendous benefit." The science behind that statement is that many people with back pain will benefit from just doing some exercise--walking is probably the best. The second statement that "strengthening your core" will help, based on research, is false--strengthening will help people who are weak. People with muscle inhibition patterns that make up a significant number of people with back pain need more specific training to correct the TIMING of how their muscles are fired (not strengthening). In fact, much of so called core strengthening promotes a global contraction of all of the abdominal muscles and does not isolate specific muscles and this is exactly the problem found in the original research on the deep abdominal muscles which people call "core" muscles. They are core muscles because they are deep like the core of an apple, not that they are "core" to your physical well being--all muscles are core to your physical well being and the great thing about pilates is that it gets people to exercise. The bad thing about pilates is that it is oversold as a solution to problems above just doing a far simpler exercise routine of aerobic walking and resistance training of the large muscle groups. When someone compares the outcomes of aerobic walking plus resistance training to Pilates and one is better than the other with the same incidence of injury, I will be satisfied that they are equally safe (walking and resistance training protocols have been tested, I am not aware of Pilates having been tested in this fashion). Maybe with an instructor, the incidence of injury is less but I am not really sure of that. With basic guidelines for resistance training and aerobic walking, studies have shown a very low rate of injury with amazing health benefits. So, the anecdotal evidence that some people have a great experience with Pilates exercise should not be generalized to a specific population of people (scoliosis in this instance) with an unsubstantiated claim that Pilates will help. Just say you really, really, really believe it will help and state why you think it might help and then say with all honesty that there is not enough money in health care research to study Pilates outcomes on people with scoliosis (there have been studies that have shown several types of interventions have not worked like braces and electrical stimulation and several exercise programs). So, I know that some things have been shown to not benefit scoliosis, Schroth's is the only exercise regime that has some research support and beyond that, it is only our opinions. I am perfectly fine with saying what my opinion is. If someone finds a really well trained Pilates instructor than understands the compressive and shear forces that certain exercises will place on an advanced scoliotic spine and they are willing to pay what the instructor charges for their expertise, that is fine. I just implore everyone to not promote opinion as being some sort of fact--it is disingenuous. And, I hope I inspire someone to go out and do the research that is necessary because I certainly would prefer a non-surgical solution to scoliosis because the surgery is dangerous as well. And, there is nothing wrong with trying Pilates as an alternative but people need to be aware that there is nothing that says it works for scoliosis and that they need to make sure their instructor knows how to avoid excessive compressive and shear forces that might in fact be dangerous (but I don't know that one way or another). As for scoliosis being a cause of pain, in the majority of cases, there is no pain associated with scoliosis. When people have pain and someone says it is because of a small scoliotic curve, their pain is probably from something else altogether so I would hate for people to think that small amounts of scoliosis causes their pain and exercises to "straighten" their spine will help. The experience that someone with scoliosis gets better with exercise (any exercise) only supports the statement that they were weak independent of their scoliosis.

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Pat:

I neglected to point out why I responded so strongly to your claim--you state in your first post that your form of Pilates is "proven" to work. It hasn't been proven. I don't doubt that many people that you train have great health benefits from your intervention. They sleep better, stand up straighter, have more stamina, etc. All proven benefits of exercise. And it is a credit to Pilates that so many people enjoy it. It is also unfortunate that there are a lot of people that teach "Piltes" who have almost no formal training.

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Thanks, Herb, for your insights on pilates and exercise. I'll proceed with caution. I've decided to postpose any surgery for a few years and may never have it. The complexity and risks are huge. Being fortunate to be pain-free, I'm not willing to take those risks or undergo it now. I plan to keep fit by good nutrition, not getting overweight, avoiding osteoporosis by taking Boniva and lots of Calcium and Vitamin D, and doing daily concentrated exercise including core conditioning, stretching , and aerobic exercise. I know no muscle toning can stop the curve but maybe it can help me stay pain-free. I do think the curve impacts the lower back and that lifting weights, for example, puts imbalanced pressure on the lumbar spine which can cause pain.
I'm monitoring the degree of curvature and my pulmonary capacity. I'm 62 with a 65 degree curve...I'll see in a few years. I'll seek good instructors/ trainers but also try to be informed about scoliosis myself and choose exercises wisely.

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Dear Linnie,

I don't know what part of the country in which you live, but might I suggest you contact a physical therapist that has a Pilates studio in his/her office. Yes, all I've been able to find is anecdotal "proof" that the Pilates Method is helpful for those who suffer from scoliosis. It has many aspects similar to the Schroth Method. Pilates can help with your pulmonary capacity with what we call "ribcage" breathing. Just like the Schroth Method, we have several apparatus to assist in stretching while performing breath exercises. There are no compressive components, nor are there shearing forces at play with the Pilates Method.

This is not to say that bracing is not recommended or that more traditional approaches are cast aside. We also do not make false claims or guarantees. Please do your due diligence and then make your own judgement.

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Pat, I am not trying to be a jerk (but I can see how my comments might come off that way). So, maybe I am confused. I have been to Pilates courses taught by physical therapist including ones from the different schools of thought in Pilates. What you are saying is new to me and I would really like to get clarification. I have three questions and I am just trying to get clarification. When you say people have "success" with Pilates with scoliosis, are you talking about relief of pain? Or, are you talking about a change in their curve. If you are talking about relief of pain, that is one thing. Most of the pain that people with scoliosis have is not from the scoliosis, it is caused by the same things that people without scoliosis have. So, that was my first question, are you talking about success with reducing pain or objectively measuring change in the curvature (not just the person appears to stand up straighter by radiological changes). I am sure that some people with scoliosis might also have pain associated with tight or weak muscles and that Pilates as well as other forms of exercise might relieve their pain so I just wanted to make sure I knew what you were talking about. Next, when you say there are no shear or compressive forces then you must be talking about some complete variation from Pilates and in that case, I am wrong. Table tops, planks, side planks, the "C" curve, 100s, supine leg raises for leg "circles" while on your back, supermans, in fact, almost all of the mat exercises have incredible amounts of shear and compression based on biomechanical studies. So, that is my second or third question--has the method of Pilates you are talking about completely done away with all the mat work and just used a reformer and props like the ladder? That would be what is confusing me. If you are talking about not using any of the traditional mat exercises and are only talking about a completely modified program using only props and other devices, you would potentially be correct. What is confusing is calling that "Pilates." The legal arguments from the different schools of Pilates is based on this confusion--it can't all be "Pilates." To be honest to the public (and me for that matter because I honestly think I am confused), Pilates should mean something. I have been to enough Pilates classes taught be physical therapists and there was always a combination of mat and Pilates equipment. If you leave out a bunch of the traditional "stuff" (which essentially are the things that I associate with Pilates) then shouldn't it be called something else? I wish we could discuss this on another forum so that we don't fill this post up with our comments. I would be really interested to know that what some people are calling Pilates has been so modified that it is nothing like the Pilates courses I have attended or the instructional material I have studied. And, if it has been modified to that degree, why is it still called Pilates?

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Hi, Herb. If you recall I mentioned that I was not discussing mat Pilates. Nor am I suggesting that an already kyphotic individual perform the hundred or other mat exercises such as the roll up in which an individual makes a "C'" curve with the spine and pelvis. Nor am I suggesting that anyone without a stable pelvis engage in mat exercises like leg circles. However, I am suggesting that all individuals learn diaphragmatic breathing to open up the ribcage. It is possible also, as in the Schroth method to breathe into one lung to stretch one side of the body. The exercises I am suggesting make use of the cadillac (most importantly the push through bar) which allows for unilateral lengthening, very similar to the poles used in the Schroth method. I am also suggesting the use of the ladder barrel and other arc barrels. I'm not interested in a debate either, but when you are single-handedly closing off the possibilities for those who subscribe to this discussion, I get a little offended.

I am talking about refief from pain as well as bringing about a change for those that practice this method. There is also homework involved, just as in the Schroth method.

Again, I apologize that there is not peer reviewed research approving of this approach. It is not what is considered "classical" Pilates, but rather a "contemporary" approach. There are branches that call themselves one or the other. I hope this helps to clarify things for you.

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Pat:
Great answer. Going back through your posts, I do see you mention not using the mat exercises--sorry, I missed that. I apologize for jumping on this so emphatically. Literally, all day long, and I mean at least 3 of my 10-12 patients in a day, tell me that they have been told that strengthening their "core" is the answer to their back pain--it hasn't been but they have kept at it because that is the common myth out their. As I stated earlier, any exercise is typically better than no exercise for people with pain. My experience with Pilates has been that the instruction has been over the top too intense for someone with an injury. You will say that those are poorly trained instructors and I would agree. Unfortunately, poorly trained Pilates instructors (and poorly trained PTs for that matter) are not helping the situation. If it were so simple, back pain would not be considered at epidemic levels. We are getting worse at treating it rather than better and a big part of the problem in my experience has been misinformation. On this website, spineuniverse, there is so many suggestions that have no evidence to support the recommendations--have surgery, don't have surgery, stretch, Pilates, strengthen the core, spinal decompression therapy, etc, etc. Back pain is not a diagnosis, it is a symptom with many causes. It takes a lot of skill to classify people and treat them according---pain from a compresson fracture is different than discogenic pain is different from facet injury is different from a trigger point[s] is different from deconditioning. As an instructor and a researcher, I am trying to educate people that classifying people correctly is difficult but once that is done, treating is much easier (and specific to their problem). So, again, my apologies but I would hate for a adolescent to embark on a strenous exercise program with understanding the differences in the various Pilates approaches--it appears that at least Polestar attempts to define the process much better than the instructors I come in contact with (and the patients I see are going to Pilates studios and physical therapy clinics in Atlanta not instructors at a fitness center).

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