Schroth Physiotherapy: Staying Ahead of the Curve

Authored by Lauren Wilkes

Art by Angela Yuan

For too long, spinal fusion surgery has been the dominant solution to severe idiopathic scoliosis. But, does this have to be the only solution? Is there a way for scoliosis to be impacted conservatively? Thanks to emerging research, less invasive solutions such as physical therapy techniques are garnering a lot of support for their potentially substantial impact on the lives of scoliosis patients that would otherwise be undergoing massively invasive surgery. 

Scoliosis is a sideways curvature of the spine and is most commonly idiopathic (the cause is relatively indeterminable) [1]. Scoliosis usually develops in children ages 11 and older and is related to growth during puberty. It is linked to genetics as well as health conditions, such as neuromuscular diseases [1]. The severity of symptoms and the consequent impact on the patient’s daily life depends on the degree of the scoliosis curvature. Scoliosis can be classified as mild, moderate and severe, with curves ranging from 10-20 degrees, 20-40 degrees, and above 40 degrees, respectively; surgical treatment is recommended for those of 45 degrees and above [2].

Originally, spinal fusion surgery involved the anchoring of rods to the spine, while in modern instances, screws, wires, and tethers are used to correct the curvature by force [3]. Roughly 38,000 individuals undergo the invasive spinal fusion surgery each year to combat severe scoliosis [4]. Classified as a major medical surgery, scoliosis surgery can take anywhere between four and eight hours to complete and comes with an extensive recovery period. Additionally, scoliosis surgery can be economically unfeasible for many individuals, with surgery ranging from $140,000 - $170,000 [5]. Moreover, radiologic findings demonstrated that, upon taking x-rays of scoliosis patients who underwent the surgery, 22 years later, the curvature returned to its original degree of severity [6]. With statistics and circumstances such as these, it is inevitable that many patients may wonder: is this the only option for treating severe scoliosis? 

In fact, the Schroth physiotherapeutic method of physical therapy has emerged as a potential conservative method of preventing further scoliosis curve progression, particularly when done in addition to other non-invasive treatments, such as bracing. Developed in 1920 and pioneered by physiotherapist Katharin Schroth in an effort to find options other than thoracic bracing and surgery, the Schroth technique has recently become an increasingly more common mode of conservative scoliosis treatment [7]. More specifically, according to the National Library of Medicine, “The Schroth method is a physiotherapeutic scoliosis-specific exercise (PSSE) approach consisting of neuromuscular, postural, and breathing exercises and education on adjusted activities of daily living. The Schroth method capitalizes on auto-correction and principles of motor learning and control, and is highly individualized” [8]. Schroth encompasses a variety of techniques that focus on using targeted breathing exercises to hone muscle strengthening and postural correction. For instance, patients are instructed to hang from pull-up bars and drop their pelvis as low as possible to achieve spinal elongation and alignment. Further, patients may stand with arms in 90 degree angles while they posturally correct and begin to engage targeted breathing by expanding the weak points of the back/torso (where the curve does not protrude), and by contracting the strong points (where the curvature is deep and protrudes). However, Schroth has been largely overlooked in undergraduate, graduate, and physical therapy curricula [9]. Therefore, both students and educators have not been informed on nor performed experiments to demonstrate efficacy of this method. In fact, compared to the 38,000 individuals who undergo the invasive spinal fusion surgery each year, there are roughly just 3,000 scoliosis cases per year that utilize the Schroth techniques as treatment [10]. 

What literature has been published demonstrates that Schroth is effective for scoliosis patients. The implications of physiotherapeutic scoliosis specific exercises (PSSE) such as Schroth indicate a reduced back-brace prescription, indicating that curves can potentially be stabilized without the use of more invasive treatment. In a study conducted in 2019 endeavoring to examine the efficacy of Schroth exercises in adolescents with idiopathic scoliosis, results demonstrated that Schroth physiotherapy had a significant effect in reducing the degree of curvature [11]. Furthermore, the same study found that, as a result of the positive physical implications, Schroth was shown to improve quality of life for patients with idiopathic scoliosis as well [11]. Comparatively, although spinal fusion surgery is found in multiple cases to be 70%-90% effective in decreasing scoliosis curvatures in the more immediate post-surgery period, studies have shown that approximately a third of patients will lose some or all of the correction within ten years [12]. Schroth, on the other hand, has given patients visible recognition of correction and if done consistently, the patient can work to maintain the stability long term.  

Based on these recent findings regarding the potential for using Schroth physiotherapy in combating scoliosis, particularly when combined with other conservative treatments, such as bracing, it is owed to scoliosis surgery candidates as well as scoliosis patients in general, to provide a more in depth presentation and analysis of the possibilities available when considering treatment. Surgery is undesirable for many due to the extensive recovery process and physical side effects. When there is evidence to support potential measures to even prevent further curve progression, the decision to try could crucially impact a patient's quality of life.  

References:

1. National Institute of Health: National Institute of Arthritis and Musculoskeletal and Skin Diseases. (Last Reviewed 2023). Scoliosis in Children and Teens: Diagnosis, Treatment, and Steps to Take. Retrieved from https://www.niams.nih.gov/health-topics/scoliosis/diagnosis-treatment-and-steps-to-take

2. Horng, M. H., Kuok, C. P., Fu, M. J., Lin, C. J., & Sun, Y. N. (2019). Cobb Angle Measurement of Spine from X-Ray Images Using Convolutional Neural Network. Computational and mathematical methods in medicine, 2019, 6357171. Retrieved from: https://doi.org/10.1155/2019/6357171 

3. Maruyama, T., & Takeshita, K. (2009). Surgery for idiopathic scoliosis: currently applied techniques. Clinical medicine. Pediatrics, 3, 39–44. https://doi.org/10.4137/cmped.s2117 

4. Lee Health. (No date given). New Therapy Shows Scoliosis Improvement Without Surgery. Retrieved from: https://www.leehealth.org/health-and-wellness/healthy-news-blog/health-hub/new-therapy-shows-scoliosis-improvement-without-surgery 

5. Myers, M. (No date given) How Much Does Scoliosis Surgery Cost? Retrieved from: https://clear-institute.org/blog/how-much-does-scoliosis-surgery-cost/#section3

6. Danielsson, A. J., & Nachemson , A. L. (2001). Radiologic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis: comparison of brace and surgical treatment with matching control group of straight individuals. Spine, 26(5), 516–525. Retrieved from: https://doi.org/10.1097/00007632-200103010-00015 

7. TAG Physical Therapy (2021). Scoliosis Therapy. Retrieved from: https://tagptfl.com/services/scoliosis/#:~:text=Schroth%20Based%20Scoliosis%20Therapy,specific%20 exercise%20 approaches%20for%20 scoliosis.

8. Schreiber, S., Whibley, D., & Somers, E. C. (2023). Schroth Physiotherapeutic Scoliosis-Specific Exercise (PSSE) Trials-Systematic Review of Methods and Recommendations for Future Research. Children (Basel, Switzerland), 10(6), 954. Retrieved from: https://doi.org/10.3390/children10060954 

9. Negroni, S. (2014). Physiotherapeutic scoliosis-specific exercises for adolescents with idiopathic scoliosis. Retrieved from: https://air.unimi.it/retrieve/dfa8b9a2-1757-748b-e053-3a05fe0a3a96/R33Y2014N01A0111.pdf 

10. TAG Physical Therapy (2021). Scoliosis Therapy. Retrieved from: https://tagptfl.com/services/scoliosis/#:~:text=Schroth%20Based%20Scoliosis%20Therapy,specific%20 exercise%20 approaches%20for%20 scoliosis.

11. Burger, M., Coetzee, W., du Plessis, L. Z., Geldenhuys, L., Joubert, F., Myburgh, E., van Rooyen, C., & Vermeulen, N. (2019). The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. The South African journal of physiotherapy, 75(1), 904. Retrieved from: https://doi.org/10.4102/sajp.v75i1.904.  

12. Siddiqui A. (May 20, 2023) Scoliosis Surgery (Spinal Fusion): Risk vs Benefits. Retrieved from: https://treatingscoliosis.com/scoliosis-surgery-spinal-fusion-risks-vs-benefits-treating-scoliosis/#:~:text=In%20fact%2C%20%E2%80%9Cthere%20is%20no,it%20all%20within%2010%20years.