What Is Physiotherapeutic Scoliosis-Specific Exercise All About?
Author Kelly Grimes, Physiotherapist
(Full disclosure: I am a physiotherapist who has PSSE training. This is my take on PSSE.)
Here is your brief lowdown on specific exercise for scoliosis and spine structural variations.
If you’re an individual with scoliosis, kyphosis, or other spine structural variations, or a parent/family member, you may have come across the term, Physiotherapeutic Scoliosis-Specific Exercise (PSSE). Perhaps you’ve seen images or video on the internet that contain a number of props and detailed cueing or instructions. Possibly, you’ve seen some really promising before and after pics. PSSE is one of the few non-surgical intervention options to address spine structural variations, such as scoliosis. In this blog post, we’ll break down PSSE so you have a better understanding of it as a treatment option.
PSSE addresses trunk shape and alignment in 3D
Physiotherapeutic Scoliosis-Specific Exercise (PSSE) represents a group of approaches that train a person with scoliosis, kyphosis, and other spine structural variations, to create the most optimal, centered, and sturdy alignment they can achieve in all three-dimensions.
What is meant by “three-dimensions” you ask? The term “three-dimensional” considers three viewpoints when observing an individual.
1) View from front or back is called the “frontal plane”
2) View from the side is called the “sagittal plane”
3) View from above, which allows the observer to see how different parts of the body are rotated in relation to each other, is called the “horizonal, or axial plane.”
Exercise approaches that specifically address spine structural variations such as scoliosis MUST consider all three dimensions because scoliosis is a spinal change that affects all three dimensions.
There are a number of schools of thought that are classified as PSSE approaches. The most commonly researched methods thus far are the Schroth method and the Scientific Exercise Approach to Scoliosis (SEAS).
See here for a recent joint webinar between SOSORT and the SRS (recorded 11/7/2020) on the latest evidence on bracing and exercise for individuals with scoliosis of all ages. These two organizations do a ton of work around scoliosis and spine structural variations. Timestamps 30:41 and 45:44 will take you directly to the exercise portion of the webinar.
PSSE is a learning process.
The concepts employed by PSSE methods vary, but what they all have in common is this: they teach an individual living with scoliosis the SKILL of finding the safest, most sturdy and centered position in 3D, and incorporating the newly centered alignment into daily life.
How does someone learn this skill? It happens in much the same way that one learns any new skill. It’s a PROCESS. The process takes time, commitment, diligence, perseverance, and PRACTICE. If you’ve ever learned to play a sport, a musical instrument, mastered a new recipe, learned to drive, or a new language, you engaged in a learning process over TIME.
The PSSE process takes an individual’s trunk shape and alignment from its current form to a more centered form by creating small movements with stability and healthy pressure inside the trunk. There are a number of variables that go into how much change to expect in the process. More on that in a later post. To start, however, the following concept was helpful to me when I was learning the process.
Scoliosis = structural and postural component
The shape of the spine and trunk can be broken down into two components. The first component is the structural component, consisting of the vertebrae (series of bones that make up the spine), intervertebral discs between each vertebrae, joints between vertebrae, the ribcage, and the surrounding connective tissue (ligaments and tissues surrounding the joints).
The second component is the postural component, consisting of the muscles and fascial system that surround the spine.
There is a lot of variability across individuals in terms of each person’s structural and postural component of their trunk shape. From my training, it is the postural component that we target first and foremost during the training process of PSSE.
Some brief PSSE logistics
The logistics of the PSSE training typically also varies. Training can range from intensive immersion experiences (long sessions of 1.5-4 hours taking place over a number of days/weeks), to more spaced out training sessions (sessions taking place 1-2 times/week over a period of several months), to group sessions for individuals who have already undergone some training, to virtual learning experiences that are on the rise thanks to Covid-19.
The training with the PSSE clinician is accompanied by daily practice on the part of the individual living with scoliosis, typically to the tune of 30 minutes or more per day, at least 6 days/week. As you research clinicians with PSSE training, inquire about how they structure their offerings and pair it with your current situation and needs to find a good fit.
To summarize, here are some key features of PSSE:
– Consideration of each individual’s unique 3D alignment and training specific to it
– Training for stability in 3D AND incorporation into activities of daily life
– It’s a training process requiring lots of practice over a period of time
– Like learning anything new, there may be bumps and valleys along the way, and that’s normal and it’s a-okay!!
About the Author: Kelly Grimes
Kelly Grimes is a physiotherapist living and working in the city of New York in the US. She has been in practice for 14 years, six of them happily immersed in helping individuals with scoliosis and other spinal structural variations live powerful lives. Kelly is trained at the C2 level of the BSPTS Concept by Rigo method (a Schroth-based method) and Level 2 of the SEAS approach. She is also a Co-Chair of the Communications Committee of the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT).