Specialized PT can freeze scoliosis in its place

By Maureen Gilmer, Riley Children’s Health senior writer, mgilmer1@iuhealth.org

Brynn Rittman is just 13, but at 5-foot-8, she’s growing up fast. While she and her older brother might not reach their dad’s height of 6-3, it’s definitely a competition to see who gets closest.

An eighth-grader, Brynn plays softball, volleyball and basketball, with soccer and swimming mixed in for good measure.

Otherwise healthy, the Indianapolis girl started noticing that she stood a little crooked when she looked in the mirror. Her tops didn’t fit quite right either.

It was a trip to the pediatrician last fall that led her parents, Mike and Brittany, to take her to a specialist for a scoliosis screening. Sure enough, X-rays showed the teen had varying degrees of curves in her spine, leading to uneven shoulders and pain.

While scoliosis, which affects 2% to 3% of the population, can appear in infancy or result from other conditions including cerebral palsy, Brynn’s is considered idiopathic, meaning there is no known cause.

Fortunately for her, she is taking advantage of a specialized form of physical therapy at Riley Children’s Health designed to freeze – and even correct – her curve before it gets worse, avoiding the need for more invasive treatment, including surgery.

“We have many cases where we actually start to straighten and correct the spine, but to set realistic expectations I always tell my patients the number one goal is to freeze it, because scoliosis is a progressive condition,” explained Brittney Galos, a Riley physical therapist trained in the Schroth Method.

Schroth, named for a German woman who had scoliosis herself in the early 1900s, 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.

That’s what Brynn is working on during weekly therapy sessions at Riley, where Galos coaches her through multiple stretching, rotating and breathing exercises, all designed to address her specific spine curves.

“This is pretty much my social hour,” Brynn said, despite the work she puts in. “Me and Brittney are besties.”

But the therapy doesn’t end at Riley. Brynn goes home with a binder packed with information and exercises that she is to work on between appointments.

That buy-in from kids and their parents is crucial, said Galos, who is determined to broaden awareness of the benefits of the Schroth Method for some patients in hopes that pediatricians and other medical professionals and parents know that it can help.

“Most of my kids’ curves show up just prior to and into puberty, and usually identification is slow,” she said. “Our goal is to get to these girls (females are disproportionately more likely to have scoliosis), apply these exercises and stretches and get that curve to pause in its tracks. We know if we can keep a curve under 30 degrees by the time a kiddo is done growing, it won’t advance the rest of their life.”

Brynn has three curves that range from about 20 to 36 degrees, and that makes her eligible for this kind of physical therapy. For perspective, anything below a 10-degree curve is considered normal, Galos said, while anything above 45-50 likely would require more aggressive treatment, up to and including surgery.

It’s been about three months since Brynn started therapy, in addition to wearing a brace, and she’s already grown an inch, said her dad as he watched his daughter go through the exercises under Galos’ careful eye.

“When you find out your kid has scoliosis, you’re combing the Internet … everyone’s got a different opinion,” he said.

He and his wife initially struggled with the decision to put Brynn in a brace in addition to seeking out therapy. Different doctors, different ideas.

“But Brittney (Galos) deals with scoliosis all day every day, and she said absolutely she should wear a brace,” he said, adding that it was a relief to be assured of the right path forward.

Education surrounding scoliosis is not what it should be – whether in medical school or physical therapy school, Galos said.

“Our training in PT for scoliosis is like two slides with the most horrific curves.”

So, when a provider identifies a milder curve, they might be inclined to take a wait-and-see approach, not knowing that therapy is an option, Galos said.

Unfortunately, that sometimes means by the time they get to her, their curves are already near surgical level, “and then we’re trying to play catch-up and it’s a lot harder.”

“The worst feeling is when a kid comes in, the parents did all the work to get here, and the curve is already 45 degrees and it’s often too late. It’s not impossible, but it’s not easy. There is no room for error.”

Of the 20 to 30 patients she sees each week, about half are kids who are receiving treatment using the Schrock method, and most come to her between the ages of 11 and 14.

For Brynn, the therapist said, her No. 1 goal is to keep her in the 30-degree range until she’s done growing, which for most kids is about two years after they hit puberty.

While it’s common for medical professionals to try to stay in their own lane, Galos said she tries to bridge that gap by educating her peers about the benefits of physical therapy in some cases.

“I think every kiddo has their own story and their own needs, and even the same curve might need two different things depending on the kid.”

Photos submitted and by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org