For decades the “gold standard” scoliosis orthosis was the Boston Style. The Boston design has been authoritatively proven to be better than no treatment in terms of preventing the spinal curves from progressing to the point surgery is needed. This treatment, however, focuses on a one-dimensional correction. The traditional TLSO is symmetric in shape and applies pressures to the convex side of the curves. The body is squeezed inside the symmetric shape of the TLSO and the curves are corrected as much as possible.
When you look at the curves on an X-ray from back to front, they are improved. Much of the rest of the body is ignored. This is important to note because all scoliosis is tri-planar, meaning not only do all curves show a bending of the spine when viewed back to front, but the curves also twist when viewed top to bottom and flatten when viewed side to side. These scoliotic deformities can be seen clinically in patients with scoliosis. Rip humps can be observed on the convex side of curves. One shoulder may sit higher than the other. The hips and torso can be twisted or translated in relation to each other. The normal flow of the spine when viewed from the side may be abnormally straight, referred to as “flat back”. All these observations are evidence of the 3-dimensional nature of scoliosis. The Boston Style TLSO only addresses one of these deviations/dimensions with a focus on correcting curves as viewed in the X ray from back to front with little to no thought regarding the way a patient’s body appears.
Dr. Cheneau, a French physician, began developing a TLSO that focuses on correcting the spine in 3-dimensions in the 1970s. His work was influenced and works in conjunction with a specialized physical therapy method used to treat scoliosis known as the Schroth Method. This therapy focuses on breathing and exercises that are intended to de-rotate, elongate, and stabilize the spine in 3-dimensions. The design of Dr. Cheneau’s TLSO works in conjunction with the Schroth Method to achieve the same 3-dimensional correction.
Dr. Rigo, a Spanish physician practicing in Barecelona, collaborated with Dr. Cheneau in the late 1980s and 1990s to further understand and refine Dr. Cheneau’s original design. Dr. Rigo’s work has been ongoing since that time and benefited thousands of patients with scoliosis at his clinic in Spain. The Rigo-Cheneau TLSO is a very complex device that treats all 3-dimensions and follows a unique curve classification protocol developed by Dr. Rigo. These classifications are critical to ensure that the TLSO is fabricated correctly to treat the scoliosis in a proper way.
Of note, in 2009 Dr. Rigo founded the Barcelona Scoliosis Physical Therapy School that certifies physical therapists in the Schroth Method. You can learn more about the Schroth Method and find certified Physical Therapists in your area at http://www.bspts.net/ .
Jay Mosesson, PT. DPT, cert. MDT, certified Schroth Therapist is a local physical therapist at Active Spine Physical Therapy who specializes in treating scoliosis following the Schroth method. If you’re interested in Schroth physical therapy, we can recommend Jay Mosesson. Click here for his website.