The effect of a 1-year-long intensive Schroth therapy

in patients with adolescent idiophatic scoliosis over 45 Cobb degrees who refused surgery

in an outpatient clinic in Hungary, a case series

1Judit Orbán – Physiotherapist, Schroth Therapist2Krisztina Horvát – Physiotherapist, Regional Schroth Instructor

Scolinea Scoliosis ClinicBudapest, HUNGARY

AISCURVES ≤45 COBB

FEW STUDIES INVASTIGATEDCONSERVATIVE

TREATMENT

SPINAL FUSIONRECOMMENDED

CONSERVATIVETREATMENT ???

Background

SCOLIOSISSPINAL FUSION

HIGH COST

LONGRECOVERY

≤ 1 YEARWAITING LIST

PRE-POSTOP PHYSIOTHERAPY

???

CONSERVATIVETHERAPY

SCHROTH + BRACE

AIMEffect of:

• 12 months Schroth

• AIS ≤45 Cobb

– Cobb anglemodification of > 5° was considered significant

– ATRmodification of > 2° was considered significant

– Objective body image

– Heights

– Chest Expansion (Axilla, Nipple line, 10th rib)

Outcome measures:

Material and Methods

Study Design:• Prospective case series design - Consecutive clinical study• Level of evidence: 4

Patients:Inclusion criteria:• female outpatients with AIS• Prescribed for surgery• Primary thoracic curve• Cobb angle above 45° ±5°• Risser value of 2 or 3

Material and Methods

Exculsion criteria:• Secondary scoliosis• Pathologies with possible

causes of scoliosis• Neurological deficits• LLD exceeding 10 mm

Individual,personalized

45 min/week

12 monthsSchroththerapy

TLSOBRACE

Cheneau-based

60 min/day home Schroth

Treatment:

Material and Methods

Schroth intervention in general

1. Heisse Rolle + Manual techniques: 5-10 min.

2. Schroth exercises: 30-40 min.– SST-Schroth-3D Scoliosis-Therapie®

according to Katharina Schroth

3. Including 5-10 min.: – Lumbar segmental stabilization– Schroth in ADL– Breathing exercises

Personalized Schroth intervention

Specific mobilization if neccessary:• Passive:

– Stretching of the weak side in side-lying

– Derotation of rib hump and ventral prominence in sitting/in supine

• Active:– Side bending– Side shift in sitting

Personalized Schroth intervention

Expanding the weak side

Pelvic shift exercise

Against flat back exercises

Auxiliary manipulations during exercises

Dinamic SCT on Th convex side

Stabilization of Corrected Posture + Increasing intensity

Stretching/decompressing thoracic concavity

Main aspects:Derotation of body blocks

SCT + derotation of main curve

• Schroth at patient’s home– Same equipments– Teaching parents– „Homework Exercise book”– „Homework sheet”

EVERYDAY SCHROTH

• Sport activities in brace

RESULTS• 7 female patients• Postmenarch • Still in therapy - Preliminary results

MeanAge

MeanBMI

MeanCobb

MeanATR

MeanHeights

MeanChest Exp.

START 13 19 47.3°±2.4°

14.3°±3.4°

165.3cm ±4.3cm

5.1cm ±0.8cm

MeanAge

MeanBMI

MeanCobb

MeanATR

MeanHeights

MeanChest Exp.

END 14 20 42.3 °±6.1°

11.1°±3.7°

167.8cm±3.5cm

6.6cm ±0.9cm

-5° -3.2° +2.5cm +1.5cm

Results – COBB ANGLE

30

35

40

45

50

55

1 2 3 4 5 6 7

startend

Improved: 9.8°4 patients

Worsened: 7°1 patient

Same 2.5°2 patientsUNDER 45° !!!

Results – ATR

0

5

10

15

20

25

1 2 3 4 5 6 7

startend

Improved: 5.3°4 patients

Same: 0.6°3 patients

Patient 1: bracing for 9 monthsCobb: 44° ATR: 17° Height: 158 cmCobb: 32° ATR: 10° Height: 165 cm

PATIENTS

Patient 2: bracing for 7 monthsCobb: 48° ATR: 9° Height: 156 cmCobb: 40° ATR: 6° Height: 162 cm

PATIENTS

PATIENTS

• Patient 3: bracing for 12 monthsCobb: 45° ATR: 11° Height: 156 cmCobb: 52° ATR: 12° Height: 158 cm

Individual+

Personalized

PREOPPROTOCOL

SCHROTHTHERAPY≤45 Cobb

MORE STUDIES

REQUIRED

POSITIVEOUTCOME

Conclusion

Thank you for your attention!