Schroth Method A 3-D Treatment Approach to Treating Scoliosis According to the Principles of C.L. Schroth Michelle Dwyer, DPT Schroth and SEAS Certified for the Treatment of Scoliosis and Spinal Deformities I use a combination of Methods, SEAS, Soft tissue work, Vestibular work, Sports Integration. The Schroth Method can also be used with adults with Scoliosis

U.S. History- Challenging the Current Model 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? Therapists Training- Needs to be more advanced- Schroth – SEAS’s.

Traditional PT Postural Awareness Stretching/ Strengthening Hip ROM Spinal Stability Body Mechanics The problem with traditional PT is we are taught general strengthening and stretching of concave side. We are strengthening the core muscles in the current Curve Pattern. Further reinforcing the neurological imbalance and motor program. In order to be the most effective in the Treatment of Scoli- The PT needs to be Curve Specific to each patient.

Challenging the Traditional Model of PT 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. Team Approach- Coaches, Massage, Gym Teachers, Therapist Word of Mouth A few methods that are challenging the Traditional Model are Schroth Method and SEAS method. The Schroth is the most specific approach and aggressive approach at this time. The SEAS approach is also Curve Specific, Vestibular and very good for high level athletes and those are not Schroth appropriate. I use a combination of both methods with my patients. We are also seeing more of a collaborative Team Approach that is patient and family focused on the best outcome possible. Other- Massage Therapists, Coaches, Websites, Curvy Girls, Hope’s Closet, Community resources

Schroth ( BSPTS) Principles 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 Spain 1968 USA 2005 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 Germany- Katherina Schroth Started in the 1920’s using breathing and 3D corrections to reshape the body. She Instructed her daughter Christa lehner-Schroth PT- Then taught her grandson Dr. Weiss – Germany Elena Salva PT brought the Method to Spain- Her Daughter Gloria Salva, MD. DO. Trained her husband Dr. Manual Rigo in the Method. Dr. Rigo is the founder of the BSPTS- Dr. Rigo trained Beth Jansen – Beth brought Schroth to US.

Treatment Guidelines Precautions: Contraindications: Osteoporosis Post- Surgery Juvenile Hypermobility Syndrome (JHS) Osteogenesis Imperfecta Spondylolisthesis Contraindications: Reactive Scoliosis (tumor, disease, etc) Inflammatory diseases- during active phase Psychiatric Issues

Treatment Guidelines 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

Treatment Guidelines Risk of Progression Factor Patient Age Risser Score Cobb Angle Age patient is first seen RPF is a calculation based on the following components Family History Other things consider are Scoli Score, patient hobby/sports, performing arts etc

Assessment Angle of Trunk Rotation- (ATR) Using Scoliometer 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 Why do we Measure ATR? Because it Correlates directly with Cobb Angle. Because the Pathomechanism of Scoli is Torsion followed by SB. Therefore an increase in Rotation is most likely indicative of increase in Progression/Cobb Angle. A minimum of 5 degrees Scoliometer= 15-20 degrees Cobb Angle * Bunnell, Bone and Joint 1984 An increase in 2 degrees is significant for Progression Indication.

Semi-Hanging Sagittal Plane Schroth Exercises Semi-Hanging Sagittal Plane Prone on Knees-Transverse Plane Anterior Gravity Assisted

Schroth Exercise Standing 3D Correction Supine Gravity Assisted- Transverse Plane

Assessment Photos

Assessment Photos

In Brace Correction

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

Sagittal Plane Correction Visit 1 Visit 3 Important to Sagittal Plane Correction first, then Elongation followed Translation moving Rside Thorax to the Left and Deflection. Notice Pre- Post the head is balanced over the thorax, the shoulders are back, the abdominals can now engage do to the decrease in excessive lordosis.

Exercises Using Schroth Principles Traction with AutoCorrection and Elongation- Seated in Corrected Posture

Exercises Using Schroth Principles Visit 1 - Uncorrected Visit 3 - Corrected Posture Standing AutoCorrection with Elongation and Deflection- Doing Standing Breathe Work

Exercises – Sport Specific and In-Brace Long Hang Tx, opposite of curve- Elite Gymnast Standing AutoCorrection –In Brace with RSC

Sport Specific Training In Corrected Posture Right Thoracic Left Lumbar non –corrected. Doing Sport Specific Training in Over Correction – For Bball and Softball

Case Study Visit 1 Visit 1 JF- 9 y/0 Low Tone, Preemie, with abdominal sx at 2 and 8 months of age

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 Options Local Program Progression Immersion Program Basic Program 2x wk- 8wks Progression Monthly, Quarterly, Bi-Annually Until Risser 5 Immersion Program Basic Program for 5 consecutive days Progression First yr every 3 months Bi-Annually to Risser 5 Home Program- 3 exercises 25-30mins Warm up- coordination Exercises in corrected posture 8 mins in each position

Assistants