Schroth Therapy and Bracing
Active Spine Physical Therapy recommends that adolescents with scoliosis do Schroth therapy, a physical therapy specific exercise (PSE) for scoliosis in conjunction with Cheneau -Rigo (CR) bracing. The CR brace is a scoliosis correction brace designed to work with Schroth exercises (Rigo & Jelačić, 2017). Recent studies prove that bracing is an effective way to keep scoliosis curves from progressing (Weinstein, Dolan, Wright & Dobbs, 2013). Negrini, Donzelli, Lusini, Minnella, and Zaina (2014) demonstrated that physical therapy specific exercises (PSE) and bracing were more effective in decreasing scoliosis curve Cobb angles than bracing alone. There is evidence that the CR brace was more effective in reducing scoliosis curve Cobb angles than the Boston brace (Minsk, Venuti, Daumit, & Sponseller 2017). However, the exercises must be at least 4 hours a day and the and the brace should be worn for 21.5 hours a day (Rivett, Stewart, & Potterton, 2014).
The first study that validated the use of bracing for scoliosis was done by Weinstein et al in 2013. They demonstrated that bracing either stabilized or reduced cobb angles on adolescents with scoliosis. Participants in the study were adolescents with immature skeletal development and 20 degrees to 40 degrees Cobb angle measurements of their largest curve. Seventy-two percent of 146 subjects who were braced maintained a Cobb angle of less than 50 degrees (patients with scoliosis whose curves are greater than 50 degrees are considered surgical candidates). Only 48 percent of 96 subjects who weren’t braced maintained largest curve Cobb angles of less than 50 degrees. The brace used in the study was called a Boston brace.
Negrini et al (2014) showed that bracing combined with (PSE) exercises is more effective than bracing alone. Of 73 adolescent subjects with curve Cobb angles of 30 degrees to 40 degrees, 90.4 percent had curves that didn’t progress or improved. Fifty-two percent had their curve Cobb angle’s improve. According to Negrini et al., these results were better than the results of other studies where only bracing was used.
Minsk et al. (2017) reviewed outcomes of 95 adolescents whom wore Boston braces and 13 who wore CR braces. They found that the CR brace decrease curve Cobb angles more than the Boston brace. Scoliosis is a three-dimensional spinal deformity because of the way the joints of the spine articulate. When the spine curves to one direction it also rotates to the same direction. This creates spinal prominences where the spine is rotated on one side and hollow spaces on the opposite side. The CR brace was designed to work with Schroth exercises. Schroth exercises as well as CR bracing work by exerting forces to move the convex part of the curve to the opposite side, der-rotate the curve and expand the hollow areas created by curve rotation (Rigo and Jelačić, 2017). Grant Wood of the Align clinic https://www.align-clinic.com/the-wcr-brace.html further improved the Cheneaux Rigo brace. WCR braces designed by Grant can be also be obtained at the DelBianco clinic http://www.delbiancopo.com/.
Rivett et al (2014) demonstrated that the success of Schroth therapy and scoliosis depends on how hard the patient works. In their study, 47 adolescent girls with largest curve Cobb angles that ranged from 20 to 50 degrees wore braces for either 12 hours a day or 21.5 hours a day and did PSE exercises for either 4 days a week or 1.7 days a week. The subjects who wore the CR brace for 21.5 hours a day and who exercised 4 days a week had decreased major curve Cobb angles. However, Cobb angles increased in those subjects who wore CR braces 12 hours a day and exercised 1.7 hours a week.
Recent studies demonstrated that bracing and PSE together can stabilize or decrease scoliosis Cobb angles in adolescents. Active Spine Physical Therapy uses Schroth Therapy as taught in Germany and recommends the WCR brace in conjunction with Schroth to get the best possible outcome from a non- surgical intervention for adolescent idiopathic scoliosis.
References:
Minsk, M. K., Venuti, K. D., Daumit, G. L., & Sponseller, P. D. (2017). Effectiveness of the Rigo Chêneau versus Boston-style orthoses for adolescent idiopathic scoliosis: a retrospective study. Scoliosis and spinal disorders, 12, 7. https://doi.org/10.1186/s13013-017-0117-z
Negrini, S., Donzelli, S., Lusini, M., Minnella, S., & Zaina, F. (2014). The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study. BMC musculoskeletal disorders, 15, 263. https://doi.org/10.1186/1471-2474-15-263
Rigo, M., & Jelačić, M. (2017). Brace technology thematic series: the 3D Rigo Chêneau-type brace. Scoliosis and spinal disorders, 12, 10. https://doi.org/10.1186/s13013-017-0114-2
Rivett, L., Stewart, A., & Potterton, J. (2014). The effect of compliance to a Rigo System Cheneau brace and a specific exercise programme on idiopathic scoliosis curvature: a comparative study: SOSORT 2014 award winner. Scoliosis, 9, 5. https://doi.org/10.1186/1748-7161-9-5
Weinstein, S. L., Dolan, L. A., Wright, J. G., & Dobbs, M. B. (2013). Effects of bracing in adolescents with idiopathic scoliosis. The New England journal of medicine, 369(16), 1512–1521. https://doi.org/10.1056/NEJMoa1307337