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Specialized Physiotherapy May Help Reduce Pain, Lessen Progression of Scoliosis

February 2, 2017
The Schroth method, an individualized exercise program, holds promise as an alternative to bracing or surgery to help improve spinal stability in patients with adolescent idiopathic scoliosis.

With Eric C. Parent, PhD, PT, and commentary by Gordon Lawson, MSc, DC

In the United States, non-surgical treatment of adolescent idiopathic scoliosis (AIS) typically includes bracing and monitoring the spinal curve for progression, and/or spinal surgery. Now, a Canadian study1 has reported that specialized physiotherapeutic exercises, known as the Schroth method, may slow advancement of the disease, reduce pain, and improve overall quality of life.  

The Schroth method, developed by Katharina Schroth in Germany, is an individualized series of physical therapy exercises and breathing techniques aimed to improve paraspinal muscle support and lessen spinal over rotation.The goal is to bring the pelvis into proper alignment, improving posture and lessen pain. 

Teenagers with idiopathic scoliosis may benefit from an individualized physiotherapy program using the Schroth Method.

''Schroth is an approach that has not been widely used in North America," study researcher Eric C. Parent, PhD, PT, associate professor of physical therapy at the University of Alberta, told Practical Pain Management. "It has been widely used in Europe for a while," he said, “dating back to the early 1920s.”

The results,1 published in PLOS One, were so impressive, Parent and his colleagues said that they plan to advocate for this exercise management to be added to the standards of care for patients in Canada.

Muscle Strengthening  May Promote Improved Posture 

Schroth exercises are customized to individual patients and adjusted to accommodate for their spinal deformation. The approach focuses on correcting spinal rotation and increasing lung capacity with a specialized breathing technique. Patients are taught how to establish and maintain better alignment of the spine, Dr. Parent said, and then learn to hold the proper alignment throughout the day.

The goals of treatment are to reverse the abnormal curvature with a customized series of exercises that take into account the physiology of the particular patient. The position of the patient’s pelvis, which typically is misaligned when scoliosis is present, is also corrected. Strengthening exercises are intended to improve muscle support, much like core exercises are promoted to improve lower back stability.

Teens Following Protocol Faired Better

Dr. Parent's team studied 50 adolescents, ages 10 to 18, who had a prior diagnosis of idiopathic scoliosis. Their spinal curvature ranged from 10 to 45 degrees (Cobb Angle). The adolescents were randomized to either the Schroth group or as controls who received standard care. The teens in the Schroth group had 5 visits in the first 2 weeks, then weekly, said Dr. Parent. In all, those following the Schroth program had about 21 sessions, repeated over a 6-month period. Teens were instructed to do the prescribed exercises for 30 to 45 minutes, daily, at home.

At the end of the 6 months, 88% of the teens in the Schroth group either showed improvement in their spinal curvature beyond or within 5 degrees of the baseline curve magnitude.1 In contrast, the average curve in the control group deteriorated by 2.3 degrees. The teens in the Schroth group had significantly smaller spinal curvatures overall than the teens in the control group (-3.5 degrees, 95% CI, p 0.006).

On average, a teenager who had a 51.2 degree curve at the start of the study would go achieve a curve measured at 49.3 degrees after actively participating in the Schroth PT program over the 6 month study period.1

"We were not testing whether exercise could replace bracing," Dr. Parent said. The researchers did conclude that Schroth exercises'' did appear to show the potential for them to control their curve."

Schroth PT Offers Significantly Better Pain Relief

Not all the teens in the study began with complaints of pain, according to Dr. Parent. "But those who did [have pain] showed significant improvement."  The current paper did not address the pain outcome as much as a previous study,3 he said.

He recounted 1 patient with scoliosis who had worn a brace every day for over a year but reported pain from just the effort of holding herself upright, which he attributed to weak muscles. After participating in the Schroth program, she gained significant back strength and had reported less pain, he said.

Another positive outcome measurement was muscle endurance, which increased in the Schroth group more than in the controls, according to Dr. Parent. The Schroth group improved their average holding time by 32.3 seconds after 3 months, as compared to 4.8 seconds for the teens in the standard care group.1

Clinical Perspective on Value of Schroth Method

"The improvement seen could be within the [standard] error of measurement," Gordon Lawson, MSc, DC, assistant professor at Canadian Memorial Chiropractic College, Unionville, Ontario, told Practical Pain Management, after reviewing the paper.

The method, he said, was a good and valuable approach, but he indicated that the study findings, at this point, were not definitive.

He also questioned whether teens would adhere to the time commitment required for the Schroth program. "Thirty to 45 minutes every day for a teen is a lot," he said.

Dr. Lawson told Practical Pain Management that he did support patient engagement in scoliosis treatment. "Anything you can do to encourage the patient to participate in their care is good," Dr. Lawson said.

Neither Eric C. Parent, PhD, PT or Gordon Lawson, MMc, DC, disclosed any financial conflicts of interest with regard to this study.

Disclaimer: While the outcome of the Schreiber et al study is encouraging, Practical Pain Management notes that the study findings are based on Phase 2 clinical trial data. Further clinical study of the Schroth physiotherapy method is needed to meet evidence-based treatment decision-making.

Last updated on: June 13, 2017
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