Case Study One
Main Issue: Postural Pain and Appearance
Female adult patient, in her 50’s, presented with pain corresponding to poor posture, struggling to work as a pharmacist owner with a normally very active lifestyle including Pilates and exercise classes. Unable to tolerate many exercise positions due to aggravating back pain. Initial cobb angles were 45 and 62 degrees.
Patient desperately needing a solution to pain, other than pain killers or fusion surgery and also asking for guidance on how to improve her posture with more specific exercises.
Aim: to reduce pain and improve posture to avoid progression of curves through life.
Treatment: Bespoke (3D Gensingen Cheneau assymetrical) brace with postural element included in design and individual Schroth home program. Patient was given 3-4 exercises to complete at home 5 times per week for 30 mins, initially twice per day. This reduced to 15 mins and to 10 mins after the first 3 and then 6 months. Reviews with orthotist and physio team every 3 to 6 months for 2 years.
Result: Pain free with an occasional discomfort when over-working. Brace only worn for short period of working day. Schroth program reduced to 10 mins x 4 weekly and regular core stability and Pilates resumed. Posture improved – pelvis more central and rotation (prominent areas seen in forward bending position) reduced and an overall improvement in balance, which should help prevent any progression of the 3D deformity. Cobb angles are unlikely to change in adults as growth is complete, therefore angle of bones are not likely to change significantly, but the X-ray was much more balanced with less lateral shift of the curve or the pelvis. Aims achieved and patient very pleased with improvements and being able to continue to work.
Case Study Two
Patient with around 40-degree cobb angle
Female teenage patient with around 40-degree cobb angle, presented at age 14 post puberty (12 months after periods started). Patient and parents main concern was to avoid surgery. Patient had no pain or reported issues with appearance but was happy to try a combination of brace and Schroth therapy as her curve was too high for Schroth exercises alone to reduce the cobb angle enough in growth to avoid the surgery.
Treatment: Bespoke 3D cheneau asymmetrical Gensingen brace, with Schroth Best Practice home program. Patient was given a 30 min home program to complete either 30 mins per day or 40 mins 5 times per week. This was reduced to 10 mins, 3 times per week after 4 months. Reviews every 3 to 6 months. New brace supplied after growth was substantial enough. And patient was able to stop Schroth exercises and continue to cross trainer and normal aerobic exercise.
Outcome: Cobb angle has been reduced from 41 and 30-degree curves to 30 and 22-degree curves. Posture normalised within 3-4 months, therefore physio monitoring patient only. Patient still having to wear brace full time, but reports it is less of an issue as she is used to it, team plan is to reduce the time in brace within the next 3-6 months as body matures. Then she can reduce to only wearing this at home and reduce further to only wearing this at night until complete maturity. Aims achieved – avoidance of surgery (now not near surgical levels of cobb angle) and improvement of appearance.
Case Study Three
Patient with around 37 degrees cobb angle
Female teenage patient with around 37 degrees cobb angle, presented at age 11, pre-puberty. Patient and parents both wanting to avoid surgery. Patient had no pain or reported issues with appearance. Patient very happy to try the combination of brace and therapy as the curve was significant and patient was in a period of fast growth, which increased her chances this would worsen, but also provided her with the opportunity to improve the angle with joint brace and therapy treatment.
Treatment: Bespoke 3D cheneau asymmetrical Gensingen brace, with Schroth Best Practice home program. Patient was given a 30 min home program to complete either 30 mins per day or 40 mins 5 times per week. This was reduced to 10 mins x 3 weekly within 3-4 months. Patient was very active so she ensured she was involved in sports at least 3 times per week.
Outcome: Cobb angle reduced from 37 degrees to 15 degrees. Second brace was provided and patient continues in full time. Patient likely to go to part time bracing once maturity has been reached – likely within 3-6 months. Posture has normalised therefore specific exercises have stopped as patient keeps herself active but continues with sports. Goal achieved – avoidance of surgery (now not near surgical levels of cobb angle) and now part time brace wear in later adolescence in order to hold the cobb angle until more complete growth.
Case Study Four
Patients initial cobb angle was 38 and 35 degrees
Male patient aged 16 when presenting in clinic. Patients initial cobb angle was 38 and 35 degrees. He and mum wanted him to avoid back pain and surgery. He didn’t have an active lifestyle but was open to exercising to normalise his waist and abdominal alignment and started to gym activities later in treatment to tone up and to avoid worsening of his improvements. Patient reluctant about bracing, but was pleased to see a small compact brace (due to his curve being a main lower curve). He was also reluctant to exercise but also managed to complete the home program well, he could visually see the improvements in the postural issues he reported.
Treatment: Full time brace treatment for 12 months and part time for 6 months. Schroth exercise home program for 3 months, reducing to 10 mins of Schroth x 3 weekly for 3 months, before returning to an active lifestyle.
Outcome: Cobb angle improved to 31 and 33 degrees. Posture normalised and back pain resolved. Surgical intervention not needed and patient pleased with appearance and night time only bracing.
Case Study Five
Schroth Home exercise program ONLY
Young juvenile female (age 8) with 19 degrees cobb angle. Mum has scoliosis and had fusion and tolerates pain, family desperate to avoid this for this young patient. Patient very fit, enjoys gymnastics and karate. Patient very motivated to complete exercises and avoid bracing and surgery.
Treatment: Postural advice for school-work and play. Individualised Schroth Home exercise program 40 mins daily (4 exercises which varied depending upon postural changes). Monitoring every 2-3 months. Low dose X-rays every 3-6 months.
Outcome: Cobb angle reduced to 6 degrees. Posture normalised. Patient completes 10 min program x 4 per week and remains very active in sports and gym. Aims achieved – No brace or surgery needed. 3 years later cobb angle now improved and has not progressed.
Case Study Six
Patient with 35-degree cobb angle
A 15-year-old female, post puberty (more than 24 months after periods started) presented with 35-degree cobb angle. Patient very active, wanted to improve posture (especially the rotation ‘rib hump’ under right shoulder blade) and reduce pain, she would never consider surgery.
Treatment: Individual Schroth Home exercise program. 40 mins completed daily. (4 exercises changing as needed for postural issues) Postural advice given. Monthly reviews with Schroth physiotherapist.
Outcome: Improvements in appearance seen at each review, plateau at 4 months. Patient has normalised posture and therefore can return to active gym work and aerobic classes. Rotation within normal ranges and therefore ‘rib hump’ not noticeable. Pain resolved. Patient is pleased with the results.
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