Postural Restoration Institute™ techniques provide a conservative approach to the management of scoliosis. While techniques may not correct a spinal curve, significant gains can be made from reducing torsion and correcting mechanics of the rib cage.
Clinical experience of Postural Restoration Certified therapists provides specific clinical data to support the use of PRI techniques as much as if not more so than other approaches to physical therapy.
Ideally, postural restoration techniques would be initiated on curves between 0-25 degrees and on patients between the ages of 7-15 years of age. Treatment can effectively stop a curve from progressing and possibly reverse curvature when patient and parent compliance and understanding are at high levels. Another component of successful intervention requires a thorough understanding and implementation of integration techniques by both the therapist and patient. Early intervention is best! Adolescent curvature and rotational curvature is more difficult to manage after the age of 17.
Curves between 25-40 degrees may also be physician managed through the use of body jackets. Determining the necessity of a body jacket or bracing is a decision that is most suited for the physician and patient/parents. Whether it be a night or day body jacket, postural restoration can be simultaneously carried out. It is most critical at this stage that patient compliance is high as techniques will most likely need to be carried out three times per day. A night jacket with PRI activities during the day may be a good option for appropriate candidates for whom a physician has recommended a body jacket. The use of a jacket with postural restoration techniques can be a positive intervention and can assist the patient’s tolerance to the jacket. A physician may opt for surgical intervention when a curve is greater than 40 degrees.
At this time we have no supportive literature/research articles, pre-post x-rays, or case studies to support PRI intervention with scoliosis patients. We are still in the discovery stage of clinical data collection. Clinical outcomes, however, are very promising and positive especially when parents, patients, and physicians are all supportive of the PRI approach.
Instability at the base of the spine (L5-S1, L4-L5) also called a pathological curve vs. a non-pathological curve occurring further up the spine resulting from respiratory imbalance must be determined in order for proper treatment to be outlined using Postural Restoration Institute™ manual and non-manual techniques.
The large majority of diagnosed scoliosis (80-90%) coincides with a right thoracic curve. X-rays and/or physician diagnosis are needed to verify the level and degree of curvature. In addition, corresponding PRI tests of trunk rotation, extremity orientation, functional measurements of respiratory function, frontal, sagittal, and transverse plane activity all can provide the practitioner with important diagnostic information regarding the degree of instability and limitation that exist.
For those patients demonstrating instability at the base of the spine and therefore presenting with a pathological scoliosis, the need to achieve left acetabular-femoral internal rotation or proper position for stability of the hips is their primary treatment goal. Neutrality and stability of the pelvis can be achieved through Postural Restoration Institute™ non-manual techniques which activate the ipsilateral hamstrings and ischiocondylar adductor and contralateral gluteus maximus for sacral stability and neutral position. Once stability is gained, a proper tri-planar program can be initiated including dynamic trunk rotation for functional activities that will reduce muscle tone associated with the original muscular skeletal pattern of torsion.
For those patients demonstrating curvature without instability at the base of the spine (ie. non-pathological curve) the primary treatment goal is achieving apical expansion of the right upper chest wall and a strong oppositional foundation for left diaphragmatic contraction. Assisting proper air flow into the right anterior chest wall will provide more symmetry and balance to the trunk. PRI manual techniques for the right brachial chain will assist expansion and flexibility of the chest wall while PRI non-manual techniques will provide needed structural stability and support.