Frequently Asked Questions
Here are the most common questions we have been asked, use the menu below to filter results, hope these are of some help to you.
If you have any questions which are not addressed here please do contact us.
Schroth based rehabilitation is billed under standard physical therapy codes and is reimbursed according to your individual Physical Therapy benefit specific to your insurance plan. Our administrative staff would be happy to answer any questions related to your specific insurance plan.
Schroth based rehabilitation is recommended for people with scoliosis with a Cobb angle of 10 degrees or more. It is also effective for those with excessive thoracic kyphosis including Sheuremann’s Kyphosis as well as structural flatback. It is highly recommended that girls begin after the age of 10 years and boys after 12 years of age. Adults can begin to learn the program at any time. People with curvatures over 35 degrees may experience up to a degree of progression per year. Adult women with curvatures over 35 degrees may experience degenerative changes and curve progression as they approach menopause. Adult men with scoliosis may also begin to experience degenerative changes and curve progression as they age. While there are fewer men with scoliosis, their curvatures tend to be more rigid and aggressive with regards to progression. If you notice any changes in your height, any increase in the thoracic or lumbar prominences associated with your scoliosis, or an increase in pain, you may be experiencing progression of scoliosis and should begin Schroth based rehabilitation.
In the United States, standard physical therapy protocols for management of scoliosis have not been found to be effective in preventing curve progression in those with scoliosis. Despite the fact that physical therapists are licensed medical professionals specializing in the evaluation and treatment of musculoskeletal problems, their training in school consists of lectures on types of scoliosis, non-specific exercise prescription, pain management, general bracing, surgical techniques and rehabilitation after surgery, unless they have gone beyond this training to take specific continuing education. Schroth based Physical Therapy, however, is the standard of care for management of scoliosis in Europe. There are no certifying bodies in the USA for training in the Schroth method so clinics who employ therapists with Schroth training are few and far between. At Avanti, we are very lucky to have two fully certified therapists who can perform evaluations and manage program progression.
There are specific movements that should be avoided on a repetitive basis to assist in halting curve progression, particularly in younger, skeletally immature patients or women following menopause. Your Schroth trained physical therapist will make professional recommendations based on their evaluation of your spine.
For adolescents, there are definitely some sports that are going to impact your curvature more negatively than others. The best exercise is swimming, as your spine is unweighted and elongated. The worst forms of exercise for your spine are gymnastics, some forms of dance and yoga. These types of exercise take an already unstable spine and create more instability. That being said, someone who adores gymnastics with a small curvature who is near skeletal maturity may be able to continue his or her sport. We will help you to decide based on your individual circumstances. Exercises such as running and running sports increase axial compression, which is a compressive force through the spine created by the hard landing of the foot on the ground. This type of force may be progressive for certain curvatures. Cycling usually involves more flexion of the spine than is advised for those with scoliosis. On the plus side, most adolescents and adults who are active have much greater core strength and postural control, which makes mastery of the exercises for scoliosis much easier. The bottom line is that we will try to help you to make the best decision for you, depending on your type of curvature, degrees of curvature, symptoms, and personal preferences.
If a curve is over 55 degrees surgery is recommended. Our goal is to keep everyone well under this measurement.
It usually takes a minimum of ten visits for one to learn their curve specific program. Follow up will vary based on each persons needs but we highly recommend that adolescents participate in scoliosis class taught by a Schroth trained/certified physical therapist at least twice a month until they stop growing.
Bracing is recommended for scoliosis in adolescents with curvatures of 25 degrees and over. The decision to brace or not is an easy one in an adolescent who has not yet reached skeletal maturity. What is difficult is determining which brace to use. There has been little change in traditional bracing methods in the US in many years. The most commonly used brace is a TLSO or thoracolumbosarcal orthotic. This is a hard plastic brace that is custom made and envelopes the torso. The most commonly prescribed TLSO in the US is the Boston brace. Its purpose is to hold you in your usual posture with the intention of slowing curve progression. Problems associated with this brace are a decrease in pulmonary volume and trunk strength.
If an adolescent has a large upper thoracic compensatory curvature, a brace that has a component that stabilizes the head and neck while providing traction may be recommended. This brace is commonly known as the Milwakee Brace. In addition to the problems associated with a TLSO, compliance with this brace is low because of discomfort and difficulty hiding under clothing.
Soft braces are sometimes recommended. The idea of a soft elastic brace that can be worn but not seen under the clothes is very attractive for anyone. However, these braces are stabilized over the shoulders and under the pelvis, which increases axial compression.
A Modified TLSO braces that provide 3 dimensional corrections of the curves is also available. This is a hard plastic brace that provides up to 50% correction of not only the lateral curvature but also of the rotational component that causes rib rotation and lumbar prominences. It provides pressure at the apices of the curve, but also has openings at the sites of the concavities. This is helpful not only for comfort and temperature control, but also allows for specific rotational breathing exercises to counter-rotate the spine. By reducing the pressure on the wedge shaped vertebrae through three-dimensional correction, we give the spine to opportunity to correct as a child grows. Our preferred provider for 3 dimensional bracing is Grant Wood at Align Clinic in San Mateo, California.
We recommend adolescents who are still growing spend 20 hours per day in their brace minimum. Adolescents with curves over 40 degrees and who have stopped growing we recommend a night brace through age 18. Adults who may benefit from bracing will have variable recommendations based on their specific situations. Your therapist will discuss this with you in more detail.
The braces that are traditionally prescribed for adolescent scoliosis are not corrective but hold you in your normal scoliotic posture. There is controversy as to whether or not they actually stop curve progression. We recommend the WCR brace (For more information, see http://www.grantwoodortho.com/index.html) which can attain up to 50% in brace correction. In someone who is still growing this takes pressure off of the wedged portion of the vertebrae and can allow for long term correction if worn through skeletal maturity in an adolescent. For adults, sometimes a hard brace in someone with a curve that is in the surgical range and progressing is appropriate as well. We may sometimes use bracing in a adult for pain management.
If you are an adolescent who is still growing and your curve is 25 degrees or greater we recommend bracing. If you are an adult and your curve is causing pain and or disability we may also recommend a brace.
We wish we could say there is a cure for scoliosis, but unfortunately there is not. The Schroth method can halt curve progression in nine out of ten people. However the Schroth method can help most people with pain management. Results are definitely linked to patient compliance with their home program although there are some curves that progress no matter what treatment intervention you try. Luckily 90% of the time we are successful at curve stabilization (halting curve progression) and half of those 90% will realize improvement in their scoliosis measurements.
Most people have what is called idiopathic scoliosis, which means we do not know the cause. We do know that there may be a genetic predisposition for scoliosis and there is now genetic testing that can predict if an adolescent’s curve will progress into surgical range. We also know that scoliosis is much more common in females than males and that half of all people with scoliosis are clinically hypermobile (increased laxity of the joints) versus 20% of the general population. Once scoliosis starts the vertebrae of the spine can become wedged shaped which causes further progression of the curve or curvatures. There is also a rotational component to the progression of scoliosis which changes the shape of the ribcage and or the abdominal cavity.
We ask that you be aware of the following policies:
- If you are a new patient, please come 15 minutes early to the first visit to fill out paper work.
- If you need to cancel your appointment we ask for 24 hour notice. We do have to hold to a strict cancelation fee of $55.00 unless you are ill. This amount does not cover the cost of the missed visit, but allows us to continue to reserve the 1 hour time blocks for our patients.
- We ask that you please notify us if you are going to be late.
- Please give your physical therapist at least one week notice if possible of your upcoming follow up appointments with your doctor so we can perform re-assessments/progress notes of your current condition and communicate those updates with your physician prior to your appointment.
- Please schedule your subsequent treatment appointments in advance with our administrative team. If you don’t schedule your appointments in advance it will be more difficult to give you the times that you need.
Your physical therapist will perform a thorough evaluation that will outline objective deficits related to your problem(s). Depending on the problem you are being treated for, the therapist will re-assess you after being seen for mulitple vists, this could be anywhere from 6 to 10 visits for example, again the time frame may vary depending on the condition you are being treated for. The measurements taken during the re-assessment will be compared to those taken at the time of your initial evaluation. We send a copy of each evaluation, subsequent re-assessments and progress notes as well as discharge notes to your referring physician. We like to keep your physician updated on your progress in therapy, this is why we request advanced notice of your follow up appointments.
Please bring with you your insurance cards, prescription from the referring doctor and any supporting medical documents you have with you regarding your health and current reason for seeking physical therapy. This might include medication lists, health history lists (you will be asked to list these in our intake form), x-rays (films are preferred if you are coming in for a scoliosis evaluation), but typically reports are preferred for all other injuries, as well as MRI, CT scan reports etc. Please wear loose fitting and comfortable clothing, shorts and tank tops will make it easiest for us to evaluate you. For subsequent appointments please bring appropriate exercise shoes as well as clothing. If you are coming in for a video gait analysis or running analysis please bring your usual running or walking shoes, bring several of them if you have more than one pair.
Avanti Therapy employs seasoned professionals who are experts in their field, and are constantly upgrading their skill sets in order to provide the best in evidence based care. We do not employ aides who take you through your exercises or remainder of treatment following your care with the physical therapist, therefore patients receive all their care from their therapist. Avanti Therapy also provides patients with longer visits. Our treatment times are 50-60 minutes, vs. the industry standard of 20-30 minutes with the PT. We have the best manual therapy, hands down. Our practitioners bring an eclectic skill set to their practice and can manage the most complicated of patients. Finally, we have a 10 year history of steady growth providing excellent patient care demonstrating stability and commitment to caring for our patients.
While receiving care at Avanti Therapy, your timely recovery and individual needs are our greatest concern. We take each patient’s care and situation into great consideration when determining a plan of treatment. In most cases each patient will primarily be seen by one therapist, and we do our best to match you closely with a therapist who can best meet your needs from the start. However, our therapists have a variety of specialty skills and backgrounds and we as therapists constantly collaborate and work as team to provide the best care to our patients. If the primary treating therapist feel you could benefit from another therapists skill set they would discuss this with you thoroughly and you would make a joint decision in order to maintain your comfort level to conclude if co-treatment is appropriate for you. They may recommend co-treatment with another therapist for a few visits or as needed in order to gain maximum potential care. Again your best interest and consent is always maintained.
On your first visit, your physical therapist will perform an extensive evaluation which includes your history, a physical exam, objective tests and measures in order to create a thorough plan of how to treat you. This treatment plan will not only be addressing your functional limitations but will be designed to help you meet your additional personal goals to return you to your pre-injury state.
Our treatment times last for 50-60 minutes. You will spend the full treatment session time with your Physical Therapist not with an Aide.
The Following are insurance companies that we are in-network with:
- Denver Options.
- Marrick Medical
- Pinnacol Assurance.
- Tri Care.
- United Healthcare.
If we are not an in-network provider with your insurance we will take the time to call your insurance company and check the out of network benefits and see what we can work out for you. We also offer discounted cash pay rates for those who have large deductibles or do not have insurance.