In the past 40 years; many educational videos have been produced. We have chosen the most characteristic with exercises carried out by the most competent physiotherapists in the Lyon method: - Jean Noël Voutey, lecturer at Lyon 1 University and who was my physiotherapist at the Clinique du Parc for more than 10 years - Jean François Müller, responsible in France for continuing professional training for physiotherapists (ALISTER), with whom I had the honor of working in the physiotherapy department of Jean Sengler at Mönschberg. The main patient presents a scoliosis with predominantly right thoracic 40 °, painful on exertion, at the end of statural growth. At the parents' request, non-surgical treatment was carried out.

 For idiopathic scoliosis, the initial clinical assessment is essentially static with plumb line measurements in the sagittal plane and in the frontal plane. A dynamic assessment in search of stiffness both in the spine and in the girdles will complete the static assessment.

 The video shows us the details of the traditional plumb line clinical examination with, in the sagittal plane, measurement of the lumbar lordosis arrow, of the C7 lordosis arrow. In the frontal plane, the occipital axis is balanced. At the pelvis, the imbalance is appreciated at the level of the iliac crests: here minus 10 mm on the right. The plumb line rib hump during the Adams test. At the thoracic level 1mm corresponds approximately to 1 ° of Cobb angle. The hamstrings stiffness is measured by the popliteal angle (full extension is limited and the angulation between the axis of the leg and the vertical is measured). In this same position, a possible asymmetry of rotation of the hips is also measured. At the level of the upper limbs the asymmetry of the pectoralis muscles is appreciated by the elbow-table distance.

 The radiological assessment, when done with EOS, allows the visualization of segmental rotations in the horizontal plane. We chose a double curvature scoliosis as a type of description. The 3D representation shows the importance of thoracic rotation.

 There are many radiological classifications. Here we have two curves with a main thoracic curve and a lumbar counter-curve without less rotation.

 The EOS 3D representation confirms the existence of rotations at the counter-curves. On the left, the Da Vinci view and on the right the segmental rotation for each vertebra.

 The initial prescription for the Lyon method includes 30 sessions of 20 'with the physiotherapist, at the rate of one or two sessions per week. A daily repetition of the exercises for 10 'each day is advised.Given the prescription of an ARTbrace, the physiotherapist will insist on the preparation for molding in the corrected position.

 The SOSORT guidelines are very general, but we have specified in the chapter of the Lyon Method principles how to correct in 3D and how to reprogram the sensors of the extra-pyramidal system in the corrected position. At 15 years, even if the final height is acquired, the bone mass has not reached its maximum resistance, which can explain the pain during sport activities and will justify specific indications.

 The first example of typical exercises of the Lyon method is the awareness of postural defects. The child sees the backs of others, but he does not see his own. The first step common to all PSSEs is therefore to show any defects using an orthopaedic mirror, or better using a video, and to explain the vocabulary specific to vertebral deviations. The auto-correction of any defaults will be demonstrated.

 Charles Gabriel Pravaz, the creator of the Lyon method was not only a doctor, but also an engineer, a pupil of the prestigious polytechnic school of Paris. This explains why he was the inventor of the syringe and why he developed ingenious methods of correcting scoliosis.

 In the tecto-spinal tract, visual information is recorded by the sensory and sensorial integration centers in the parietal and occipital cortex. The information is then transmitted to the motor centers which send a command to the muscles which contract to compensate for the imbalance. Here for example at the quadriceps muscles. The sensorimotor coupling is focused on spatial location. Head movements are recorded at the level of the semicircular canals and are compensated by eye movements. The objective is to keep the visual information allowing anchoring on the environment. The tecto-spinal tract is essential in the recovery reaction after a fall or in sports following a ball like football.

 TNote that the Lyon method uses this tecto-spinal tract in case of cervicalgia for which we prescribe the table-football.

 You remember that we have four major positions…The second example of exercise is done in prone. The objective is to stimulate all the sensors of the extrapyramidal system which are sensitive to stretching. The physiotherapist places a cushion under the child's chest to perform this stretch. In this passive axial extension posture, all the facets joints can be mobilized.

 In this position, the muscles are stretched into ideal kyphosis. Muscles contain receptors sensitive to stretching. They allow the perception of the length of the muscle that is to say their position, and their variation in length that is to say the movement. The spindles are small fibrous structures, the central part of which is surrounded by a spiral nerve ending. They will code the positions and movements of the muscle and transmit this information to the brain through an afferent fiber. At the joint level, there are also two types of receptors with a different function: Pacini and Ruffini. The Pacini sensor is sensitive to the movement of the joint capsule and ligaments, especially at maximum amplitudes. It is a dynamic or phasic sensor. Ruffini's sensor is more sensitive to position. It allows to know a fixed articular amplitude. It is a static or tonic sensor. The movement corresponds to a change of state. As long as there is movement, the dynamic sensors of Pacini are active. A change of state therefore corresponds to speed information. At the end of the movement, the tonic or static Ruffini sensors code the new position according to the degree of stretching of the muscle, giving amplitude information.

 A variant in the event of significant flat back or pain is the use of the fetal kneeling position with heels-buttocks in contact. The upper limbs in the relaxed position accentuate the upper thoracic kyphosis. A cushion is placed under the chest, which allows stretching of the deep back line.

 It is in this position that all ligamental and transverso-costal joints sensors will be stimulated by soft mobilization.

 In ARTbrace there is no longer any skin contact at the level of the vertebral spinous line. Decubitus on beam allows to restore these contacts and to compensate for the absence of stimulation in brace.

 The third type of exercise is performed in procubitus, and isostatic kyphosis in the sagittal plane. A corrective side bending can be performed in this position. If the cushion is placed under the left hemi-thorax, derotation by concavity is facilitated.

 In the thoracic region, the exercises can also be performed in a seated position. Here the kyphosis in isostatic equilibrium is controlled by the level stick. The patient performs a corrective bending, by rotation on the sagittal axis of the vertebral body. The hold relax technique can be used. The head and the vestibular system remain fixed.

 An active-passive variant is performed manually by the physiotherapist. In this isostatic kyphotic posture, the bending automatically causes a detorsion. This detorsion can be completed manually at the convexity, as there is no risk of increasing the flat back in this position. In a second step, the bending will be done actively by taking support below the apex of the convexity and by stretching the concave latissimus dorsi with the concave hand on the head.

 Third example of a 3D thoracic correction exercise while seated. The thoracic spine is positioned in isostatic kyphosis. The right upper limb fixes the convexity, while the concave upper limb pulls the fascia of the concave latissimus dorsi, in this case with detorsion by the concavity. In this posture, the lumbar lordosis must also be maintained.

 The active axial self-stretching exercise is one of the most characteristic exercises of the Lyon method. It is especially used i, brace to avoid the inconvenience of accentuating the flat back and to reprogram the whole extra-pyramidal system in the corrected position. The child walks on tiptoe, which reprograms the kinetic sensors of the reticulo-spinal tract. A small bag of sand on the head reprograms the kinesthetic sensors of the vestibulo-spinal and tecto-spinal system, especially as the child is asked to walk in front of a mirror. Walking will alternate with stationary positions that reprogram the statesthetic sensors.

 In the sagittal plane, harmony must be respected with realignment of the Tragus, Acromion, Trochanter, Malleolus line after in-brace correction.

 The rubrospinal tract for larger imbalances will be requested by the ball of the Swiss physiotherapist Suzanne Klein-Vogelbach. The child is seated on the ball and asked to roll it, while keeping the sagittal isokinetic balance. The upper limbs are automatically called upon. The asymmetry of amplitude in the frontal plane is clearly visible in this child.

 The rubro-spinal tract can be coupled to the tecto-spinal using the level stick. The exercise is then focused on the thoracic region with correction of the flat back. The overall backward projection of the trunk and the loss of lordosis will be corrected in a second step.

 After the sitting position, the exercises will be performed in a standing position. The use of a tilting plate makes it possible to stimulate the vestibulo-spinal system in a plane, for example frontal. When balance is reached, the reticulospinal system is sollicited. The physiotherapist controls the sagittal isostatic balance posture with sometimes large projections of the trunk forward.

 Exercises in the standing position can be performed with active axial self-elongation. The feet are fixed on the ground to stimulate the reticulospinal tract. If the lordosis is too great, a flexion of the lower limbs will relax the psoas, rectus femoris and pelvi-trochanteric muscles. Once the iso-static equilibrium has been reached, the child is asked to flex the trunk forward up to 90 ° while stabilizing the trunk. This posture puts tension on the lumbopelvic fasciae. When stabilization is acquired, the feet will be placed on a half ball balance tray to stress the vestibulo-spinal tract in the 3 planes of space. The same postures will be reproduced until the trunk-thigh flexion at 90 °. The Tragus Acromion Trochanter alignment is here well preserved. Statesthesic and kinesthesic sensors are stimulated without excessive deviation in the sagittal plane. The same posture must be kept when passing from standing to sitting position and when picking up an object on the ground.

 Restoring the spinal tensegrity in the corrected position is essential for the future stability of scoliosis. Core axial stabilization exercises are often performed in quadrupedal posture. The positioning of the upper limbs is specific with hands, forearms and elbows crossed on the ground to promote isostatic thoracic kyphosis. The trunk is in axial elongation. A trunk-thigh square angle of 90 ° is asked, which puts in tension the ilio-psoas and the anterior chains of the lower limbs. In a second step, the positioning of the upper limbs is modified with adduction of the convex shoulder girdle to obtain a derotation of the apex of scoliosis. On the concave side, an extension of the upper limb is requested to complete the derotation by the concavity. In a third step, it is the concave fascia of the latissimus dorsi and the fascia lata convex which will be tensioned to obtain maximum detorsion.

 After core stability in the sagittal plane, the core stability will be achieved in the frontal plane. The classic yoga side plank is modified with elbow and convex forearm on the floor. Trunk and lower limbs are rectilinear with control of isostatic lordosis. The concave upper limb will then be placed in extension, which stretches the fascia of the latissimus dorsi. The posture will be maintained at least 7 seconds.

 After the two static exercises in the sagittal and frontal plane, the Klein-Vogelbach ball will be used in a downward-facing dog bent knees posture. The upper limbs are positioned in the same way like Russian squat dance. An extension of the lower limbs is requested while maintaining the entire spine in the position of isostatic balance. This exercise solicits more specifically the vestibulo-spinal tract with both Statesthesic and kinesthetic sensors.

The Lyon braces and in particular the ARTbrace eliminate the median contact of the spinous process with the brace. Given the richness of the sensors at this level, we recently added a 13th complementary exercise: the dynamic beam.

 The beam exercises were classic and already described with the Milwaukee brace. The beam was stable and the child stimulated the kinesthetic sensors of the vestibulo-spinal and rubro-spinal tracts in the event of a fall.

 Dynamic Beam It is an innovative and multifunctional exerciser, which expands the professional background of the kinesiologist in the field of vertebral deviations and back pain. It acts on the polysensory system balance by improving the stability of the spine through the activation of the deep spine muscle. Dynamic Beam through stimulation of the biomecannical and physiological system of the column, puts it in the condition of actively participate in the reorganization of the Postural Tonic System. Its unbalancing action, during the execution of an exercise, stimulates the Spinal Proprioceptive System differently than what happens when the same exercise is performed in standing or sitting position.

 The dynamic beam allows a complementary physiotherapy of scoliosis both in children and in adults. The elastic work of the upper limbs stimulates all the sensory sensors which are sensitive to stretching. The classic work of the pectoral muscles will limit the tendency to flat back and the strengthening of the concave serratus major facilitates derotation by concavity. The instability of the beam stimulates all the static and dynamic sensors of the extra-pyramidal system and strengthens the tone of the axial muscles. The global extension takes place in disc and vertebral decompression. The deep sensitivity of the spine or proprioception is stimulated. The uses are multiple. It is possible to reprogram the sensors in the corrected scolisis posture. For adults the 90 ° angled trunk-thigh flexion facilitates tensegrity readjustment at the level of the pelvis. Walking on a beam with level stick control requires all the kinesthetic sensors and the tecto-spinal tract. A system of acquisition of 9 sensors placed at the level of the two girdles and the apex of the kyphosis makes it possible to control the balance concavity - convexity. The patient can control the recordings on his own screen and monitor the progress of physiotherapy.

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