Scoliosis-Specific Exercises in Adolescent Idiopathic Scoliosis: The Schroth Method

scoliosis-specific-exercises

WHAT TO EXPECT
Initially, a comprehensive Schroth program begins with a thorough review of the patient’s current and past medical history, a complete musculoskeletal examination, and review of X-rays for the purpose of curve classification. The in-depth interaction between patient and therapist promotes an improved understanding of the patient’s spinal curvature and an open dialogue of the goals and treatment options.

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Some clinics may utilize a surface topography scan to further assess the curve(s) and posture without additional exposure to radiation. This may facilitate the patient’s understanding of their individualized treatment program, the potential use of bracing options, and the rationale for scoliosis-specific exercises. The program can also provide management strategies at home, at school, at work, and during athletic participation.

In the past, many Schroth programs were very lengthy and intense. As programs have been refined over the years, one can expect to complete between 5 to 20 sessions over a 2 to 4 month period. These sessions may be once per week for 45 to 60 minutes depending on the individual patient and their needs.

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Looking back through the history of scoliosis treatment in the United States, physical therapy has played a minimal role in the management of idiopathic (without a definite cause) scoliosis. For many years, patients and parents were confronted with the uncertainty of a ‘wait and see’ approach.

Very few options were available as an active intervention, particularly for small curves. To improve on this paradigm, the Leatherman Spine Center built a Schroth-based scoliosis exercise program over the last seven years. Through this experience, it has become increasingly apparent that many patients and parents desire a more proactive treatment approach. The Schroth Method is a comprehensive nonsurgical approach to scoliosis management which includes scoliosis-specific exercises.

The Schroth Method was initially developed by Katharina Schroth and has advanced in its popularity and methodology over the last 60 years by her physical therapist daughter, Christa Lehnert-Schroth. This functional exercise program uses a three-dimensional approach to balancing the spine by: activating the muscles surrounding each curve, utilizing breathing techniques and trunk elongation to help with rotation, and using the pelvis to stabilize posture.

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GOALS OF THE SCHROTH METHOD
In a Schroth exercise program, the goal is to provide each patient with the ability to derotate the spine, elongate the trunk, and stabilize the spine in a three-dimensional plane. These goals are addressed by teaching awareness of postural deficits, restoring muscular and postural symmetry, and achieving the ability to breathe into the concave side of the body.

Through a comprehensive Schroth program, additional goals are to prevent the development of pain, reduce existing spinal pain, improve postural aesthetics, and prevent or address any respiratory dysfunction. Ultimately, one of the most important goals is providing the patient with an opportunity to be actively engaged in the management of their scoliosis, strength, scapular stability, postural symmetry, and body awareness. Patients will gain the knowledge needed to selfmanage their scoliosis by maintaining specialized breathing patterns, strength, functional movement patterns, and pelvic alignment.

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KEYS TO SUCCESS
Although Schroth-based programs will differ, there are three key components to success. One must become increasingly aware of all postural asymmetries and how they affect daily life while being mindful of any positions that exacerbate poor posture. One must work toward achieving muscular symmetry by addressing the inherent weakness of one side of the curve and the overworked prominent side of the curve.

Finally, one must understand the importance of applying breathing strategies to help derotate the spine
through reshaping of the rib cage and the surrounding soft tissues. A physical therapist trained in the Schroth method can tremendously help those with idiopathic scoliosis understand and achieve these
basic components of a scoliosis-specific exercise program. Perhaps most importantly, a Schroth program promotes active patient participation in the management of their scoliosis by providing long term management strategies that extend beyond the duration of the formal program.

For a list of Scoliosis BSPTS-North America trained physical therapists in your State, go to https://www.schroth-barcelonainstitute.com/.

by Ron Lasley, PT, DPT & Steven D. Glassman, MD