Remember those tests that we used to have to get in elementary school to make sure our backs were okay? Well, scoliosis hasn’t gone anywhere, in fact it’s a lot more common than you might think, so we wanna give you some fast facts about that ailment.
Brad Means: We’re so pleased to have Dr. Andrew Merget with us, he’s with Georgialina Physical Therapies, he’s a doctor of physical therapy, and a Schroth scoliosis therapist. What’s Schroth?
Andrew Merget: Okay, so, the Schroth method was developed in the 1920’s, and it was actually by a woman who had scoliosis herself.
Brad Means: Mhmm.
Andrew Merget: And so she developed a program with her children that one became an orthopedic surgeon, one became a physiotherapist, and developed a method that has been shown to, as considered of, to be able to help reduce curvature progression.
Brad Means: Alright, so let’s go back to the first time that many of us, maybe this is too old school, heard about scoliosis, disease by the way that impacts more than three million people every year, so it’s out there, it was like elementary school, right? Where the teacher or the school nurse–
Andrew Merget: Sure.
Brad Means: Would look at your back, does that still happen to see if there’s that early curvature, and is that typically when it manifests itself in small children?
Andrew Merget: So, to understand the testing portion, the test is still done by the school nurse or the pediatrician, at a certain age group, ’cause at a certain age group, the diagnosis of scoliosis is very important.
Brad Means: How old about is that?
Andrew Merget: So we’re really looking for, especially for females, between the ages of 10 and 15 years old. At that age group, when we do the tests, the test is looking at someone bending forward, and they’re looking to see if there’s any rotation of the spine.
Brad Means: Mhmm.
Andrew Merget: There’s two types of scoliosis present, there’s functional scoliosis, that’s like me sitting like this, or someone has a back injury later in life and they functionally move away from that, and there’s what’s called structural scoliosis. That’s the type of treatment that I’m certified in, as well as that’s what they’re screening for. They’re screening for structural abnormality, and once that test is positive, when they bend forward and they see a rotation change, they will then have the patient go in for imaging that will then confirm if there is a structural curvature.
Brad Means: From a therapy standpoint, what is your goal at Georgialina, are you trying to keep them pain-free, make them stand up straighter? What are you doing?
Andrew Merget: Okay, so, there’s a difference between patients that come in for pain with scoliosis, and then patients that are asymptomatic. So we kind of branch them off, we try to individualize treatment to each patient. So, there’s patients that come in for pain, we’re looking at, a lot of those patients are later in life, in fact, only one in three patients that are adolescents with scoliosis have pain. So that’s why it’s so important that patients are screened, because we can have a curvature that could be somewhat larger at risk of progression, and they may need the proper physical therapy treatment with the Schroth method, or bracing, or monitoring, and it’s important to look at that at its stage when there isn’t pain, and the goal with physical therapy for that patient and that program would be to help them to make sure that they can learn postures and positions that decrease asymmetries and reduce curvature progression, in like a brace.
Brad Means: Can that brace make you symmetrical and make the scoliosis go away? ‘Cause I knew a friend, it seemed like, who wore one for a year and then seemed fine.
Andrew Merget: Okay, so, I think the kind of same thing with the differentiation of pain versus function. A lot of the patients will, that I will see at a younger age, will have… That are in braces will not have pain, or if they’re in pain, it’s due to more of their function, their posture when they’re in the brace. The brace itself, there was a research study that looked at bracing and they found that those that used bracing at a curvature to 20 to 25 degrees, it statistically will show that there is a difference in the progression, and the goal is, when they’re done and their skeleton mature, and because females go through skeleton maturity at a earlier age, when their segment, so let’s say a male will at 13 years old have a stronger structural musculature and stability than a female who is 10 years old, but she’s going through maturity at a earlier age because of puberty.
Brad Means: Right.
Andrew Merget: And so, the goal for these patients and the bracing is to make the curvature is as small as possible before they’re done being skeleton mature.
Brad Means: What kind of time table are we talking about? From when someone first comes to you, and from when you release them into the world, hopefully with less pain, hopefully with more symmetry.
Andrew Merget: Yes, so usually the typical plan of care was, it previously another research study looked at the bracing would be the standard in waiting and seeing. So the patient would be given an x-ray yearly, or every six months, and then they were given a brace depending on the certain amount of curve. Now, with this method, another research trial had shown that the Schroth method with bracing, waiting and seeing, versus just bracing, waiting and seeing alone, has added a 40 percent reduction in risk of progression. And so as a result, the plan of care for patient to learn the Schroth method, this specific treatment for scoliosis care, that increases symmetry or decreases pain, is usually between 15 and 20 visits.
Brad Means: Alright, 15 and 20 visits, and then at that point, I don’t wanna get overly optimistic here, but are we looking at much better mobility when they leave you or are we looking at the ability to participate in sports again maybe?
Andrew Merget: So, for most of these patients that have scoliosis, they are able to still participate in sports, and actually we encourage activity. That creates more movement, more mobility. The goal is for a patient that is maybe an adult with scoliosis, that has pain and disability, we’re looking for them to restore mobility, restore function, so their program may be more based off of if they’re not at risk of progression, we’re design is back to get them back to being functional. Health and restore pain. And so the long term goals for a scoliosis patient is not necessarily like someone that has sciatica, or sudden onset of pain from an ankle sprain or something like that, that would be maybe two times a week for four weeks. These patients, it’s long term management strategies that they can restore their function in their life as well as understand ways that they can improve their breathing endurance, and their posture and mobility.
Brad Means: What about mom and dad in this situation, what can parents do to help manage scoliosis and make sure their kids get the best outcome?
Andrew Merget: So I think it’s really important for any female or any family history that has scoliosis–
Brad Means: Mhmm.
Andrew Merget: Especially between the age of 10 and 15, that they are starting to be screened yearly. Okay, and I think it’s commonly that we maybe need to be double checked, so we do it at school, but I think the pediatrician, make sure the pediatrician is checking it. We also do free screenings at our facility, you call in, I will be able to do a free screening for the family. I think the whole idea with the program is that it can be a whirlwind or motion of scoliosis. It’s not something that for a majority of patients that is going to lead to them to not be able to do things like playing sports, being active, it doesn’t always have to even lead to pain. So, I think the most important thing is helping develop a team with the parents, a family, and a person, if they need bracing, to have a strong orthotist that makes the brace, and the physician to have a team group so we can give a support system that can help them to have an optimal outcome.
Brad Means: A lot of that starts at home.
Andrew Merget: Sure.
Brad Means: Andrew Merget, doctor of physical therapy at Georgialina Physical Therapy. June is scoliosis awareness month, and you’ve made us a lot more aware of it, and I appreciate that.
Andrew Merget: Thank you for having me.