Price Transparency
Physical Therapy Treatment for Scoliosis

Physical Therapy Treatment for Scoliosis

by | Oct 29, 2019 | Therapy Services

Scoliosis is one of the most common pediatric conditions our experts treat and presents very differently depending on the patient. Our team is committed to providing the best possible care to each child, making sure that the treatment plan helps get them back to doing what they love.

Scoliosis specific exercise (SSE) is a treatment provided by a trained physical therapist. Several of our physical therapists have completed extensive training in one approach called the Schroth method. A child will be evaluated by one of our pediatric orthopedic spine specialists to diagnose the type and magnitude of their curve. For many patients, a physical therapist will teach proper form for the exercises and progress the movements over time. 

Like other SSE, the Scroth method lengthens muscles and ligaments to increase mobility, activates and strengthens muscles, improves resting posture and teaches how to perform daily movements in improved posture. Benefits of Schroth method include:

  • Improves pain
  • Prevent/limits curve progression
  • Improves lung capacity

Important information about the Schroth method:

  • Most effective for children who are still growing.
  • It can serve as a stand-alone treatment, but is also used in conjunction with other care, such as bracing.

Courtney Warren, a physical therapist at our Frisco campus, says that it is very rewarding to hear patients report that their work is paying off when dance instructors and coaches notice their ability to perform activities in a new posture.

Learn more about the care and treatment of scoliosis.

Get to Know our SRH Staff: Daniel Stokes, Physical Therapy

Get to Know our SRH Staff: Daniel Stokes, Physical Therapy

by | Jul 2, 2019 | Spotlight

What is your role at the hospital? What do you do on a daily basis? 
I am a sports physical therapist. I assess, examine, plan and treat athletes. Most of my time is used looking at movement proficiency to make sure an athlete is moving well. I will typically differentiate movement into two categories: dysfunctional/functional and painful/non-painful patterns. I will then breakout these movement patterns to find the cause of the issue that the athlete is dealing with. This allows me to focus on the cause, and not just the symptoms.
 
Because of my interest in golf, I have completed special training with Titleist Performance Institute. With a TPI Medical Certification, I have enhanced my expertise as a physical therapist with a solid understanding of the mechanics of a golf swing. I also enjoy evaluating and working with baseball players.
 
What led you to Texas Scottish Rite Hospital for Children? How long have you worked here?
I have worked at the hospital for two years. Prior to physical therapy school, I worked in sports performance as a certified strength and conditioning specialist. I knew I wanted to work with athletes and the values of the hospital really aligned with mine. Another physical therapist, Lorenzo Vite, brought me on and shared that the sports medicine team was expanding with the addition of the Frisco location. Having the opportunity to be mentored by Lorenzo, plus the opportunity to put patients first, has been incredibly fulfilling.
 
What do you enjoy most about Texas Scottish Rite Hospital for Children?
Pediatric sports physical therapy is rewarding and fun. Being able to work with athletes, no matter their background, is truly a special opportunity. I have the chance to influence young athletes and, in some cases, I will spend up to 24 weeks with them while in rehabilitation. Over time, we develop trust and a strong relationship. The best part of my job is when a patient states that he or she feels better and stronger than before their injury. That means I did my job. I want them to return to their sport with confidence. To sum it up, being able to impact the life of an athlete, long past their injury, is what I enjoy most about working for the hospital.
What was your first job? What path did you take to become a PT?
After receiving my degree in kinesiology from West Texas A&M University (go Buffs!), my first job was an internship in strength and conditioning at Texas Christian University. This led to a graduate assistant position in strength and conditioning for two years at the University of Texas at Arlington. There, I trained athletes in men’s golf, tennis, volleyball, basketball, track & field, softball and baseball. I also received my master’s degree in exercise physiology. 

From there, I worked at an elite training facility in North Texas working with youth, college and professional athletes, as well as some Olympic athletes and teams. At this facility, I met Lorenzo Vite, who is currently our senior physical therapist at Scottish Rite for Children. He made a huge impact in my decision to change careers and pursue a doctorate in physical therapy and I am grateful for his influence.

What do you like to do in your spare time?
Lots of family time with my wife of nine years, Bethany, and our two little girls, Lucy and Stella. We have two dogs, Bear and Reagan. We are very involved with Citizens Church and when time allows, I enjoy playing golf and cooking out with the neighbors.

What would you do (for a career) if you weren’t doing this?
I love my job. I would still choose to work in the golf industry, working on golf performance, biomechanics and injury prevention.

Where is your favorite golf course? Where do you want to play some day?
My favorite golf course right now is The Outlaw golf course in New Mexico. I spend most of my time playing at Westridge Golf Course in McKinney, Texas. Dream course would be at Pebble Beach Golf Links in California.

Are you a golfer? Learn more from Daniel on how to warm up the RITE way.

Speak Now for Kids: Physical Therapy Month with Emmitt

Speak Now for Kids: Physical Therapy Month with Emmitt

by | Oct 11, 2018 | Hip Disorders, Press Coverage

View the original story on the Speak Now for Kids website here.

October is National Physical Therapy Month, and we invite you to read about our amazing little patients who have benefited from physical therapy services at our children’s hospitals. Today’s blog is about Emmitt from Texas Scottish Rite Hospital for Children!

Three-year old Emmitt got off to a rocky start. While he was in the utero he was positioned head up ―or breach― instead of head down. As a result, his hips were unable to develop correctly, and he was born with hip dysplasia― an unstable joint dislocation where the upper leg bone does not sit properly in the hip socket.

In an effort to treat the dysplasia, Dr. Rathjen first placed Emmitt in a detachable brace, however the family was soon told that surgery was inevitable. In preparation for the procedure, Emmitt’s legs were wrapped and stretched. This photo was taken at one of the pre-op stretch sessions.

At seven-months-old, Emmitt had his surgery. All went well, but afterwards he spent almost three months in a body cast that extended from his chest to his ankles. “The cast made everything challenging,” says Emmitt’s mother Jennifer. “We had to make adjustments to the way he rode in his car seat, the way he sat down, the way he got his diaper changed, and the way he was held. We are thankful to the extended McMurry family who really came together and also to Dr. Rathjen and the wonderful staff at Scottish Rite Hospital that took care of Emmitt as if he were one of their own.”

When at last the cast was taken off, Emmitt learned to walk in almost no time and―like any little boy―was into everything. “I couldn’t be more grateful for my child being able to run, walk and play like any other healthy two-year-old child,” states Jennifer.

Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis

by | Jun 18, 2018 | Scoliosis & Spine

Article originally published by staff orthopedist Amy L. McIntosh, M.D., in first quarter, 2018 issue of Pediatric Society of Greater Dallas newsletter. 
What is scoliosis?
Scoliosis is a rotation in the spinal column that creates a “C”-shaped single curve or an “S”-shaped double curve, when viewed from behind (Figure 1). Some cases worsen with time and can result in serious problems such as abnormal appearance in posture, increasing back pain as one ages, and in the worst cases, interference with heart and lung function. Idiopathic (no underlying cause) scoliosis occurs in 2 to 3% of the adolescent population, usually affecting young people between the ages of 10 to 16. Scoliosis onset is usually earlier in girls than in boys—generally, ages 10 to 14 for girls and 12 to 16 for boys.


Figure 1

When should I screen patients for adolescent idiopathic scoliosis (AIS)?
Scoliosis screening is designed to identify adolescents with abnormal spinal curvature. Screening can detect scoliosis at an early stage, when the curve is mild. Most curves can be treated without surgery if detected before becoming too severe. Therefore, early detection is the key to controlling spinal deformities. Ideally, spinal screening should be conducted as a part of the annual examination for females at age 10 and 12 years, and males once at age 13 or 14 years. Signs to watch for include (see Figure 2):

  • One shoulder higher than the other. One shoulder blade higher or more prominent than the other
  • One hip higher than the other.
  • Space between arms and body greater on one side.
  • Leaning to one side.
  • Head not centered directly above the pelvis.
  • When bending forward, thoracic rib prominence or lumbar fullness that is asymmetric to the opposite side. (+ Adams forward bend test) (Figure 3)​

If any of these signs are present, then the child should be referred to a pediatric orthopedic surgeon. Texas Scottish Rite Hospital for Children has a low dose X-ray machine (EOS) that obtains high quality images with significantly less radiation exposure to the patient. For that reason, please do not obtain X-rays. Just refer the patient if clinical signs of scoliosis are apparent on physical exam. The orthopedic surgeon will obtain standing, full length (posterior-anterior and lateral) spine X-rays to measure the cobb angle in both the frontal and sagittal planes. The Cobb angle measurement and the skeletal maturity of the child will determine the treatment.
What are the treatment options for AIS?
Observation:
Routine rescreening or observation by the physician is a form of treatment for mild curves (11-20 degrees). This observation period consists of regular clinical exams and spine X-rays throughout the rapid growth years of adolescence until the spine is mature. It is important to note that more than 90 percent of patients with scoliosis require no treatment other than observation. 

Brace: 
For curves greater than 20 degrees in patients that are still growing rapidly, a brace is prescribed. The brace can prevent the curve from progressing and may eliminate the need for spinal surgery. However, the brace cannot correct the curve that already exists. Bracing is generally recommended for curves between 20 to 40 degrees in adolescent patients with significant growth remaining. The main factor in achieving a high rate of bracing success is the number of hours a day that the brace is worn. Various spinal orthoses are available, with the most common being a Thoracolumbo Sacral Orthosis (TLSO). The TLSO is named by the areas it is designed to stabilize: the thoracic, lumbar and sacral parts of the spine. It is cosmetically acceptable as it can be covered well by clothing. Wearing a brace is not an easy treatment for an adolescent. Even covered by clothing, it is hot, hard and can make the student feel self-conscious. Getting into a daily routine of wearing the brace while participating in activities helps with compliance, which is key to successful treatment.

Surgery: 
Some patients present with severe spinal deformity, and other patients scoliosis worsens despite compliant brace wear.  In these specific patients, surgery can reduce a portion of the curve and prevent it from increasing in the future. Usually, surgery is reserved for adolescents and pre-adolescents who already have a curve of 45 to 50 degrees or more. The most common surgical procedure is a posterior spinal fusion with instrumentation and bone graft.

This type of surgery involves attaching rods to the spinal column to help straighten it. The bone graft between the affected vertebrae encourages fusion to prevent further progression of the curve. Instrumentation refers to the various rods, screws, hooks or wires that are used to hold the spine in the corrected position while the bone fusion occurs. The instrumentation is rarely removed. Following surgery, the fused section is no longer flexible. The average hospital stay is about two to three days, and the student can usually return to school in approximately four weeks. During the first six months after surgery, some limits will be placed on strenuous physical activity. After this healing phase, the surgeon will usually release the patient for all activities, including competitive, low-contact sports.
Does physical therapy help treat scoliosis?
The Schroth method is a nonsurgical option for scoliosis treatment. It uses exercises customized for each patient to return the curved spine to a more natural position. The goal of Schroth exercises is to de-rotate, elongate and stabilize the spine in a three-dimensional plane. This is achieved through physical therapy that focuses on:

  • Restoring muscular symmetry and alignment of posture
  • Breathing into the concave side of the body
  • Teaching you to be aware of your posture

This approach to scoliosis treatment was developed by Katharina Schroth and further popularized by her daughter Christa. Born in Germany in the late 1800s, Katharina Schroth had scoliosis that was unsuccessfully treated with bracing. She developed her own breathing technique and exercises to manage her scoliosis. She and her daughter opened a clinic, where they treated more than 150 patients at a time.
A Schroth-trained physical therapist or specialist should guide you in learning this program. The duration of this treatment varies and the patient is expected to continue exercises at home to keep scoliosis in check.

Scottish Rite Hospital is currently investigating the use of Schroth physical therapy alone and combined with brace treatment for patients with mild scoliotic curves.

Print the PDF

Physical Therapy: Helping Patients Make a Full Recovery

Physical Therapy: Helping Patients Make a Full Recovery

by | Dec 5, 2017 | General News

At Texas Scottish Rite Hospital for Children, our doctors, nurses and therapists provide the best possible care throughout each stage of treatment. The hospital’s physical therapy department is committed to helping a child improve their movement and function so they can make a full recovery. We received a behind-the-scenes look of the department to learn more about the great work of our trained physical therapists and the services they provide our patients. 

What are the various services the PT department provides our patients?

  • Individualized therapy plan
  • Provides patient education regarding exercises and stretches specific to the patient’s needs.
  • Teaches patients how to do various activities in a safe way depending on their condition.

How does PT help our prosthetics/orthotics patients?

  • Physical therapists work with these patients to make sure the prosthesis fits and aligns properly for the patient.
  • Teach patients how to move and use the prosthesis.
  • Work with patients who have changes to their prosthetic or orthotic.
  • Introducing a controlled fall: working with patients on getting up from a fall independently and safely.

Working with the hospital’s inpatients:

  • Strengthening patients’ function after surgery.
  • Implements a plan of care for each patient depending on their condition or injury.
  • Teaches correct way to use crutches and a wheelchair.
  • Educates patient and family about therapy once discharged from the hospital.

Other services provided by the PT department:

  • Clubfoot treatment – stretches the foot to place in correct position.
  • Process of taping for clubfoot treatment:
    • Tape is used to position the foot in the correct position.
    • Splint is then molded to fit the foot to keep in the correct position for treatment.
  • Casting:
    • Treatment for patients who walk on their toes.
    • Treatment for correcting clubfoot.

Watch the physical therapy tour to learn more about the services this department provides for our patients.