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Schroth Method

Original Editor - Marleen Moll Top Contributors - Marleen Moll, Nikhil Benhur Abburi, Kim Jackson, Vidya Acharya, Aminat Abolade, Ahmed Ezzat and Alexandra Stead


Description

The Schroth technique was developed by Katharina Schroth, a German physiotherapist, in the early 20th century. After experiencing scoliosis herself, she sought to create an effective method for treating the condition. Her work laid the foundation for a comprehensive therapeutic approach that has evolved over the years and gained international recognition.

The spine is addressed in all three anatomical planes: sagittal, frontal, and transverse.

The purpose of the method is to create spinal balance and stability by improving body mechanics and spinal stabilization to prevent further curve progression.[1] Several studies suggest a significant effect on reducing the Cobb angle and improving Quality of Life (QOL) in adolescents with idiopathic scoliosis.[2] [3] [4]

Among all scoliosis-specific exercise approaches, the Schroth method is the most studied and widely used.

Indication

Adolescent idiopathic scoliosis (AIS) is the most common structural spine deformity in adolescents.[1] It presents as a laterally rotated curvature of the spine and becomes apparent around the time of puberty.[3] The diagnose of AIS will be made when the spinal curvature in the coronal plane is equal to or greater than 10 degrees, also know as the Cobb angle. It is determined by measuring the angle between the deformity's upper and lower limits in the coronal plane. The magnitude of this angle is used for classification of the severity of the scoliosis.[2]

  • Curve up to 25° - mild scoliosis
  • Values between 25° and 45° - moderate scoliosis
  • Curve aboce 45° - severe scoliosis

Once the diagnosis of scoliosis has been made, effective management should be instituted to address the deformity and to prevent long-term consequences.

Method

[5]1. Assessment and Evaluation

  • Initial Assessment: A thorough evaluation by a trained Schroth therapist is conducted to assess the patient’s spinal curvature and overall posture. This includes physical examination and potentially imaging studies like X-rays.
  • Curve Classification: The therapist categorizes the type and severity of scoliosis, often using classifications such as the Cobb angle to determine treatment direction.

2. Individualized Exercise Programs

  • Curve-Specific Exercises: Each exercise program is tailored to the individual’s unique spinal curvature. Common exercises may target the thoracic or lumbar regions, focusing on:
    • Rotational Exercises: These help counteract the rotation associated with scoliosis, promoting spinal alignment.
    • Side-Bending and Stretching: Targeting muscles on the convex side of the curve to improve flexibility and balance.
    • Strengthening Exercises: Focusing on the muscles that support the spine, particularly the core, to enhance stability.

3. Breathing Techniques

  • Diaphragmatic Breathing: Emphasizes breathing into the ribcage, promoting lung expansion and helping to mobilize the spine. This aspect is crucial as it encourages optimal posture and supports spinal decompression.

4. Functional Integration

  • Daily Activities: Patients learn how to apply principles from their exercises to everyday movements, such as sitting, standing, and walking. This helps in maintaining proper posture throughout daily life.


Schroth exercises although different from person to person include three important components:

  1. Muscular symmetry
  2. Rotational angular breathing
  3. Awareness of posture

The Schroth method consists of scoliosis-specific sensorimotor, postural and breathing exercises.[4] The patient's ability to reduce the spinal deformity through active postural alignment of the spine in three dimensions (known as auto-correction) is a fundamental component of the method. This auto-correction is achieved through self-elongation and postural corrections that are specific for each curve pattern and will eventually be integrated in daily activities.

Effectiveness:

Research has shown that the Schroth technique can effectively reduce the curvature of the spine, improve functional abilities, and enhance quality of life. Key benefits include:

  • Reduced Cobb Angle: Studies indicate that patients often experience a measurable decrease in spinal curvature and slowing in curve progression with consistent practice.[6][7]
  • Pain Management: A six-month RCT from 2015 showed improved pain and many individuals report significant reductions in back pain and discomfort with positive outcomes on back muscle strength, contributing to improved daily functioning.[6]
  • Enhanced Physical Fitness and breathing function: Strengthening and flexibility improvements contribute to overall better physical health and athletic performance.[6]
  • Decreasing the prevalence of surgery.[8]
  • Self-image and back muscle endurance in patients with AIS, compared to the standard care.[9]
  • RCT from 2015 showed that a program of well-planned individualized Schroth exercises under physiotherapist supervision is an effective method for improving regression or stopping the progression of idiopathic scoliosis in adolescents.[10]

Comparison with Traditional Treatments

A clinical trial published in BMC Musculoskeletal Disorders (2019) compared the Schroth method with standard physical therapy for scoliosis management, The results showed that participants in the Schroth group had greater improvements in spinal curvature and functional outcomes than those receiving traditional therapy alone.[11]

Other outcomes apart from the correction of the curve may include:

  • Improved posture
  • Improved core stability and strength
  • Improved overall movement pattern and function
  • Better pelvis alignment

References

  1. ↑ 1.0 1.1 Cheng J., Castelein R., Chu W., Danielsson A., Dobbs M., Grivas T. et al. , 2017, ‘Adolescent idiopathic scoliosis’, Nature Reviews Disease Primers
  2. ↑ 2.0 2.1 Romano M., Minozzi S., Zaina F., Chockalingam N., Kotwicki T., Hennes A. et al. , 2012, ‘Exercises for adolescent idiopathic scoliosis-review’, Cochrane Database of Systematic Reviews 8, 10–12.
  3. ↑ 3.0 3.1 Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA Lancet. 2008 May 3; 371(9623):1527-37.
  4. ↑ 4.0 4.1 Lehnert-Schroth C. Three-dimensional treatment for scoliosis. 7th ed. Palo Alto, California, USA: The Martindale Press; 2007.
  5. ↑ Scoliosis Care Centers.What is Schroth Therapy?. Available from: https://www.youtube.com/watch?v=6q7nQWrfXRM[last accessed 30/04/2021]
  6. ↑ 6.0 6.1 6.2 Otman S, Kose N, Yakut Y. The efficacy of Schroth s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Saudi Med J. 2005;26:1429–35.
  7. ↑ Weiss H-R, Weiss G, Petermann F. Incidence of curvature progression in idiopathic scoliosis patients treated with scoliosis in-patient rehabilitation (SIR): an age- and sex-matched controlled study. Pediatr Rehabil. 2003;6:23–30.
  8. ↑ Rigo M, Reiter C, Weiss H-R. Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil. 2003;6:209–14.
  9. ↑ Schreiber, Sanja, et al. "The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis—an assessor and statistician blinded randomized controlled trial:“SOSORT 2015 Award Winner”." Scoliosis 10.1 (2015): 24.
  10. ↑ Kuru, Tuğba, et al. "The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: a randomised controlled clinical trial." Clinical rehabilitation 30.2 (2016): 181-190.
  11. ↑ https://pubmed.ncbi.nlm.nih.gov/31286903/
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