*2.3.2 Lyon method during the total time*

First week. Physiotherapy is for analgesic purposes and is performed in the supine position by soft traction and a muscular work with irradiation of the short external rotators. Breathing is controlled because of the limitation of the abdominal expansion. The thoracic breathing is facilitated by the mobilization of the intercostal muscles.

Second week. The iliolumbar angle is mobilized to adjust tension at the iliolumbar level. The hump can be modeled with progressive closure of the ratcheting buckle. Physiotherapy is performed in sitting position.

Third week. Physiotherapy is more global, more general, more tonic, and stronger. The lever arm of shoulder and pelvic girdles is used. The sessions are made in standing position.

*Bracing Adult Scoliosis: From Immobilization to Correction of Adult Scoliosis DOI: http://dx.doi.org/10.5772/intechopen.90196*


### **Table 3.**

*Main differences between adolescent and adult scoliosis Lyon method physiotherapy.*

### *2.3.3 Physiotherapy during partial time bracing*

We first determine the sagittal direction of muscular work, usually lordosis for lumbar and thoracolumbar scoliosis. For each session there is a progression from supine to sitting and standing position.

### *2.3.3.1 Examples of basic exercises*

*Rib hump erasing*. Having refocused the spine from the vertical in the sagittal plane and in the frontal plane, the patient is asked to lengthen from the brace at the rib hump level. The movement is controlled manually. The trapezius muscle is relaxed.

*Sagittal tensioning girdles*. The aim is to relax the posterior chain muscles while avoiding cervical lordosis. The exercise is made with control of inspiration breathing.

*Self-axial lengthening*. The patient straightens his head, his hands resting on the anterosuperior part of the brace. It can be done in a sitting position using a proprioceptive system. When the head is at the correct high position, a sound and a light stimulate the patient. If the spine is close to a wall, a cushion at the cervical level must be stabilized by the patient. This exercise can be completed with the upper limb extension.

*Posture memorization*. Exercise can be more complete with the work of the lower limbs. The starting position is knees bent for self-axial elongation of the spine; the upper limbs are fixed on the espalier. The patient is asked to stand up to a position of global extension. This exercise improves the quadricep muscle that will be key to saving the spine.

*Strengthening of weak muscles: quadriceps and abdominals*. The exercise will be started in a supine position. The pelvis is locked in the brace posture. This work is associated with an isometric tension of the posterior chain and expiration. This exercise is completed by a stabilization of the shoulder girdle with a stick and control of the rotation of the hip by a ball between the knees. The solicitation is obtained by an oblique manual push on the side of the patient. By gradually lowering the legs, it also seeks the rectus femoris. The anterior chain has been stretched, and it is in this posture of extension that strengthening is performed with isometric contract-relax muscular work.

*Stretching strong muscles: hamstrings and short external rotators*. It starts at the lumbosacral junction with pelvic-femoral, tricep, and hamstring stretch in lumbar lock controlled by the brace. It also stretches the psoas and rectus femoris. We can stimulate muscular work by manual push on the pelvis. The buttocks and the latissimus dorsi are solicited in the prone position, emphasizing the control of the cervical lordosis. When sitting, it stretches the anterior chain by adjusting the hip. Stretching can also be controlled at home on a stair. The exercise at the bar also allows global stretching.

*Proprioceptive rehabilitation*. On a Klein Vogelbach ball, it transfers the body weight in all plans, with emphasis on relaxation of tone and breathing control. The muscle tonicity is improved by changes in posture, standing, and lying and by the addition of loads. The global proprioceptive work prepares the patient for the definitive weaning of the brace.

### *2.3.4 Advice*

In case of major disc degeneration, physiotherapy will be conducted in physiological lordosis, rather than in a standing position.

In case of major facet joint degeneration, physiotherapy will be conducted in physiological lordosis in prone position, legs bent or in a sitting position.

In case of leg length discrepancy, the feet imbalances adjustment with a shoe lift of 5 mm if it improves both pelvic and spine alignment.

In the sagittal plane, one can use small high heel stubs from 3 to 5 cm to reduce a lumbar kyphosis.

The food control helps to reduce overweight.

The postural control concerns mainly the workstation.

The regular practice of physical activity outside is essential. It is necessary to insist on the strict brace wearing during 2 hours after the sports activity.

### *2.3.5 Difficulties*

Excessive mobilization of passive structures may lead to a progression of scoliosis, so the hyper flexibility is avoided and a position closest to that of the brace is better.

High thoracic breathing is less efficient than the usual abdominal breathing, and we must insist on improving the vital capacity for thoracic or double major curves. If lumbar scoliosis is treated, the risk of an increase of scoliosis during inspiration is low; however, breathlessness is to be avoided.

As the brace can be asymmetrical in the direction of the rebalancing of the spine, it will, however, always ensure the balance of the shoulder girdle.

### *2.3.6 Practice of sport*

When the body is fully developed, we advise high-impact sports such as running and dance, to favor the fixation of the calcium on the bone and the constitution of an important bony mass.

*Bracing Adult Scoliosis: From Immobilization to Correction of Adult Scoliosis DOI: http://dx.doi.org/10.5772/intechopen.90196*

In a specific way when ribs are asymmetric, we recommend avoiding deep and quick inhalation which favors the vertebral rotation and therefore the breathlessness during the practice of sports.

For lumbar curves, we advise, as well, against the quick flexions of the trunk forward or the position extending with an anterior flexion of the trunk.

During the period of maximal tensegrity up to 40 years, all sports can be performed at a high level as long as the spine is straight.

After 40 years, decreased intervertebral disc height and sarcopenia reduce the body's performance.

After 65 years, osteoarthritis is predominant. Swimming avoids overloading the lower limbs and helps maintain lumbar lordosis (**Table 4**).

### **2.4 Results**

*2.4.1 Bivalve polyethylene short brace with lateral overlap for lumbar scoliosis*

Immobilization braces made of polyethylene have been used for more than 50 years in case of mechanical pain. They complement classical physiotherapy by reducing load by 30% at the lumbar spine. We specifically studied the 158 patients with 5-year follow-up from our prospective database [25].

The principle of bracing is completely different from that of adolescent scoliosis. Indeed, we try to:


A specific frame is used to stabilize the patient in the most corrective posture in the frontal and the sagittal plane.

For those patients who had a progressive scoliosis, Cobb angle is stabilized or improved by more than 5° in 80% of cases, and only 20% of scoliosis remain candidates for surgery [25].

The frontal and horizontal clinical parameters are improved, but not the sagittal parameters with the forward trunk projection (**Figure 9**).

The sternoclavicular support is poorly tolerated, and due to reduced dexterity in the older person, lateral closure is a handicap for elderly patients, even if adaptations are possible, that is why we currently use the 3 mm Europlex'O.


**Table 4.**

*Sports activity according to the age.*
