Evidenced Based - Schroth 3D Therapy

According to the SOSORT 2016 Guidelines, there is now strong evidence emerging which is supporting the use of physiotherapeutic scoliosis specific exercises (PSSE) for adolescents with idiopathic scoliosis. The Schroth Method is acknowledged by SOSORT as a ‘School’ which is compliant with its PSSE exercise guidelines.

In formulating the latest consensus guidelines, with respect to bracing and PSSE exercises, the focus was on study designs (clinical trials), which provided meaningful and valid outcome information regarding PSSE exercises in conjunction with bracing.

The 2016 guidelines reaffirmed that PSSE exercises should continue to adhere to the following criteria:

• Auto-correction in 3D
• Training in activities of daily living (ADL)
• Stabilizing the corrected posture
• Patient Education.

In all, 11 recommendations were made on PSSE exercises to prevent scoliosis progression during growth. Significantly, PSSE exercises are recommended as the "first step to treat idiopathic scoliosis to prevent/limit progression of the deformity...". Bracing is  recommended for patients with curves of 20°- 25° who are still growing, and are deemed to be at a high risk of progression.

With regards to PSSE exercise programs the consensus guidelines recommended they be designed by therapists, specifically trained in their school of therapy, such as the Schroth Method; and that programs are always customized to the individual, even if they perform exercises in small groups.

Several recommendations were also made with regards to breathing, specifically that exercises need to improve respiratory function.

The 2016 SOSORT guidelines are specifically intended as an aid for professionals involved in conservative treatment of idiopathic scoliosis, and their patients.

The need to standardize research methods of conservative treatment effectiveness is acknowledged by the SOSORT  2016 guidelines and the Scoliosis Research Society (SRS) non-operative management Committee.

SRS Statement on Physiotherapy Scoliosis Specific Exercises:

"SRS members actively support optimal treatment for each patient which may include non-operative, operative and combined treatment methods."

SRS supports pilot research studies with regards to exercises as a treatment for scoliosis, and is collaborating with SOSORT to formulate research guidelines for the studies of non-operative approaches such as bracing, physiotherapeutic scoliosis specific exercises...

The results of a study (March 2016) undertaken at a hospital in South Korea reported Schroth exercise therapy as being significantly effective as a conservative form of treatment for idiopathic scoliosis.

The study was conducted with 5 female patients over a 12 week period which involved 3 x 60 minute Schroth exercise therapy sessions per week. The patients participating in the study each had idiopathic scoliosis with a thoracic curve of 40° and were at risk of progression, and possibly surgery. Excluded from the study were patients whose scoliosis: was of a neurological diagnosis; had recently undergone surgery; wore a brace; or periodically were taking medicine.

The results of the study specifically report a decrease in both the thoracic trunk rotation angle, Cobb angle, and an increase in vital capacity  for each female patient. The authors of the report state that the results of the study are statistically significant.  However, they also acknowledged a limitation with the study was that it only included a small number of patients with a scoliosis of 40° or greater.

The authors recommend that in future a study be undertaken comparing outcomes with a group in which the Schroth exercise therapy is combined with brace treatment. And, that “universal exercise approach methods and preventive training for the treatment of scoliosis should be developed further.”

Detailed below is the article citation and external link to the referred study:

Kim K-D, Hwangbo P-N. Effects of the Schroth exercise on the Cobb’s angle and vital capacity of patients with idiopathic scoliosis that is an operative indication. Journal of Physical Therapy Science. 2016;28(3):923-926. doi:10.1589/jpts.28.923.

See also Schroth Method-Preventing Progression.

Evidence that the Schroth Method of conservative treatment for scoliosis can alleviate, and eliminate pain, and therefore enhance quality of life despite the presence of adult scoliosis, is well documented in a research article published in 2012 – The Schroth Method of Treatment for a Patient Diagnosed with Scoliosis: A Case Report.

The 62 year old female patient noticed the uneveness in her hips and shoulders when she was at high school, but because there were no specific symptoms, she did not seek treatment. At the age of 56 she was formally diagnosed with scoliosis. X-rays revealed a 20° right lumbar curve, a 17° left thoracic curve, and a mild right cervical curve.

The onset of various muscular pains occurred 2 years before she was diagnosed with scoliosis. Pain was constant in her right scapula (shoulder blade), right lower back and hip, which increased when walking. The pain in her scapula disturbed her sleep and interfered with her daily activities. Shortness of breath was problem during prolonged activities. Occasionally, she experienced difficulty climbing stairs, due to a weak left hip.

All previous treatments, including chiropractic, physiotherapy, and stretching over the previous 8 years had not provided her with lasting pain relief.

Just before engaging in a program of Schroth Method exercise therapy her scoliosis was diagnosed as: a primary curve to the right in her lumbar spine, right thoracic concavity (in her back), prominent (lower) anterior rotated ribs, prominent left hip, elevated and anterior rotated left pelvis, a secondary curve in her left thoracic spine, posterior rib hump, mild right cervical curve, an elevated and winged left scapula, and a forward head position with the neck tilting to the right.

Her program goals were to eliminate pain, improve her endurance with prolonged activities, increase her overall strength, and be independent in managing her scoliosis with a home program.

The patient’s Schroth Method therapy program included manual therapy and instruction in scoliosis exercises. Initial sessions focused on patient education in the Schroth conservative treatment approach for scoliosis. Emphasis was placed on the patient performing exercises independently while maintaining corrected posture.

After completing 18 Schroth Method exercise therapy sessions over a period of 9 weeks the patient achieved her program goals and was able to return to her daily activities without pain in her right scapula, hip or lower back. She confirmed being able to manage her muscle soreness. Her shortness of breath episodes had reduced in number and duration, and she was better able to manage episodes when they occurred. She was able to sleep without disturbance, while climbing stairs was no longer a concern.

Through compliance with her home program and maintaining her corrected posture the patient enhanced her quality of life.

Detailed below is the research article citation and external link to the referred Case Report.

Citation: Watters H, Volansky K, Wilmarth M (2012) The Schroth Method of Treatment for a Patient Diagnosed with Scoliosis: A Case Report. J Nov Physiother 2:113. doi: 10.4172/2165-7025.1000113

A preliminary study conducted in Hong Kong focused on evaluating the effectiveness of Schroth scoliosis-specific exercises performed by idiopathic scoliosis patients with high-risk curves, whilst receiving brace treatment.

Twenty-four (5 males and 19 females) were recruited into the experimental group, Schroth scoliosis-specific exercises and bracing; and 24 patients were matched in the control group, bracing only, for age, gender, skeletal maturity, and curve magnitude.

Patients in the experimental, together with their caregivers, attended 4 x 1 hour private training sessions once every 2 weeks during the initial 8-week outpatient program. Patients were then given a home program of Schroth scoliosis-specific exercises, and were also required to participate in supervised outpatient sessions, once every 2 months.

Patients in the experimental group who were compliant with their exercise program had a higher rate of Cobb angle improvement. The study shows that the effectiveness of bracing can be improved with the addition of Schroth scoliosis-specific exercise program, providing there is a strong compliance to both.

“This is the first study to investigate the effects of Schroth exercises during bracing in patients with a high risk of curve progression. The findings from this preliminary study suggest that Schroth exercises during bracing can further improve the Cobb angle compared with bracing alone and compliance is associated with greater benefit..."

Click on the following citation to access the study briefly explained in this post:

Kwan KYH, Cheng ACS, Koh HY, Chiu AYY, Cheung KMC. Effectiveness of Schroth exercises during bracing in adolescent idiopathic scoliosis: results from a preliminary study—SOSORT Award 2017 Winner. Scoliosis and Spinal Disorders. 2017;12:32. doi:10.1186/s13013-017-0139-6.