The Schroth method of physical therapy for the treatment of idiopathic scoliosis

Abstract

Scoliosis is a common orthopaedic condition in children and adolescents. It is a complex three-dimensional deformity of the spine, featuring lateral spinal curvature and a rotational deformity of the vertebrae and ribs. According to the Scoliosis Research Society, scoliosis can be classified into functional or organic. Functional scoliosis can be compensatory, antalgic and static. Organic scoliosis can be classified as idiopathic, congenital, and neuromuscular (paralytic). Idiopathic scoliosis is divided into three sub-groups according to the age of the patient at the time of diagnosis: infantile (age 0-3), juvenile (age 4-9) and adolescent (age 10 up to maturity). The diagnosis of adolescent idiopathic scoliosis is based on physical and radiological examination (Cobb’s angle) and has a prevalence in the general population of 1-3%. Scoliosis can be treated either conservatively or surgically depending on the severity of the disease. Conservative treatment includes the use of a brace and physiotherapeutic scoliosisspecific exercises (PSSE) for mild curves. The brace is recommended for patients with curves between 25° and 40°. The Schroth method is a type of Physiotherapeutic Scoliosis-Specific Exercises (PSSE) program, that involves posture training and exercises effective in reducing pain and improving scoliosis curves, respiratory function, and overall quality of life in scoliosis patients. It was developed in 1921 by Katharina Schroth (1894-1985). According to Hans-Rudolf Weiss (2011), Schroth was suffering from scoliosis herself and underwent treatment with a steel brace at the age of 16 years. Consequently, she decided to develop a more functional approach to the treatment herself. Inspired by a balloon, she tried to selfcorrect by breathing away the deformities of her own trunk by inflating the concavities of her body selectively in front of a mirror. In the 1970’s, the Schroth method was improved by her daughter Christa Lehnert-Schroth. Together they founded a rehabilitation center in Germany, which provided a specifically designed intensive rehabilitation program for patients with adolescent idiopathic scoliosis. The therapeutic approach in these patients lasted for 6 consecutive weeks performed by certified therapists of the Schroth method. It then became known in a broad network of therapists not only in Germany, Russia and other European countries, but also in Canada and the United States, in Australia, and several countries in Asia. The method constitutes of specific exercises of isometric contraction aiming at a three-dimensional selfcorrection of posture and the extension of the spine (selfelongation). It also endorses the application of rotational breathing (rotational angular breathing) and the education of corrective exercises in daily activities.