What is scoliosis, how do I know if my child has it?
Scoliosis is a curvature of the spine which includes both a side bend to the right or left (also called lateral flexion) and twisting or rotation of the vertebrae. Usually there is one major curve, and a compensatory curve above or below that. The majority of cases of scoliosis are called idiopathic, meaning the cause is unknown. Visually, a person with scoliosis may look asymmetrical when standing, such that one hip may appear higher or more prominent, one shoulder blade may be higher or more prominent, the ribs on one side may be more prominent (also called a rib hump), and the shoulder and hip levels may not be level. These asymmetries may be more apparent when one bends forward as when touching your toes. The diagnosis of scoliosis is verified by an x-ray of the spine taken in a natural, standing position. Typically, patients are diagnosed in the early teen years, often at their annual physical. Since the curves continue to progress until skeletal maturity, early diagnosis and intervention is imperative.
What is the Schroth method?
The Schroth method was developed more than 80 years ago by Katharina Schroth, who had sciolosis herself. She developed a treatment method that was unique in term of the approach, the intensity and the success rate. Since scoliosis is a 3-dimensional deformity she developed her method to treat all 3 dimensions. Her method consists of a special series of exercises based upon active correction of the pelvis as the foundation of the spine, and subsequently performing trunk elongating exercises. This process also addresses de-rotation of the ribs and flattening of the rib hump. The main goal of rehabilitation is to prevent the curve’s progression and to improve the esthetical appearance of the body. Education regarding the purpose of the exercises and understanding of the given curve pattern is essential for success with the Schroth method.
What can I do as a parent?
Our goal with Schroth is to create a tailored exercise program which is challenging, yet easy to recall at home. As the program progresses, 40-60 minute of home practice is recommended at least 5 times a week. With time, clients will be able to perform corrections on their own and incorporate the new alignment into functional activities.
With all these things in mind, it’s safe to say that Schroth therapy can be little overwhelming during the first phase. Creating a supportive and motivating family environment is essential to enhance the success of the exercise program.
Is the Schroth method good for other postures as well?
Yes, it is! There are many exercises addressing other common problems of the spine besides scoliosis such as slouched posture, flat back, and Scheuermann disease (a kyphosis with wedged shaped vertebrae). A flat back or a rounded back will not progress to idiopathic scoliosis. These conditions tend to be less severe and more mobile, therefore easier to treat.
Is there an age limit to participate in the Schroth program?
Basically, there are no age limits for using this method, however, it is most effective during the growing phase of development. Bones in the growing period are less dense and more flexible making it possible to shape them. Schroth method utilizes specific muscle pull combined with special breathing techniques to mobilize the thorax into expanding or narrowing where needed. The earliest age to initiate the Schroth method is approximately at the age of 10 since an established body awareness should be present to start the active exercises. Before age 10, passive correction methods should be used to improve curvatures.
Scoliosis is a life-long condition however this doesn’t equal life-long therapy. Once the body and the brain are taught how to facilitate corrections, only regular yearly check-ups are required in addition to the home exercise program, which is gradually reduced to 3x per week or incorporated into other activities.
Once reaching adulthood, the focus is shifted to functional tasks along with a balanced amount of individualized, specific home exercises as well as sports and recreational activity. Schroth can also be initiated with adults at any age to provide education regarding each individual curve pattern and establish the specific exercise regime to prevent further progression of the curvature.
How much improvement is possible?
We do understand that clients and their parents wish for the greatest improvement in the shortest period of time. It is impossible to foresee the exact results with the therapy, however, it is proved that Schroth method could help to reduce the curvatures by an average of 10%. The results depend on the age, curve type, degree, severity and adherence to the personalized home exercise program. During Physical Therapy, we measure progression with a Scoliometer, an easy-to-use tool used to screen for changes. The more precise measurements are taken with X-ray and measured by Cobb-degree by the physician.
Is swimming helpful to prevent spinal deformities?
We are asked about swimming all the time! Swimming is good for spinal and peripheral joint mobilization, strengthening and endurance. However, with diagnosed scoliosis, a more tailored exercise program is required to prevent curve progression over time. Physical activities with a symmetrical, even load on the spine (running, biking, swimming) are recommended in addition to a personal home exercise program.
Is it possible to have scoliosis in adult life?
Adult scoliosis could be present due to many reasons:
- Degenerative causes like osteoporosis with resultant spinal asymmetry
- Secondary to Adolescent Idiopathic Scoliosis
- Other orthopedic issues related to the spine
Schroth method could be an efficient treatment method to prevent further progression in these cases.
What does a treatment involve?
Each and every scoliosis is different in curve patterns, locations, severity and even compression types. As a result, treatments and exercises are different and individualized. Typically, manual techniques (joint and soft tissue mobilization, stretching) are combined with active Schroth exercises in each treatment session.
In the first few we put a great emphasis on rebuilding secondary spinal curves such as the lumbar arch or lordosis and the desired thoracic curve, since these curves are usually lost with scoliosis, and give the back a flattened appearance. Further sessions will incorporate more active corrections such as those pictured below which include breathing techniques as well as specific positions specific to each curve pattern.
For more information or to see if this technique is right for you, contact DTS where a Schroth certified therapist will be able to assist you.
A proper bike fit will allow you to enjoy cycling while decreasing the chance of injury. The American Physical Therapy Association (APTA) makes the following recommendations for posture & fit:
Trunk Position & Shoulder Angle
- For the recreational rider, trunk position should be 40-80° from horizontal and shoulder angle should be between 80-90°
- For the road cyclist, trunk position should be between 30-40° and shoulder angle should be between 90-100°
Handlebar position will affect your hand, shoulder, neck and back comfort as well as overall handling.
- For the recreational rider, the width should allow hands to be slightly wider than shoulders
- For the road cyclist, hands should be approximately 2 cm wider than the shoulders
Knee to Pedal
The closer the angle is to 35°, the better the function and less stress on knee
- For the recreational rider, the angle should be between 35-45°
- For the road cyclist, the angle should be between 30-35°
Foot to Pedal
- Position the ball of your foot over the pedal spindle for the best leverage, comfort & efficiency
- A stiff soled shoe is best for comfort & performance
- The saddle on your bike should be level – if the saddle tips downward, pressure will be placed on your hands & lower back
- The saddle should also be a comfortable distance from the handlebars – too close, and extra weight will be placed on your mid-back and arms; too far away, and you may put extra strain on your lower back and neck
Many have heard the phrase “W sitting” and that it is “bad” for their child to sit this way. However, many are unaware of the reason that children are discouraged from sitting in this position.
First of all, what is W sitting?
W sitting is when a child is sitting on their bottom with both knees bent and their legs turned out away from their body. If you were to look at the child from above their head, his or her legs will be in the shape of the letter “W”.
Why is W sitting bad?
When a child “W” sits, it puts their hip joints into extreme internal rotation. This tightens the muscles on the inside and stretches the muscles on the outside of the hips.
Since everything is connected, what happens at the hips also affects the joints at the low back, knees and ankles.
- This extreme rotation can cause a knock-kneed position and/or in-toeing of the feet.
The excessive stress and strain being placed on the hip and knee joint often result in increased risk of hip dislocation, long term leg pain and postural deformity.
The tightness in the hips also affects a child’s ability to sit erect in a chair or on the floor.
- The legs are often wide apart and the heels lifted up to accommodate the tightness in the leg muscles, specifically the hamstrings. To accommodate the restricted hip movement the child tilts the pelvis backward and flexes the trunk.
W sitting makes it impossible for the child to shift their weight from one side of their body to the other, negatively impacting the strength of the outer hip muscles.
- The ability to weight shift and build upon lateral hip musculature is especially important in standing and single limb balance and when developing the ability to run and jump.
W sitting does not allow the child to develop strong hip and trunk musculature.
- In this position, the hip and trunk muscles are not challenged and balance reactions are not incorporated.
Why do some kids sit like this?
It is the most stable way for children of all ages to sit because pelvis is relatively fixed and less muscle strength and control is needed to keep the trunk erect.
It has also been attributed to prolonged time spent in infant carrier devices.
- i.e. swings, bouncy seats, car seats
Prolonged W sitting throughout childhood can lead to chronic hip and knee pain and a delayed development in gross motor skills such as coordination, balance and the ability to sit, walk and run with appropriate posture.
What can you do?
Make your child aware of this sitting position and remind he or she to avoid it.
Suggest other ways for your child to sit, such as:
- long sitting, side sitting, crisscross sitting or sitting on a small bench
Pediatrics published a meta-analysis on the association of children’s physical activity levels in childhood and adolescence with depression. Fifty studies (89,894 participants) were included from 2005-2015 that measured physical activity in childhood or adolescence and examined its association with depression. The results indicated that stronger effect sizes were seen in studies with:
- Cross-sectional versus longitudinal designs
- Using depression self-report versus interview
- Using validated versus non-validated physical activity measures
- Using measures of frequency and intensity of physical activity versus intensity alone
The researchers concluded that children’s higher physical activity levels are associated with decreased concurrent depressive symptoms although the association with future depressive symptoms is weak.
Reference: Korczak, D.J., Madigan, S., & Colasanto, M. (2017). Children’s Physical Activity and Depression: A Meta-analysis. Pediatrics, e20162266.
Your Therapy Source, Inc. Web Link: Children’s Higher Physical Activity Levels Associated with Decreased Depression
Permission granted by: Your Therapy Source, Inc. 4/2017
Most school staff are already aware of the physical benefits of exercise, such as strengthening of the heart and lungs, preventing weight gain, healthy bones, good posture and more. However, many are not aware of the potential brain-boosting benefits of physical activity with regard to school performance. Unfortunately, students are missing out on opportunities to accomplish this physical activity. For example, years ago kindergarten was meant to teach children how to play, listen, follow rules and interact with peers. Now kindergarten teachers, and even preschools teachers, are forced to spend more time on structured, academic instruction. This frequently translates into more seatwork time and less movement and active free play time. Physical education class and recess are usually the first things cut when more academic time is required for remediation in reading and math skills. At the end of the day, the children are spending too much time in a sedentary mode. Research indicates that this sedentary lifestyle has a negative effect on cognitive development.
To continue reading this article please visit the following website:
How Do Gross Motor Skills Affect Academics
Permission granted by: Your Therapy Source, Inc. 9/2016
Whether it is a swimming pool, lake, or the ocean, exercises can be performed in the water and can be good for people of all ages. The properties of the water can help reduce pressure and stress on the body and joints and it can also act as a form of resistance to help strengthen muscles without heavy weights.
Here are some exercises to try, but keep these safety tips in mind: exercising in water can sometimes feel easier than on land so be aware of your limits, exercise with a partner and consult with your doctor before starting an exercise program. Remember to wear sunscreen and have fun!
1. Water Walking/Running
Start in waist deep water and walk forward, sideways and backwards (make a square). Be careful in lakes and oceans for moving current and rocks or other things on the ground that may hurt your feet. Walk faster or run to make it more challenging and get your heart pumping! You can also try walking lunges, or high knee marching for alternate movements.
2. Leg Lifts
In a swimming pool, hold onto the wall and lift your leg out straight to the side, out straight to the back and out straight to the front. Repeat on one leg until it gets tired, then try the other leg. Not only do these exercises work the legs, it also improves balance and strengthens your core.
3. Squat and Jump
In a swimming pool, move to waist deep water. Bend your knees and then forcefully jump out of the water as high as you can! Try it with both legs, then with each leg individually.
4. Tread Water
Keeping yourself afloat in the water with your head out of the water is good exercise for your muscles, including your heart! Try using different kicks: bicycle kick or an “egg beater” kick (alternating legs). You can also try keeping your hands out of the water to challenge your legs more!
While holding onto a kickboard, keep your legs straight and perform a free style kick or flutter kick. Try performing intervals of fast, small range kicking and then slower, bigger range kicking. This will not only work your leg muscles, but can also get your heart rate up too for a cardiovascular work-out!
6. Play Ball
Playing catch in the water can be a fun game, but can also be good exercise. Jumping, lunging and quick movements in different directions to retrieve the ball make your muscles work while you hare having fun!
*Some equipment ideas that can be used in the water: flippers, paddles/webs, barbells, kickboard, swim float/water floatation belt, water noodle, water weights
What is Plantar Fasciitis?
Simply put, it is inflammation of the fascia on the bottom of the foot. There can also be changes in the fascia as a result of inflammation that cause the tissue to thicken and become gritty with less flexibility of the tissue to stretch. Plantar fasciitis typically presents as heel pain from the inflammation and increased tension and/or shortening of the fascia. It can also present as pain in the arch of the foot. The fascia spans from the heel, spreading out in a fan shape, attaching into the base of each toe. The onset of pain can be slow and progressive or come on quickly without warning and not necessarily related to specific trauma. Many people wake in the morning and complain of foot pain as they stand up and first put weight on their feet. In many cases, the pain can improve as you walk and muscles and fascia loosen up after rising in the morning but if it has progressed too far, the pain may limit the ability to tolerate walking and/or standing throughout daily activities.
What causes this?
The fascia on the bottom of the foot not only supports the arch of the foot but it has to stretch and allow movement as you bear weight on your feet to stand, walk, run, etc. If a muscle imbalance/weakness, joint or soft tissue restriction and/or altered dynamic from normal lower body mechanics has developed, this can put increased strain on the fascia of the foot as it tries to control the landing of the foot on the ground. Then the additional, repeated tension and load on the fascia creates an inflammatory reaction leading to pain and possible changes in the quality of the fascial tissue. The cause is typically multi-factorial and the treatment involves identifying the possible causes and implementing the appropriate treatment techniques to resolve the identified areas of need.
What are possible treatment options?
- Rest/Activity modification
- Night splints
- Soft tissue and joint mobilization
- Instrument assisted soft tissue mobilization-GRASTON TECHNIQUE
- Strengthening and balance training
- Muscular/Movement re-training
- Shoe wear changes
- Shoe inserts (over-the-counter/custom)
- Patient education and home programs
Skilled Physical Therapy intervention for plantar fasciitis is invaluable to identify the cause of inflammation and dysfunction and design an individualized treatment plan to resolve the problem.
Foot pain does not have to be a barrier to an active lifestyle!
To address restrictions and improve tissue mobility, the therapists at DTS are now trained to incorporate Graston Techniques along with traditional hands-on therapy and specific, individualized exercise programs. Graston incorporates specialized hand guided stainless instruments to specific areas to assist in pain relief and tissue recovery. Research has demonstrated a more rapid return to desired activities with the use of the Graston Technique.
Graston may be indicated in many inflammatory and overuse conditions such as Achilles tendonosis/itis, carpal tunnel syndrome, cervical sprain/strain (neck pain), lateral epicondylosis/itis (tennis elbow), medial epicondylitis (golfer’s elbow), lumbar strain/ pain (low back pain), patella-femoral pain/ disorders (knee pain), plantar fasciitis (foot pain), shoulder pain and disorders, shin splints, scar tissue, and women’s health issues.
Contact DTS for further information!