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
• 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?
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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
 Correct scoliosis posture
 Germany 1921
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Inpatient
 Spain 1968
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Outpatient
 USA 2005
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First certified therapists
2011 First US course held
Steven’s Point, WI
 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
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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 Study
Visit 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 Options
 Local 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
Assistants