Schroth-Based Scoliosis Treatment

What is the Schroth Method?

A CONSERVATIVE physical therapy treatment approach consisting of mental and physical training that brings together proper breathing techniques with self-perception to prevent or minimize spinal curve progression.

Goals of the Schroth Method:

  • Minimize symptoms through self-management
  • Increase control/stability of the spine
  • Slow spinal curve progression
  • Improve self-appearance, general health, quality of life
  • Avoid invasive treatments including bracing and surgery

Focus of Treatment and Interventions:

  • Posture and body awareness education
  • Corrective breathing
  • Hands-on facilitation
  • Exercises for the spinal musculature focusing on stabilization and straightening of the spinal curvature
The Schroth Method offers you a "4th option" in managing your spinal curvature: Scoliosis current model of care: (The three "O's")
  1. Observation
  2. Orthosis
  3. Operation
4. Schroth Method Schroth Method Chart

Additional Information:

The Schroth Method is a therapy plan that entails cognitive, sensory-motor, and kinesthetic training to teach the patient to improve her/his scoliosis posture. The program is an intense routine of auto-elongation exercises and stretches, rotational breathing, muscle facilitation, stabilization education and postural awareness techniques. The goals of this non-surgical treatment are to stop/limit curve progressions, improve cosmesis, improve general health, to help the patient cope with the deformity and the treatments, and most importantly diminish functional limitations. A study by Zaborowska-Sapeta, et al, showed that the combination of bracing and the Schroth Method helped to improve scoliosis curves.

The treatment approach has been practiced successfully in Germany and Spain for several decades now, and, with a growing body of practitioners in the United States, we are seeing similar results. Bill Block, DPT received his C1 certified training through the Barcelona Scoliosis Physiotherapy School in March of 2011 and has been using the Schroth Method of treating idiopathic scoliosis since that time with positive patient feedback. In October 2013 he earned his C2 certification through the Barcelona Scoliosis Physiotherapy School, further enhancing his knowledge of treatment for clients of all ages.

The Crooked Ninja

By: Nicole Coderre, MPT, DPT; Caroline Coderre and Bill Block, DPT

Nicole: It started a year-and-a-half ago at a typical annual well visit at the pediatrician. Until, that is, the doctor asked my 11-year-old daughter, Caroline, to bend forward to check her spine. "Hmmmm" the doctor said. "Hmmmm", I said after noticing a rib hump that is a telltale sign of scoliosis. The pediatrician recommended following up with an orthopedic doctor. Under normal circumstances, I probably would not have been overly worried but my husband's niece was diagnosed with scoliosis at the same age and ended up having spinal fusion surgery the summer after her freshman year in college (on an amusing side note, her highly regarded surgeon was none other than her college roommate's father).

At her first appointment, we found out that Caroline had a small scoliotic curve as well as a leg length discrepancy. I went into warrior mode. I knew how to correct the leg length discrepancy! Thanks to Amazon Prime, I had a plenty pack of heel lifts at my door two days later. I placed a heel lift in the left shoe of ALL of Caroline's shoes (basketball, soccer, skateboarding, gym, tap, winter boots, even slippers"... did I mention I'm a bit neurotic??) But... how was I going to help her with the curve?

Even though I, myself, am a PT, I don't treat kids. I deferred to the orthopedic doctor who recommended a specific type of physical therapy called the Schroth Method. I remembered hearing the term when my niece was diagnosed 13 years earlier, but at that time there were only three physical therapists in the Midwest who were certified, the closest one being in Wisconsin. Imagine my surprise when the doctor specifically recommended Dr. Bill Block from Fyzical Therapy & Balance Centers - Naperville, a mere 4 minutes from my home!

At our first appointment with Bill, I learned that the Schroth Method uses exercises to de-rotate, elongate and stabilize the spine. Made sense to me! He went to work creating a personalized exercise program for Caroline to do in the clinic as well as at home. I went to work being the enforcer, making sure Caroline did her exercises every day. Even though I have 20 years of experience as a PT, Caroline makes sure to remind me "You are NOT Mr. Bill! He knows so much more than you!" She's absolutely right and I'm so thankful for his expertise!

A year-and-a-half later, Caroline has grown 2.75 inches and only had a 4-1/2 degree increase in her curve (a win in the world of scoliosis according to Bill). Even though her curve is still considered mild (17.3 degrees) and well below the baseline of 25 degrees used for bracing, I asked her doctor about getting her a Boston brace to wear at night (did I mention I'm neurotic?). Truthfully, I had my niece in mind, and, knowing her curve changed from 30 degrees to 52 degrees, I wanted to do anything in my power to prevent Caroline's curve from worsening. The doctor agreed.

The next thing I knew we were at an orthotist, having a mold made and then, two weeks later, having the brace in our possession. I would now like to turn this blog over to Caroline, to allow her to share her thoughts on this experience to date.

Caroline: So, unlike my mom, when the doctor noticed the rib hump I really didn't care because I didn't know what it meant. Fast-forward a few weeks to the appointment with the spine doctor and I still wasn't really worried or concerned because I didn't understand what the x-ray showed, or the numbers meant. When the doctor recommended physical therapy, I was open to going because my mom is a PT and she always says how much she likes her job so I figured it couldn't be that bad, right? RIGHT! I met Mr. Bill and he did a great job explaining things to me, so I finally understood what scoliosis meant.

He explained that I needed to strengthen my abs and back muscles, stretch the shortened side of my spine and learn how to move in a straight line (i.e., squat without sticking my hip out to the side which makes my trunk curve). I like working out and being strong, so the exercises aren't too bad. The hardest part is probably learning how to move with a straight spine.

At first, I saw Mr. Bill every week, and then I was able to progress to one time a month and then to every three to six months. This requires me to do PT at home five days a week. Honestly, some days are better than others. I have my favorite go-to exercises but my PT mom makes sure I do the ones I don't like too (thanks mom!). Here is a picture of me doing one of my exercises using resistance bands to strengthen my back.

Throughout this journey something really cool happened. I started junior high and ended up with a locker neighbor named Emerson who competed on American Ninja Warrior Jr. (and who is now one of my best friends). She invited me to her ninja gym (Ultimate Ninjas in Naperville-check out their website at www.ultimateninjas.com/naperville) and I was hooked! I went with Emerson a bunch more times and realized I found a new love. My dad built me my own training obstacles in our garage, and I create my own courses in the basement. I have lovingly named myself "The Crooked Ninja" due to my curved spine.

Caroline doing back strengthening exercises
Caroline and Emerson

During quarantine, the ninja gym hasn't been open, but it just finally opened back up and I have started taking classes there. Mr. Bill thinks it's a great idea because ninja training works so much on strengthening the core. YES! Here are a few pictures. The first is of Emerson and me, hanging out on her home course. Then there are a few of the obstacles in my garage and one of me tackling the 12-foot warped wall at the ninja gym (next up-the 14-foot warped wall):

  • Caroline doing Ninja Gym exercise in her garage
  • Caroline at Ninja Gym
  • Caroline at Ninja Gym

OK, so now for my thoughts on the brace. When my mom first brought up the idea of me wearing a brace at night to the spine doctor I was like "Thanks a lot mom. Why can't you just keep quiet, stop being a PT and just be my mom?" I really hated the idea. Then I Googled lots of pictures of braces and found out a Boston brace isn't as bad as I thought. I had to go be casted for the brace. During the casting, I felt like a paper mâché doll. The casting material was cold, then warm, then HARD! I could barely take a breath in. I thought, "how am I going to wear this thing 12 hours-a-day when I can't breathe?"

The orthotist (the nice lady who made the brace) promised the final product would not be as bad as the cast. She let me pick out a design for the brace. I picked purple butterflies (see below for some pictures).

Over the next two weeks of waiting for the brace to be made, I got a little excited. I wanted to see it and thought it would be a piece of cake to wear. Well, I was wrong. Although it IS more comfortable than the cast, it is still uncomfortable. Especially the bump you can see on the back of the brace that sits on my left hip.

Thankfully, I got to start off wearing it slowly"... twenty-five minutes at a time on day one, 30 minutes on day two, 45 minutes on day three, etc. That made things a little more bearable.

Speaking of "bearable", in my Google searches about scoliosis, I came upon a website that I would HIGHLY recommend checking out if you are in need of something to make you feel better during your own scoliosis journey"... www.higgybears.com. On the site, I found out I could buy a stuffed animal that would come with its own matching brace to my brace.

I picked a cream-colored bear with, of course, a purple butterfly print brace (see below for a picture). If I am feeling down or frustrated, it always helps to give my bear a hug. Also, when I think I've got it rough, I remind myself of the owner of Higgy Bears' personal journey with scoliosis (please read her bio) and I know I've got it pretty good!

  • Caroline's Boston Brace
  • Caroline's Boston Brace
  • Caroline's Teddy Bear with matching Boston Brace

Now I want to turn this blog over to my PT, Mr. Bill, so he can tell you more about how he treats patients with scoliosis.

Bill: I am honored to be included in this blog as a small part of Caroline and Nicole's journey. Yes, I am "Mr. Bill" as previously mentioned. I am part owner of FYZICAL Therapy & Balance Centers - Naperville (check us out on our website www.NapervillePT.com and Facebook page) and I am a C2 Schroth certified physical therapist who has had the pleasure of working with Caroline and Nicole. I have been using the Schroth Method to help people with scoliosis for almost 10 years. The driving force behind my continued passion and dedication to the Schroth Method is the empowerment it offers individuals and families with scoliosis. The diagnosis of scoliosis can be frightening with all the unknowns and uncertainties of "just how bad can this curve get?". The questions of "What can I do?", "When should I worry?", "Should I use a brace?" and "Will I need surgery?" can be very overwhelming and often leave the patient and family members feeling hopeless.

When I first meet family members like Caroline and Nicole, I make sure to express my understanding of their fears but also reassure them that we will have a plan that they can actively participate in which helps relieve their feelings of helplessness. I also make sure to connect with the child, in this case, Caroline, and let them know that I understand that they did not sign up for this for fun. Managing scoliosis can feel overwhelming but I remind the patient that we will have a plan and will take it one day at a time. I know that they have busy lives and that physical therapy may be hard to fit in, but we build a plan that works and encourages dedication that will help them accomplish their daily goals and long-term goals of minimizing curve progressions.

As a physical therapist, there is nothing more satisfying than to see a family dedicate time and execute a plan of care as Caroline and Nicole have done. To see them actively fight against this progressive condition with the empowerment of the Schroth method is amazing. Their efforts and success not only help them, but they are hoping this blog and the resources provided will help the many patients that come down this same path in the future.

Please contact FYZICAL - Naperville at 630-369-1015 if you have any questions or would like to set up an appointment with Dr. Bill Block. To learn more about The Schroth Method visit our YouTube page to see videos of the techniques. Follow us on social media to keep up to date on our latest forums.

Additional Resources:

Frequently Asked Questions:

Am I a candidate for physical therapy?
  • The focus of the Schroth Method is to stop progression of the spinal curve prior to needing more intense treatment options such as surgery. The target population is adolescents between the ages of 10-18. Younger children and/or adults without a history of spinal/back surgery may also benefit.
How long does physical therapy last?
  • Treatment lasts 30 minutes to 1 hour based on the custom Plan of Care created for each individual. Typically a patient will be seen for 8 weeks (1-2 visits per week). After treatment ends, patients will receive a home exercise program to continue treatment independently.
How do I go about starting the program?
  • You may contact us with any questions in regards to the Schroth Method of Physical Therapy. You may also talk with your pediatrician or physician who will refer you to physical therapy.
Scoliosis Case Study

The Effectiveness of Conservative Treatments for the Improvement of Scoliosis Curves in an Adolescent Child: A Case Report

By: William Block, DPT 2013

Abstract

Background: The effectiveness of conservative management of Scoliosis in the adolescent population continues to require further investigation. A study by Stefano Negrini et al (1). supports that the combination of bracing and Schroth based exercises reduced patients scoliosis curve progressions. The aim of this case report is to further increase the literature available to support these findings.

Subject: The subject in this case report was a 10 year old female who was diagnosed with idiopathic scoliosis on 5/16/12. Her initial Cobb angles were measured to be 32° right thoracic curve, with a 19° left lumbar prominence. Axial trunk rotation through the thoracic spine was defined by Raimonde of 14°. She was a 0-1 on the Risser scale. Schroth classification was a right thoracic 4-curve pattern. The subject is active with karate, basketball, and volleyball. She has not undergone any other treatments for scoliosis prior to our initial evaluation. She is highly motivated, with a great support system from her family.

Methods: This is a retrospective case report, single subject. The subject began the Schroth based method of physical therapy for her scoliosis on 6/11/12. Our initial plan of care entailed 2 visits per week for 6 weeks. All clinic sessions were 1 hour in duration. This plan included a total of 12 visits from 6/11/12 through 8/8/12. Her home exercise program (HEP) consisted of 15 minutes of Schroth based exercises per day, 6 days per week. The subject was fit for a 23 hour Rosenberger brace on 6/28/12. The subject's in brace x-ray revealed a 12° correction of her thoracic curve. Her scoliosis curve improved from 32° to 20° in brace.

Phase 2: After her original plan of care was completed, we decreased her frequency of visits to 1x/week for 10 weeks from 9/5/12-12/27/12. Frequency of visits was decreased due to her increased independence in technique efficiency and accuracy. At this time, HEP was continued 15 minutes/day for 6 days/week. The subject had her first follow-up x-ray at the end of this second phase plan of care. Her thoracic Cobb angle improved from 32° to 21°, her lumbar curve remained at 19° and her degrees of rotation improved from 14° to 11°.

Phase 3: The third phase of treatment included a plan of care consisting of 1 visit every other week for 20 weeks. This phase was carried out from 1/7/13-6/20/13, and consisted of 10 visits. At this time, patient and her mother reported full independence with the HEP, but patient was highly motivated by clinic exercise sessions and new challenges. During this time, Schroth based method postures were progressed and accessory exercises for core and total body strengthening were further progressed. Follow-up x-rays were taken on 6/20/13, upon completion of phase 3 plan of care. Her thoracic Cobb angle had improved to 17° and her lumbar curvature improved to 15°. The patient is currently wearing her brace 23 hours/day, and continues her home exercise program only. Follow-up phone calls are used for tracking progress.

Results: The subject participated in the Schroth based method of physical therapy program from 6/11/12 to 6/20/13. She had a total of 32 visits during this 1-year span. Her and her family report great compliance with her 15 minute/day, 6 days/week HEP. She also reports great compliance with her Rosenberger brace 23 hours/day regimen. Since beginning her conservative treatments for scoliosis management, the subject’s thoracic Cobb angle has improved from 32° to 17°. Her Lumbar curve has improved from 19° to 15°. Her thoracic rotation classified by Raimonde has improved from 14° to 11°. The numbers observed in this case suggest that conservative treatments were successful in significantly reducing Cobb angles.

Conclusion: The combination of Schroth based physical therapy method and 23-hour bracing were found to be successful in significantly reducing Cobb angles in this case. This suggests that in the case of mild to moderate idiopathic scoliosis, good compliance with conservative treatments can be effective in reducing curvatures.

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