CHOC offers Schroth Method physical therapy treatment for scoliosis

Two CHOC pediatric physical therapists, Ruchi Bagrodia and Adam Shilling, answer questions about the Schroth Method, a physical therapy treatment option for patients with idiopathic scoliosis. The non-invasive approach can improve symptoms and, in some cases, can even prevent the need for surgery. Bagrodia and Shilling are among a limited number of specialists in the nation who are certified in the Schroth Method.

Ruchi Bagrodia and Adam Shilling, Schroth Method-certified physical therapists at CHOC

What do you want referring physicians to know about the Schroth Method?

Schroth is a research-supported, conservative treatment method used for individuals with Adolescent Idiopathic Scoliosis. Treatment is provided by physical therapists who have completed a rigorous nine-day course and obtained a Schroth certification. The goals of Schroth treatment are to improve posture, prevent curve progression, decrease the likelihood for surgery, reduce pain, increase body awareness (proprioception) and strengthen the postural muscles.  

How does Schroth Method differ from traditional physical therapy? What are the benefits?

Traditional physical therapy can be helpful for improving trunk and core strength, range of motion and pain. However, it usually fails to address the three-dimensional changes of the trunk caused by an individual’s unique scoliosis.

With Schroth treatment, each person is guided through specific postural corrections to achieve the most optimal spinal position possible as well as strengthening exercises to maintain this posture during everyday activities. The benefits include improved postural alignment and awareness, a more balanced body position, decreased pain, improved efficiency of breathing and increased trunk and core strength.

Is the Schroth Method a new program?

The Schroth Method was first developed by Katherina Schroth in Germany in the 1920s. In 1968, the Barcelona Scoliosis Physical Therapy School was founded, which follows the original Schroth principles, providing three-dimensional treatment based on breathing and muscle activation. Since then, it has continued to gain attention worldwide due to successful, research-supported outcomes.

Are there certain types or degrees of scoliosis that the Schroth Method is effective for?

A wide range of patients benefit from the Schroth Method. At CHOC, we aim to help patients stop the progression of their curve and avoid surgery. Treatment can also be beneficial for those who have already had surgery to improve strength and body awareness. In addition to looking at curve severity, orthopaedic doctors and Schroth-certified physical therapists will consider the patient’s age and skeletal maturity, as these three factors help indicate likelihood of progression.

What does the Schroth Method entail? Is there a typical course of sessions patients can expect?

The treatment is designed and progressed based on an individual’s specific scoliosis. It involves facilitation techniques for elongation and de-rotation of the spine in different positions, as well as exercises aimed to increase proprioception (body awareness) and strength of postural muscles.

Sessions usually include a brief proprioceptive warm-up followed by postural exercises to promote elongation and de-rotation of the spine in specific areas. Next, the patient is challenged to maintain their newly achieved postural alignment during functional activities and everyday movements, such as getting up off the floor, standing from a chair or climbing stairs.

Most individuals would benefit from attending weekly Schroth Physical Therapy for up to 12 weeks and are also expected to perform a specific home exercise program at least five days per week to achieve best outcomes.

Can the Schroth Method be used in place of traditional physical therapy? Of other scoliosis treatment?

The Schroth Method is specific to treating scoliosis, and not all physical therapists are Schroth Certified. It involves specialized treatment sessions with a physical therapist and supports collaboration with a medical team including the orthopaedic doctor, orthotist and sometimes a psychologist. The Schroth Method is often used in conjunction with bracing when recommended by an orthopaedic doctor. In some cases, it can even prevent the need for spine surgery.

What are the outcomes of Schroth Method treatment? How does it differ from outcomes of other physical therapy methods for scoliosis?

The primary outcome measure for those seeking to avoid surgery is a decrease in Cobb Angle, which is measured on X-rays. Additional outcome measures include self-postural alignment, muscle strength and endurance, balance, shoulder range of motion, height, chest circumference, functional lung volume, pain management and quality of life.

Learn about referrals to CHOC's Orthopaedic Institute

Meet Dr. Francois Lalonde

CHOC Children’s wants its referring physicians to get to know its specialists. Today, meet Dr. Francois Lalonde, a board certified pediatric orthopaedic surgeon.

Q: What is your education and training?

A: I attended medical school at University of Toronto School of Medicine. I completed my orthopaedic surgery residency at the University of Ottowa, and a pediatric internship at Montreal Children’s Hospital/McGill University. I completed a pediatric orthopaedic surgery fellowship at both Children’s Hospital of Eastern Ontario/University of Ottawa, and San Diego Children’s Hospital and Health Center/University of California San Diego.

Q: What are your current administrative appointments?

A: I am president of the CHOC Orange medical staff; medical director of the hip program, CHOC Orthopaedic Institute, member of the CHOC board; and president of Adult & Pediatric Orthopaedic Surgery medical group.

Q: How long have you been on staff at CHOC?

A: 11 years.

Q: What are your special clinical interests?

A: My clinical interests include infant, child, adolescent and young adult hip conditions (DDH, Perthes, SCFE, impingement); pediatric fractures and musculoskeletal injuries; pediatric foot conditions and reconstructive surgery; general pediatric orthopaedic conditions; limb lengthening; surgical treatment of bone deformity in osteogenesis imperfecta; and cerebral palsy.

Q: What are your most common diagnoses?

A: We see a variety of conditions, including forearm and elbow fractures; developmental dislocation of the hip in infants; Perthes disease; slipped capital femoral epiphysis (SCFE) condition of the hip; joint, extremity pain in children, adolescents (overuse, growth related); idiopathic adolescent scoliosis; among others.

Q: Are you working on any current research?

A: Yes, on Legg-Calve-Perthes research. We are looking at our five year experience with patients treated with open hip adductor lengthening, range of motion, nighttime orthosis and limited weight bearing protocol.  Our patients have maintained femoral head sphericity and containment with congruent hip joint with very limited surgery.  Many patients have been back to sports without any symptoms.

Q: What are some new programs or developments within your specialty?

A: Orthopaedic surgeons are better able to diagnose hip impingement based on radiographic and imaging assessment and depending on severity of underlying findings or condition, treat this condition with arthroscopy or surgical hip dislocation with femoral head/neck osteochondroplasty and/or acetabular rim trimming.  In doing so, we are better able to differ the onset of premature degenerative changes (arthritis) of the hip.

Advanced hip joint preservation surgical techniques such as the Ganz periacetabular ostetomy and relative femoral neck lengthening have emerged to treat the sequelae of developmental dysplasia of the hip and other childhood conditions. In the appropriate setting, these surgical techniques are able to relieve hip pain and significantly delay or prevent the onset of premature degenerative changes (arthritis) of the hip.

A modular magnetic intramedullary nail (Precise nail) is now available to allow orthopaedic surgeons to lengthen the femur or tibia by up to 8 cm in patients with moderate or large limb length inequality.  This internal device is being better tolerated by patients with less soft tissue irritation.

In addition, for several years now, the Fassier-Duval telescoping intramedullary nail has been used at CHOC to correct severe deformities of the femur and/or tibia in patients with osteogenesis imperfecta.  This modular implant which is anchored at the top and bottom telescopes as the bone grows and has helped avoid multiple revision surgeries in childhood due to migration of the implant and refracture.

Q: What would you most like community providers to know about your division at CHOC?

A: Our division covers the entire spectrum of subspecialties in pediatric orthopaedics (fractures, upper extremity, spine, hip, lower extremity, sports medicine, foot/ankle, bone tumours, neurosmuscular conditions – cerebral palsy, spina bifida, muscle disease, osteogenesis imperfecta, brachial plexus injury, concussion. We have three offices in Orange, Irvine and Mission Viejo, in addition to the CHOC Clinic. We try to see our referral patients promptly, and are accessible by phone for questions from physicians.

Q: What inspires you most about the care being delivered at CHOC?

A: I’m inspired by the expertise, drive and dedication of our physicians, nurses and support staff, as well as our state-of-the-art facility, the wide range of subspecialists within pediatrics, the emphasis on patient safety and experience, and the emphasis on delivering high level quality care to our patients.

Q: Why did you decide to become an orthopaedic surgeon? 

A: I decided to become a doctor as a teenager. I had a part-time job as a lifeguard at local pools and beaches in Ottawa, Canada, in which I was required to take first aid courses, and that piqued my interest. Later, while attending university, I worked as a children’s swim instructor and gained interest in pediatrics and pediatric orthopaedics. I became interested in orthopaedic surgery as a medical student during a pediatric orthopaedic surgery rotation when I was exposed to a great role model.

In addition, my uncle, who is an obstetrician and gynecologist, was an early role model. I often listened to him talk about his work and schedule during the summer. I used to spend the entire summer at my parents cottage in the Laurentians in Quebec, Canada.  My uncle’s cottage was right next door.  I liked the diversity of his daily routine.  His days were busy either seeing patients in his office for initial consultation or follow-up, or performing surgeries/delivering babies.

Q: If you weren’t a physician, what would you be and why?

A: I would have become a marine biologist. I became interested in this field by watching documentaries, taking biology classes, and by scuba diving.

Q: What are your hobbies/interests outside of work?

A: I enjoy playing ice hockey, as well as watching or attending all sports events.

Q: What have you learned from your patients?

A: I have learned that making funny noises when I examine babies’ hips really distracts them and elicits a smile and lets me conduct my exam more effectively and reliably. With older kids, I have learned how challenging it is to treat great athletes, who present with joint or extremity pain often from overuse, and they can find it difficult to commit to a period of rest, which is often necessary to allow for recovery.

Q: What was the funniest thing a patient told you? 

A: One of my patients keeps asking me, “Where is your gold tie?” The first time he met me I was wearing a gold tie.  Every time he sees me now, he asks me about my gold tie.  I keep asking him to call me the day before so that I can wear it on the day he comes but he keeps forgetting to call.

In the Spotlight: Jessica McMichael, M.D.

A new orthopaedic surgeon with special training in orthopaedic trauma has joined the CHOC Children’s Orthopaedic Institute team. Dr. Jessica McMichael specializes in the care and treatment of fractures and a variety of pediatric musculoskeletal disorders, including limb and foot deformities, and cerebral palsy.

Jessica McMichael, M.D.

“There is incredible talent here,” Dr. McMichael says proudly of her team. “Several of my colleagues have been amazing mentors.”

Dr. McMichael is working with the CHOC team to develop a multidisciplinary comprehensive bone health program, which would serve children with osteogenesis imperfecta, muscular dystrophy and other conditions that impact bone health.

After completing medical school and her residency at Saint Louis University School of Medicine, Dr. McMichael served as an orthopaedic surgeon in the U.S. Air Force in Korea. Later, she provided trauma care training to military personnel as an adjunct faculty at the Center for Sustainment of Trauma and Readiness Skills in St. Louis, Missouri. Dr. McMichael completed her pediatric orthopaedic surgery fellowship at Shriners Hospitals for Children Northern California/UC Davis Medical Center.

It was during her fellowship at Shriners that Dr. McMichael became captivated by her young patients’ resilience.

“It was so invigorating to take care of someone who just wanted to play and get better,” she says. “It’s like kids are programmed to do well. That helps in their care and recovery.”

A fierce advocate for families, Dr. McMichael strongly believes in treating her patients and their parents exactly how she would want herself and her family to be treated.

“I like to take the time to listen to their questions,” she explains. “I know that if they’re at the clinic or hospital, they have probably taken time from work, school or other duties, and I want to show them that their time is valuable to me.”

This dedicated physician is a board-certified orthopaedic surgeon with the American Board of Orthopaedic Surgeons. She is a member of the Pediatric Orthopaedic Society of North America, the Orthopaedic Trauma Association, and the American Academy of Orthopaedic Surgeons, among other professional organizations.

In her spare time, Dr. McMichael enjoys spending time with her husband and daughter, reading, camping, and any Disney-related activities.

To contact Dr. McMichael, please call 714-633-2111.

Learn more about the CHOC Children’s Orthopaedic Institute.

Join us May 21 for Orthopaedic Medicine: What Every Pediatrician Should Know

Education on performing routine exams on knees, back and hips; diagnosing common upper and lower extremity issues; and ways to improve the patient referral process from PCP to orthopaedic specialists are among the topics featured at an upcoming conference hosted by CHOC Children’s. We spoke with Dr. Afshin Aminian, medical director of the CHOC Children’s Orthopaedic Institute, about what guests can expect on May 21.

Q: What is the importance of the “Orthopaedic Medicine: What Every Pediatrician Should Know” conference?  

A: Orthopaedic injuries and musculoskeletal problems are common problems that our general practitioners see on a routine basis. They range from newborn hip screening exams to diagnosis of overuse athletic inures and scoliosis screening exams, among other common issues. We hope that we can partner with our attendees to provide them some valuable, interactive education so that they feel confident when facing these issues with their patients.

Q: What will attendees be able to take away from your presentation on the management of back pain and scoliosis?

A: The incidence of back pain is on the rise in adolescents, and scoliosis is very prevalent in adolescent females. Our attendees will develop an algorithm for diagnosis and management of back pain in children and be able to succesfully perform a scoliosis screening exam.

Q: What can attendees expect at the breakout sessions?

A: The break out sessions will feature hands-on training on performing musculoskeletal exams and a chance for one-on-one tutorials with the expert group leaders.

Q: When should a pediatrician refer a patient to a pediatric orthopaedic specialist? 

A: Referral guidelines will be discussed in an open forum style with audience participation and input. The referral guidelines currently on the CHOC website, will then be updated for ease of access to our referring physicians.


An internationally-recognized and sought-after expert in pediatric orthopaedics, Dr. Aminian has presented at numerous conferences and meetings in the United States and abroad. His clinical interests include scoliosis surgery, treating spinal deformities in children, and assessing surgical correction in relationship to patient outcome in radiographic parameters. Dr. Aminian is board certified in orthopaedic surgery, and is affiliated with the Pediatric Orthopedic Society of North America, the American Academy of Orthopedic Surgery and the Scoliosis Research Society.


“Orthopaedic Medicine: What Every Pediatrician Should Know” will be held on May 21, from 8 a.m. to 5 p.m., at CHOC Children’s Hospital, in the Harold Wade Education Center.

CHOC designates this live activity for a maximum of 7.25 AMA PRA Category 1 Credit™. 

Click here to register and learn more.   

In the Spotlight: Jonathan Minor, M.D.

The newest addition to the CHOC Children’s Orthopaedic Institute team, Dr. Jonathan Minor brings a unique expertise in ultrasound-guided injections and procedures, as well as diagnostic ultrasound evaluations. As a non-surgical sports medicine physician, he has a special interest in sports and dance injuries, concussion management and advanced musculoskeletal ultrasound medicine.

CHOC Children's Orthopaedic Institute

Dr. Minor’s commitment to helping young athletes stems from his own experience growing up playing sports. As an adult, he has completed multiple marathons and Ironman triathlons, including three Long Course World Championship races with Team USA.

In addition to recognizing and treating acute injuries, Dr. Minor is dedicated to preventing overuse injuries. His research has been diverse: identifying running gait mechanics related to injuries, reporting of concussions, and evidence-based approaches to joint injections. He presented original work at the 2015 American Academy of Pediatrics National Conference showing concussion reporting among high school football players remains problematic, and is trying to shed light on risk factors that may influence reporting.

Dr. Minor’s passion for sports medicine and orthopaedics was inspired by his father, an accomplished orthopaedic surgeon.

“I was moved by my dad being able to take an injury, and just like a carpenter, put it back together,” Dr. Minor said. “As a non-surgeon, I consider myself more like an architect, laying out a floor plan, and bringing together a team of providers to safely return our athletes back to the sports arena. I recognize that often there are multiple ways to solve the same problem.”

Dr. Minor attended medical school at Texas A&M University System
Health Sciences Center, College of Medicine. He completed his residency training at McLane Children’s Hospital Scott & White, followed by a non-surgical sports medicine fellowship and an additional musculoskeletal ultrasound fellowship at Boston Children’s Hospital.

During his training in Boston, he served as team physician for several collegiate and high school teams, including Northeastern University men’s and women’s basketball and soccer teams.  He also worked closely with the Boston Ballet.

Dr. Jonathan Minor

A chance to work with the expert team at CHOC eventually led him back to his native California. He was drawn to the opportunity to help grow the program. The CHOC Orthopaedic Institute plans to expand the footprint of the sports medicine program, with the addition of physical therapists, new regional physical therapy locations, and integrating injury prevention with clinical practice. The department has also added Dr. Jessica McMichael, an orthopaedic surgeon, who will help to develop an osteogenesis imperfecta program at CHOC.

Dr. Minor has quickly become an integral part of the team, treating everything from ankle and knee ligament sprains, to overuse injuries and concussions. Through the use of ultrasound-guided injections, he provides bedside visualization of body tissues, which can confirm the location of pain and assist with surgical decision-making. Classically, injections are performed blindly, with risk of poor accuracy, or with fluoroscopy, with exposure to radiation and often, increased discomfort. The ultrasound-guided injections offer a quicker recovery and can sometimes be used to avoid surgery altogether.

“While cortisone injections are not performed brazenly among pediatric patients, they can be used judiciously here at CHOC to provide cutting-edge care,” Dr. Minor explains.

He offers physicians the following guidelines on when to refer:

  • An acute injury or ankle sprain, with negative x-rays and pain after 1-2 weeks.
  • Persistence of pain despite rest, ice, compression/bracing, stretching and physical therapy.
  • Persistent joint swelling.
  • Painful popping and clicking.

Dr. Minor sees patients at CHOC Children’s Clinic; CHOC Children’s Health Center, Corona; and Adult & Pediatric Orthopaedic Specialists in Mission Viejo. To contact him, please call 949-600-8800, ext. 205.