A 3-D Treatment Approach to Treating Scoliosis According to the Principles of C.L. Schroth

Michelle Dwyer, DPTSchroth and SEAS Certified for the Treatment of Scoliosis and Spinal Deformities

• Parents- Too much “wait and see”• Patients- Lack of knowledge regarding how to help themselves beyond bracing and waiting• Therapists- Inadequately educated and equipped in scoliosis treatment• Orthotists-Traditional bracing lacks 3-D corrections, resulting in flat back and other poor cosmetic changes• Doctors- Is there a way to help patients sooner?

• Postural Awareness• Stretching/ Strengthening• Hip ROM• Spinal Stability • Body Mechanics

• Schroth Based PT - Barcelona Physical Therapy School• SEAS - ISICO, Stephano Negrini MD, Milan, Italy• Team Approach PCP/ Pediatrician, Orthotist, Orthopedic/Neurosurgeon, Other?• Community Involvement Curvy Girls, Hope’s Closet, local meeting and support groups.

• Primarily Adolescent Idiopathic Scoliosis Treatment• Deformities in the Sagittal Plane ( Scheurmann’s,

Hyper-Kyphosis and Hyper- Lordosis

• Curve Specific

• Cognitive, sensory- motor, kinesthetic, neuromuscular exercises to reduce scoliosis posture

History and Goals Germany 1921

Inpatient

Spain 1968 Outpatient

USA 2005 First certified therapists 2011 First US course

held Steven’s Point, WI

Correct scoliosis posture Reduce risk of

progression Strengthen

asymmetrically Improve respiration Diminish functional

limitations Reduce pain Improve body mechanics Improve self image and

quality of life

Precautions:• Osteoporosis• Post- Surgery• Juvenile Hypermobility Syndrome (JHS)• Osteogenesis Imperfecta• Spondylolisthesis

Contraindications:• Reactive Scoliosis (tumor, disease, etc)• Inflammatory diseases- during active phase• Psychiatric Issues

May be treated but with limitations:

• Syndromic and Neuromuscular Scoliosis• Post – Surgery• Adult Degenerative Scoliosis• Infantile (Age 0-3), Juvenile (age 4-9) *

* SRS Classification

Risk of Progression Factor Patient Age Risser Score Cobb Angle Age patient is first seen

• Screening- Adam’s Test• Angle of Trunk Rotation- (ATR) Using Scoliometer

• >5 ° in sitting = + Screen • Postural- Frontal, Sagittal and Aerial • X- Ray- Cobb, Apex, Rotations, CSL, Risser• Height Measurement – Sitting and Standing• Vital Capacity• Thoracic Function• Pain• Quality of Life – SRS 22, SRS 36, TAPS, QLSPD

Schroth Exercises Semi-Hanging Sagittal Plane

Prone on Knees-Transverse Plane Anterior Gravity Assisted

Schroth Exercise Supine Gravity Assisted- Transverse Plane

Standing 3D Correction

Assessment Photos

Assessment Photos

In Brace Correction

Pre/ Post Brace Comparison Pre Brace X-Ray In Brace X- Ray

Sagittal Plane Correction Visit 1 Visit 3

Exercises Using Schroth Principles

Exercises Using Schroth Principles

Visit 1 - Uncorrected Visit 3 - Corrected Posture

Exercises – Sport Specific and In-Brace

Sport Specific Training In Corrected Posture

Case StudyVisit 1 Visit 1

Sagittal Visit 1

Visit 2 Sagittal Plane Correction

Sagittal Correction Psoas Stretch

Stretching- Stabilization Supine Hamstring Stretch

Scapular / Core Stability

Sagittal Correction Visit 1 Visit 6 - 2 month follow up

Patient Follow Up Visit 1 2 Month follow up

PT Treatment OptionsLocal Program

Basic Program 2x wk- 8wks

ProgressionMonthly,

Quarterly, Bi-AnnuallyUntil Risser 5

Immersion ProgramBasic Program for 5

consecutive days

ProgressionFirst yr every 3

monthsBi-Annually to

Risser 5

Assistants