monica_and_elena Dr Rigo doesn’t, himself, seem to do any  exercise prescription anymore. I spent the day  with him in his consulting office. The first case was of a young girl who originally  presented at age 11 with  a 25 degree curve (risser 0) and hence  a strong chance of progression. She  was braced by  Dr Rigo and  returned for follow up after weaning  out  of the  brace (she was in brace for 4 years). Her  curves are  now 14 degrees with hardly any rotation humps and  great balance. My  subsequent thoughts of how  simple conservative management is were short lived when the next patient walked in. She  had been managed in a Milwaukee brace and then a Cheneau  brace and eventually landed up with Dr Rigo as relatively mature girl with a decompensated rigid 75 degree curve.  Dr Rigo reluctantly agreed to brace her  and as expected was unsuccessful in changing her curve.  Dr Rigo recommended that  she  is a candidate for surgery but  the  patient  and family have decided to wait and have surgery  only when they feel it is  appropriate. She has no pain and is comfortable with her aesthetic appearance; pulmonary function is good so they will wait. They advised that they had seen a surgeon who was supportive of their decision to delay surgery. Dr Rigo conducts a lecture with the families of the kids at the end of the second week. It lasted a few hours and was presented in English and Catalan. The language was different but the questions were the same. He repeatedly stressed that scoliosis is a condition which should not develop into  a life destroying event. It is not a terminal condition and the truth is that we don’t know many  aspects about it. It was refreshing to note that he is asked the same questions that I am. One father recounted the story of his two daughters. One is braced and going through Schroth and one is not. Dr Rigo was asked to ‘guarantee’ the brace, exercise treatment option.  He said he couldn’t do that and said that there was no proof that the daughter who exercises will  avoid progression, neither was  there proof that the  daughter who doesn’t exercise will progress.  Just as we don’t know if surgically fused spine will not continue to have problems or progress. The general assumption is that EVERYONE needs to exercise whether they are scoliotic or not. However if you have scoliosis then your exercises should be specific for scoliosis.  There is the added benefit in that in some cases the exercises can be beneficial in managing the scoliosis. Over the last few years I would hear a term called ‘rectification’ regarding Schroth. I spent some time with  Dr Rigo in the bracing workshop and got to see first hand what rectification is.  Dr Rigo makes his own braces by hand according to Cheneau principles. A mould is created in plaster and then he shapes it by hand by removing some areas of plaster and applying plaster to other areas. Its an art blending sculpting, medical and anatomical knowledge and an immense awareness of the subtleties required to rectify the postural asymmetries of the growing spines.  The brace does the work from the outside and Schroth  exercises do the work from the inside. Luckily Dr Rigo’s bracing knowledge is available through a German firm called Ortholutions who  work with Jeb.  However Dr Rigo did qualify  that some braces still need to made by  him by hand as some curves are complicated and he needs to feel the subtleties of the curve and patient. Dr_Rigo_brace I’m on a  plane back to Sydney, back to work and my family. in 3 weeks I am attending a workshop on spinal deformity surgery. Its run by a spinal instrumentation company for orthopaedic and neurosurgeons. I would love to say that I can attend the seminar positing that we can offer a non-surgical alternative scoliosis, which is not the case.  In May I attended a  spinal surgery conference and often heard a term ‘in my hands’. The surgeons were describing their technical skill and competence and confidence with certain procedures. I think that I now have a sense of ‘in my hands’ I can do something for   some of my scoliosis patients. The surgeons, the patients, and even I would like proof that these treatments work but I suspect that it’s almost impossible  to prove this on a wide enough scale to validate the science.  I will have to work out how to implement some the nuances I saw in Barcelona into my practice. I often underestimate the lack of free time when attending these overseas trips. I however did spend Sunday touring Barcelona seeing some of the sights I missed out on last year at SOSORT 2011.  It is an incredible city with a long history and interesting architectural character. The most notable architect was Antonio Gaudi whose designs are perfect for a city  housing a specialist scoliosis clinic. Some of his  buildings have absolutely  no  straight  lines and anatomical harmonic curves are seen throughout. I joked with Dr Rigo that  he  is like anti Gaudi. I  also managed to go for a daily swim at a gym nearby my hotel which also allowed me experience a new yoga  ‘fad’ style called anti-gravity yoga which  is very interesting and I am sure with some tweaking  will open up a spinal pathology treatment protocol. I often joke with my osteoporosis class group that they need to swim in the sea and I will be able to tell them that I made it into the Mediterranean.]]>

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Larry is a highly skilled physiotherapist who specialises in treating back and neck pain, postural issues and scoliosis. He is certified in Schroth and SEAS methods and through the Egoscue University. Larry has a background in elite gymnastics and springboard diving and also has many years experience in endurance running and triathlons. His specialist knowledge and techniques have seen him appointed as a gymnastics coach and physiotherapist at both the Olympics Games and Special Olympics.

His passion and driving philosophy is about achieving the best outcomes for his patients utilising an amalgam of the latest techniques and theories while recognising there may sometimes be a need for invasive procedures. Where deemed appropriate Larry will then refer to a specialist. To further his holistic understanding and approach, Larry is currently undertaking a Ph.D. in Spinal Deformity and regularly attends and speaks at international conferences and courses and clinics.

Fun fact: Larry is learning how to surf - so be careful next time you go to the beach! Qualifications: B.Sc (Physiotherapy); M.Sc. (Exercise Physiology); Advanced Certificates in Schroth (BSPTS) and Egoscue (PAS) and SEAS Larry is Level II certified (advanced) in the conservative treatment of Scoliosis based on the Schroth method. The training was conducted by Dr Manuel Rigo of the Barcelona School at Scoliosis Rehab Inc in Wisconsin. He has completed his SEAS scoliosis treatment training at ISICO in Milan. Larry has also spent time working with Dr Rigo in the Barcelona clinic. Larry also has advanced certificates in shoulder treatment, posture alignment therapy and acupuncture.