The Schroth Method: A 3-Dimensional Treatment for Adolescent and Adult Scoliosis

The Schroth (pronounced shroth) Method is an exercise method for treating adolescent and adult scoliosis. Using specific therapeutic exercise to focus on muscular balance, healthy posture, and breathing, the Schroth Method is part of a multidisciplinary approach to conservative management of scoliosis.
Female physiotherapist examining little patient's spine in pediatric orthopedic clinic.The Schroth Method uses specific therapeutic exercise to focus on muscular balance, healthy posture, and breathing. Photo Credit: 123RF.com.
Looking Beyond the Curve to Treat Scoliosis
The Schroth Method is sometimes likened to other core and posture-strengthening exercise methods like Pilates or the Alexander Technique, but the Schroth Method differs in that it focuses on posture 3-dimensionally and is scoliosis specific.

A 3-D approach is important, because scoliosis is a 3-D spinal deformity. An x-ray of a typical single-curve scoliosis shows the curve as a “C” or “S,” but that’s a 1-dimensional understanding of scoliosis. What looks like the spine bending actually has a certain amount of vertebral rotation as well. It may be easier to visualize the spine more like a spiral or a coil shape than a curve.

The spiral is a consequence of multiple factors around bone growth, which is why it tends to appear or progresses around any rapid growth spurt.1

Treating scoliosis isn’t merely straightening the spine from one angle—it takes a comprehensive approach to align the 3-D geometry of the spine. The Schroth Method achieves this by addressing postural control in the sagittal plane (front-back), side to side displacement in frontal plane, as well as rotation in the transverse plane. (anatomical body planes explained).

The History and Goals of the Schroth Method
The Schroth Method first appeared in 1921, developed by a German physiotherapist, Katharina Schroth who had scoliosis herself. K. Schroth worked on her own body to design the method.

She used postures designed to balance her muscle strength. She noted that the muscles in the concave or “narrow” areas were atrophied and weak and needed widening and strength, while muscles over the convexities or “prominences” were elongated and overused. Integrating breathing mechanics helped move her ribs and influence the shape of her torso, working from the “inside out.”2

The Schroth Method has evolved over the years, but what has remained is the focus on tapping into the deep system of postural muscles—the muscular system that stabilizes and supports the spine and trunk/torso.

The goal of the Schroth Method is not necessarily to completely eradicate the scoliosis; rather, it’s to achieve trunk balance, so that the head, torso, and legs rest in a global harmony. Using breath and working the deep postural muscles to support and stabilize the spinal curve toward midline are the goals of the method.

Bracing and the Schroth Method: A Powerful Pair for Pediatric Scoliosis
Juveniles and adolescents with scoliosis may use the Schroth Method to prevent further progression of the curve because their spines are still relatively flexible.

In milder cases of juvenile or adolescent scoliosis (Cobb angle between 10-30 degrees, the SOSORT guidelines* recommend Physiotherapeutic Scoliosis Specific Exercise, or PSSE, like the Schroth Method to treat the scoliosis).3 Curves over 20 degrees are more vulnerable to progression and in those cases, your doctor may recommend pairing the Schroth Method with a custom 3-D brace. A certified Schroth Method practitioner can coordinate the exercises to work with the 3-D shape of the brace to treat the curvature.

*International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)

Enhancing Postural Awareness and Boosting Quality of Life in Adults with Scoliosis
The Schroth Method is used differently in adults with scoliosis compared to children. For one, the adult spine is fully developed, therefore it is “stiffer.” As such, the goals shift more toward postural control and improving how you move in daily activities.

Additionally, treating adults with scoliosis is more complex because adults may have degenerative spines—that is, spinal wear and tear primarily caused by aging. If an adult with scoliosis also has spondylolisthesis, spondylosis, herniated disc, or other degenerative spinal disorder, the Schroth Method practitioner may have to adjust the exercise plan to prevent causing further injury and manage pain.

Though the adult spine is more rigid, the Schroth Method may still benefit the adult with scoliosis. To start, learning about their curve type builds postural awareness and makes patients smarter about how to help themselves. Even if achieving a balanced trunk isn’t entirely possible, other benefits in the method, such as improved breathing, finding a posture that relieves pain, or simply knowing how to position themselves in a way that promotes trunk balance, can be beneficial.

Schroth Method’s Exercise Design
The Schroth Method is a highly personalized therapy. Therapists work intensely, one-on-one, coaching and training with mirrors to help patients visualize their corrections, so they can make changes and continue practicing at home.

Schroth exercises vary based on age, medical history, and severity of scoliosis, but a typical exercise generally follows 2 phases.

The first phase focuses on positioning the body. A therapist shows you how to align your posture from the bottom up. Starting with your feet, your therapist will teach you proper foot placement. Then, moving to your pelvis, he or she will show you how to set your pelvis and adjust weight bearing and angles. Moving up the kinetic chain (refers to how the human body moves), the focus is on aligning your rib cage over your pelvis. Finally, the focus is on positioning your head over your ribs. The method also uses equipment like a ladder wall for lengthening the spine, and straps and props like rice bags to assist in positioning the torso.

The second phase focuses on activation of the corrections just acquired. This is the muscle endurance training phase. A therapist will encourage active elongation, and expansion of your body using concepts of traction to stretch the body upwards, lengthening the areas that need to be taller and less compressed. Concepts of expansion, widening those areas need to be fuller and broader to draw the scoliotic curve closer to midline.

After active elongation and expansion, you may work on addressing rotation, which shapes the ribs in a way that leaves some areas of the front and back of the ribcage relatively flat.

In this phase, active diaphragmatic breathing techniques are important. The Schroth Method emphasizes breathing into areas that are more concave to help them expand and help de-rotate the spine. When you exhale, activation of the abdominal and trunk muscles will help stabilize the spine, and train the muscles that help control the areas that are curving outward.

What Patients Benefit Most from the Schroth Method?
The Schroth Method can be part of virtually any scoliosis treatment plan—adult and adolescent, mild and severe curves. However, a patient’s medical history may limit their results and some personality types may struggle with the treatment approach.

For aging adults, the Schroth Method may need to be adjusted (eg, avoiding traction or certain positions) to work safely with degenerative changes in the spine.

Additionally, people who have had scoliosis surgery or other spine procedure with instrumentation (eg, screws or rods) may find limited value with the Schroth Method because the instrumentation restricts any further curve correction. However, patients who’ve had surgery may still benefit from the breathing component of Schroth therapy.

Finally, learning the Schroth Method is complex—it takes time and dedication to master. For this reason, this method may not be universally appropriate. A patient’s personality or cognitive ability may not be a good match, if they do not possess postural awareness or the will to concentrate on learning new ways of moving. Think of it as learning a new instrument, it rarely sounds good from the beginning, but with dedicated practice, one may acquire the ability to correct, control, and have endurance in maintaining postural corrections over time in relatively still positions.

The reward may be a surprising reduction in spine pain, improved posture, and prevention of the scoliotic curve progression.

Where You Can Find a Schroth Method Specialist Near You
The Schroth Method is a safe and effective non-surgical or conservative treatment for adolescent and adult scoliosis. If you’re interested in exploring more about this treatment, the next step is to locate a specially trained Schroth Method physical therapist. To find a Schroth Method therapist near you, visit the Schroth-Barcelona Institute’s web site, which features a Physical Therapists Directory that lists certified Schroth physical therapists in the United States and worldwide.

Updated on: 10/09/18
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