Scoliosis - 15-year-old girl (left) with left lumbar and right thoracic curvature
15-year-old girl (left) with left lumbar and right thoracic curvature.
After a six-week course of Schroth treatment (right).
Degrees of curvature are marked on the X-rays.

The Schroth Method Halts Curve Progression
and Avoids Spinal Fusion Surgery

A growing literature written by physical therapists documents the results of Schroth exercise therapy for scoliosis. Abundant evidence in clinical studies, some of them cited below, demonstrates that the Schroth method can stop curve progression in adolescents, reverse abnormal curves, reduce pain, increase vital capacity, and avoid surgery.

Treatment is not uniformly successful in every case. Success is influenced by factors that include diagnostic and treatment skill, the degree of curvature, age of the patient, and patient compliance in performing the exercises.


Schroth Therapy Reduces Curves, Avoids Surgery

A Schroth clinic in Spain reports surgery rate as low as 5.6%

Since 1991, Dr. Manuel Rigo's clinic in Barcelona has practiced bracing and physical therapy for adolescent idiopathic scoliosis (AIS). His scoliosis database was searched for patients with AIS who were at least 15 years of age at last review and who had adequate documentation of their Cobb angle.

Of 106 braced cases ( 97 followed up), only six cases (5.6%) ultimately underwent spinal fusion.

Even if all nine cases from whom data could not be obtained had undergone surgery, the greatest number of spinal fusion cases would be 15 (14.1%). In contrast, published data from an Irish center with a policy of non-intervention reported surgeries on 28.1% of their AIS patients.

Source: Rigo M, Reiter Ch, Weiss HR. "Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis." Pediatric Rehabilitation 2003 Jul-Dec;6(3-4):209-14.

Schroth patients are much less likely
to suffer curve progression

Two independent patient groups matched by age and sex at diagnosis were analyzed using the outcome parameter, incidence of progression (> or =5 deg ). One group was untreated and the other received scoliosis in-patient rehabilitation (SIR) at the Katharina-Schroth-Klinik, Bad Sobernheim, Germany. Untreated patients progressed 1.5 to 2.9 times more than those treated with SIR, even though some SIR-treated patients had more severe curvatures

Source: Weiss HR, Weiss G, Petermann F. "Incidence of curvature progression in idiopathic scoliosis patients treated with scoliosis in-patient rehabilitation (SIR): an age- and sex-matched controlled study." Pediatric Rehabilitation 2003 Jan-Mar;6(1):23-30.

No curve progression in Schroth patients
3 years after treatment

This preliminary study begun in 1989 included 181 scoliosis patients, average age 12.7 years, average Cobb angle curvature 27 degrees, average risser sign 1.4, average follow-up 33 months.

Results of the preliminary study were compared to natural history as known from literature. For the worst-case analysis additionally a questionnaire was sent to the non-repeaters who had been treated at the same time (1989 and 1990) as the patient sample, using essentially the same inclusion criteria.

Results showed no curve progression (defined as increase in curvature of 5+ deg/yr). The lack of progression of the 181 patients from the preliminary study and the 116 questionnaire patients together exceeded natural history even if all drop-outs were considered failures.

Source: Weiss HR, Lohschmidt K, el-Obeidi N, Verres C. "Preliminary results and worst-case analysis of in patient scoliosis rehabilitation." Pediatric Rehabilitation 1997 Vol. 1(1): 35-40.

Schroth program reduces abnormal curve by an average of 10 percent

X-rays were made of 107 patients at the beginning and end of a 4-6 week in-patient exercise program at the Katharina-Schroth Clinic. Average Cobb angle was 43.06 degr (std. deviation = 22.87) before treatment and 38.96 deg (SD = 23.00) afterwards. 43.93% of the patients showed curve improvement of 5+ degr.; 53.27% were unchanged; 2.8% showed curve increase of 5+ deg.

Source: Weiss HR. "Influence of an in-patient exercise program on scoliotic curve." Italian Journal of Orthopedic Traumatology, 1992;18(3):395-406.

Schroth Reduces or Eliminates Pain

80 percent of 311 patients reduced or eliminated their pain in a Schroth program

In 1989, 311 scoliosis patients at the Katharina Schroth Klinik filled out pain questionnaires at the beginning and end of their treatment programs. Subject age range was12 to 69 years, average was 32.6 years. Average Cobb angle was 50.5 (±29.2) degrees.

Average pain severity dropped from 2.7 to 1.1 on the Collis-Ponseti scale of 1-5 (0 = no pain, 1 = low, 2 = moderate, 3 = rather intense, 4 = very intense, 5 = scarcely bearable). 43.7% of these patients received total pain relief from the program.

Before the program, more than 60% of the patients had pain ranging from 3 to 5. Afterwards 80% of them felt their pain reduced to the range 0 to 2.

The study identified 20 different pain localizations, the most frequent being lumbar angular facets (34.1%), paravertebral muscles on the lumbar convex side (30.5%), and shoulder and neck region (27.3%). Severity grade was averaged for those who had more than one type of pain.

Source: Weiss HR, "Scoliosis-related pain in adults: Treatment influences," European Journal of Physical Medicine and Rehabilitation 3/3 (1993): 91-94.

Schroth Therapy Increases Vital Capacity

Schroth therapy increases vital capacity (the amount of air you can exhale after full inhalation) by 14% to 19%.

813 Schroth inpatients treated at the Schroth clinic between 1984 and 1987 increased their vital capacity between 14% and 19%, and increased their chest expansion more than 20%.

Source: Weiss, Hans-Rudolf, M.D., "The effect of an exercise program on vital capacity and rib mobility in patients with idiopathic scoliosis." Spine, Vol. 16 (1/1991).

Schroth reduces abnormal curves by over 30% and increases lung capacity

Out-patient Schroth therapy of 50 patients at the Physical Therapy and Rehabilitation School, Hacettepe University, Ankara, Turkey, reduced average Cobb angle from 26.1 to 17.85 deg in one year. Vital capacity increased by 420 ml.

Source: Otman S, Kose N, Yakut Y. "The efficacy of Schroth's 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey." Saudi Medical Journal (9/2005), vol. 26(9):1429-35.

PHYSICAL EXERCISES AND SURGERY FOR SCOLIOSIS

Book dispels common misconception that exercises do not help correct scoliosis

Despite nearly 90 years of Schroth therapy in Germany, conventional Anglo-American medicine still commonly asserts that physical exercises have no effect on scoliotic curvature. In her book, Dr. Martha Hawes reviewed the pertinent clinical, peer-reviewed literature in English and demonstrated conclusively that there is no scientific basis for this belief. The articles sometimes referred to as sources for this claim do not in fact make and support it with evidence. In contrast, Hawes found a growing literature in English testifying that properly designed exercises can have a positive effect on scoliotic curves. She devotes pages 99-105 of her book to a discussion of the Schroth program.

Source: Martha Hawes, Scoliosis and the Human Spine. Tucson, West Press, 2002.

Some Schroth exercises for spinal fusion patients

Spinal fusion surgery does not eliminate the need for physical therapy to correct patients' posture and maintain stability above and below the fused segment. Nine exercises are described and depicted.

Lehnert-Schroth, Christa. "Physiotherapy for scoliosis patients following spinal fusion surgery." Krankengymnastik 48 (1996): 212-219.

For an English translation of the original German article (PDF), see the page "What can patients do?" at Christa Lehnert-Schroth's personal website: http://www.schroth-scoliosis-treatment.com

A review of the literature finds high rate of complications for spinal fusion surgery, and no evidence for recommending surgery

The authors find no evidence that spinal fusion can alter health related signs and symptoms of scoliosis in the long term, thus we cannot derive a clear medical indication for surgery.

For this review, English-language articles and bibliographies in Pub Med and the SOSORT scoliosis library were searched for the terms: 'scoliosis'; 'rate of complications'; 'spine surgery'; 'scoliosis surgery'; 'spondylodesis'; 'spinal instrumentation' and 'spine fusion.' An electronic search on the keywords "scoliosis", "surgery", and "rate of complications" found 287 titles.

Rates of complication varied between 0 and 89% depending on the etiology of the entity investigated. There are no reports on long-term rates of complications from surgery.

This varying but high rate of complications
may be even higher than reported. A medical indication for surgical treatment cannot be established, because of lack of evidence to support it. This study recommends mandatory, standardized reporting for all spinal implants using a spreadsheet list of all recognized complications to show a 2-year, 5-year, 10-year and 20-year rate of complications.

Source: Weiss HR, Goodall D. "Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature." Scoliosis 2008 Aug 5; 3:9.

Comparison study: Schroth patients had surgery at only 25% to 43% the rate of untreated patients (1993-1996)


The study compares incidence of surgery in two groups of scoliosis patients: 343 who had conservative treatment at the Schroth clinic between 1993 and 1996, and 153 patients reported by a center in Ireland in 2001.* All were at least 15 years of age at the time they were last investigated or questioned.

Schroth subjects were 343 females, curvature averaged 33.4 deg (standard deviation = 18.9), followed up by questionnaire. Forty-one of them (12%) had gone on to have surgery, as recommended by their home physician. But this incidence of surgery was only 7.3% of Schroth AIS paitents, compared with 28% in the control group with the same diagnosis. Our conservatively treated early-onset and congenital scoliosis patients had a higher incidence of surgery (20.8% and 22.2%), yet still lower than the control group.

Statistically, the incidence of surgery in the Schroth groups was significantly lower than the incidence of surgery in the control group from Ireland and other centers described in literature.

The authors write: "Referrals to our centre [the Schroth clinic in Bad Sobernheim, Germany] . . . are from spine centres, general orthopaedic surgeons, paediatric physicians and general practitioners. Therefore the patient sample is pre-selected with bad prognosis." [p. 116]

Source: Weiss HR, Weiss G, Schaar HJ. "Incidence of surgery in conservatively treated patients with scoliosis." Pediatric Rehabilitation 2003 Apr-Jun;6(2):111-118.

*For the control group in the above study see: Goldberg CJ, Moore DP, Fogarty EE, Dowling FE, "Adolescent idiopathic scoliosis: the effect of brace treatment on the incidence of surgery," Spine 2001 Jan 1;26(1):42-47.

Literature review validates conservative treatment

A review of clinical literature reveals that scoliosis normally does not have such dramatic effects that would justify immediate surgery. Out-patient physiotherapy, intensive in-patient rehabilitation, and bracing have proven effective in conservative scoliosis treatment in central Europe. The positive outcomes of this practice validate a policy of offering conservative treatment as an alternative to scoliosis patients.

Source: Weiss HR. "Rehabilitation of adolescent patients with scoliosis--what do we know? A review of the literature." Pediatric Rehabilitation 2003 Jul-Dec;6(3-4):183-94.

Review of literature finds evidence to support conservative treatment of AIS, but no controlled study supports surgery for scoliosis

Traditional treatment options (in Germany) for adolescent idiopathic scoliosis (AIS) are exercises; in-patient rehabilitation; braces; and surgery.

The largest medical databases were searched for the outcome parameter "'rate of progression," targeting prospective controlled studies that considered the treatment versus natural history.

Search strategy included the terms: ''adolescent idiopathic scoliosis''; ''idiopathic scoliosis''; ''natural history''; ''observation''; ''physiotherapy''; ''physical therapy''; ''rehabilitation''; ''bracing''; ''orthotics;'' and ''surgery''.

Prospective short-term studies were found to support outpatient physiotherapy. One prospective controlled study supported scoliosis in-patient rehabilitation (SIR). Bracing is supported by one prospective multi-center study, a long-term prospective controlled study, and a meta-analysis.

No controlled study over any time span produced substantial evidence to support surgery as a scoliosis treatment. No evidence in prospective controlled studies supports surgical intervention.

Because of unknown long-term effects of surgery, a randomized controlled trial (RCT) seems necessary. However, due to evidence supporting conservative treatments, a RCT for conservative treatment options may be unethical.

Some evidence supports conservative treatment for AIS. However, this evidence for conservative treatment is admittedly weak in number and length of studies.

Source: Weiss HR, Goodall D. "The treatment of adolescent idiopathic scoliosis (AIS) according to present evidence. A systematic review." European Journal of Physical and Rehabilitation Medicine. 2008 Jun;44(2):177-93.

Arguments for and against spinal fusion surgery for scoliosis

Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for AIS patients remains controversial. Advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome. Opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome.

Source: Weiss HR, Bess S, Wong MS, Patel V, Goodall D, Burger E. "Adolescent idiopathic scoliosis - to operate or not? A debate article." Patient Safety in Surgery 2008 Sep 30;2(1):25.

Patients with congenital scoliosis benefit from Schroth treatment

The paper addresses current practice of recommending early surgery for patients with congenital scoliosis (CS), even in mild cases of formation failures in the first three years of life.

Two patients with rib synostosis denied surgery before entering the pubertal growth spurt. These patients were treated with braces and Scoliosis In-Patient Rehabilitation (SIR) and now are beyond the pubertal growth spurt. One patient with a formation failure and a curve of greater than 50 degrees lumbar was treated with braces and physiotherapy from 1.6 years and was still under treatment at age 15.

Severe decompensation was prevented in the two patients with failure of segmentation. However, a severe thoracic deformity is evident, with underdeveloped lung function and severe restrictive ventilation disorder.

The patient with failure of formation is well developed, currently with no cosmetic or physical complaints, although his curve progressed at the end of the growth spurt due to final malcompliance.

CONCLUSIONS: Failures of segmentation should be advised to have surgery before entering the pubertal growth spurt. If they refuse, c onservative treatment can be partially beneficial. Conservative rather than surgical treatment should be recommended for patients with failures of formation, because long-term outcomes of early surgery beyond pubertal growth spurt are still undocumented.

Source: Weiss HR. "Congenital scoliosis - presentation of three severe cases treated conservatively." Studies in health technology and informatics. 2008;140:310-3.

Selected Publications of Katharina Schroth
and Christa Lehnert-Schroth

Katharina Schroth:

Altogether Katharina Schroth published 13 reports on her method from 1924-1972

Die Atmungs-Kur, Leitfaden zur Lungengymnastik (The curative breathing program: guidelines for lung therapeutics).
Buchdruckerei Gustav Zimmermann, Hohndorf Bezirk Chemnitz, 1924.

Atmungs-Orthopaedie und funktionelle Behandlung der Skoliose (seitliche Rueckgratverkruemmung)(Breathing orthopedics and functional treatment of scoliosis--lateral curvature of the spine)
Essen, 1930.

Christa Lehnert-Schroth

The author reports that at her clinic, pain diminishes or disappears in 85% of patients. Vital capacity increases in about 95% of cases. 22% of patients gain up to 600 ml vital capacity after a six-week program, and 11% improved VC up to 800 ml. ome patients increased vital capacity by more than 1,000 ml.

Source: Lehnert-Schroth, Christa, "Introduction to the Three-dimensional Scoliosis Treatment According to Schroth," Physiotherapy 1992 Nov;78(11):810-815.

BOOKS:

Dreidimensionale Skoliose-Behandlung, first edition, Stuttgart: G. Fischer-Verlag, 1973. This first comprehensive manual of Schroth therapy documented all the insights and techniques that Katharina Schroth and her daughter Christa had developed in more than fifty years of treating scoliosis patients.

Dreidimensionale Skoliosebehandlung: Atmungs-Orthopaedie System Schroth, revised seventh edition, Munich and Jena, Urban & Fischer (Elsevier), 2007. This classic handbook has remained in print since 1973.




Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine. Palo Alto, The Martindale Press, 2007. Purchase the book