Schroth-Based Physical Therapy: Does It Improve Scoliosis Outcomes?

A physical therapy regimen developed in the 1920s by a young German woman, Katharina Schroth, to treat her own scoliosis and later refined by her daughter Christa Lehnert-Schroth, PT, has been used in Europe for decades and is growing in popularity in North America. Can it improve outcomes for patients with adolescent idiopathic scoliosis (AIS) either with or without bracing? Research may provide the answers. The Schroth regimen of muscle-strengthening and stretching exercises aims to derotate and elongate the spine into a straighter position. The method has been called three-dimensional since the therapy exercises work to correct in all three planes: sagittal, coronal, and transverse ( www.schrothmethod.com ; www.scoliosisrehab.com ). After a careful diagnosis to determine a patient's curve type, the therapist designs an individual program of curve-specific movement, body awareness, and mental imagery to improve posture. "Although research in Europe indicates that scoliosis-specific exercises have been efficacious, American orthopedic surgeons generally have not felt that the evidence is solid enough to support its use," explains Karina Zapata, PT, DPT, Texas Scottish Rite Hospital for Children (TSRHC), Dallas. Zapata is certified in the Barcelona Scoliosis Physical School (BSPTS) method of treating scoliosis patients, which is based on the Schroth method, and is involved in research at TSRHC. The BSPTS program was developed in 1968 by Spanish physical therapist Elena Salvá, founder of the institute bearing her name. Although Salvá died in 2007, her daughter Gloria Salvá, DO, now directs the clinic and her son-in-law, Manuel Rigo, MD, PhD, developer of the Rigo-System Chêneau scoliosis brace, is medical director. Research The planned research study Zapata is leading at TSRHC aims to investigate the efficacy of the Schroth-based method for AIS. The hospital has applied for a research grant; the research may take a couple of different directions, depending on the grant, according to Don Katz, CO, LO, FAAOP, vice president of facilities and process design. One direction would be to investigate whether Schroth-based physical therapy would help prevent premenarchal girls with relatively small curves from progressing to larger curves requiring bracing, Katz says. He gives a theoretical example of an 11-year-old girl at Risser 0 with a curve of 17 degrees. "We wouldn't recommend a brace at that stage. But we would recognize that there is a risk of that curve progressing to a larger degree where the use of a brace may be indicated; however, there's also a very reasonable chance that the curve will not progress, so it would be over-treating to use a brace at presentation. It's an interesting question: Is this a patient population that we should just observe or a population that we should have do the Schroth exercises?" This study could show that treating this population with the Schroth-based regimen could prevent the need for later bracing, he explains. "We have the previous natural history studies showing that they have a pretty high risk of progressing," Zapata adds. Research planning is under way to identify issues and concerns and to standardize protocols. Some young patients are being treated with the Schroth-based regimen at the hospital, including some using a brace and others with mild curves not being treated with a brace to see how they are responding to the treatment, Zapata says. Another possible direction, according to Katz, would be to develop research protocols in which a control group is treated with bracing only and compared with a cohort that is being treated with bracing plus the Schroth-based physical therapy in order to find out first, if there is a difference in outcomes, and second, whether patients doing the Schroth-based therapy are more compliant with brace wear. The University of Alberta, Edmonton, Canada, also is undertaking research on the Schroth regimen, Zapata notes. The primary aim of the randomized controlled trial is to compare the effect of a six-month "Schroth exercise program combined with standard-of-care" to "standard-of-care alone" on scoliosis curve severity measured using the Cobb angle ( http://clinicaltrials.gov/show/NCT01610908 )." Secondary aims include: To determine the effect of Schroth exercises at six months on secondary outcomes including quality of life, spinal appearance, objective posture, and spinal muscle endurance measurements. To determine the efficacy of six months of Schroth therapy offered to control participants after completing six months in the standard-of-care group (using subjects as their own controls). To determine the efficacy of six months of Schroth therapy offered to control participants after completing six months in the standard-of-care group (using subjects as their own controls). The study, titled "Schroth Exercise Trial for Scoliosis (SETS)," is being conducted in collaboration with the Glenrose Rehabilitation Hospital Foundation, Edmonton, and the Scoliosis Research Society (SRS). Schroth-based physical therapy may make brace wear more tolerable for the young patients, Zapata says. "Parents often ask us, 'Is there anything more we can do?' Schroth-based therapy gives patients and families some options." —Miki Fairley

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