Schroth Method Scoliosis Physical Therapy

Schroth Method for Scoliosis and Hyper-Kyphosis:

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THE SCHROTH METHOD

The Schroth Method is a 3 – dimensional treatment approach for people with idiopathic scoliosis, adult onset scoliosis and hyper-kyphosis.  The purpose of this treatment is  to help the patient learn  a “self correction” of the scoliosis curve pattern.  This includes postural re-education  and decompression of  the curve concavities in order to reduce curve progression.  The Schroth Method  focuses on chest wall expansion with targeted breathing and neuromuscular stabilization in order to support the “corrected” posture. This method includes scoliosis specific exercises – exercises that focus on the concavities of the curves to reduce compression and ultimately help reduce scoliosis progression.  Scoliosis specific exercises are different from typical fitness or rehabilitation exercises in that they provide a “corrective” force to targeted areas of the curves.  Fitness exercises cannot create the same “corrective” forces, and must be modified for people with scoliosis to prevent increasing compression  which will  simply strengthen the curve pattern.

The Blocks are used to demonstrate the  3 dimensional nature of scoliosis.   Block organization represents how scoliosis may affect the cervical, thoracic and lumbar spinal segments, and pelvis.  Scoliosis specific exercises are uniquely designed for each individual based on the patient assessment and curve type.

WHAT IS IDIOPATHIC SCOLIOSIS?

Scoliosis Research Society (SRS) defines Idiopathic Scoliosis (IS) radiographically.  The SRS defines scoliosis as a lateral curvature of the spine  greater than or equal to 10 degrees (Cobb angle) with rotation of unknown cause.   Click here for more information.  Structural changes of the vertebrae cause wedging and torsion. This leads to a 3 dimensional spine deformation. Many people do not understand the difference between  a structural scoliosis and a functional spine asymmetry.  A functional asymmetry is a muscle imbalance causing the appearance of spinal curves. The Cobb angle (curve angle) represents a structural scoliosis if it is at least 10^0.  It is used  by the SRS to inform treatment guidelines.  A structural scoliosis must also demonstrate wedging and rotation that is greatest in the apical vertebra.

Balanced 3-4 Curve Pattern

General Treatment Guidelines:  Adolescent Idiopathic Scoliosis

< 25⁰ Cobb angle:  Treatment Recommendation – Observation.

25⁰-50⁰ Cobb angle:  Treatment Recommendation –  Bracing

50⁰ Cobb angle:  Treatment Recommendation – Surgery

Age and bone maturity will affect these recommendations: see  SOSORT Guidelines 

Adult Scoliosis is divided into 3 categories:

1.  Adult onset/De Novo = Primary degenerative scoliosis that starts later in life, mostly based on a disc and/or facet joint arthritis affecting those structures asymmetrically with predominantly back pain symptoms

2.  Adolescent Idiopathic Scoliosis, stable or progressing into adulthood (may be combined with degeneration)

3.  Secondary scoliosis (a) Due to: pelvis oblique, leg length discrepancy or hip pathology or as a secondary curve in idiopathic, neuromuscular and congenital scoliosis, or asymmetrical anomalies at the lumbosacral junction (b) In the context of a metabolic bone disease (mostly osteoporosis)  combined with asymmetric arthritic disease and/or vertebral fractures.

Pain and Adult scoliosis:  While some adults with scoliosis have pain and disability, research indicates that there is no correlation between the extent of the Cobb angle and pain (Schwab FJ et al Spine 2006).  In fact, adult scoliosis is often more of a sagittal plane problem:  flattening of the lumbar lordosis (sagittal plane curve) and increased posterior pelvic tilt.  This is often the result of compensations for pain or degeneration (Schwab F at el. Neurosurgery 2013).

WHAT IS HYPER-KYPHOSIS AND SCHEUERMANN’S KYPHOSIS?

The normal kyphotic angle of the thoracic spine (upper back) is between 26 and 46 degrees (Bernhardt and Bridwell Spine 1989). Hyperskyphosis is therefor a flexion angle greater than 46 degrees.  This produces the appearance of a “hunched” or rounded upper back.  This postural dysfunction can affect the cervical and lumbar lordosis in the neck and low back causing pain.  This postural dysfunction is often changeable.  Scheuermann’s Kyphosis, however, is hyper-kyphosis that is a structural spine deformity.  It is defined radiologically as a kyphotic angle greater than 40 degrees with anterior vertebral wedging greater than 5 degrees of 3 or more vertebrae (Sørensen KH. Copenhagen: Munksgaard; 1964).  Click here for more information.

What To Expect

The initial evaluation includes assessment of full spine X-rays to determine curve classification based on the Rigo Classification System.  The physical assessment includes spirometry, musculoskeletal testing and scoliometer measurements.  Postural digital photographs will be taken for documenting progress and an overall determination of progression risk will be made.  Videos of initial home program exercises will be made to help facilitate practice at home.

Commitment to the program is imperative for success.  Sessions last 1-1.5 hours and may be scheduled up to 2 x per week initially.  The number of sessions recommended for adolescents varies based on the initial evaluation. The average amount of sessions is 10-12 for success with the program.  Progression risk, body awareness and the ability to integrate self corrections will ultimately determine the number of sessions required. For out of town patients, a 2 week intensive is recommended, but these days may also be scheduled in several intervals based on the needs of the patient.

Adults with scoliosis or kyphosis, especially in the presence of pain, should be more cautious with respect to intensive sessions for out of town patients –  to avoid exacerbation of symptoms. Recommendations are made based on the initial evaluation.  Sessions are typically scheduled weekly until the adult is independent with the scoliosis specific exercises and understands how to modify fitness exercises to avoid simply strengthening the curve pattern.

Home Program Compliance

Compliance with the home program  is the most important factor to predict success with the Schroth Method.  While frequency of physical therapy visits is important in the beginning to ensure understanding of  curve pattern and principles of correction, it is the compliance at home that will help determine the results a patient will receive from the Schroth program.  Understanding and committing to the home program exercises will enhance independence, and gradual reduction of  physical therapy visits.  The timing will vary with each patient.  The home program will be a lifelong commitment, and will change as the patient is able to gradually incorporate  Schroth principles more and more  into daily life activities.

Research:   

PSSE and Scoliosis  Schreiber 2015       KURU 2016        Monticone 2014       Schreiber  2016       Kwan 2017  

PSSE and Scheuermenn’s Kyphosis  Bezalei 2019

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