Archives for Category: Orthopedic

Scoliosis & The Schroth Method

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.

Finding a Good Bike Fit for 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

  • 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


Plantar Fasciitis

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
  • Stretching
  • Ice
  • Night splints
  • Taping
  • 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!

An Overview of Graston Technique

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!