Schroth Method Level 1 Certification Course – September 2017

Two of our clinicians, Cindy Marti, PT and Meg Gogin, MPT, just finished teaching the Schroth Method Level 1 Certification Course (C1) to nine students from the United States and Canada. Students will be returning to private practices and hospitals to work with pediatric and adult patients with scoliosis-specific exercises based on the Schroth Method. The class is an intense 8-day course, combining lecture and hands-on patient lab experience, followed by an exam. Thanks to several of our patients who worked with our students as models! The course curriculum is part of the Barcelona Scoliosis Physical Therapy School (BSPTS), taught under the Schroth Barcelona Institute

Want to learn more about upcoming courses for the conservative treatment of patients with scoliosis? Click here for information and dates of future courses

5 Common Scoliosis Myths — Debunked

  1. Scoliosis does not worsen or occur after you are done growing  

It is true that adolescent idiopathic scoliosis (scoliosis that starts after the age of 10) has the highest risk of worsening during rapid growth. However it is a myth that scoliosis remains stagnant after skeletal maturity. Although the risk of scoliosis progression is much lower after a child is done growing, scoliosis can still progress after bone maturity. In patients with untreated scoliosis, research suggests that curve progression occurs at the rate of approximately one to three degrees a year in adulthood. This can add up over time.

Another myth is that scoliosis only occurs in children. In fact, not only can childhood scoliosis worsen in adulthood, but scoliosis can actually begin in adulthood. When this occurs, it is called “de novo” scoliosis, which is a totally scoliosis than adolescent idiopathic scoliosis. A 2005 study published in the U.S. National Library of Medicine suggests that 68 percent of people over the age of 60 show signs of degenerative scoliosis – scoliosis due to age related “wear and tear” on the spine. Adult onset scoliosis can also be related to the bone density changes seen in osteoporosis.

The “take home message”  is that children with scoliosis should continue to care for their condition into adulthood, and adults should understand even if they never had scoliosis as a child, age related spinal changes may cause scoliosis later in life.

  1. Bracing is outdated and does not work

When thinking about scoliosis back braces, many people have visions of the antiquated, metal braces of the 1950’s that come up under a person’s neck. In fact, most scoliosis braces are now made of thermoplastic materials easily concealed under clothing. The concealed nature of braces may be feeding a perception that scoliosis braces aren’t used anymore – which is not true. Braces are still used for treatment to control scoliosis in children that are still growing.

Another myth is that bracing doesn’t work. Whereas it is true that past research has not fully supported the use of braces, a study published in October 2013 reported clear evidence that bracing helps prevent surgery in the majority of growing children with moderate severity curves.  

The “take home message” is that bracing should now be considered standard of care for preventing curve progression in skeletally immature children with curves between 20-40 degrees.  

  1. Scoliosis does not cause pain

One reason scoliosis can go undiagnosed in children is because it is often pain-free. It can “sneak up on us” as a child develops. But just because scoliosis doesn’t always cause pain, it doesn’t mean that it never causes pain.

In fact, scoliosis can often lead to painful symptoms in children that require medical care. Pain can come from curve-related biomechanical stress on the surrounding soft tissues such as joints, discs, ligaments, tendons, and muscles. In adulthood, if scoliosis is accompanied by more degenerative age-related changes, pain can also come from compression of nerves or a condition called spinal stenosis – a narrowing of the space where the nerve exits the spinal column.  

The “take home message” is that back pain can be related to scoliosis. The painful symptoms of scoliosis can be improved with conservative treatment such as physical therapy by treating both the soft tissues and joints of the spine and any biomechanical compensations related to the postural asymmetry.

  1. Exercise does not help scoliosis

The key to addressing this myth is understanding the goals of scoliosis-specific exercise therapy. Critics will often state exercise can’t help scoliosis because it is a structural condition. In truth, scoliosis has a structural (or rigid) component as well as a postural (or flexible) component.

The  “Cobb angle” – which is the x-ray measurement of scoliosis – actually represents the sum of both the postural and structural components. The aim of exercise is to affect the postural component of the curve, and through improved posture, the patient can better achieve multiple additional goals, such as: controlling curve progression, improving torso shape, improving respiration, and reducing pain.  

The “take home message” is that scoliosis specific exercise is aimed at improving the overall quality of life the patient through improved control of the postural element of their curve.

  1. Scoliosis screening  isn’t beneficial  

The provision of scoliosis screenings in the US public schools has been on the decline, despite the American Academy of Pediatrics and Orthopedics recommending screening for kids between ages 10 and 15. The lack of screenings may be due to a potential belief that screenings are not worth the costs, and a misunderstanding that nothing can really be done to treat scoliosis in the early stages of detection.  

In truth, screenings are quick and easy to perform, and can be done at a relatively low cost. If a child screens positive for scoliosis, an early x-ray can be done to catch a curve when it is mild. Early detection will facilitate effective early intervention. Without screenings, curves may go undetected until they reach higher degrees of severity. More severe curves are more difficult to treat, or may require surgery.

The “take home message” is screening for scoliosis is worth it. If school budgets don’t allow for in-school screening, parents can seek screenings from physicians and physical therapists in the community.  Parents can learn more about self-screening their children here.

June National Scoliosis Awareness Month

 

June is National Scoliosis Awareness Month, which serves as a beacon to spotlight education, early detection, and public awareness about the disease. Accordingly, Spinal Dynamics has a couple of interesting updates in ways we have adopted the initiative, and are striving to help serve the cause of scoliosis beyond our excellent standard of care. 

Scoliosis affects over 7 million people in the United States, or about 1 in 40 Americans. Consequently, it is the most widely diagnosed spinal deformity nationwide. Although it can affect any age, it is typically found between the ages of 10 and 15, with females being twice as likely to be diagnosed.

Fewer than half of the schools in the U.S. provide screening, although the American Academy of Pediatrics and Orthopedics has recommended two screenings for females at the ages of 10 and 12, and one for males at the age of 13.

 

Free Screenings

We are pleased to be offering free scoliosis screenings for kids ages 10-15 on Tuesday for the rest of the month of June, walk-in or call ahead. Screenings take only about 10 minutes, and early detection is the key for successful treatment!

Wisconsin has been recognizing June as National Scoliosis Awareness Month for half a decade, but still does not provide in-school screenings for adolescents, as only half of the country does. As a result, we have decided to open up our clinic for free screenings for ages 10-15 from 12:00-1:00 for the duration of June, in support of the goals put forth nationally for this month.

Support prevention and awareness by getting your child or teen screened this month for no cost to you. We are honored and happy to provide information and resources about this disease to the public in support of the National Scoliosis Awareness Month initiative!

Schroth-Barcelona Institute 

Spinal Dynamics President Cindy Marti, has been working hard with four colleagues (Hagit Berdishevsky, Beth Janssen, Patricia Orthwein, and Amy Sbihli) to establish Schroth-Barcelona Institute, a Schroth Method teaching group sanctioned by the BSPTS based in Europe. The SBI mission, “to provide a central organization based in USA which facilitates the training and certification of physical therapists and to develop standard of education and practice standards in the Schroth Method”, fits hand in hand with the June Awareness Month goals of education and public awareness.

Though the five BSPTS certified therapists have been teaching and bringing this revolutionary treatment option to the U.S. for years through their original group, Scoliosis Education Seminars, they have recently formed this exciting new LLC to grow above and beyond their previous goals. 

One of the Schroth-Barcelona Institute continuing education teaching opportunities has already been underway with optimism and success, as the group has been teaching and increasing awareness through their 2-day  course at Beaumont Hospital in Michigan, Introduction to Scoliosis and Hyperkyphosis – Evaluation and Coordination of Care.

This course seeks to expand upon the introduction to scoliosis given in PT school, and gives therapists the tools and understanding to identify clinical signs of scoliosis/hyperkyphosis in adults and children, refer patients for x-ray diagnosis, coordinate care based upon key variables, and apply protective principles for scoliosis/hyperkyphosis in the clinical setting.

In addition to these new programs, Schroth-Barcelona Institute continues to teach their BSPTS certification courses, and Spinal Dynamics plays a supporting role in hosting and teaching some of these certification classes (pictured above). Most recently, SBI was proud to certify the March 2017 C1 level class (pictured below) featuring some of the newest group alumni, many of whom will go on to propagate the June Awareness Month initiatives and the Schroth Method teachings. 

More about Schroth-Barcelona Institute and their attempt to bridge the gap in education from PT school to specialized Scoliosis therapy using the Schroth Method can be found on their website at www.schroth-barcelonainstitute.com

 

 

Weekly Summer Scoliosis Open Gym!

Scoliosis Open Gym

Does your daughter or son need a way to stay consistent and motivated with their scoliosis home exercises over the summer? Spinal Dynamics & Body Dynamics of Wisconsin will be offering a special weekly open gym to help our patients to keep up with their scoliosis management program.

One of our resident scoliosis experts, Meg Gogin, MPT, will direct open gym on Fridays from 11:00 a.m. until noon beginning on June 16, 2017.

Participants will be able to:

  • Check in to make sure they are performing their exercises correctly
  • Use all of our equipment, including ladders, bands, rollers, and more
  • Experiment with new exercises to advance their home program
  • Answer questions about exercises and scoliosis
  • Socialize with others with scoliosis for motivation and support

Interested in learning more? Chat with your PT to determine if this would be a good fit for your child. You can also call our office at (414) 302-0770 or send our front office an email for more details. Each open gym session will cost $25. We require preregistration to ensure that there is enough equipment for all participants.

 

Meg Gogin, MPTMeg Gogin, MPT

  • Bachelor of Science in Kinesiology from Indiana University, 1996
  • Master of Science in Physical Therapy from UW-Madison, 2000
  • Certified in the Schroth Scoliosis Rehabilitation Method, 2007
  • Lab assistant for Barcelona Scoliosis Physical Therapy School.
  • Completed the Scientific Exercise Approach to Scoliosis (SEAS) Accreditation Program, 2012
  • Specific interest in foot orthotics, scoliosis, vertigo treatment, and spinal and lower extremity conditions.
  • Certified in dry needling techniques through Myopain Seminars.
  • Unique golf expertise in collaboration with her husband, Dan Gogin, PGA

 

Baseball Injuries

Monday was Opening Day for the Brewers, which means that spring is finally here. In our physical therapy clinic, this is also about the time we start seeing an uptick in the number of high school and college baseball players who come to see us for elbow or shoulder pain.

So, why are shoulder and elbow pain so common in baseball?

Baseball pitch

 Baseball players, especially pitchers, typically have shoulders that are very flexible in external rotation (see picture to the right), which allows them to generate speed as they throw. Over time, they may develop stiffness into internal rotation (the opposite direction) due to tightness through the rotator cuff and other shoulder structures. This can lead to irritation and pain in the shoulder, as well as compensations at the elbow. In the cocking position (see picture to the right), the shoulder is stretched into maximum external rotation and there is also a lot of stress transmitted to the inside of the elbow. To tolerate this position hundreds or thousands of times over the course of a season, the arm needs a good balance of mobility of the joints and stability of the surrounding muscles. 

Overloading the arm with too many throws or throwing with poor mechanics can lead to injuries, especially in a growing athlete. Bones grow more quickly than muscles and this imbalance often leads to injuries near the growth plates of elbow or shoulder. Overuse can also lead to irritation and gradual tears of the rotator cuff muscles or labrum (cartilage) in the shoulder. Excess strain through the elbow can overstretch or tear the ligaments that stabilize the inside of the elbow. This is known as a “Tommy John” injury in baseball circles. If not caught early, some of these injuries may require surgery and a very long recovery.

How someone throws can also be a risk factor for shoulder or elbow injuries. Poor mechanics can lead to increased torque and strain through the shoulder and the inside of the elbow. A good pitching coach can identify throwing flaws and address them in order to prevent problems down the road. Learning good mechanics early on is much more effective–and safer–than waiting until there is a problem.

Preventing Injuries

Current research shows that a high number of pitches is one of the biggest predictors of having either shoulder or elbow pain. Baseball players between 9 and 14 years old were more likely to have shoulder pain if they threw more than 600 pitches throughout the course of the season and elbow pain with more than 800 pitches. In response to this research, Little League instituted pitch counts based off of the player’s age to avoid overtaxing growing joints. The following chart shows the maximum number of pitches allowed by age, as well as the recommended days of rest following a start.

Age                 Daily Max (Pitches) Required Rest (Pitches) Required Rest (Pitches) Required Rest (Pitches) Required Rest (Pitches) Required Rest (Pitches)
    0 Days 1 Day 2 Days 3 Days 4 Days
7-8 50 1-20 21-35 36-50 N/A N/A
9-10 75 1-20 21-35 36-50 51-65 66+
11-12 85 1-20 21-35 36-50 51-65 66+
13-14 95 1-20 21-35 36-50 51-65 66+
15-16 95 1-30 31-45 46-60 61-75 76+
17-18 105 1-30 31-45 46-60 61-75 76+

Information from http://www.momsteam.com/sports/baseball/safety/2014-little-league-baseball-pitch-count-limits-and-mandatory-rest-periods#ixzz4bPUpySeo

It is also important to gradually increase the amount of work the arm has to tolerate, especially at the beginning of the season, after injuries, or after time off. Gradually increasing the distance, speed, and number of throws over several weeks is important to avoid overtaxing the joints as they get used to the stress of throwing.

Along with gradually increasing the work on the arm, it is important to make sure that players, especially pitchers, have adequate rest. Pitching with a sore or tired arm is a significant risk factor for injuries. It is essential that pitchers have days off after starts to allow their arm to recover. Players that play on multiple teams may play year-round, never giving the arm sufficient time to rest and recuperate. It is recommended that athletes play their main sport a maximum of 9 months a year, as specializing in any sport year-round has been associated with a higher incidence of injuries. Players should have a 6-8 week recovery period following their season and focus on rest, off-season conditioning and injury prevention. This may also help with avoiding burnout.

Given the high demands on a baseball player’s arm, every player should have an exercise program that addresses their need for shoulder and elbow mobility and stability. A physical therapist can check for adequate range of motion and strength, take a look at the structures around the shoulder or around the elbow and develop a specific, individualized program to help keep the arm happy and healthy throughout the course of a long baseball season.

Sources:

Brotzman SB, Manske RC. Clinical Orthopaedic Rehabilitation: an Evidence-Based Approach – Expert Consult. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011.

Straus LB. 2017 Little League Pitch Count Limits and Mandatory Rest Rules. MomsTeam. http://www.momsteam.com/sports/baseball/safety/2014-little-league-baseball-pitch-count-limits-and-mandatory-rest-periods#ixzz4bPUpySeo. Published February 27, 2017. Accessed March 23, 2017.

Temporomandibular Joint (TMJ) Pain & What to Do About It

Temporomandibular joint (TMJ) or jaw pain is a very common condition – actually the second most common musculoskeletal condition after low back pain. It affects around 12% of the population or 38 million people.1 It typically affects more women than men, often between the ages of 35-45 years of age, but may occur at any age. Interestingly, 70% of patients with TMJ pain also have neck pain2 and there is a lot of overlap between both conditions and treatment.

The temporomandibular joint is where the mandible (or jaw bone) meets the temporal bone (part of the skull, forms the temple). You can find the joint on yourself by gently pressing just in front of the ear below the bony ridge of the cheekbone. There are a lot of muscles that attach in this region that help you open and close your mouth. They can become tight or irritated. There is also a small disc of cartilage that lies between the two bones of the temporomandibular joint and moves with the joint. In some people, the disc can cause clicking as the person opens and closes the mouth. This may or may not be painful.

Common Symptoms:

  • Pain or stiffness in the jaw, often first thing in the morning
  • Pain through the temples or frequent headaches
  • Pain with chewing gum, hard or tough foods
  • Pain opening mouth or moving jaw forward or to the side
  • Pain with talking, kissing or yawning
  • Frequent clenching or holding the back teeth together
  • Ear fullness or ear pain

If you are experiencing TMJ pain, there are several things that you can start working on to reduce your pain.

  1. Be aware of clenching your teeth during the day. Your back teeth should only be touching when you are chewing, as holding your back teeth together all day overworks the muscles and may cause pain.
  2. A good, relaxed position for the jaw is with a slight space between your top and bottom front teeth with your tongue gently resting (not pressing) on the roof of your mouth. This allows the muscles to relax.
  3. Posture has a huge effect on your jaw pain. A slumped position with a forward head changes the position of your jaw and increases how much the neck and jaw muscles have to work. Check your posture frequently during the day, especially while sitting.
  4. People often clench their teeth when they are stressed. Frequently take a look at how you’re holding your teeth and consciously work on relaxing the muscles of the face and jaw.
  5. Avoid sleeping on your stomach or resting your head on your hand during the day or while on your phone. The increased pressure directly over the jaw can cause pain.
  6. Focus on soft foods and avoid things that are excessively hard or chewy (including gum) to allow your muscles to relax.

Treatment:

Your dentist or physical therapist can help you with improving your jaw pain and function. Other treatment strategies may include:

  • Soft tissue mobilization, massage, dry needling and other manual therapy techniques to the neck and jaw musculature and joints to improve mobility and decrease feelings of tightness and pain.
  • Exercises to improve mobility and strength for improved posture and body mechanics.
  • Gentle electric stimulation, heat and relaxation exercises.
  • Oral appliance or a night splint to decrease clenching or grinding at night.

Pain through the jaw can be exhausting and affect someone’s personal, social and work lives. Most people will improve with treatment, so if you are experiencing frequent pain through your jaw, don’t hesitate to call your physical therapist. Spinal Dynamics & Body Dynamics of Wisconsin has several physical therapists that are specially trained in treating this condition. We can help you with strategies to reduce your pain and improve your function. We can also assist you in finding a dentist experienced in treating temporomandibular dysfunction if needed. Let us know if we can help.

Sources:

  1. Dworkin SF, Huggins KH, Leresche L, et al. Epidemiology of Signs and Symptoms in Temporomandibular Disorders: Clinical Signs in Cases and Controls. The Journal of the American Dental Association. 1990;120(3):273-281. doi:10.14219/jada.archive.1990.0043.
  2. Ciancaglini RG, Testa M, Radaelli G. Association Of Neck Pain With Symptoms Of Temporomandibular Dysfunction In The General Adult Population. Scandinavian Journal of Rehabilitation Medicine. 1999;31(1):17-22. doi:10.1080/003655099444687.