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livingtwisted

“The scoliosis saga”

Tag Archives: Schroth Method

January 27, 2011 A Week in the Brace

Today I had my one week follow up with the orthotist, Gez. The week of bracing started out pretty rough, but it got easier quickly. The pressure point pain got a lot better and I’m able to contract the convex side to pull it away from the brace. I can definitely see and feel differences in my back already, and my husband, the skeptic, sees it too. I realize this doesn’t mean its permanent, but at least there’s hope for someone at the old age of 30. Seeing the results makes the pain more bearable.

Gez seemed to be pretty encouraged too. He said my back had loosened up a lot and he tightened the top strap a good two inches, which is encouraging, but it also means I have to start all over in terms of adjusting to the pain. I was hoping he would say he could shorten the extension on my right hip, but he thinks its adding leverage that is helping and wants to keep it, at least for now. Hopefully at least tightening it will keep things in the right place so it doesn’t rotate so much and jab me in the wrong places.

The hardest part of it though is the breathing. I still get winded and tired very easily in it. And Gez said that wouldn’t get better for a long time, if at all. He said my husband can massage the concave side to stimulate movement, but I’m hoping Beatriz will have some advice too. I’d like to start walking the dogs while wearing it to get a little exercise, but right now I don’t think I would make it back up our hill. But I’m not too worried about sleeping in it because already I’ve found my breath getting shallower if I get comfortable on the couch, and the next thing I know I’m asleep.

Well I’ll have another follow up with Gez in two weeks. I’m supposed to get up to 6 hours this weekend, and then start sleeping in it too. I ordered a 3 inch memory foam topper for the bed because the mattress is pretty hard so hopefully it will arrive in time. And he said after another week, I should try tightening the straps a little more. Yikes!

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January 25, 2011 Schroth by the Book

I’ve finally had time to make it through the Schroth Textbook. I can’t say I read it cover to cover, but I read everything that pertains to my particular brand of scoliosis. I don’t feel comfortable selecting specific exercises and training myself on them. But the book did give me a better overall understanding of the general principles and approach. What I found most interesting is that on a very stripped down level there is a pattern to the Schroth method that is very similar to that in the CLEAR method. The specifics of the treatment are different but the three key phases that CLEAR focuses on and uses to market their treatment are also present in Schroth…

Schroth vs. CLEAR

  1. lengthening / mobilization vs. Mix
  2. shaping exercises vs. Fix
  3. isometric strengthening vs. Set

This makes a lot of sense to me and I’m excited to learn more, but what I found most helpful for the present were some general guidelines for daily life. These are much easier to put into practice right away and I’m really glad to have a set of rules to follow instead of making up what I think is good or bad for me. Here is a list of things I am trying to stick to.

  • Never lie on my rib hump (right) side. Even with a pillow under it to push the curve toward the center, it is causing the rib cage to widen under the pressure.
  • When sitting cross legged, place the leg from the concave side (left calf) on top of the leg of the convex side (right calf). This is the opposite of my usual pattern, but when I switch it I can definitely feel my concave side open up.
  • When standing, shift my weight to the concave side (I tend to carry my weight on the convex side)
  • Avoid bending or rotating the rib cage in any direction. Even bending or twisting in the direction against the curve will still result in exaggerating the present hills and valleys. All stretches should elongate and shift, but not bend.

This is in addition to a few other postural changes from Beatriz and Gez…

  • When standing, shift my hips to the right, keep my ears over my heels, and keep my right shoulder down and back.
  • When sitting, rest on the left arm rest.

The only exercises I have adopted from the book for now are for my feet. Beatriz had pointed out that I have a bunion forming on my left foot and that I need to stretch my big toe every day. I have been doing that and I also bought toe spacers. But there are two easy exercises in the book that strengthen the arches and alleviate hallux valgus so I’ve been incorporating those as well.

I was hoping the book would go more into proper breathing with a brace. I think I’ll reach out to Beatriz and see if she has any new tips for me for the brace until I get up to see her in March.

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January 20, 2011 Holy brace!

Today I picked up my brand spanking new Cheneau brace. Over the last few weeks I went back and forth debating whether or not to get it, or what type to get, but in the end I just went for it. Because that is what this phase of my life is about. Whether it works or not, at least I can say I tried. And the reality is even if everything stays just how it is now, that just might mean its working. I have to accept that I may not ever know what the right choices are, but I still have to make them.

The fitting was about what I expected, except that the brace was actually pretty comfortable. I tried it on, Gez made a few adjustments, and then taught me how to get it on and off. It was a little uncomfortable in my left armpit and front rib, but surprisingly fine on my right hib hump. Gez was great, and I walked out feeling confident and excited to put it back on at home.

I was told to start with just an hour at first, a very painful hour. Maybe it’s just the difference between the morning (when my appointment was) and the evening (when I tried it on by myself) caused by the usual compression throughout the day, but my right rib hump was killing me. Or maybe it was the stress from not being sure if I was doing it right combined with restricted breathing. It’s good that I’m going back in a week to make sure everything is ok because suddenly I have a lot of questions. How can I keep it from rotating without tightening it more than I was told to? Is my left shoulder really supposed to be that far forward? Are my floating ribs just getting pushed further inside my body? But toward the end of the hour I did find some relief from trying to breath into the concavities and move with the brace instead of fighting it. Hopefully this will start to come more naturally with practice.

The biggest change I didn’t expect is how wrong it all felt. For some reason I thought there would be some sort of relief from being put in a more right position. But it actually just felt all wrong. I was suddenly more clumsy than usual, and beyond just the awkwardness of the brace. I also had a hard time concentrating on anything — whatever I tried to do was just too hard because I couldn’t get beyond how to move my own body. It actually felt a lot like the frustration I experienced when I switched my mouse to my left hand. I assume this all has to do with proprioception. Maybe relearning the “right” way to view the world is more important than squished ribs, unfortunately it seems I have to squish my ribs to see it.

Tomorrow…two hours! And I’ll post pictures when I can.

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January 15, 2011 Rolfed etc.

It’s been a long hectic week for me so I have some catching up to do on cataloging my every feeling. I had my second Rolfing session last weekend. It focused on the “root of the tree,” otherwise known as the legs and feet. And again, it was excruciating. But unlike a deep tissue massage, I’m not sore at all the next day. In fact, I felt good walking out and it lasted for the next day or two. The overall effect is pretty impressive despite the fact that she barely touched my back. It just shows how everything really is connected. It was also a good reminder about proper walking. The idea is that all it takes is a slight shift of your weight forward and your legs will follow automatically with very little effort. But if everything isn’t in alignment the muscles in your hips, legs, and feet have to work extra hard to compensate. In my case, it is just about balance within my incorrect alignment, not that I have to have a straight spine to walk properly. And I also need to be careful that the shift in weight comes from my center and that I don’t lead with my shoulders as I tend to do.

So I started the week feeling good and as it went on I tried hard not to loose sight of that. But I was going into a particularly stressful shoot Thursday and Friday and so on Wednesday a massive headache — the kind that takes over my whole body — was in full effect. We also had out of town visitors arriving late Wednesday night so maybe between doing a quick whirlwind cleaning and the stress of not knowing how available I would be to entertain, it all added up to more than I could handle. But with Advil and heating pads I was able to get a good night’s sleep and woke up feeling good and ready for the shoot. Typically the combination of physical and mental stress from a shoot can push me over my limit and by the end of the day I am completely destroyed. But I approached it with a new awareness — stick to my diet despite all the bad options I’m presented with, drink lots of water, use the time on my feet to stretch and walk around more than I typically can in the office, sit with awareness despite un-supportive chairs, and don’t let anything get to me. The result was a first — I made it through both days (14 stressful hours and all) virtually pain free!

Sometime mid week my Schroth textbook arrived (hooray!). I’ve only started to get into it but plan to spend some time with it this weekend. And my brace isn’t ready yet which means it will be sometime next week (eek!).

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January 8, 2011 When you need it most

Well, it was really easy to stay focused and pain free in December when I wasn’t busy. Work was slow, plus I had lot’s of time off with no traveling at all. I got used to having a lot of time for my daily routines. And having no stress made it easy to keep my posture in check all the time. But it’s when I’m physically and mentally torn in a million directions at once, that I need to remember to release tension and do things the right way. That’s when I need it most.

So I started last week in pain because I let the stress take over. But after a couple days, I learned how to do both. I found the balance between the high stress, fast paced world I live in and constantly checking in with my body. Am I hunching or clenching? Could I be shifting my torso? Is my head over my heels? Then I successfully made it through several activities pain free that would normally send me into 24 hours of pain. I just have to keep reminding myself to check in. And maybe some day some of it will become automatic.

I’m also not losing sight of the bigger plan…

  • Healthy diet and daily supplements
  • Inversion table and the start of some Schroth, including breathing exercises and postural corrections throughout the day
  • I’ve ordered my brace which should be ready as soon as next week. I have to say at the moment I’m accepting that it will be painful and almost looking forward to it. Never before have I experienced the sensation of being pushed toward straight while standing up. I’m sure I will feel differently later, but I’m keeping this attitude as long as I can.
  • As soon as my sister settles in San Francisco we’ll pick a weekend for me to go to see Beatriz. Aetna denied my request for in network coverage, but I’ve written what I hope is a pretty convincing appeal. And if that doesn’t work, I’ve decided this year I’ll invest my holiday bonus in myself.
  • I have another Rolfing appointment tomorrow
  • And I’m continuing with regular therapy appointments (not to mention that writing this is therapeutic too)

I’m covering all the bases — approaching from the inside and outside, active and passive, structure and flexibility. My goal is the straightest, most pain free me I can be now and in the future.

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December 31, 2010 Cosmetic improvement ≠ Decreased Cobb angle

I came across a case study yesterday of a girl who improved the appearance of deformity in her back, but her Cobb angle measurements worsened in the same time frame. What makes it especially interesting to me is that she was doing the same treatment I am about to embark on — Schroth exercises combined with a Cheneau brace. The study gives two main explanations for her cosmetic improvements. First, it’s possible that her vertebrae were too stiff to improve, but that the thorax was still flexible enough to get some reduction of the rib hump. Second, it’s possible that simply by expanding the concavity one is able to give the appearance of an overall improvement.

This all makes perfect sense to me having already experienced some amount of cosmetic change — a softening and expanding of the concave ribs and surrounding muscle — albeit noticeable only to me and greatly affected by the time of day and my activity level. And this particular treatment does focus heavily on the rotation or 3-dimensional aspects of the curve. But why did the curve itself continue to progress? Wouldn’t it have at the very least held stable given the other improvements? Is it possible that correction in one plane actually led to progression in the other?

It raises big questions in terms of what the goals of treatment should be and how to measure success. If the result is less deformity, better self image, and less pain, is that enough? I would say yes for the present, and yes if the curve was being held stable. But if the curve progresses, then isn’t it only a matter of time before degeneration leads to greater deformity and more pain?

One of my greatest fears is that I am going to “unhinge” something that has been stable for years, kick-starting a phase of rapid progression. Of course this is just one case and there’s no way to know what my outcome will be. The subject is much younger than me which makes her more flexible, but it’s also possible her curve would still be progressing more rapidly at her age regardless of treatment. But since what I’m about to do would probably be considered experimental given my age there really isn’t much in the way of relevant literature so I’m looking for any clues out there.

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December 28, 2010 Bracing Myself

Today was my first visit to the orthotist who was recommended to me. The visit was just to discuss the options available depending on my goals and how aggressive I want to be. And also to take my measurements so that the brace could be made once I decide. He presented me with three options, all of which would be a Cheneau style TLSO, and allow me to do Schroth exercises while in the brace:

1. Full Brace / Hard Plastic

  • The most aggressive, least comfortable
  • Best for night time use

2. Short Brace / Hard Plastic

  • Would not provide support under my left arm, forcing me to hold my left thoracic upright
  • Best for postural corrections

3. Full Brace / Soft Plastic

  • Least aggressive, most comfortable
  • Best for day time use because of comfort

In my case, he said, there are several factors to consider. To stop progression when growth is no longer involved I need to work against gravity which means day time use is more important than night time. Four hours of use during the day shouldn’t limit my lifestyle and won’t cause muscle atrophy. I will have the freedom to support my own weight within the brace if I am diligent. Wearing it at night — if I can adjust to it — could help with pain, but it won’t help to hold or correct the curve. I am older and stiffer than growing kids so comfort is a big issue and may be a barrier to me wearing it as much as I should (and I was surprised to find out that they don’t put any pads inside the brace!).

My goal is to wear it for Schroth exercises, to maintain a better position when I would normally be lazy (like watching TV), and to sleep in it.
I don’t plan to ever wear it more than four hours during the day. This rules out #3 for me. But I’m not sure between #1 and #2. I like the idea of having more control and more comfort. But I find it easier to expand my left back ribs when there is something back there to work toward like a hand or the floor. But maybe this will get easier with time.

It’s impossible to know how I’ll feel until I try it on and get used to wearing it. That’s the drawback with custom made — with Spinecor you can try it on and walk away. Some might think I’m crazy choosing to wear a piece of hard plastic. It’s never going to be comfortable and is possibly as un-sexy as it gets. It’s not that I want to, I just don’t want to leave any rock unturned. Beatriz thinks I can benefit from it and I want to learn as much from her as I can.

I also learned that all my insurance frustration may have been for nothing. They called my insurance while I was there and seemed to think that it would all be covered In Network. Yee-haw! All I need to do is have one of my docs fax over a letter prescribing it. I don’t know why I got so many different answers leading to no coverage at all. But I’m glad I trudged forward and didn’t give up.

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December 20, 2010 DEAR INSURANCE, YOU’RE FIRED

It’s been a rough day on the twisted road of scoliosis. It started with a call to the orthotist, Gez Bowman, although none of what followed is his fault. First I learned that based on his measurements on my same x-rays he thinks my curve is 68*, not 63*. I always knew that there was a margin of error, but I’m not liking how this sounds a lot more like 70 than 60. And I’m tempted to believe this new measurement is more accurate since all he does is treat scoliosis whereas the orthopedist who took the first measurements I have since written off as a complete jackass unwilling to admit that this isn’t his specialty. So 68* puts me a lot closer to the 1 degree per year average and a lot farther away from any change being chalked up to human error. So now I can’t help but think that if it continues at this rate, I’ll be at 100* by the time I’m 62. And that’s assuming I’m just as strong at 50 as I was at 20.

Regardless, as expected, Gez recommends a brace to be worn at night and for some of the day. I wasn’t thrilled with his answers regarding the effectiveness, but at least he was honest. He basically said that they haven’t been combining the brace with Schroth or using it on adults long enough to show substantial results. I have to keep reminding myself that I already knew going into this that there wasn’t going to be any solid proof for stabilization or correction. But then I call the insurance with the cost and code that he gave me ($1800 including 3 appointments to fit it and adjust it; main code is L1300) and find out that it’s not just Out Of Network, my policy doesn’t cover orthotics of any kind. That means what I was quoted for the Spinecor brace was wrong too. So the risk to me just went up. I spent too long on the phone with them being transferred around looking for a way to make an exception, but it just ended in frustration to the point of tears. The best answer I got was to send a letter to the main address and wait and see what happens.

I’m thinking the main reason I would use the brace is to get the most out of Schroth and Beatriz as possible. I can see that watching my sleep position is helping me and if the brace forces that even more that can’t be a bad thing. Plus you can do the Schroth exercises while wearing the brace which, as far as I understand, helps you maintain a straight position while also showing you where you need to expand the concavities. I don’t think I would wear it enough during the day that muscle atrophy would be a problem. Beatriz believes in the brace and I want her to teach me everything she can. She has already been amazing at giving me advice and exercises to start right away, although I’m finding it very difficult to get them right based on a phone conversation alone. Some pictures would be fabulous so that I could be confident I’m doing the right thing. I’ll just keep breathing and expanding my left quadratus lumborum…

Quadratus Lumborum

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December 18, 2010 More Schroth Homework

I sent Beatriz a series of photos that she had requested and she called me back within the hour to review what she saw in the photos. In addition to the breathing exercises she gave me yesterday, which are not as easy as they sound, I now have some new assignments.

To add to the before bed routine…

– Lay on my back with knees bent

– Fold a wash cloth in half twice so it’s in squares, and then in half diagonally to make a triangle

– Place the triangle under the highest part of my right rib hump

– Lay there for 20 minutes

– Also during this time massage my right pectoralis minor and major muscles with my left hand, moving in the the direction of the muscle, not in circles. I pulled some images for reference of the correct muscle. Note to self: get a good anatomy book.

Pectoralis Minor

Pectoralis Major

Postural corrections to do throughout the day….

– Any time I am standing, notice that my hip rests touching my left arm. Consciously move my pelvis to the right and hold it there.

– Also while standing, keep my ears over my heels. I tend to list forward.

– Always keep my right shoulder down and back. It tends to pop forward.

An other change I need to make is moving my mouse to my left hand. She noticed that my right arm is overworked, even though I am left handed. I will move my mouse to the right at work, which will definitely be an adjustment, but I think I can stick to it since it will physically be on the left. At home, I’m on a laptop so I need to retrain my brain to use my left hand. This is going to be tough. I’ve already forgotten several times while typing this.

Lastly, she mentioned that she sent my x-rays to Gez Bowman and he thinks I could probably benefit from a short brace to wear at night. I will be calling him to find out more.

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December 17, 2010 The Schroth Journey Begins

Today I finally got it together to get jpgs of my x-rays, which required bringing the disc with the images to work so I can open them on a PC, and complicated by the fact that my disc drive is busted at work so I had to ask someone to transfer them over for me. But the software opened no problem and I quickly took screenshots of it, hoping not too many people were looking at my screen. I’m attaching the images below.

When I sent them off to Beatriz, she got right back to me with a new urgency. She said I need to start working right away, even before I come see her. She gave me a list of photos she wants from all different angles. And gave me three very basic exercises to do, which I will describe the best I understand it.

#1
– Kneel, ideally in front of a mirror
– Notice if one knee wants to be in front of the other

#2
– Place your hands on the ground under your shoulders with elbows straight
– Notice how your shoulder blades sit
– Turn your hands in
– Notice how your shoulder blades sit
– Breath into the concave areas (one on each side)

#3
– Have someone place a level across your back where your bra strap would sit
– Inflate the left side to move the bubble in the level
– Slowly breathe in through the nose and out through the mouth 3-5 times. Don’t collapse when you breath out.

She also asked my permission to send my x-rays to an orthotist, named Gez Bowman. A quick search on him turned up that he is the creator of a Chenaeu style brace called the L.A. Brace, and surprise, he’s in L.A. The concept is that it treats the curve 3-dimensionally, and uses computer accurate measurements to custom fit the brace. Data supposedly shows that progression in this braces is greater than the Spinecor. But this still isn’t convincing enough for me. I’m not rapidly progressing so that isn’t really the concern or reason to use it. I’m still trying to get over the fact that a brace might help me. Ever since I was first diagnosed I’ve been told my curve is too large for bracing to help. And, of course, since then I’ve also stopped growing.

Beatriz’s opinion of bracing is that you need to be able to work your curve in and out of a brace. This means a brace that leaves space for your ribs to expand. She does not recommend the Spinecor, which I expected knowing that Schroth doesn’t support it in general. Interestingly, I also happened to read last night that Spinecor also doesn’t support Schroth. It seems the general feeling is that they are both tackling it in a different way and therefore run the danger of canceling each other out. Instead she talked about wearing a brace at night, or in her case she wears it once a month to remind herself where she is failing. I’d like to ask Dr. Lamantia why he has chosen to combine the two, if both recommend against it.

I also called my insurance back today and requested an exception due to network deficiencies. If they approve it, Beatriz will be paid by the insurance as if she is In Network. Fingers crossed!

Thoracic, September 2010

Lumbar, September 2010

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