World Master 2020: let’s go!

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On January 16 the World Master Online officially opened, now in its fifth edition. Participants come from all over the world with the entry of countries like Colombia, Armenia, Norway, Egypt and Mongolia for the first time.
It is the only online International Master that offers the possibility of training on the Rehabilitation Treatment of Scoliosis.
Over the years there have been over 200 participants, coming from 50 countries for 5 continents.
The Online course does not stop growing, so much so that one of the ideas in the pipeline is to expand the editions, starting to work alongside the English one in Chinese, as we have been asked several times.
What do they say about the Master? “I recommend the experts interested in Scoliosis conservative treatment join this course“. And also “The content is extensive, up to date and evidenced-based. This course gives clinicians a profound understanding of scoliosis and non-surgical management”.

For more info please visit the website: www.scoliosismaster.org

Scoliosis and pregnancy: it’s possible!

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The Isico blog www.scoliosi.org is a dedicated space where patients can ask questions and swap experiences, but it is also a place where those involved in treating scoliosis can take a more in-depth look at a series of topics and also engage with patients.

Here is one of our published posts

“I have scoliosis, can I have children?” This is a question we are often asked. And we have no hesitation in answering: “Yes, becoming a mother is a great joy that should be experienced without anxiety, even if you have scoliosis”.

It is, in fact, absolutely untrue that if you have scoliosis you can’t have children. A woman with scoliosis can have children. She should simply consult a spine specialist for advice and monitoring of her curve. 

Moreover, just like any other woman, she can, on the basis of specialist advice from a gynaecologist/obstetrician, opt for a natural delivery or a C-section. 

During pregnancy the body produces a hormone, called relaxin, which serves to “soften” the back and the pelvis, allowing the physiological changes that are necessary for giving birth.

During pregnancy itself, there will be no particular problems, as the expanding uterus supports the column and helps to stabilise it. 

After childbirth, however, the back remains very mobile for a few months, and this is the period in which there is an increased risk of a worsening of the curve, not least because the child, no longer supporting his mother’s back from within, will often be in her arms, placing an added strain on her back.
If the scoliosis is severe, it is a good idea to “plan ahead” and take some preventive measures: by working out an appropriate exercise plan before pregnancy, and continuing to do the exercises right up to the birth, it is possible to prepare effectively for the critical postnatal period when, moreover, the mother will probably have less time for doing exercises!

As for the birth itself, epidural anaesthesia may be well possible.
It depends mainly on whether the woman has had spinal fusion surgery, and, if so, on which part of the spine: if the surgery was performed at the level of the dorsal spine and the lumbar spine is free, then there will be no problem. 
If, instead, the lumbarlevel was also involved in the surgery, the anaesthesiologist will establish which was the last vertebra involved and, on this basis, decide whether or not an epidural is possible.

A Christmas Carol from Isico

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Our very best wishes for Christmas and 2020: a whole new year for each of us to “shape” as we like! 

Our greetings come to you with a story.
More than just a trip down memory lane (to the bike rides and dripping lollipops of our youth), “Liquorice Wheels” is a story of hope: a reminder that things work out for the best, most of the time!

Thanks to Roberto Angero, father  of a young Isico patient, who shared with us “his” story and we want to share this story with you as our Christmas Carol for this year.

Liquorice Wheels

Every kid in town would stop to watch him, especially when he reared up for more than a dozen consecutive pedal turns. He could do that – we counted them! He would lift his BMX like a tamed horse and then, balancing on the back wheel, would twist the handlebars, first right and then left. He could steer while rearing, too, and even jump up onto the pavement.

In the afternoon, after homework, we would wait for him on the playing field. He was always the last to appear, and you couldn’t leave without him. Simone was the one with the best bike — the best not because it was new, but because it had belonged to his cousin, who had been in a gang war.

That’s what he used to tell us at least. Simone showed us all the scratches the bike had acquired during various raids, but the thing that amazed us was that sticker on the crossbar with “Iron Maiden” written on it. Simone told us that only gang leaders had that sticker. I believed it because I once saw one on my brother’s friend’s Vespa. Surely, he must have been a gang leader, too, because everyone else just had a Garrelli scooter, and no sticker! Once everybody had arrived at the playing field, we could leave, with Simone in the lead. Elisa, who had a Graziella (ladies’ bicycle), was the prettiest in the group, but she would only ever talk with Simone, and sometimes with Sandrino, too. Filippo, instead, rode a red Saltafoss (mountain bike) with a gearbox, and I remember that he used to make us laugh a lot because he could imitate all our teachers. 

Then there was Tommy, who always brought the ball, which he kept in a plastic bag hanging from his handlebars. Jessica, meanwhile, used her mother’s bike, which had a basket, and she could barely reach the pedals. I remember she wasn’t as pretty as Elisa, and she also wore a strange body brace because she said she had a crooked back, but she always had a great supply of sweets. Sandrino was always the one with a new bike — he used to say that his father was rich —, but he never let anyone have a go. On just one occasion he let Elisa have a ride in exchange for a kiss on the cheek, but that was the one and only time. He was very possessive with his belongings.

The group also included Carlo and Marco, the “little twins”, who were inseparable. They had identical bikes, and they both rode one-handed because the other hand was always holding a lollipop, which dripped to the elbow. Actually, they weren’t twins at all. They had been friends since kindergarten, but they did look very similar, maybe because of all the time they spent together! Then there was me. With my gold coloured bike. Always bringing up the rear. 

Simone usually led the group, and we all fell in behind him, including me, of course. We moved in single file, except for Carlo and Marco, who rode side by side. Whenever Simone decided to go faster, we all had to speed up, but we made sure we never overtook him. We used to go round town that way. Our town, Somma, seemed very little at the time, and we felt like the whole place belonged to us.

There was a group of younger kids that we often encountered, and when we did Simone would rear up, leaving them astonished. On the other hand, we were always careful to avoid the older groups. We were scared of them, although Simone always said that they would never stick around if his cousin were with us! Our bike ride usually ended up at Paradise Street, which was legendary! It was a hilly road that made for a thrilling ride. We would all stop at the top of the first hump. We kept in line, except for Marco and Carlo, and no one ever went before Simone did. The second to go was always Filippo, who would imitate our maths teacher as he careered headlong down the hill, leaving us doubled up with laughter. Brilliant!

Gradually, all the others followed suit, racing down like there was no tomorrow. Jessica and I, on the other hand, almost never took part because we were afraid of falling off. Well, I was afraid of falling off. Jessica didn’t want to ruin her mother’s bike, or so she said! So, we would wait for the others, eating sweets together. After Paradise Street, we would make our way to the playing field. Tommy would get the ball out, while Simone and Filippo formed the teams. These were never even, of course. I always ended up with Marco, Carlo and Jessica. They weren’t much good at football and, what’s more, they always put me in goal. The other team always scored loads of goals, and at the end of the match Simone would tell me I had been lucky because, if his cousin had been there, they would have scored many more. And I let myself believe it.

In those days, evening always came far too fast. You started to hear someone’s mum calling in the distance, usually Sandrino’s, and we knew it was time to call it a day. 

Simone was always the first to go home, quickly followed by Elisa. Tommy would put the football back in its bag, while Filippo would do one of his famous imitations, such as our religious education teacher in a temper, screaming at everyone in a falsetto voice.

Those were the last laughs of the evening. I had to go home, too. I usually said goodbye to Jessica first who, in exchange, gave me a liquorice wheel, while the twins went off together as usual, happily challenging each other to an armpit raspberry contest!

Today, 30 years later, sitting on a bench near those places (now gone) where we used to play, I am lost in thought. The memories of the past blend with thoughts of the present. I find myself remembering how I was always the last one and Simone the cool one.

No one would think that seeing him today: once the blond “golden guy”, now he is overweight, grizzled and balding. He doesn’t have a secure job, and is constantly looking for some “cousin” to liven up his dull life. I also thought about everyone else. For example, about Marco and Carlo, who, years later, still seek each other out just like they did as small children: a brotherly bond that will last forever. I think about Elisa, who used to run after a thousand cool guys like Simone, in the futile hope of finding her Prince Charming among them. Today, she’s still as beautiful as ever; after three divorces, she has now moved on to yet another flashy entrepreneur. Tommy hasn’t changed either: he’s just as “public-spirited” as he always was. Back then he was the one who always thought to bring a ball, now he’s the one likes to get a round of beers in for everyone, especially if Filippo is there. Filippo still loves to entertain everyone, and the more beer he drinks, the more he shoots his mouth off, cracking us all up! Unfortunately, we’ve seen little of Sandrino since his dad’s company went bankrupt, and he had to start learning to get by on his own. By all accounts, he’s not doing too well: he drives a dilapidated van now and has maybe even moved away.

And so that just leaves me. I used to feel like I was at the back of the queue in life, but now I have come to realise I am the luckiest of the bunch. I still have my old friends, but mainly I have Jessica, my lovely wife — now with a perfectly straight back —, who has been by my side all these years, making sure I’m never short of love and affection, or sweets! There’s no point hiding the fact: I’ve always been mad about her!


— 

MARTA, BRACE AND MEDALS

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Marta Pagnini is a former Italian gymnast, captain of the Italian National Rhythmic Gymnastics Team, a Knight of the Order of Merit of the Italian Republic and a member of the Air Force Military Corps and … she has scoliosis!

Discovered when she was thirteen years old initially treated with only exercises, she had to surrender to the corset when she was already 18 and was risking sporting qualification to the competitive activity. Given the late development due to gymnastics and her growth not yet completed, the brace was still an option.
After the inevitable initial moments of fatigue, pain and despair, within a few months, she got used to it and understood that the brace was her ally. She had hoped she wouldn’t have to wear it, but once accepted, everything went downhill. Marta was lucky to have a coach who understood and tried to understand; thus, she was able to express herself to the fullest, feeling at ease despite scoliosis.
Marta has won countless medals, and it was sports activity that was also in the sleeve against the disease: it helped her to keep the physical fitness, elasticity and muscle tone, doing a lot of good to her back.

Martha is living proof of what has been demonstrated recently by an ISICO study, Winner of the SOSORT Award 2019, on over 700 patients according to which those who wear a full-time brace and practice sport are more likely to improve than those who are sedentary. (Effect of sport activity added to full-time bracing in 785 Risser 0-2 adolescents with high degree idiopathic scoliosis).

«Playing sports several times a week, even at a competitive level, has positive effects for those who wear a rigid brace and it makes no sense to forbid it to those who have scoliosis “, underlines Alessandra Negrini, physiotherapist in Isico, who has conducted the research. «Sport is not a therapy so that in the presence of a pathology of the spine it is essential to associate it with a specific treatment. Without any doubt, it has a positive impact: once a week it is irrelevant, from two upwards, the positive effect is much more marked. Not quitting is fundamental, also because competitive spirit is a deep passion and can make therapies easier to accept.»

Marta has recently become patient in our Milan headquarter, where she follows our specific exercise approach to scoliosis with SEAS exercises.

Can scoliosis be treated with exercises?

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The answer is yes, and they are indeed fundamental, but sometimes exercises alone are not enough. Whether or not an exercise-based treatment is sufficient depends, above all, on the severity of the curves and the evolutionary potential of the scoliosis itself, which is partly determined by growth.
Therefore, exercises sometimes need to be combined with another treatment, such as bracing. Rigid  brace wearers always need to do specific exercises in order to minimse the side effects of the brace and maximise its corrective impact.
Patients prescribed the Spinecor wrapping system, a dynamic brace, do not need to do any specific exercises since this device allows movement and therefore guarantees the natural trunk muscle strengthening  that favours correction of the spine. 

Scoliosis treatment can be likened to climbing a mountain; a true climber is well aware that the path ahead of him will present obstacles, but he  is confident he will be able to overcome them in order to reach the top.
That is his goal and he is determined to achieve it, whatever it takes and however long it takes him, because he already anticipates the enormous satisfaction he will feel on finally reaching the summit .

The various treatment options can be seen as different steps on a ladder, where the lowest is the one that has the least impact on the individual, but is also the least effective; instead, the highest step represents the very most that can be done in terms of treatment, and the treatment that will have the greatest impact on the youngster’s daily life. 

The ideal therapy is one that allows the best possible results with the least possible impact.

The first step on the treatment ladder is simple observation; at this level the patient needs to attend frequent medical check-ups in order to keep the scoliosis monitored, and the physician needs to be ready to intervene if the need arises.
The next step involves exercises alone, which are sufficient to control scoliosis of mild and mild-medium severity.
At the next level, patients are offered braces consisting of soft bands, and then, if the condition warrants it, braces made of more or less rigid materials.

Sometimes parents immediately want a therapy that, in their view, gives greater guarantees of success, regardless of the impact on their child.
This attitude is generated by the mistaken belief that opting for  the most aggressive therapy will allow the worst outcome to be avoided, and also by the idea that bracing is more convenient .
To return to the metaphor of the mountain, this amounts to starting the ascent running, in the hope of getting to the top more quickly, but it is an approach that may see the climber paying a very high price in terms of his health and even ending up having to end his career early.

Since scoliosis is an evolving disorder, the treatment, too, needs to be constantly evolving: the best strategy is to be ready  to introduce timely changes in response to emerging needs.

It is important to see the treatment from a global perspective: a patient who starts off simply doing exercises, and does them well for a certain number of months, before then being obliged to wear a brace  will at least have avoided some months of brace wearing, which is certainly a good thing.
Changing treatment does not mean that the previous one was unsuccessful, it simply means that it has become apparent that a  stronger method is needed order to win the struggle (like an arm wrestling contest!) with the scoliosis.

What happens when scoliosis is left untreated?

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Our paper entitled “The natural history of idiopathic scoliosis during growth: a meta-analysis” was published some months ago in the American Journal of Physical Rehabilitation.
The research focuses on 13 studies in the scientific literature that examine the natural history of idiopathic scoliosis, that is to say, the way scoliosis evolves in the absence of any treatment.

“We conducted a systematic search of the literature in order to identify all published studies dealing with the natural history of idiopathic scoliosis. Our aim was to pool the data in a meta-analysis that might provide insight into disease progression rates” explains Isico physiatrist Dr Francesca Di Felice.

The data in the studies included in our meta-analysis were collected from individuals affected by infantile, juvenile and adolescent forms of idiopathic scoliosis from the time of detection until they were fully grown: these individuals, observed over time, never received any treatment for the condition.

 “Some of the studies included, generally the oldest ones, presented methodological weaknesses, such as failing to provide systematic data on the size of scoliotic curves at the beginning and end of treatment, to distinguish clearly between juvenile and adolescent forms, or to consider outcomes other than rate of progression: aesthetics, humps and sagittal balance, for example” Dr Di Felice goes on. “The meta-analysis revealed high rates of progression for all the forms of idiopathic scoliosis, and the data on infantile scoliosis  showed the highest variability: suffice it to say that the three studies referring to that category showed progression rates ranging from 5 to 80%!

I would say there is now little prospect of adding to the available data on the natural history of scoliosis through new randomised studies, given that it has become impossible, from an ethical point of view, to leave scoliosis patients untreated”.

When the brace turns you strong

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Cecilia is 18, and she has been wearing a brace for the past six years. Since she has learned a lot about herself over that time, she has decided to share, in words and pictures, her experience of growing up in a brace. And so here she is, captured with the “friend she loves to hate” in a series of delicate, almost magical, pictures taken by a young photographer.
Let’s hear what Cecilia has to say. 

There was a time when I would never, ever have considered being photographed with my “worst enemy”, but then I met Tatiana Minelli, and changed my mind.

My story begins when I turned 12. It was so hard to accept the prospect of being “locked” in a plastic case for years! I can still remember all the crying, screaming and arguing over it, the sheer desperation I felt at the idea that, once I was wearing my shell, people wouldn’t love me so much, I wouldn’t be accepted, and I would stop receiving all the attention, love and hugs I was used to. 

I had to force myself to take courage and think that, without the brace, my back would eventually give way completely: I had to be prepared to put up with some discomfort now, so that the future me need not suffer. 

I had to re-invent myself, or rather discover a new me. Ever since I was a little girl, I had always loved clothes – drawing them, choosing and matching them –, but now I found myself deciding that I needed to find a way of hiding the brace beneath my clothes. That was my priority, because there was no way I was going to let anyone see it!

My solution was to wear baggy, loose-fitting clothes, far bigger than my true size. It was hard, because when you are that age, you naturally start wanting to show off your figure. The sacrifices and tears that come with having to “befriend” a brace are something that few others can really understand. 

I am so grateful to my parents, my sister and everyone who has always been there for me, no matter what. And that goes for my friends, too. Whatever the occasion, a sleepover, party or trip somewhere, they always knew that I came with a “hidden extra”, and perhaps wouldn’t be able to do all the things they did because it was painful or uncomfortable for me, but they just accepted me, and never made a big deal of it. 

At first, I had to wear the brace all the time, 24 hours a day. Then, as time went, by I was able to reduce, gradually, the number hours I needed to keep it on.

Which brings me to today, and my decision, after eight long years, to finally let people see me in my brace, without any sense of fear or embarrassment and without filters. I have come to realise that I perhaps ought to have let my brace be seen from the start. To paraphrase one of my favourite writers, I should have risen above the “problem” that used to make me feel so awkward, and accepted it with a lighter heart.  

Today, eight years on, I realise that our true value lies in the things that make us different, and that it is my brace that has made me the stronger person that I am today. But wearing a brace has been just the start of my long journey. I am soon to embark on the next phase, and those who know me know that I am again going to have to draw on my reserves of strength and determination. But let’s take things one step at a time!

Thank you, Tatiana Minelli, for the pictures of me and the friend I loved to hate!

P.S. Choosing not to show pain doesn’t mean you don’t feel it. 

Scoliosis in the elderly: why exercises are important

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When talking about scoliosis, one often immediately thinks of a condition that affects young people, but that is not always the case. In a study of 554 people aged between 50 and 84 years, scoliosis was diagnosed in 70% of cases, showing that this is also a common condition in older people, too.However, there are certain distinctions to be drawn, and it is important to understand when scoliosis in an older person first developed. This is possible only if the patient is able to supply previous X-rays that document the period of onset.

Scoliosis in the elderly can be divided into three types.

– Primary degenerative scoliosis, also known as the “de novo” form, is scoliosis that occurs as a result of disc degeneration, and it causes considerable pain and stiffness. This makes it very difficult for the patient to create curves able to compensate for the lateral or forward bending of the spine inevitably seen in those affected by this condition.  

–  Progressive idiopathic scoliosis in adults is scoliosis that they have had since they were  young, as it is the form that is diagnosed in adolescence. With this type of scoliosis it is important to bear in mind a couple of parameters, because the likelihood of the condition worsening depends on the severity of the curve.

According to literature data, scoliosis with a Cobb angle greater than 50° will almost inevitably worsen; instead, a curve measuring less than 30° will give little cause for concern in adulthood.

–  Secondary degenerative scoliosis can have various causes, some found directly in the patient’s back (such as a lumbosacral abnormality) and others (such as hip disease) found elsewhere in the body. Metabolic disorders and osteoporosis leading to multiple fractures are also among the causes of this type of scoliosis.

Regardless of their causes, all these forms of elderly scoliosis have certain characteristics in common.

Elderly people affected by scoliosis inevitably experience postural changes. Particularly prominent is forward or lateral bending of the back: in other words, their back seems to be “falling” forward or to one side.

These changes can result in loss of the normal inward curvature (lordosis) of the lower back, causing the trunk to bend forwards and leading to accentuated dorsal kyphosis.

A further characteristic of all these types of scoliosis is pain, and it is one of the main reasons why individuals with elderly scoliosis decide to try to do something in order to improve their back and, as a result, their overall health. 

Another type of alteration observed in elderly scoliosis is a lateral collapse of the spine caused by an increase in the scoliotic curve that the patient is unable to counter; this results in a lateral imbalance.

To try to improve the situation, it is necessary to undertake a course of rehabilitation involving specific exercises for the spine.

These exercises have several purposes; the main one is to reduce pain. The therapist will  “explore” the patient’s back, performing assessments and seeking to identify pain-free positions that can be taken as a starting point both for providing some relief and for starting to plan a programme of work designed to help the patient’s back cope with more active exercises.

As with youngsters, with elderly people, too, it is crucial to teach self-correction, even though, in this case, the objectives will be different.
An elderly person with scoliosis, by definition, has a stiff back and can therefore have mobility problems; obviously in these circumstances self-correction should not be seen as a means of obtaining the best possible correction of the back, but rather as a way of supporting it and countering, as far as possible, the abnormalities that have developed.  

In the presence of lateral bending, the aim will be to support the back as much as possible against the direction of the curve, whereas forward bending will be tackled by attempting to restore lordosis and mobility of the lumbar spine, so as to move the patient’s back into an upright position. A key element in both these cases is an axial extension of the spine, which serves to reduce dorsal kyphosis and open, as much as possible, the scoliotic curve.

However, when embarking on a rehabilitation pathway, patience is always the key, because exercises, unlike drugs, cannot eliminate or reduce pain in the space of a few hours.

The very term “pathway” implies the need to allow a certain amount of time in order for the desired results to appear.
In fact, the treatment demands not only patience but also constancy over time, as patients have to do much of the work on their own, having first been taught the exercises and instructed to do them independently at home.

It is also important not to make the mistake of becoming complacent as soon as there is some improvement; indeed, it is crucial to continue following the programme consistently so as to consolidate the results achieved.

All this is the only way of obtaining the kind of results that, over time, will lead to improvements in different areas of the patient’s life.

The first positive result perceived by the patient will be a reduction of the pain experienced; subsequently, he/she will become aware, both in the course of the day, but also when standing in front of a mirror, that his/her posture has also improved.

An equally important development will be better general physical conditions and a better quality of life, as the patient, starting to feel better and happier about his/her appearance, will start resuming his/her previous activities.

The specific exercises prescribed are very important for preventing/limiting possible deterioration over the years, and patients will therefore need to go on doing them for the rest of their lives: since these are patients who have difficulty supporting their backs, it is essential to work on strengthening all the relevant physical abilities. And this can be achieved solely and exclusively through specific exercises.
All the other treatments that exist for scoliosis have other objectives, e.g. to provide pain relief (drugs) or to replace lost function (bracing or surgery), and they are, in any case, more invasive.

Spine Week 2020

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Registration is now open for Spine Week 2020 which will be held from April 27th to May 1st in Melbourne, Australia. It will be possible to register at a reduced rate until February 15th. The 15th International SOSORT meeting will also be held during SpineWeek from 27 to 29 April.

The first SpineWeek meeting which was held in Porto, Portugal in 2004. It was well received by individual participants, the involved scientific spine societies and by the supporting MedTech industry.

Three more SpineWeeks followed: Geneva (Switzerland) in 2008, Amsterdam (The Netherlands) in 2012 and Singapore in 2016.

One of the remarkable evolutions noted from one SpineWeek to the next, was the increase of participants coming from Asia. This incited the SpineWeek committee to move east for the 2020 SpineWeek meeting.

SpineWeek meetings have been at the origin of many a scientific collaboration bringing together clinicians and scientists from around the world and from very different scientific societies, such as the International Society for the Study of the Lumbar Spine (ISSLS), the North American Spine Society (NASS) .

Same language, same treatment

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www.scoliosi.org: the Isico blog that gives patients a voice!

Over the past 13 years or more, we have published dozens of posts and thousands of comments on our forum dedicated to scoliosis.
The Isico forum is a dedicated space where patients can ask questions and swap experiences, but it is also a place where those involved in treating scoliosis can take a more in-depth look at a series of topics and also engage with the patient.  Here is one of our published posts.

ISICO in Italy: “Same language, same treatment”

ISICO works with many operators – physicians and rehabilitation specialists – in clinics covering most of Italy. Sometimes patients aren’t sure (and will therefore ask us) which specialists or centre they should contact. It actually makes no difference, since we strive daily to ensure that each of our clinics offers exactly the same high level of professionalism and quality of care. Everyone in the ISICO family speaks “the same language” and pursues the same goals. For us, who work here, this goes without saying, as this is our established modus operandi.

Scoliosis is not only an infrequent condition (it affects 2 to 4 people in every 100), it can also be devious, that is to say unpredictable! Highly aggressive forms are even rarer. The challenge for the physician is to understand whether your scoliosis is going to be as gentle as a kitten or as aggressive as a tiger that needs to be caged. It follows that only a physician with experience of many cases of scoliosis is fully equipped to interpret the multiple aspects of this complex disease.

According to the relevant international guidelines (http://www.scoliosisjournal.com/content/7/1/3),  the specialist who deals with the treatment of scoliosis must be an expert and must comply with the following criteria:

1. an apprenticeship of at least 2 years alongside a physician experienced in the treatment of vertebral growth disorders (that is, who has at least 5 years of experience in the field);

2. at least two consecutive years of experience in the treatment of scoliosis with a brace;

3. at least one brace prescription per week (corresponding to about 45 per year) in the last two years;

4. At least 4 examinations per week of subjects with scoliosis (corresponding to about 150 per year, for at least two consecutive years).

Consequently, what usually happens is that the expert physician sees patients in large cities that are easily reached and moves from one city to another in order to be able to see a sufficient number of cases and therefore become an “expert.” This is the traditional pattern: physicians move from city to city, and patients often have to travel from small towns to big cities in order to have a consultation with an expert physician.

When ISICO was founded it only had one physician who used to travel around Italy, seeing patients. But then the number of physicians increased, and so did the number of ISICO clinics. But the original concept has remained the same: our physicians travel around, in order to examine patients in other branches; they also regularly frequent the Milan clinic, not only to carry out examinations but also, and above all, to keep up to date with their colleagues and exchange information and opinions.

The therapists, too, work in multiple clinics and regularly meet up, among themselves and also with the physicians, to get updates and to guarantee the teamwork that characterises ISICO.

All this is also facilitated by the use of sophisticated software that, on the one hand, allows constant communication between all the operators involved and constant monitoring of each patient’s situation, and on the other, ensures consistency in terms of the assessment methods and practices adopted.

Even the orthopaedic technicians who work with ISICO as external consultants meet up regularly in Milan: on these occasions, they also see physicians and therapists to discuss the braces our patients are being offered.

Every day we work to build a close-knit and competent team and to organise our work in such a way as to provide patients with the best care available and with as little travelling as possible.

Each ISICO clinic, therefore, has the same characteristics as the others: in Rome, you can see the same physician you would have seen on another day in Milan; similarly, the physician who was in Pescara yesterday is in Asti today. The same goes for the therapists, and this guarantees a consistently high level of performance quality everywhere.

At ISICO, everyone speaks “the same language”, uses the same clinical software, and pursues the same goals: therefore, you don’t need to worry if, when you come to try out your brace, you do not find the same physician who prescribed it.

The experience of our physicians and therapists is guaranteed by the large number of patients treated and by the ongoing professional exchanges between all the ISICO team members.