Physical Therapy and the Schroth Method for Scoliosis
Practiced internationally for nearly a century, the Schroth Method is a safe and effective treatment option for adolescent and adult scoliosis. Most often diagnosed in adolescence, scoliosis is a sideways, abnormal curvature of the spine that continues to elude physicians and researchers as to why. About 80 percent of scoliosis cases have no identifiable cause, according to the American Association of Neurological Surgeons (AANS). Scoliosis changes a person’s overall spinal alignment, leading to muscle imbalances, poor posture, and sometimes pain. Scoliosis symptoms are often subtle during the early stages, making them easy to overlook. The condition typically develops during growth spurts before and during puberty, but it can happen at any age. Catching scoliosis early gives patients time to correct the curve before it becomes severe.
The good news is most cases are mild, progress slowly, and do not cause major deformity – meaning observation, bracing, and rehabilitation physical therapy are considered before surgical treatment. Some doctors do recommend surgery in severe cases, but there are effective non–surgical treatments including the Schroth Method. This multidisciplinary, nonsurgical approach incorporates scoliosis specific exercises tailored to each patient’s spine scoliosis curvature. The goal is to return the curved spine to a more natural position using a three-dimensional approach to correct spinal and muscle imbalances. Targeted exercises help de-rotate, elongate, and stabilize the spine to address the curve from all angles, as well as promote postural awareness.
Signs and Symptoms of Scoliosis
Scoliosis causes the spine to move to the side and turn. Doctors detect the condition through a physical examination, an x-ray, spinal radiograph, CT scan or MRI. Patients are diagnosed when the curvature of the spine measures 10 degrees or greater on an X-ray. A curve greater than 25 to 30 degrees is considered significant, and curves exceeding 45 to 50 are considered severe.
There are two main types:
Adolescent idiopathic scoliosis (AIS) is usually diagnosed between the ages of 10-18 years. This is the most common type and called idiopathic scoliosis because it has no definite cause. The condition is more progressive in females, and they are more likely to require scoliosis treatment. Other causes are congenital and neuromuscular.
Adult scoliosis falls into three categories:
- Patients who were diagnosed and treated as adolescents who have reached skeletal maturity
- Adults who did not receive treatment when they were younger
- Adults with some degeneration of the spinal discs, arthritis or osteoporosis
Family history: Studies have found genetics may play a role in scoliosis. About 30 percent of AIS patients, or three in 10, have some family history, according to the Scoliosis Research Society.
Other conditions that can increase the odds include a birth defect, such as muscular dystrophy or cerebral palsy, infections, trauma during childhood, and unusually rapid growth spurts.
Abnormal posture: The earliest visible signs of scoliosis can be seen in one’s posture. It is one of the symptoms, but not the cause.
- Uneven shoulder height
- Uneven hip height
- An uneven waistline
- An awareness that the 2 sides of the body don’t line up
- Pain in the areas surrounding the spine including the shoulder, pelvis, and hip
- Pain with specific movement or activity. Uneven alignment of the ribs when bending forward
Back pain: Initially, scoliosis doesn’t limit movement or cause pain until the curve becomes more pronounced. Pain is more common in adults with scoliosis. The curvature in the spine starts to put pressure on the nerves and sometimes the entire spinal cord. Symptoms include lower back pain, weakness, numbness, or chronic pain in the joints and extremities.
Fatigue: Some people feel fatigued after long periods of sitting or standing. The muscles around the spine have to work harder to keep the body aligned and balanced. In severe instances, the curvature can put pressure on the chest cavity and restrict breathing, leading to chronic fatigue.
How physical therapy and the Schroth Method can be a nonsurgical option
A scoliosis diagnosis doesn’t mean spinal fusion surgery is inevitable. For mild scoliosis cases, or those diagnosed early, doctors recommend regular monitoring, special braces for children, and physical therapy treatment to help correct or manage the condition. Scoliosis surgery may be necessary depending on the severity or progression of scoliosis.
The Schroth Method is credited to German physiotherapist Katharina Schroth who had scoliosis herself and didn’t have success with bracing. She developed her own breathing technique and scoliosis exercises to manage her scoliosis and balance her muscle strength. The method was introduced in 1921 and gained popularity as a recognized treatment option. Katharina and her daughter, Christa, opened a successful clinic in Germany. Christa became a physical therapist and dedicated her career to treating scoliosis patients and training therapists in the Schroth treatment method.
Schroth exercise therapy can help correct muscular imbalances, improve postural awareness, and enhance quality of life. The targeted exercises and corrective breathing help develop and strengthen the inner muscles of the rib cage, change the shape of the upper trunk, and correct spinal deformities. Schroth scoliosis exercise therapy can prevent further curve progression in pediatric patients because their spines are still relatively flexible, but it also has benefits for adult Schroth patients.
Schroth physical therapy exercises are individualized for each patient but include three important components:
- Restore muscular symmetry and spinal position with pelvic corrections and stabilizing isometric exercises
- Rotational breathing to help correct spinal rotation and increase lung capacity
- Teaches you to be aware of your posture during daily living
Physical therapists have specialized training in treating scoliosis
Physical therapists help guide patients through the exercises and give them options for standing, sitting, or lying down. Props such as therapy balls, poles, and Schroth Method exercise bars can be incorporated to help correct scoliosis. Working one-on-one with patients, therapists also coach and train using mirrors to help patients visualize their corrections and continue practicing at home.
Ivy Rehab therapists have specialized training and certifications in orthopedic physical therapy and in specific scoliosis treatment programs including the Schroth System Scoliosis Specific Exercises, the Gyrotonic Expansion System Scoliosis program and the Stott Pilates Rehabilitation Program.
Therapy outcomes are customized to each scoliosis patient based on the curve patterns and severity, as well as the patient’s function and mobility, but include:
- Prevent scoliosis from advancing
- Reduce or stabilize the spinal curve
- Improve postural alignment and range of motion
- Improve core stability and strength
- Easier breathing and increased lung capacity
- Better pelvic alignment
- Manual therapy to mobilize stiff body parts and reduce pain
- Strengthen muscles surrounding the spine
- Teach activities of daily living
- Increase muscle strength and endurance
- Retraining to restore spinal alignment and mobility
- Promote self-management and understanding of the spine
- Family and patient education
- Developing a home program of exercise and care
Physical Schroth therapy can be used to treat all stages of scoliosis and all ages of patients. It is beneficial as complementary care or to help rehab the spine and surrounding muscles after surgery. The best plan of care, including frequency and duration of therapy sessions, is developed based on your individual evaluation.
The most successful outcomes require buy-in from patients and a long-term commitment to follow the Schroth guidelines and exercises. Continuing a home exercise program is a lifelong commitment and necessary to maintain postural improvements.
Whether you are worried about your own spine or your child’s, have received a scoliosis diagnosis, or need rehab after spinal surgery, Ivy Rehab’s specially trained orthopedic physical therapists can perform a thorough evaluation and help develop a customized therapy plan. Find a clinic in your area and don’t delay in seeking treatment or ignore your spinal health!
Article by: Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA
Holly is a practicing physical therapist, partner and Director of Clinical Services at Ivy Rehab Network with more than 40 years of experience in sports management with young athletes, and is board certified as a geriatric clinical specialist and certified exercise expert for aging adults. Deuer is certified as an aquatic and oncology rehabilitation specialist and serves as adjunct faculty at Central Michigan University and Grand Valley State University.