The Lyon method and specific physiotherapy exercise for scoliosis
In the field of physiotherapy conservative treatment of scoliosis exist 7 officially recognized schools in Europe, listed below in the historical order in which they developed:
- Lyon method (France)
- Method by Katharina Schroth Asklepios (Germania)
- Scientific Exercise Approach to Scoliosis (SEAS) (Italia)
- Barcelona Scoliosis Physical Therapy School (BSPTS) (Spain)
- Dobomed approach from (Poland)
- Metodo Side Shift (United Kingdom)
- Functional Individual Therapy of Scoliosis (FITS) (Poland)
The different methodologies adopted by these schools actually have many similarities to each other: the corrective exercises take into consideration all three planes of space; breathing exercises play a key role; the development of stability, balance and posture awareness are among the primary goals of the treatments.
Also given the similarity found in the results of the treatments, a common term has come to be used to indicate a rehabilitation based on any of these methods: “Physiotherapeutic scoliosis-specific exercise” (ESSP).
Scientific evidence of the PSSE
From a recent literature review [1]Seleviciene, They were, et al. “Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended… Continue reading it can be seen that in recent years the PSSE methods for the conservative treatment of scoliosis have had a large diffusion. This study evaluated the efficacy of PSSE in the conservative treatment of adolescent scoliosis (AIS, adolescent idiopatic scoliosis) and the results showed that:
“… conservative interventions that help stabilize the curvature of the spine and improve aesthetics are preferable. The corset has traditionally been the mainstay of treatment, but mounting evidence suggests that PSSE physiotherapy enables effective management of adolescent idiopathic scoliosis.”. Scientific evidence indicates that “PSSE physiotherapy helps stabilize spinal deformations and improves patients' quality of life.”.
A previous scientific review of the 2008[2]Negrini, Stefano, et al. “Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature.” Disability and… Continue reading, which analyzed the results of the PSSE on 1654 patients, had already highlighted the effectiveness of treatments in reducing the progression of scoliosis (mainly in the initial stage of puberty), but above all he found the’efficacy of PSSEs in reducing brace prescribing. In the conclusions of the article it is stated that this systematic review “(…) confirms and reinforces the previous ones. The actual exercise evidence for the AIS is level 1b[3]Quality of primary studies and systematic reviews: level of evidence rating:IaMeta-analysis or systematic reviews based on multiple studies of diagnostic IbIbTrial levels or studies of… Continue reading.
On the basis of the scientific evidence of the PSSE, the linee guida dell’International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (Sonsort).
SOSORT GUIDELINES[4]Negrini, Stefano, et al. “2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.” Scoliosis and spinal disorders 13.1 2018: 1-48.
The SOSORT guidelines underline that the PSSE is a type of approach suitable for patients of all ages as it has both programs aimed at adolescent scoliosis and comprehensive programs, suitably modified, for other age groups.
With reference to AIS, the guidelines state that:
“The efficacy of PSSE in the treatment of patients with adolescent idiopathic scoliosis (AIS) has been proven by recent studies. PSSEs have been found to improve posture by reducing spinal asymmetry and the muscle imbalance that results from this asymmetry, the Cobb angle, the angle of rotation of the trunk, pain and quality of life. In severe cases of thoracic scoliosis, it has also been shown to improve respiratory function.”.
- Awareness of asymmetries
- Kyphotization of the thoracic region
- Passive mobilization by lengthening the concavities
- Passive mobilization of the costovertebral joints (manual hump modeling and breathing exercises)
- Opening of the ilio-lumbar angle
- Active mobilization of the convexity
- Lumbar lordosis in sitting position
- Side-shift lombare
- Auto stretch active (exercise of the "grand porter")
- Proprioceptive exercises in lumbar lordosis and thoracic kyphosis
- Balance exercises
- Stabilization in the gestures of daily life
Note
| ↑1 | Seleviciene, They were, et al. “Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice.” International journal of environmental research and public health 19.15 2022: 9240. |
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| ↑2 | Negrini, Stefano, et al. “Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature.” Disability and rehabilitation 30.10 2008: 772-785. |
| ↑3 | Quality of primary studies and systematic reviews: level of evidence rating: Ia Meta-analyses or systematic reviews based on multiple level Ib studies Ib Good quality diagnostic trials or outcome studies II Diagnostic trials or outcome studies of medium quality, insufficient number of patients, or other trials such as case-controls, other designs III descriptive studies, case reports and other studies IV Directions of committees, expert opinions, non-systematic reviews etc. |
| ↑4 | Negrini, Stefano, et al. “2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.” Scoliosis and spinal disorders 13.1 2018: 1-48. |