Ok, I know what you’re thinking…I’m going to try to sell you some crazy contraption, similar to the waist trainers that the Kardashians use and promote, and even make some grandiose promise about body transformation that sounds too good to be true…
Not quite, although torso re-shaping can seem pretty magical.
Torso re-shaping is a goal of conservative care in both juvenile and adolescent idiopathic scoliosis. Because this population is skeletally immature (i.e. they are still growing), their bodies – bones, joints, soft tissues – are highly malleable. I liken their bodies to clay that can be molded and shaped into a new form using customized bracing and scoliosis-specific exercises.
Let’s introduce one of our current patients to dive into this further. Meet Stephanie. She came to us in May of 2022. She was 12 years old and had just been diagnosed with adolescent idiopathic scoliosis. She had not yet had her first menarche.
Sidenote: this is a very important piece of information when making clinical decisions about scoliosis care. Girls who have not yet had menarche have a lot of growth ahead of them and are therefore more susceptible to scoliosis progression. Any female who is pre-menarchal with a curve greater than 25 degrees should be braced immediately.
Back to Stephanie. Her lumbar (lower) curve measured 27 degrees and her thoracic (upper) curve measured 17 degrees. She had been prescribed a full-time (i.e. 21 hours per day) Rigo Cheneau style brace but had yet to receive it.
This is what her torso looked like in May 2022, the day we first evaluated her.
In this picture, you can see:
- Her right shoulder is higher
- Her hips are traveling to the right (we call this a pelvis shift)
- She’s leaning to the left
- The left half of her torso is “greater” than the right half of her torso when divided in half starting from the center of the sacrum (we call this a trunk asymmetry)
This is a torso that is prime for re-shaping. The tools needed are a customized corrective brace, and scoliosis-specific exercises, also known as the Schroth Method.
Stephanie received her Rigo Cheneau brace in June 2022 and began wearing it 22 hours per day, an additional hour more than prescribed. It only came off for showering and exercise. She began attending weekly Schroth Physical Therapy appointments and did the prescribed exercises at home at least 5 times per week for at least 20 minutes. She works hard and continues to do so to this day. She even somehow has time to star in her school theater production!
Stephanie is a model patient. She is compliant with what is being asked of her, which is not easy. Because of this extreme compliance, her torso has already transformed in just 9 months. We recently re-evaluated her in early February of 2023. These re-evaluations are common practice to allow the patients (and their parents) see the results of the hard work being done.
Astonishingly, you can now see:
- Her shoulders are level
- Her hips are no longer traveling to the right
- She is no longer leaning to the left
- The left and the right halves of her trunk are now symmetrical
And the kicker? Her curves are currently measuring 24 degrees in the lumbar and 22 degrees in the thoracic. That’s right, while the lumbar curve is slightly better, the thoracic curve is actually worse than it was in May 2022 (this is simply due to the progressive nature of scoliosis – it would likely have gotten much worse without a brace). But her overall torso shape is dramatically better, and this is what matters, and not just esthetically.
The importance of symmetry and alignment in the body cannot be understated. Even patients with large curves, say 40 degrees, can live a normal and pain-free life if they stay aligned and symmetrical. Most problems and pain start to occur due to malalignments and asymmetries.
Much credit in Stephanie’s case is due to the top-notch team of orthotists at National Scoliosis Center (NSC) who made her brace and continue to adjust it to achieve maximum curve correction.
Braces are worn for 21 hours per day. Exercises are done for 20 minutes per day. When patients ask me if they can just “do the exercises” instead of wearing the brace, I sigh and say “I wish, but it doesn’t work that way.” Bracing is number 1. The Schroth method is incredibly supportive of the bracing, meant to activate muscles that the brace is passively “holding”, but it’s not the end all and be all.
We think the marriage of bracing and scoliosis-specific physical therapy yields the most optimal results. We work closely with the orthotists at NSC to provide comprehensive, conservative scoliosis care.
Now, for the money shot…the side-by-side “before and after” photos that everyone wants to see. Hours and hours of bracing and exercise went into achieving this outcome, but it shows us that under the right conditions, this “magical” concept of torso re-shaping can and will happen.
