Category: Blog

Is Walking A Good Exercise For People With Scoliosis?

It’s well known that exercise is a great way to stay healthy whatever other conditions you may have – it’s all now well known that some sports and activities (especially those which focus only on one side of the body) may not be the best choice for those with Scoliosis.

We get many questions about exercise and which are the best options for people with Scoliosis – but the most important one is this, is plain old walking a good choice? The short answer is yes. Walking is generally considered a safe and effective exercise for people with scoliosis – it works both sides of the body evenly, it’s easy, does not put too much strain on the body, can be done with your brace on and is surprisingly effective!

 

The benefits of walking for people with scoliosis

Walking is a low-impact exercise that can help strengthen the muscles in the legs, hips, and back. This can be particularly helpful for people with scoliosis, as weak muscles in these areas can contribute to poor posture and spinal curvature. Walking also helps improve balance, coordination, and flexibility, which are important for maintaining good spinal health.

In addition to physical benefits, walking can also have mental health benefits. Exercise has been shown to reduce stress and anxiety, improve mood, and increase overall feelings of well-being. For people with scoliosis, who may experience pain and discomfort as a result of their condition, walking can provide a natural way to manage symptoms and improve their quality of life.

 

Precautions to take when walking with scoliosis

While walking is generally considered safe for people with scoliosis, there are a few precautions you should take to minimise any potential risks.

First, it is important to work with a healthcare professional, such as a physical therapist or orthopaedic specialist, to develop a safe and effective exercise program. They can help you identify any limitations or areas of weakness that may need to be addressed before starting an exercise program. This is less about the way you walk and more about taking sensible steps to avoid things like walking with a heavy backpack etc – each case is different here, but follow any relevant guidelines you are given.

It is also important to wear supportive shoes and to choose a safe walking route. Avoid uneven or rocky terrain that could increase your risk of falling or injuring yourself.

Another important consideration is posture. Good posture is important for maintaining a healthy spine, and people with scoliosis may need to work on improving their posture as part of their exercise program. Focus on keeping your shoulders back and down, your chest lifted, and your chin level.

It is also important to start slowly and gradually increase the intensity and duration of your walking sessions over time. This can help prevent injury and reduce the risk of overexertion.

 

Alternative exercises for people with scoliosis

While walking is generally considered a safe and effective exercise for people with scoliosis, it may not be suitable for everyone. Some people may find that other exercises are more beneficial or more comfortable for them.

For example, swimming and water aerobics are often recommended for people with scoliosis, as they provide a low-impact workout that is gentle on the joints and muscles. Yoga and Pilates can also be beneficial, as they focus on building strength, flexibility, and balance, all of which are important for maintaining good spinal health.

Ultimately, the best exercise program for people with scoliosis will depend on their individual needs and limitations. It is important to work with a healthcare professional to develop a safe and effective exercise program that takes into account any medical conditions, injuries, or other factors that may affect your ability to exercise.

 

Is walking a good choice for those with Scoliosis?

Walking can be a safe and effective exercise for people with scoliosis, as long as certain precautions are taken. Walking can help strengthen the muscles in the legs, hips, and back, improve balance and coordination, and provide a natural way to manage symptoms and improve overall quality of life.

 

How Important Is Compliance For Scoliosis Bracing Success?

Scoliosis is a condition that affects the curvature of the spine. It can be caused by a variety of factors, including genetics, injury, or underlying medical conditions. Scoliosis can range from mild to severe, and treatment options depend on the severity of the curvature. One of the most common treatments for scoliosis is bracing. While bracing can be effective in preventing further curvature of the spine, compliance with the treatment plan is crucial for success.

 

What is scoliosis bracing?

Scoliosis bracing involves the use of a custom-fitted brace to prevent further curvature of the spine. The brace is typically worn for a set number of hours each day, depending on the severity of the condition. The goal of bracing is to prevent further curvature and ideally, to reduce the existing curve. Modern “over-corrective” braces, such as the SoliBrace make this possible, whereas with older braces stopping progression was the best possible outcome.

 

Why is compliance important for scoliosis bracing success?

Compliance is crucial for the success of scoliosis bracing. When a patient wears a brace as directed by a Scoliosis specialist, they are more likely to prevent further curvature of the spine and reduce an existing curve. Compliance also ensures that the brace is working properly and providing the necessary support to the spine. Ultimately, Scoliosis braces work by gently applying pressure to the spine in a direction which opposes the curvature – over time, the spine will tend to correct itself – but time is the keyword here. Unless the brace is on a patient’s body for enough time, it simply cannot do its job.

Non-compliance, or failure to follow the treatment plan, can lead to a number of issues. If the patient does not wear the brace as directed, the spine may continue to curve, which can lead to more severe scoliosis and potential surgery. Non-compliance can also cause discomfort and pain, as the brace may not fit properly or provide the necessary support if the curve worsens from its “starting” state.

Compliance is therefore critical to the success of bracing – and while many patients often perceive this as a negative (especially when adjusting to brace wearing) it’s important to realise that research suggests this relationship is proportional, so, consider the flip side – the longer you wear the brace, the faster your Scoliosis will improve![1]

 

How can patients increase compliance with scoliosis bracing?

There are several strategies that patients can use to increase compliance with scoliosis bracing. The first step is to understand the importance of compliance and the potential consequences of non-compliance. Patients should of course discuss any concerns or questions they have with their specialist to ensure that they fully understand the treatment plan and have made as many adjustments as possible to make it viable – this is all well and good for adults but for children, it can be more complicated.

Parents of children being treated with Scoliosis braces should do everything they can to explain the process to their children, but on a practical level, they can also work to make the brace more comfortable and convenient to wear. This may involve adjusting the fit of the brace or finding ways to wear it that are more comfortable. Braces such as ScoliBrace are highly customisable and provide a lot of flexibility in this regard. Some patients find that wearing the brace while sleeping or during sedentary activities is more comfortable than wearing it during more active times – again, braces such as ScoliBrace are easy to put on or take off yourself, which makes it much easier to be more flexible with the times of day that a brace if worn.

Support from family and friends can also be helpful in increasing compliance. Encouragement and reminders to wear the brace can help patients stay on track with their treatment plan.

 

Is compliance the most important factor?

Compliance is crucial for the success of scoliosis bracing. When a patient wears a brace as directed, they are more likely to prevent further curvature of the spine and potentially improve a curve or at least avoid surgery. Nonetheless, compliance with a program is only valuable if that program is optimised to achieve individual results for a given patient – and this is why the choice of brace, and clinic matters so much.

[1]Effects of Bracing in Adolescents with Idiopathic Scoliosis
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

 

How Fast Does Scoliosis Get Worse?

Scoliosis is a progressive condition – this means it tends to worsen with age, but the speed at which it does this can vary. Scoliosis is known to accelerate during growth spurts, and worsens more quickly in young people than adults. Then again, a form of scoliosis, known as “de-novo scoliosis” is common in older adults, and can also progress quite rapidly.

Each Scoliosis case is unique, and predicting growth rates depends on factors like severity, rigidity, and family history. Broadly speaking, Juvenile scoliosis over 30 degrees can rapidly progress, usually necessitating surgery, while 21 to 30-degree curves may lead to surgery or disability if left untreated[1][2].

Acting quickly and proactively is crucial to halt scoliosis progression and correct curvature before surgery is required.

 

Don’t wait and see

Research by the British Scoliosis Society reveals that even during the consultation process, scoliosis curves can progress considerably. In a 2018 study, patients waiting for scoliosis surgery experienced rapid curve progression, with some requiring more extensive surgery than initially planned. The study included curves ranging from 17° to 90°, emphasising the need for timely intervention[3].

This shows why “wait and see” is such a bad approach to scoliosis treatment – this study alone highlighted the impact of delayed consultation, turning smaller curves into larger, more challenging cases. This is all the more important when you consider that today, with modern approach to treatment, something like a 30-degree curve has an excellent prognosis with conservative treatments like scolibrace,

 

Older Adults and Scoliosis

In general, Scoliosis in adults can be described as slightly more predictable. Adult scoliosis cases tend to progress at a steadier rate, but an additional risk arises with age – degenerative or de-novo scoliosis. Caused by wear and tear on spinal discs, this form is common among older adults, affecting about 30% of those over 60[4].

De-novo scoliosis progresses more slowly than childhood or adolescent scoliosis but faster than the very gradual development seen after reaching skeletal maturity and before age 60. De-novo Scoliosis can significantly impact quality of life. Patients often experience back and leg pain, making walking or standing difficult. Standard conservative treatments may not provide relief, and surgery may not be an option due to conditions like osteoporosis.

For these patients, a gentle supportive brace can offer relief, helping them stand more comfortably for longer periods. Early intervention and proper treatment can make a substantial difference in managing degenerative scoliosis in older adults.

 

Conclusion

Scoliosis progression is not a linear process, it’s unpredictable and that makes taking proactive action as soon as possible all the more important. Waiting for consultation or surgery can lead to rapid and undesirable changes, turning manageable cases into more severe ones. Both young patients with progressive scoliosis and older adults facing degenerative scoliosis require proactive approaches to halt progression, manage symptoms, and improve quality of life.

 

 

[1] Charles YP, Daures JP, de Rosa V, Diméglio A. “Progression risk of idiopathic juvenile scoliosis during pubertal growth.” Spine. 2006 Aug 1;31(17):1933-42.

[2] H V Dabke, A Jones, S Ahuja, J Howes, P R Davies. “SHOULD PATIENTS WAIT FOR SCOLIOSIS SURGERY?” Orthopaedic Proceedings. Vol. 88-B, No. SUPP_II.

[3] Angelo G Aulisa et al. “Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies.” Scoliosis. 2014; 9:3. DOI: 10.1186/1748-7161-9-3.

[4] Kebaish KM et al. “Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender.” Spine. 2011 Apr 20;36(9):731-6.

Is Scoliosis Classed As A Disability In The UK?

Scoliosis is an unusual condition since it can have a huge impact on someone’s life – or almost none at all. Many people with small Scoliosis cases never experience any significant disruption, whereas those with severe cures may even find they have trouble getting around. Scoliosis also sits in an unusual category, since it’s still viewed as a condition which is “permanent” even though today it’s often possible to correct it. With this in mind, does Scoliosis count as a disability?

 

Is Scoliosis a Disaiblity?

In the UK, disabilities tend to be defined not by the condition themselves, but more by the way they impact a person’s life – therefore, whether scoliosis is considered a disability in the UK depends on the severity of the condition and its impact on the person’s daily life.

Under the Equality Act 2010, scoliosis is considered a disability if it has a substantial, long-term adverse effect on a person’s ability to perform normal day-to-day activities. Long-term means that the condition has lasted, or is likely to last, for at least 12 months. This is already complex since people under treatment for Scoliosis will (hopefully) eventually overcome the condition, but how long this will take is very hard to say!

Because of the way that disabilities are assessed in the UK, it is therefore unlikely that Scoliosis will be counted as a disability on its own – you’ll need to prove that it makes living your life difficult.

 

Protection from discrimination

Slightly clearer is the position visa-vis The Equality Act 2010 – this act provides legal protection against discrimination in employment, education, housing, and other areas. In most cases, a scoliosis diagnosis would be an item which an employer, for example, would need to take into account as an aspect of ensuring equality. This means that employers, schools, and service providers are required to make reasonable adjustments to accommodate the needs of people with scoliosis.

Reasonable adjustments may include making physical adjustments to the workplace or school environment, such as providing ergonomic chairs or desks, allowing for breaks or adjustments to working hours, or providing assistive technology or devices.

 

Does Scoliosis qualify me for benefits?

People with scoliosis may be eligible for disability benefits in the UK, but only if the condition makes it difficult for them to live their lives normally. The Department for Work and Pensions (DWP) provides disability benefits to people who have a health condition or disability that affects their ability to work. The benefits include Personal Independence Payment (PIP), which helps with the extra costs of living with a long-term health condition or disability, and Employment and Support Allowance (ESA), which provides financial support for people who are unable to work due to their health condition or disability.

 

To be eligible for disability benefits, the person with scoliosis must show that their condition has a significant impact on their ability to work or perform day-to-day activities. The DWP uses a set of criteria to assess the severity of the condition and its impact on the person’s life. If the person meets the criteria, they may be eligible for disability benefits. As you may know, the bar for said benefits is often very high, so sadly it’s unlikely that you’ll be eligible unless your Scoliosis has caused significant mobility issues.

 

Is Scoliosis a disability?

Every scoliosis case is different, and the degree to which it impacts your life will be the biggest factor in deciding if it’s considered a disability and if you can receive benefits or support in the UK. In most cases, having Scoliosis alone won’t be enough to qualify you.

That being said, Under the Equality Act 2010, people with scoliosis are protected from discrimination, and employers, schools, and service providers are required to make reasonable adjustments to accommodate their needs.

 

How To Stay Comfortable While Wearing A Scoliosis Brace

Scoliosis is a medical condition in which the spine curves abnormally to one side. Scoliosis braces are designed to help correct this curvature by applying pressure to the spine. However, wearing a scoliosis brace can feel uncomfortable, especially during the initial adjustment period. Much like wearing braces on your teeth, it takes a bit of getting used to. Once you’re through this part, however, you can make choices which make wearing a brace easy – or hard. Make your life easy by planning ahead! Let’s look at some of the easiest ways to make wearing a brace work for you.

 

Find the right fit

The first and most important step to ensure comfort when wearing a scoliosis brace is to find the right fit for the brace itself. A properly fitted brace should be snug but not too tight. If the brace is too tight, it can cause discomfort and even lead to skin irritation or sores. On the other hand, if the brace is too loose, it will not provide the necessary support and correction.

ScoliBrace, the system used at the UK Scoliosis Clinic is designed to fit the wearer like a glove – we measure and custom produce your brace to millimetre tolerances to ensure that it’s just right. Braces like the ScoliBrace also allow some degree of adjustment, so that we can get more life from the brace – it’s important to ensure that whenever your brace is adjusted you test it out for comfort and have it modified if anything is uncomfortable.

 

Wear a moisture-wicking undershirt

Scoliosis braces, like anything worn on the body, tend to retain heat – in the winter this can be helpful, but in summer it can cause sweating and discomfort, especially during very hot weather. Wearing a moisture-wicking undershirt can help keep the skin dry and prevent chafing or irritation. These undershirts are made of breathable fabric that wicks sweat away from the skin and keeps the body cool.

 

Use skin protectants

Wearing a scoliosis brace can cause friction and pressure on the skin, leading to skin irritation or sores. This isn’t usually an issue with a properly fitted brace during everyday wear, but if you’re using a lightweight brace like ScoliBrace and leave it on during exercise you might experience some discomfort. Using skin protectants, such as creams or ointments, can help prevent these problems. The protectant forms a barrier between the skin and the brace, reducing friction and pressure.

 

Practice good hygiene

Practising good hygiene can help prevent skin irritation and infection. It is essential to clean the skin under the brace daily using mild soap and water. Dry the skin thoroughly before putting on the brace since if you do sweat throughout the day the skin can become more prone to soreness.

 

Wear comfortable clothing

Wearing comfortable clothing can help reduce discomfort when wearing a scoliosis brace. Choose loose-fitting clothes that do not rub against the brace especially when relaxing at home. Avoid wearing tight clothing or clothing with thick seams, as they can cause pressure points and discomfort – this isn’t really to do with the brace – tight-fitting clothes can cause irritation for anyone – but when wearing a brace the effect is often more noticeable.

 

Stay active

Staying active can help improve comfort when wearing a scoliosis brace. Exercise helps improve muscle strength and flexibility, which can reduce discomfort and improve posture. Consult a healthcare provider before starting any exercise program, as some activities may be restricted when wearing a scoliosis brace.

 

Stay hydrated

Drinking plenty of water can help prevent dehydration and reduce discomfort when wearing a scoliosis brace. Dehydration can cause fatigue, headaches, and muscle cramps, making wearing the brace more uncomfortable. Aim to drink at least eight glasses of water per day.

 

 

Does poor posture cause Scoliosis?

Scoliosis is a medical condition that affects millions of people worldwide. It is characterised by an abnormal curvature and twist of the spine, which can result in physical limitations and discomfort. While the exact cause of scoliosis is not fully understood, it is believed to be the result of a combination of genetic and environmental factors.

 

Can poor posture cause Scoliosis?

One of the environmental factors that is often associated with scoliosis is poor posture – people with scoliosis are often perceived as having poor posture, and many parents worry that poor posture can cause Scoliosis – but can it? The bottom line is no – poor posture does not cause Scoliosis. Poor posture is a common problem that affects many people worldwide – and it can be a painful issue though. Poor posture can be caused by a variety of factors, including muscle weakness, joint stiffness, and poor ergonomics – but while Scoliosis might cause someone to appear to have poor posture, there’s no evidence to show that poor posture will lead to Scoliosis.

When we have poor posture, our bodies are not in alignment, which can lead to a variety of health problems, including back pain, neck pain, and headaches. Poor posture can also cause our muscles and joints to work harder than they should, leading to fatigue and discomfort. That “hunched” appearance which used to be associated with teens but seems to apply to almost everyone these days is more characteristic of Kyphosis, rather than Scoliosis – and in extreme cases, poor posture might be caused by Kyphosis, but not Scoliosis.

 

Is there any relationship between Scoliosis and Poor posture?

Most Scoliosis research focuses on establishing the true cause of Scoliosis, and the best ways to treat it, so there hasn’t been much research into whether poor posture might contribute once the condition already exists. Therefore, while poor posture is not a direct cause of scoliosis, it might be a factor which could contribute to the progression of the condition. When we have poor posture, our spines are not in the proper alignment, which can cause our muscles and ligaments to become strained and weakened, it’s feasible that this might make it more possible for scoliosis to progress.

Many aspects of a Scoliosis treatment plan are aimed at creating balance and strength in the core muscles which support the spine, so while maintaining good posture is important for everyone, it’s fair to say that focusing on good posture is especially important for those with scoliosis. Good posture can help to alleviate some of the painful symptoms which some people experience with scoliosis at the very least.

 

Maintaining good posture

Scoliosis or not, you can only do yourself a favour by maintaining good posture – Here are some tips:

  1. Stand up straight: When standing, make sure your weight is evenly distributed on both feet, and your shoulders are relaxed.
  2. Sit up straight: When sitting, make sure your back is straight, and your feet are flat on the ground.
  3. Use proper ergonomics: Make sure your desk and chair are at the proper height and distance to promote good posture.
  4. Exercise regularly: Regular exercise can help to strengthen the muscles and ligaments that support the spine, helping to prevent the progression of scoliosis.
  5. Stretch regularly: Regular stretching can help to alleviate the symptoms of scoliosis and improve flexibility.

 

Treating Scoliosis

Treating Scoliosis is about much more than altering postural imbalances – Scoliosis treatment requires a focus on good nutrition, exercise, and healthy lifestyle habits as well as a proactive approach such as Bracing. In this regard, there’s a lot we can do to help patients support treatment plans – and much of the advice would be beneficial to almost anyone!

For example, regular exercise can help to strengthen the muscles and ligaments that support the spine, and eating a balanced diet that is rich in calcium and vitamin D can also help to promote strong bones and a healthy spine.

So, while poor posture is not a direct cause of scoliosis, it’s not impossible that it might contribute to the progression of the condition. This being said, maintaining good posture is important for everyone, and might even help with pain relief in those with Scoliosis. By focusing on good nutrition, exercise, and healthy lifestyle habits, we can care for our spines, with, or without Scoliosis!

 

 

 

Happy New Year from the UK Scoliosis Clinic!

As the calendar turns to 2024, all of us at the UK Scoliosis Clinic want to extend our warmest wishes for a happy and healthy New Year to our patients, their families, and our wider community.

The past year has been a journey of growth and positive change. We’ve had the privilege of helping many individuals manage their scoliosis, witnessing their progress and resilience. Your trust and commitment inspire us daily, and we are deeply grateful for the opportunity to be part of your healthcare journey.

In 2024, we are excited to continue providing top-notch care and innovative treatment options. We have several new initiatives and programs planned to enhance our services and support our patients even better. Our goal, however, remains the same – to offer the best, most comprehensive care that not only addresses the physical aspects of scoliosis but also supports overall well-being.

As we step into this New Year, we encourage you to set new goals, prioritise your health, and stay committed to your treatment plans. Remember, managing scoliosis is a team effort, and we are here to support you every step of the way.

Thank you for being part of the UK Scoliosis Clinic family. May this year bring you peace, joy, and good health. Happy New Year!

Warm regards,

The UK Scoliosis Clinic Team

Happy Christmas 2023!

One of the best things about Christmas is spending time with loved ones. Whether you’re cuddled up by the fire with your significant other, or surrounded by family and friends at a big holiday party, there’s nothing quite like the feeling of being surrounded by those who care about you.

Of course, Christmas wouldn’t be complete without all the delicious food and drink that goes along with it. From turkey and stuffing to eggnog and mulled wine, there are plenty of festive treats to indulge in during the holiday season. And let’s not forget about all the sweet treats like Christmas cookies and candy canes!

But beyond the presents and the food, there’s something truly special about the spirit of Christmas. It’s a time of year when people come together to spread joy and kindness, to give back to those in need, and to reflect on all the things that we have to be grateful for.

From all of us here at the UK Scoliosis Clinic, we wish you a very Merry Christmas! May your holiday season be filled with love, laughter, and lots of festive cheer. We’ll be back in January 2nd – see you then! 🙂

Christmas Opening Hours 2023

The UK Scoliosis Clinc is open on a number of dates in the run-up to Christmas- Paul will be in the clinic on:

Wed 27/12/23

Thurs 28/12/23

Fri 29/12/23

 

If you’d like to book an appointment on any of these dates please do so quickly as hours are limited. Thank you!

How Long Does Scoliosis Bracing Take?

Scoliosis bracing is a highly effective, non-surgical treatment option for children and adolescents with moderate to severe scoliosis. Braces are custom-made to fit the patient’s body and apply pressure to the spine to encourage it to grow in a more normal alignment. The goal of scoliosis bracing is primarily to stop the progression of the curvature until the child’s spine has stopped growing, and, ideally to correct the existing curve to leave the patient with as straight a spine as possible.

 

Factors which impact bracing time

Scoliosis bracing works over time – the fundamental aspect of the treatment is the gradual application of corrective force over a period of months, and probably years. The exact length of time a person needs to wear a brace depends on several factors, including the severity of the curvature, the age of the child, and the rate of spinal growth. Children who are diagnosed with scoliosis at a younger age are more likely to need longer treatment times because their spines are still growing, and the curvature may progress more quickly. The severity of the curvature is also an important factor, as more severe curvature may require a more rigid brace or a combination of bracing and other treatments, such as surgery. At the same time, cases which are caught early in young children have some of the best chances of a complete correction – although these patients will generally need to continue with some form of Scoliosis prevention until they reach adulthood.  Cases which are treated for the first time in Adults (often a form of Scoliosis known as degenerative or “de-novo” Scoliosis) often improve with only part-time bracing[1].

The compliance of a patient with wearing the brace is also an essential factor. If a patient wears the brace as directed, they are more likely to see positive results and need to wear the brace intensively for a shorter period of time. Again once a curve has been corrected, some maintenance is required, but this can usually be part-time brace-wearing, often at night or in the evening.

The length of time a patient needs to wear a brace can therefore vary widely, but on average, children wear a brace for a considerable amount of time (often 20+ hours a day) for two to three years. After this part-time wear or a program of Scoliosis specific exercise is usually sufficient to prevent a reoccurrence.

 

Is wearing a Scoliosis brace hard?

The duration of scoliosis bracing is an important consideration for parents and children. It can be challenging for children to adjust to wearing a brace consistently for an extended period, but it is crucial for the success of the treatment. Parents can help their children by providing emotional support and encouragement and ensuring that the child wears the brace as directed – as a clinic, we do everything we can to make brace wearing as comfortable and manageable as possible!

It’s also important to monitor a patient’s progress regularly as part of treatment to ensure that the brace is working as intended. Based on this progress, wear time can be adjusted up or down based on goals as well as how well the brace is being tolerated. We usually recommend regular X-rays to check the progression of the curvature and adjust the treatment plan as necessary – this approach allows maximum flexibility in the trade-off between in-brace time and speed of treatment.

While scoliosis bracing can be challenging for children and adolescents, it can also be an opportunity for personal growth and resilience. Children who successfully complete scoliosis bracing often develop increased self-confidence and a sense of accomplishment.

[1]Effects of Bracing in Adult With Scoliosis: A Retrospective Study
Palazzo C, Montigny JP, Barbot F, Bussel B, Vaugier I, Fort D, Courtois I, Marty-Poumarat C, Arch Phys Med Rehabil. 2016 Jun 22. pii: S0003-9993(16)30256-8. doi: 10.1016/j.apmr.2016.05.019