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

Physical Therapy’s Role in Wound Care

By Ruchi Bagrodia, physical therapist at CHOC Children’s

Did you know that the physical therapy team provides wound care for the kids at CHOC Children’s?

Part of their scope of practice, both physical therapists and physical therapist assistants complete coursework in wound management during their higher level education. Several PTs and PTAs at CHOC have received specialized training in wound care and many have gone on to receive board certifications in wound care. With this training, a therapist is able to evaluate wounds, decide on the best treatment, and create a comprehensive wound care plan in collaboration with the patient, family, and medical team.

Physical therapists are able to use their expert knowledge of anatomy, tissue healing, movement and positioning to develop an individualized plan of care that also aims to improve movement and function. Successful wound healing may allow a child to more quickly return to school, participate in gym class and enjoy a summer trip to the beach with their family.  The ultimate goal of physical therapy is to restore function and allow people to get back to the things they love doing!

How do PTs provide wound care at CHOC?

At CHOC, PTs and PTAs provide wound care services for kids on both an inpatient and outpatient basis. During an evaluation, a PT will decide how to best clean, dress, and protect the child’s wound, and also provide recommendations to the parent to encourage wound healing and to prevent complications.

Here are some tips to share with patients’s families when caring for their own minor wounds or skin injuries at home:

  • Keep dried scabs moist using a healing ointment or petroleum jelly for faster healing time. While it may be challenging, try your best not to pick at scabs!
  • If a wound is open (appearing wet, bleeding or draining liquid), cover it with some type of bandage. Leaving it open to air will increase the risk of infection.
  • Common signs of infection include redness, swelling, pain and warmth. Call your doctor if you notice an increase in signs of infection that are not already being treated.
  • When using over-the-counter antibiotic ointments for minor cuts and scrapes make sure to follow the dosage instructions. It is not recommended to use many of these ointments for more than seven days unless stated by your doctor. Many people have allergic reactions to triple antibiotic ointments. If you notice a wound is getting worse with an ointment, stop using it and talk to a health care professional.
  • Hydrogen peroxide and rubbing alcohol are commonly used to clean wounds, although both are damaging to your healthy skin cells. Instead, simply use mild soap and water to clean a cut or scrape.
  • Different types of sandals, shoes, plus foot and ankle braces can all cause areas of redness caused by too much pressure to the skin. If the redness does not go away after 15 minutes upon removing the pressure, the fit needs to be modified to avoid further injury to the skin.
  • Nutrition makes a difference in wound healing! Incorporate foods that are high in protein, Vitamins A and C, and Zinc into your diet to help with healing. Learn more by visiting ChooseMyPlate.gov for tips on how to create a balanced diet.

 

Olympic Medalist Turned Physical Therapist

When athletes of any caliber come to physical therapy appointments, they often struggle with emotional hurdles as big as their physical challenges. Working with an expert who understands their struggles can make it easier to cope, especially when that expert is a former Olympian.

Robin Beauregard, a physical therapist at CHOC Children’s and two-time Olympic medalist in women’s water polo, understands the physical challenges that can sometimes stand in the way of achieving athletic goals.

“Having a career in athletics helps me establish a rapport with my patients, particularly my history with sustaining and overcoming injuries,” she says. “Sincere empathy creates a stronger bond than sympathy.”

Shortly before the team was named for the Sydney Olympics in 2000, the first time women’s water polo was to be recognized as an Olympic sport, Beauregard dislocated her knee and didn’t know if a recovery was possible. Distraught but determined, she committed fully to her physical therapy plan, as well as a rigorous conditioning program, and made the team. They’d win a silver medal that year, and a bronze four years later. She was later inducted into the USA Water Polo Hall of Fame.

Beauregard’s experience with physical therapy in the midst of her Olympic career ultimately played a big role in her professional career.

“I was not the perfect patient, but it prepared me for being a physical therapist because it gave me an idea of asking only what is reasonable of my teen and young adult patients,” she says. “I really do understand their worry of not being able to get back to the top level in their sport, but also weighing the risks of not wanting to cause further or permanent injury.”

Growing up in Southern California, Beauregard loved to be outdoors and was always active. Having an older brother who was also athletic made her competitive, too. She started swimming competitively for a local club team on her fourth birthday simply because her brother swam, and she wanted to be as a good as he was. Water polo came into play just four years later, and by age 8 she joined a competitive club team.

But when she got to high school, there was no girls’ varsity team. Instead of giving up on her passion, she simply joined the boys’ team instead. Playing with the boys didn’t faze her, or them, since they’d been competing together for almost a decade by that point. When opponents made comments about playing with a girl, she channeled it into her game and used it as fuel to play even harder.

After high school, she attended UCLA to play water polo, and originally planned on becoming an orthopedic surgeon. She later changed her path to physical therapy, which would ultimately give her a different kind of interaction with patients and athletes.