12-year-old girl with Scheuermann's kyphosis (left).
After five weeks of Schroth treatment (right).
Book Review in ADVANCE for Physical Therapy and Rehab Medicine, November, 2009
Review by physical therapist Karin J. Edwards in the professional journal ADVANCE for Physical Therapy and Rehab Medicine recommends the book to her colleagues.
— — — — — — — — — — — — —
Translated book reviews of the original German editions, written by specialists in the field of scoliosis treatment
REVIEW OF THE SIXTH EDITION, 2000
Review in Die Säule (The [spinal] Column), vol. 10/3 (Aug., 2000). By Dr. med. E. Schmitt, Professor of Orthopedics, University Clinic, Frankfurt am Main
Scoliosis has challenged the medical fraternity since the time of Hippocrates, ever since physical therapists and orthopedic mechanics have existed. Despite acquisition of much knowledge and undisputable partial successes, for example operative procedures, one must admit that fundamental therapeutic problems still cannot be solved. Even with critical appraisal, a method of resolution is not in sight.
Here the present book intervenes, now in its sixth edition, which in the meantime [since the first edition] can be regarded as the standard work in the field. The idea of the author, Mrs. Lehnert-Schroth, whose mother even in the first third of this century became known for her concepts, has since occupied generations of scoliotics and motivated them to take active charge of forming their own fate rather than enduring it passively.
Mrs. Lehnert-Schroth recognized that scoliosis is not simply a simple lateral bending, but rather a three-dimensional occurrence which plays out in the frontal and sagittal planes and also in rotation. She put this knowledge into practice and developed conservative therapeutic procedures for derotation, for reversing the twist of the rib cage through a special technique of breathing. In addition come effects of extension and reduction of lordosis of the lumbar spine. This EDF [extension, derotation, flexion] principle has since been adopted in other conservative and pre-operative procedures, for instance in plaster cast treatment and in brace preparation.
The core of this method remains the special breathing techniques, which after being acquired make possible a successful self-treatment, namely the Schroth system of respiratory orthopedics. To be sure, such techniques do not solve the problem of scoliosis, but they are a significant component of the therapeutic offering.
The book is clearly laid out and reads well. A large amount of informative illustrations supplement the text. After an introduction and an account of the theoretical foundations of the Schroth method, the author presents practical examples. This task is not easy, for it is not always possible to express in words what must actively be done. Nonetheless the author successfully represents the illustrated successions of movements in a manner that they can be translated into action. There follow many pages with exercise instructions, and finally a documentation section with photos, X-ray monitoring pictures and statistical evaluations of her treatment results.
The author of this book review knows many patients who have been treated by the Schroth method. Unanimously, they rate the effect of the treatment positively. The reports of patients who have been treated at the Schroth clinic are convincing when they say that they have been strengthened in their motivation and in their resolve to continue the therapeutic plan independently.
Mrs. Lehnert-Schroth proves openly what Morscher has said elsewhere: "Scoliosis therapy demands much patience, skill, experience, and human leadership. It is one of the orthopedist’s most difficult challenges."
Thus this book truly belongs to the classics of conservative scoliosis therapy. Mrs. Lehnert-Schroth . . . developed it to a level of perfection that today has found general recognition. The book is recommended. Its acquisition will be worthwhile for the orthopedist, for physical therapists, and of course also for scoliosis patients.— — — — — — — — — — — —
REVIEWS OF THE FIFTH EDITION, 1998
Review in Therapie und Praxis (Therapy and Practice), April/May, 1998. No reviewer named.
The Three-Dimensional Treatment of Scoliosis by Christa Lehnert-Schroth is one of the classics of conservative scoliosis therapy. The "Schroth system of respiratory orthopedics" corrects faulty postures by extension, derotation, and reduction of lordosis. The active, individual influencing occurs also through stretching muscles and respiratory breathing therapy.
This manual, now in its fifth edition, graphically demonstrates the principles and practice of this form of scoliosis therapy. First the fundamental theoretical assumptions are elucidated in a manner understandable even for beginners. Building upon this foundation, the connection between theory and practice is explained in detail. The last part consists of exercise instructions, which enable one to adopt scoliosis therapy systematically in one’s own practice. Over 600 illustrations with often very distinct findings facilitate understanding and underscore the meaning of this conservative form of therapy.
The book is thus at once a teaching manual and a practical guide. Its simple and easily understandable language enables beginners to gain quick access to the method. However, the close connection between theory and practice makes it also very applicable to the advanced physical therapists and for orthopedists.
Review in Orthopädische Praxis (Orthopedic Practice) 09/1998. By Dr. med. C.Carstens, Heidelberg
After its first edition in the year 1973, the book at issue is now in its 5th edition. It may be mentioned to the reader who does not know the previous editions that the book contains five sections in which the physical therapeutic treatment system of scoliosis developed by Mrs. Lehnert-Schroth is presented.
The first three sections, comprising three-fourths of the book, explain the theoretical bases and exercises of the method initially developed by Katharina Schroth.
Interesting and valuable is the extraordinary and extensive photo documentation (more than 600 illustrations), which gives a vivid description of the practical proceedings. Every physical therapist who wants to incorporate this method in his or her practice needs to read this book. The extensive illustrations have real value for the interested orthopedic or general practioner, since he can at least have a theoretical introduction into a field which he may only know from his "prescriptions." The reader who expects to read about the scientific basis for the treatment’s success will be disappointed. But, of course, this is not the task of a physical therapist, but of clinical-medical research.
REVIEW OF THE FOURTH EDITION, 1991
Review in Orthopädie (Orthopedics), 1991. By Dr. med. H.P.Bischoff, orthopedist, Isny-Neutrauchburg
This is the 4th edition – the intervals between editions growing shorter – which proves the dissemination of the method, and the fact that it is the most-used conservative treatment of scoliosis in the German-speaking community.
The basic corrections of the pelvis and the "Right-Angle Breathing" are shown in the familiar valuable manner. Photo data and exercise instructions have been made more instructive through supplementation and exchange. Anyone who is engaged in this method will recognize the necessity of consistently performed daily exercises, which are presented clearly.
Although there is euphoria in the presentation, it shows in a realistic manner that this is not a method to cure scoliosis but rather a method which can bring improvement and stabilization when used consistently. The book should be a Must for doctors dealing with conservative treatment of scoliosis and presurgical treatment, because they should discuss the treatment plan with the physical therapist and the patient, and because they need to be capable of watching over and accompanying the treatment. The book addresses not only physical therapists and doctors but also the patients themselves. One wishes for the patient a more compact and more easily comprehensible presentation of method and exercises, however.
— — — — — — — — — — — —
REVIEWS OF THE FIRST EDITION, 1973
199 pp., 215 ill. (some in color).
Review in Erfahrungsheilkunde (Experiential Medicine) 1974/ 4. By Lieselotte Boden, Mainz
If one can say of a book that it contains the life work of two generations and introduces a new epoch of scoliosis treatment, then it is this work by Christa Lehnert-Schroth. The author gives a large-scale yet detailed account of the scoliosis treatment method which was developed by her mother Katharina Schroth and continued by the daughter.
Due to the adversity of her own scoliosis condition, Katharina Schroth tested and improved this unprecedented therapeutic method of "Respiratory Orthopedics" on herself and her patients — an ingenious, guiding achievement in the field of the treatment history of this affliction, which is often labelled incurable.
The book shows in an instructive and graphic manner how early invalidity and crippling can be avoided or reversed, and thus how the path to a new and positive outlook on life may be smoothed.
The "Schroth method" of respiratory orthopedics is based upon the concept that the so-called main curvature is the lowest curvature of the spine. The central point of the method is to eliminate the dysfunctions which are created by the pelvic shifts and spinal rotations. This is shown in the many systematic exercise instructions, which are accompanied by impressive pictures and diagrams. They all aim at identifying and correcting the manifold malpostures of the body. The book demonstrates in detail how breathing may be used to derotate the distortions. Even by reading, the reader learns how correctly to carry himself and move in everyday life.
This work not only guides the physical therapist in treating scoliosis conservatively with success, but also represents an excellent theoretical and practical source of information for the patient.
In a time in which the rapid increase of juvenile malpostures and spinal dysfunctions constitute a serious alarm signal, this book gives valuable advice for prophylaxis and early treatment (also for the educator). One wishes a world-wide propagation of this work for the benefit of scoliotics, who may then be able to look more optimistically to the future.
Review in Orthopädische Praxis (Orthopedic Practice) 11/IX (1975). By Dr. med. Rabl.
[This is] A very important book in a time when the field of scoliosis treatment is interested almost only in operations and in reshaping by passive apparatus [braces], and when we do not practice physical exercises (though we theoretically recognize their value) with the necessary diligence. The author has 30 years of experience of her own, and bases her work on 20 years preliminary work of her mother. After she had previously conducted her physical therapy practice in Saxony, she opened a rehabilitation center in Sobernheim (Rhineland-Palatinate), where the surgeon Dr. Hundt assists her medically. She perfected her methods in cooperation with Dr. Teirich-Leube and the orthopedist Dr. Wi. Baumann.
Although the book is written stylistically such that even physical therapists with below-average education can understand it if they exert themselves, it is no less important for orthopedic doctors. As indicated even in the title, the main point of this scoliosis treatment (and of other postural and formal problems of the spine) is training of certain breathing movements. On the one hand, these breathing movements form the rib cage. On the other, targeted contractions of the diaphragm in connection with leveling of the pelvis act upon the lumbar spine. Special emphasis is placed on working out the concave side. Even cranial posture must not be neglected. All this, again as indicated in the title, must happen three-dimensionally.
In order to facilitate for the therapist the guiding of movements, the book constructs a conceptual workaround. The author conceives healthy lumbar, thoracic and cervical spines diagrammatically as oblong rectangles observed frontally, and sagitally as slightly trapezoidal quadrangles. In order to return them to their correct form by respiratory movements, the method strives for overcorrection. Proceeding from these conceptions, an exhaustively thought-out system is elaborated, tested successfully for many decades. All movements demand the interaction of many muscles, so to speak all of them. The book depicts and describes in detail how the patient learns to master them. More than 200 figures illustrate the work.
A cursory read will not suffice for successful, practical application. The method must be acquired. The patient, too, must exert considerable effort. It is best taught for at least a month as an inpatient, or longer if possible, so that the patient learns everything that he or she must continue to practice at home.
An important aspect of the book is the illustration of typical mistakes that easily creep in. In addition to the different types of scoliosis, kyphosis plays a significant role in the book. Postural mistakes can lead even in adults to significant impairment of general health. Occasionally, methodical improvement of posture improves circulatory insufficiency and liver congestion so that previously-used pharmaceuticals are rendered superfluous.
The author is honest enough not to depict only perfect or sensational examples. But since most patients were at an age where their scoliosis had a strong tendency to progress, even small improvements are valuable.
Review in Zeitschrift für Orthopädie und ihre Grenzgebiete (Journal of Orthopedics and its Related Disciplines), vol. 114/4 (1976). "Scoliosis treatment according to Schroth." By K.F. Schlegel, Professor of Orthopedics, University of Essen
If one draws the conclusion from the achievements of Haeusermann, then without physical therapy all other procedures of scoliosis therapy make no sense. This fact changes nothing about the still more fundamental fact that the problem of scoliosis treatment is solved neither by the conservative nor the operative sector. Because the essential requirement — not to allow the deformity to commence — cannot be fulfilled, there remains for us no other choice than to attempt to correct the deformity and to hold the achieved correction result.
To accomplish this, one can proceed purely with physical therapy, or purely with a brace apparatus, or purely surgically. However, one can also combine and apply several paths, either selectively together or temporally staggered.
The so-called Schroth method of respiratory orthopedics was founded over 50 years ago by Mrs. Katharina Schroth and further developed in recent years by her daughter, Mrs. Lehnert-Schroth. For decades, the label "respiratory orthopedics" caused the method to be shunted aside into the paramedical domain. It lacked the requisite physical explanations as well as the assistance of academic medicine. On the credit side, there were the somewhat amateurishly expressed thoughts of a scoliotic physical therapist, who with her healthy common sense had developed a method which today could be smiled at condescendingly only by those who give conservative methods of scoliosis treatment no credence whatsoever.
In the theoretical explanation of Schroth scoliosis therapy, the author’s working hypothesis proves to be not inexpert: a tripartite division of the trunk into lumbar spine with pelvic girdle, of thoracic spine with rib cage, and finally of cervical spine with shoulder girdle and head. In scoliosis, these three trunk sections deform trapezoidally and twist against each other.
With this gymnastic method, the principle of Extension, Derotation, and Flexion with their corresponding breathing gymnastics was inaugurated 40 years before [the French physician] Cotrel. Such an Extension, Derotation and Flexion can, however, only be achieved when a fixed point is created, making possible a three-dimensional correction. In Schroth, as with Cotrel, it is primarily the pelvis which is fixed.
From this fixed pelvis position, the correction occurs in ascending order. By means of this passive-active unbending, extension and untwisting, one can successfully tackle the lumbar secondary curvature. Once this is controlled, there ensues the passive or active derotation influencing of the primary curvature. Thereby the load is transferred from the "pelvic wedge" to the corresponding "thoracic wedge", and the costo-transversal joints of the rib cage are fixed in their final position. . . . .
Once this corresponding stretching is achieved, the third Schroth postural wedge, with the head as counterweight, can be brought into the extending and derotating compesatory curvature.The Schroth method of three-dimensional scoliosis therapy should better be called the brace-less EDF-therapy of scoliosis.
After the deep physical insight, that we are concerned here with a three-dimensional gymnastic scoliosis treatment, necessarily the later insight followed, namely that it must not be built up in a sectarian fashion as treatment without a brace, but rather that Schroth therapy is essential to the brace-extension therapy.
It requires no discussion that the active holding powers can never suffice to correct a pathological posture continuously. It may be possible temporarily in malpostures, until the symmetrical muscle action has been achieved. A muscular equilibrium in a structural scoliosis is impossible, since it is founded on the one hand in the morphological change of skeletal elements and on the other in the autonomous spinal musculature which is not subject to the conscious will.
Furthermore, the following positive factors should be mentioned: the treatment is accomplished consistently over a period of several weeks in a group at the Schroth clinic. The children are familiarized with their spinal problems, without the feeling of being sick. They learn to live with the condition and are taught posture and the power of musculature.
The parents and the children themselves see the meaning of postural training in the momentary success. The extent to which it is only apparent, or whether it is real, will not be discussed here. Moreover, they receive an explanation which they as laypersons can understand. All affected parties become receptive to meaningful therapeutic measures, as long as they do not consist of uncritical homage and equally uncritical rejection or in one-sided sectarianism of some therapeutic procedure.