Schroth Method

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Description

The Schroth method is a non-invasive treatment for scoliosis that uses specific exercises that are based on a patient's unique spinal curve pattern. 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 stabilisation 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.[5] It presents as a laterally rotated curvature of the spine and becomes apparent around the time of puberty.[6] 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.[7]

  • 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

The Schroth method consists of scoliosis-specific sensorimotor, postural and breathing exercises.[8] 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. Several cohort studies to the Schroth method have shown positive outcomes on back muscle strength[9], breathing function[9], slowing curve progression[10], improving Cobb angles[9][10] and decreasing the prevalence of surgery[11]. A six month RCT from 2015 showed improved pain, self-image and back muscle endurance in patients with AIS, compared to the standard care.[2] Another RCT from 2015 showed that a program of well-planned individualised Schroth exercises under physiotherapist supervision is an effective method for improving regression or stopping progression of idiopathic scoliosis in adolescents.[3]

Resources

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References

  1. Lehnert-Schroth, Christa. "Introduction to the three-dimensional scoliosis treatment according to Schroth." Physiotherapy 78.11 (1992): 810-815.
  2. 2.0 2.1 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.
  3. 3.0 3.1 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.
  4. Burger, Marlette, et al. "The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis." The South African journal of physiotherapy 75.1 (2019).
  5. Cheng J., Castelein R., Chu W., Danielsson A., Dobbs M., Grivas T. et al. , 2017, ‘Adolescent idiopathic scoliosis’, Nature Reviews Disease Primers
  6. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA Lancet. 2008 May 3; 371(9623):1527-37.
  7. 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.
  8. Lehnert-Schroth C. Three-dimensional treatment for scoliosis. 7th ed. Palo Alto, California, USA: The Martindale Press; 2007.
  9. 9.0 9.1 9.2 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.
  10. 10.0 10.1 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.
  11. 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.