Thursday, May 23, 2019

Easy Mobile Access for Home Health Providers

We have listened to home health providers and have made improvements to our PT-Helper CONNECT web-based exercise prescription service. It is now even simpler to use on both smartphones and tablets.  You can easily create home exercise programs on your mobile devices.

Let us show you how easy it is. While creating a new patient in CONNECT, you only need to provide the First and Last Name of your patient. If you would like to email them a copy of their home exercise program, simply include an email address in their profile. The screenshots below are all from my smartphone.

     

   
Once you have created a patient profile, just enter an injury and then add exercises to their treatment plan for that injury. In the example below, Princess Leia has specified Low Back Pain for her patient, Jabba Hutt.

While adding exercises into the treatment plan, you can select them within categories to help quickly identify the ones you want and then customize sets, reps, etc. You can also create your own Templates or Protocols in CONNECT to further organize your preferred exercises. In the example below, the exercise Dead Bug was selected for Jabba Hutt.

     

     
Once a treatment plan is developed, CONNECT will automatically create a unique HEP code.  If your patient has the PT-Helper mobile app, you can simply give them the code and the exercises you selected for them will appear instantly. You would not need to print the exercises!



If you do need to print the home exercise program, we have created a blog “Printing for the Home-Care Physical Therapist” to walk you through the process of setting up and printing to a small portable printer.

The PT-Helper CONNECT always has a 30 day FREE Trial period.  Sign on and try it out!  Credit Card is not required.  Let us know what you think. We would love to get your feedback!

Thursday, May 16, 2019

5 Easy Exercises to Help Ease Pregnancy Aches and Pains

by guest blogger Sigourney Cross, DPT  at Pelvic Health and Rehabilitation Center


Pelvic and low back pain during pregnancy affects up to two-thirds of women and can start anytime from the first trimester to months after giving birth.1 This is due to a couple of reasons. First, there is a change in your hormone levels. Increased levels of the hormones relaxin, estrogen and progesterone begin to loosen the ligaments that hold your pelvis together in order to prepare you for childbirth. When these ligaments get stretched too far, it can cause pain. Another cause for pain is your rapid weight gain. As your belly grows during pregnancy your center of gravity is shifted forward. This causes an increased lordosis or pronounced curvature of your low back. This places excessive strain on your lumbar spine as well as the muscles and ligaments around the pelvis. When pregnant you may also spend more time resting and sitting which can lead to muscular imbalances, weakness and trigger points.

The pain location and type women experience varies. Pain can be experienced in the lower back, top of your hip bones, back or front of your hips, groin, over your buttocks, down the back of the legs, over the pubic bone and into the vulva. The nature of the pain can be anywhere from a mild to severe achiness, stinging or burning sensation, or sharp and stabbing sensation. Thankfully, there are multiple measures women can take to alleviate their pain including pregnancy support garments such as leggings, belts, bands or girdles, sleep pillows for optimal posture and alignment, acupuncture, pregnancy approved pain relievers, prenatal massage, prenatal pelvic floor physical therapy, and of course exercise! Women with uncomplicated pregnancies are encouraged to engage in aerobic, stretching and strengthening exercises with the necessary modifications to ensure safety for both mom and baby. According to The American College of Obstetricians and Gynecologist an exercise program during pregnancy should include moderate intensity exercise for at least 20-30 minutes per day on most days of the week.

The following exercises can ease the aches and pains of pregnancy and prepare your body for the rigors of labor.

1. Cat-Cow (Mad Cat/Saggy Nag): Being on all fours, keeping the top of your feet flat on the ground. Your hips should be aligned directly over your knees and your shoulders over your wrists. To get into the cow inhale while letting your back arch and belly drop. Keep shoulders rolled back while looking slightly up. As you exhale, round your upper back and shoulders while looking down at your belly. This is cat. Continue moving into your cow on your inhales and cat on your exhales. This exercise helps increase spine mobility and circulation and gently strengthens your low back helping ease hip, pelvic, low back and round ligament pain.


2. Bridges: Begin by lying on your back with your arms at your sides. Bend your knees so that your heels are close to your butt. Next, press your heels into the floor and lift your hips up until you form a bridge with your body. As you are lifting your hips, remember to squeeze your butt muscles, hold this pose for a second at the top before slowly lowering your body back down. This exercise can help ease back pain by strengthening your glutes (butt muscles), low back and abdominals as well as providing a gentle stretch to your hip flexors.


3. Child’s Pose: Start out on all fours with your ankles together and knees wide apart. Next, slowly sit back bringing your butt down to your ankles as low as you can go. Then stretch your arms out in front of you on the floor. Allow your weight to sink down and back to slightly round. Hold this position for a few minutes, while breathing deeply. This is a great stretch for low back and hip pain. It helps elongate your spine and take away tension from the added weight you are now carrying, by relieving pressure on the surrounding nerves. This is also a great exercise to relax your pelvic floor muscles!


4. Seated Piriformis Stretch: Sit on a chair with your feet flat on the ground. Cross one foot over the other knee making the number 4. Lean forward keeping your back flat until you feel a stretch in your low back and buttocks of your top leg. Hold this position for 30-90 seconds and repeat on the other side. The piriformis muscle is a small muscle deep in the glutes that can spasm during pregnancy. This can often cause back and leg pain because it extends across the sciatic nerve. Gentle stretching of this muscle can help decrease tightness and pain.


5. Seated Row: You can use either free weights or resistance bands. Begin in a seated position with your back upright. Tighten your abdominal muscles and have your arms extended forward in front of you. Slowly pull the weights or resistance band all the way towards your stomach, keeping your elbows down at your sides while pulling your shoulder blades together. Hold this position for one second before slowly returning to your starting position. Repeat. Remember to keep your shoulders down and back during this exercise. This is a great exercise to help improve your posture, relieve back pain and strengthen your back muscles and as they become weaker with your growing belly.


Other exercises that have been proven to be beneficial in preventing and/or reducing pelvic pain include walking, swimming and prenatal yoga. Walking is the number one option for many women as its low-impact, a great way to maintain and improve your cardiovascular fitness, easy to make a part of your daily routine and free! Swimming is another great way to get exercise, especially later in your pregnancy as the buoyancy of the water takes the strain off your joints and ligaments. Finally prenatal yoga is a great way to keep your core strength, flexibility and balance in check. It’s important to remember to maintain a mild to moderate intensity while exercising, to take frequent breaks, practice good form and posture, and avoid positions or movements that increase pain or discomfort. Whether you’re a seasoned athlete or a beginner, be sure to get clearance from your doctor before starting an exercise program while pregnant. Women with higher risk pregnancies may have more restrictions.

If these exercises don’t do the trick I recommend getting a physical therapy evaluation for a more focused program that fits your needs.

References:
  1. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e135–42.
  2. Prendergast, SA. Pelvic floor physical therapy for vulvodynia: a clinician’s guide. (2017). Obstetrics and Gynecology Clinics of North America, 44(3), 509-522.
  3. Babycenter.com


About Sigourney Cross, DPT

Sigourney grew up just outside Minneapolis, MN. She graduated from the University of Minnesota with a Bachelor’s degree in Journalism followed by her Doctor of Physical Therapy degree from Hampton University. Having worked across the country and being licensed in six states, she brings a wealth of experience and knowledge to Pelvic Health and Rehabilitation Center (PHRC). Sigourney looks forward to sharing her expertise with patients to help them gain a better quality of life. When not working, she enjoys playing the piano, dancing, trying new restaurants and spending time with family and friends.

Thursday, May 9, 2019

New Features on PT-Helper Mobile App

We continue to work on improvements in our PT-Helper mobile app to make it even easier to use and more useful to patients and health professionals.

There are 2 new features we would like to share with you:

  • Multiple Copies of the Same Exercise
Our app allows the addition of multiple copies of the same exercise into Favorite Exercises within the app. When an exercise has been added to Favorites, that exercise will display a star letting you know that at least one copy of the exercise has been selected. If you choose the exercise again, it will now allow you to add another copy of the exercise into Favorites.

  




  • Create Folders within Favorites
This feature allows you to organize and sort your exercises within Favorites.

One example is to group exercises into different programs that need to be done at different times of the day. In the first image below, we have added 3 exercises into Favorites, 2 of which are Bilateral Shoulder Abduction 1. We have then created 2 folders (second image): Morning Exercises and Evening Exercises. Using a new drag and drop feature, we placed 2 of the exercises in the folder Evening Exercises (last image).

The drag and drop feature can also be used to easily change exercise order.

   

   

       
The combination of creating multiple versions of the same exercise and creating folders in Favorites allows you greater flexibility to customize how exercises are organized.

Thursday, April 25, 2019

PT-Helper's April Blog Posts for Physical Therapists

How Does Pain Work?

By guest blogger Dr. Damon Bescia DPT, OCS, SCS, FAAOMPT
Published on April 18, 2019

Dr. Bescia presents 6 common misconceptions about pain to help therapists understand pain and to promote a healthy approach to it without unwittingly contributing to increased pain and disability.  


Published on April 11, 2019

PT-Helper's exercise library includes diaphragmatic breathing exercises that can be prescribed to patients. We particularly like the article “The Role of Breathing in Physical Therapy“ by Lily Mercer as it presents excellent background on the role of breathing, postural stability, and musculoskeletal impairments.


By guest blogger Jean Masse PT, DPT, PRC, OCS, ATC
Published on April 4, 2019

Dr. Masse writes about the foundations of scoliosis specific exercises as it addresses asymmetries in scoliosis curves with 1) front to back, 2) side to side and 3) rotation aspects of the curvature to balance symmetry. 

Thursday, April 18, 2019

How Does Pain Work?

By guest blogger Dr. Damon Bescia DPT, OCS, SCS, FAAOMPT

What is Pain?

What is Pain?  Pain is an unpleasant subjective experience generated by an individual’s unique pain neural signature that may be activated either spontaneously or when a stimulus is perceived as a threat.

Why Learn About Pain?

Erroneous ideas about pain abound among patients and health care providers alike.  If you are seeking relief from pain, understanding pain is a very important step on your way to recovery.  If you are a health care provider who treats patients in pain, you owe it to your patients to 1) have a correct understanding of pain and 2) be able to explain it accurately in plain language to your patients.

Misconceptions About Pain

Many understand pain to work like this: “Pain fibers throughout the body send pain messages from an injured body part up to the brain so that a person will do something to eliminate the pain.”  While it may sound logical, this outdated model has fallen short on many fronts.

Let’s break it down into 6 common myths about pain:

Myth #1: “Pain receptors in my body convey the pain message to my brain.”

If this myth were true, phantom limb pain wouldn’t exist.  However, 90-98% of individuals report experiencing phantom sensations in a limb following its amputation – the majority of them reporting distinct pain. [1],[2],[3]  Therefore, pain may be experienced even in the absence of any tissue in that area at all.

Myth #2: “Pain means tissue damage.  Therefore, when I have severe pain, it means I have severe tissue damage.”

This may sound reasonable, but it has been disproven in scientific studies several times over.[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] Many people have injured tissue such as bulging discs, arthritis, labral tears, tendinopathy, degenerative changes, muscle tears or ruptures, etc without any pain at all.  Others have incapacitating pain without any tissue damage at all.  Pain is not simply “an issue of the tissue.”  Tissue injury can occur without pain, and pain can occur without injury.  (You're also invited to consider the inability of X-ray, MRI, and CT Scan findings to explain the patients' pain.)

Additionally, this myth cannot explain why surgeries that successfully remove injured structures don’t always eliminate – or even improve – pain afterward.[16],[17]  Conversely, it cannot explain why sham orthopedic surgeries were just as effective as actual surgery in reducing pain and disability.[18]

Myth #3: “I’m always in pain, but I’m not aware of it at present because I’m just used to it.”

Pain is an unpleasant subjective experience.  Therefore, you cannot be in pain without being aware of it.  For instance, no pain is experienced during surgery despite the extensive bombardment of sensory information because anesthesia removes the conscious component of the experience.

Myth #4: “Chronic or persistent pain means that my injury hasn’t healed properly.”

Injuries heal in predictable stages, and even slow-healing tissues, such as herniated discs, have been shown to heal over time.[19]  Most tissues heal within weeks; however, some pain experiences last for months or even years.  Further, many individuals have chronic pain with no history of injury.  Typically the longer the pain lasts, the less important tissues are and the more important a sensitive nervous system is.  For more information, you're invited to read my blog "Subclassification of Chronic Pain".

Myth #5: “Pain is all in your head.”

It is true that pain is an experience produced by the brain - with or without contribution from the body.  However, the phrase "pain is all in your head" inaccurately and insensitively implies that your pain is imaginary.  Additionally, chronic pain may be due to a series of physical changes that happen over time called "central sensitization".  While learning about the scientific explanation may not be for everyone, simply understanding that your pain is not “all in your head” can be very liberating.  For those intrigued by the physiological explanation of chronic pain, this is for you:

It appears that the chronic bombardment of C-fiber activity into the dorsal horn results in permanent changes over time, killing off the interneuron with high levels of amino acids, and allowing more information to be passed onto the spinal cord and brain.  As C-fibers pull back and A-fibers grow into the dorsal horn, light touch fires more easily into the spinal cord and leads to increased sensitization and decreased endogenous mechanisms, leading to allodynia or hyperalgesia.  Chronic retrograde firing may result in inflammation, swelling, and immune responses.

Myth #6: “I feel your pain!  I know how that feels!”

Despite good intentions, none of us can truthfully make that claim.  That is because each pain experience is dependent on a unique combination of each person’s experiences, beliefs, knowledge, logic, social behavior, anticipated consequences, mental state, emotional state, financial concerns, sensory cues, anticipated outcomes, fears, environment, and more.  A typical pain neural signature commonly involves a map of these 9 areas of the brain:
  • Amygdala – responsible for processing and memory of emotional reactions, fear, fear conditioning, addiction.
  • Primary Somatosensory Cortex – involved with somatic sensation, visual stimuli, movement planning.
  • Hippocampus – performs consolidation of info from short-term to long-term memory, spatial navigation, memory, fear conditioning.
  • Anterior Cingulate Cortex – regulates blood pressure and heart rate, assists with reward anticipation, decision-making, empathy, emotion, and concentration.
  • Primary Motor Cortex – assists with planning and executing movements
  • Hypothalamus – regulates body temperature, hunger and thirst, fatigue and sleep.
  • Thalamus – plays a role in consciousness, sleep, alertness
  • Prefrontal Cortex – moderates personality expression, decision-making, social behavior, memory.
  • Cerebellum – facilitates movement, balance, proprioception, coordination, cognition, and fear.
Therefore, it’s impossible for two persons to experience the same pain.

So… What Is Pain?

As we have discussed, misconceptions about pain are prevalent.  But, they have fallen short of accurately explaining the true pain experience.  Arguably the most concerning fact is that an outdated and inaccurate theory of pain can lead to an increase in both pain and disability for individuals who persist in avoiding activity or certain movements out of fear of pain[20], and some well-intentioned health care providers unwittingly contribute to this increase by advising their patients to avoid certain activities altogether.

Therefore, we need to better understand pain.

Pain is an unpleasant subjective experience generated by an individual’s unique pain neural signature that may be activated either spontaneously or when a stimulus is perceived as a threat.

The truth is that there simply are no “pain fibers”; there are only “nociceptors”.  These terms are not synonymous.  Nociceptors are nerve cells that transmit sensory information – not pain – to the brain via the spinal cord for processing.  Nociceptors do not perceive, produce, or transmit pain.  Pain is experienced only after the sensory input is sent to the brain, processed by the pain neuromatrix, and is determined to be a threat.[21]

The amazingly complex neural signature located in your brain ultimately determines when you experience pain, and the body may or may not be involved in the process.  For a sensation to become painful, you must perceive it as a threat.

You are likely to experience pain when spraining your ankle while playing a recreational sport; you are highly unlikely to experience pain when spraining your ankle while running from a tiger.  In the latter scenario, you likely wouldn’t be tremendously concerned about your ankle that just got tweaked, as you’d have a bigger threat to deal with in the 600-lb combination of speed, power, and teeth right behind you.  If you are fortunate enough to survive that encounter, you may eventually experience ankle pain once you’re able to calm down and compose yourself.  Ultimately, the level of perceived threat assigned to a given sensation determines whether or not you experience pain with it.

Further, the nervous system is a dynamic and living organism driven by thought and emotion, and it is very closely linked to the immune and endocrine systems.  Therefore, cognitions such as fear, anxiety, and catastrophization are strongly correlated to the pain experience as they are to overall health and wellbeing.[22],[23],[24]

If you are a health care provider who treats individuals in pain, you owe it to your patients to have an accurate understanding of pain and to promote a healthy approach to it without unwittingly contributing to increased pain and disability.  If you are a patient seeking relief from pain, it’s critical that you choose a health care practitioner who has an accurate and up-to-date understanding of pain and knows how to best treat it.  You're also invited to consider how a manual physical therapist treats pain.


Dr. Damon Bescia is a fellowship-trained Doctor of Physical Therapy, board certified in orthopedics and sports physical therapy, who specializes in Orthopedic Manual Physical Therapy and serves Naperville and its surrounding communities by way of his Concierge Practice.  For more information, please visit www.NaperManualPT.com.







[1] Melzack R. Phantom limbs and the concept of a neuromatrix. Trends in neurosciences. 1990 Mar 31;13(3):88-92.
[2] Melzack R. Pain and the neuromatrix in the brain. Journal of dental education. 2001 Dec 1;65(12):1378-82.
[3] Ramachandran VS, Hirstein W. The perception of phantom limbs. The DO Hebb lecture. Brain. 1998 Sep 1;121(9):1603-30.
[4] Twomey L, Taylor J. Age changes in the lumbar spinal and intervertebral canals. Spinal Cord. 1988 Aug 1;26(4):238-49.
[5] Alyas F, Turner M, Connell D. MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players. British journal of sports medicine. 2007 Nov 1;41(11):836-41.
[6] Videman T, Battié MC, Gibbons LE, Maravilla K, Manninen H, Kaprio J. Associations between back pain history and lumbar MRI findings. Spine. 2003 Mar 15;28(6):582-8.
[7] Taylor JR, Twomey LT. Age Changes in Lumbar Zygapophyseal Joints: Observations on Structure and Function. Spine. 1986 Sep 1;11(7):739-45.
[8] Kjaer P, Leboeuf-Yde C, Sorensen JS, Bendix T. An epidemiologic study of MRI and low back pain in 13-year-old children. Spine. 2005 Apr 1;30(7):798-806.
[9] Spielmann AL, Forster BB, Kokan P, Hawkins RH, Janzen DL. Shoulder after Rotator Cuff Repair: MR Imaging Findings in Asymptomatic Individuals—Initial Experience 1. Radiology. 1999 Dec;213(3):705-8.
[10] Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan 1;77(1):10-5.
[11] Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJ. Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. The Annals of The Royal College of Surgeons of England. 2006 Mar;88(2):116-21.
[12] Milgrom C, Schaffler M, Gilbert S, Van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. Bone & Joint Journal. 1995 Mar 1;77(2):296-8.
[13] Munk B, Lundorf E, Jensen J. Long-term outcome of meniscal degeneration in the knee Poor association between MRI and symptoms in 45 patients followed more than 4 years. Acta Orthopaedica Scandinavica. 2004 Jan 1;75(1):89-92.
[14] Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC musculoskeletal disorders. 2008 Sep 2;9(1):116.
[15] Major NM, Helms CA. MR imaging of the knee: findings in asymptomatic collegiate basketball players. American Journal of Roentgenology. 2002 Sep;179(3):641-4.
[16] Ostelo RW, Costa LO, Maher CG, de Vet HC, van Tulder MW. Rehabilitation after lumbar disc surgery: an update Cochrane review. Spine. 2009 Aug 1;34(17):1839-48.
[17] Deyo RA, Mirza SK. The case for restraint in spinal surgery: does quality management have a role to play?. European Spine Journal. 2009 Aug 1;18(3):331-7.
[18] Louw A, Diener I, Fernández-de-las-Peñas C, Puentedura EJ. Sham Surgery in Orthopedics: A Systematic Review of the Literature. Pain Medicine. 2016 Jul 11:pnw164.
[19] Autio RA, Karppinen J, Niinimäki J, Ojala R, Kurunlahti M, Haapea M, Vanharanta H, Tervonen O. Determinants of spontaneous resorption of intervertebral disc herniations. Spine. 2006 May 15;31(11):1247-52.
[20] Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr 1;85(3):317-32.
[21] Louw A, Puentedura E. Therapeutic Neuroscience Education: Teaching Patients about Pain: a Guide for Clinicians. International Spine and Pain Institute; 2013.
[22] Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. Archives of physical medicine and rehabilitation. 2010 Aug 31;91(8):1153-9.
[23] Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. European Journal of Pain. 2004 Feb 1;8(1):39-45.
[24] Vlaeyen JW, Kole-Snijders AM, Rotteveel AM, Ruesink R, Heuts PH. The role of fear of movement/(re) injury in pain disability. Journal of occupational rehabilitation. 1995 Dec 1;5(4):235-52.

Thursday, April 11, 2019

Diaphragmatic Breathing

PT-Helper’s initial exercise library did not include diaphragm breathing exercises when we first introduced our online exercise prescription service, CONNECT, at the American Physical Therapy Association’s CSM conference in 2016 at Anaheim, CA. While there, a few therapists asked if we included diaphragm breathing. Recognizing that we needed to expand upon our library, we have since added these exercises.

Part of our process of adding new exercises into our library includes doing a little bit of research on how these exercises should be illustrated and how they should be performed. We often stumble upon some great articles that provide excellent background on the topic. “The Role of Breathing in Physical Therapy“ : by Lily Mercer is one such article. In this article, Ms. Mercer covers the basics of respiration, breathing and the nervous system, the role of the diaphragm on breathing and postural stability, as well as breathing and musculoskeletal impairments. She concludes that incorporating breathing assessment and treatment by physical therapists can improve outcomes and lifelong recovery.

Other online resources like Coury & Buehler Physical Therapy’s blog on breathing will recommend slowly inhaling through the nose for 5 seconds and exhaling though the mouth for 5 seconds. Another resource such as the COPD Foundation’s blog recommend breathing in through the nose for 2 seconds while exhaling through pursed lips for 4-6 seconds.

Which ever breathing sequence you recommend, your patients can use PT-Helper’s mobile app to pace their breathing exercises. You can set their Hold Time to their inhaling period and their Rec (Recovery) Time to their exhaling period. Set their Reps to the number of breaths that you want them to take. By default, Hold Time is set to 2 seconds and Rec Time to 4 seconds.


  • Diaphragmatic Breathing (seated) : Sit with your knees bent. Place one hand on your upper chest and your other hand on your abdomen, below your ribs. Breathe in slowly through your nose while expanding your abdomen. Your upper chest should remain as still as possible. Slowly breathe out through pursed lips while tightening your stomach muscles into your body. Repeat



  • Diaphragmatic Breathing (supine): Lie on your back with your knees bent. Place one hand on your upper chest and your other hand on your abdomen, below your ribs. Breathe in slowly through your nose while expanding your abdomen. Your upper chest should remain as still as possible. Slowly breathe out through pursed lips while tightening your stomach muscles into your body. Repeat



Thursday, April 4, 2019

What is Scoliosis Specific Exercise?

By guest blogger Jean Masse PT, DPT, PRC, OCS, ATC

Scoliosis can have many forms. We have general categories for scoliosis and spine curvatures, but each is unique. Scoliosis Specific Exercise are designed to balance scoliosis curves.  They address the unique curvatures of each person.

Asymmetry is something all scoliosis curves have in common. Asymmetries occur in 3 dimensions: 1) Front to back, 2) Side to side, 3) Rotation. With both the Schroth Method and Postural Restoration, we address all 3 aspects of the curvature to balance asymmetry. Our patients begin Scoliosis Specific Exercise with front to back correction, then side to side. Rotation will then follow.

In the front to back, curves are known as either lordosis (most commonly increased arching in the low back), or kyphosis (increased rounding in the back, most often the upper back).  In the side to side dimension curves are often a C-shape or an S-shape. The C-shape is considered a “3-curve” using Schroth terminology. The S-shape is considered a “4-curve” in Schroth terminology. Rotational curves can be seen when a person bends forward, and one side of the back is more prominent. Also, in the front of their body one side of the rib cage is often more protruded than the other.

Precise exercise positions place the body so that a person’s muscles, previously underused, are activated. Muscles targeted are different on the right and on the left depending on the person’s curve pattern. Wedges, towel rolls, bolsters, stools, poles, bars, bands, balls, are a few tools we use. These help us for positioning our patient, to give sensory input to our patient, and to guide the patient’s muscle activity. Once in the corrected position, specific breathing techniques are used to expand restricted, concave areas. Breathing alone is a powerful tool for repositioning the spine and rib cage.


Postural Restoration based spinal correction activity


Schroth based spinal correction activity

Scoliosis exercises are progressed as a person gains mastery of each position and breathing technique. The Schroth Method outlines basic Principles of Correction that include mental focus on changing the body’s habits.

Scoliosis Specific Exercises are challenging. They are also empowering and offer a deep and enduring awareness of our body position, breathing and postural balance.


About Jean Massé

Jean Masse PT, DPT, PRC, OCS, ATC received her BS degree in Physical Therapy in 1991 from SUNY Stony Brook and in 1996, her MS degree in Human Movement Science from UNC Chapel Hill. Also in 1996, she completed the Sports Medicine Program at UNC Chapel Hill becoming a licensed athletic trainer. Jean has worked extensively with athletes ranging from NCAA elite to senior Olympians to Little Leaguers.

Jean became a nationally recognized Orthopaedic Certified Specialist through the American Physical Therapy Association in 1999. She re-certified in 2009.

Still interested to understand why some patients do not seem to heal, Jean returned to UNC Chapel Hill where she earned a doctoral degree in Physical Therapy with the focus on pain management and began teaching at UNC Chapel Hill as adjunct faculty in the Physical Therapy Department soon after, in addition to her work with patients at Advance Physical Therapy.

Advance Physical Therapy is a physical therapist owned practice offering quality rehabilitation to clients in Chapel Hill, Durham, Carrboro, Pittsboro, Cary and surrounding areas of the Triangle in North Carolina.

Advance Physical Therapy is offering a 2 day course for PT's on scoliosis management at our Chapel Hill, NC clinic May 18-19, 2019.