Frequently Asked Questions

What is scoliosis?

Historically, scoliosis was defined a lateral or sideways curve in the spine with a Cobb angle greater than 10 degrees ¹. We now know that scoliosis is a 3-dimensional deformity of the spine, involving forward, sideways, and rotational movement of the involved vertebrae ². If the scoliosis is structural, boney changes will show on x-ray films. These skeletal changes along with soft tissue imbalances cause a trunk deformity. Scoliosis is classified by the age at which it is found. It is described as infantile at less than 3 years; juvenile from 3 to 10 years; adolescent greater than 10 years.

What causes scoliosis?

There are many causes for scoliosis, but most scoliosis (80-90%) is described as idiopathic, meaning "of one's own" or as having no known cause or triggering event. However, once the curve has begun a vicious cycle occurs, with uneven loading of the spine causing more changes in the bone shape and orientation. The curve can lose some flexibility and over time, changes in the shape of the trunk occur. This leads to more uneven loading of the spine, and more progression of the curve and deformity. This vicious cycle was described by Stokes ³.

Stokes, I.A.F.: Hueter-Volkmann effect.
Spine: State of the Art Reviews (modified from Stokes)

How can curve progression be predicted?

Because we don'’t know the cause of idiopathic scoliois, curve progression prediction is not fully possible at this point in time.

Statistics tell us that:

1. Curves are more likely to progress in females⁴.
2. If curves progress, they are more likely to progress during periods of growth⁴.
3. Most curves do not progress beyond 20 degrees Cobb⁴.
4. Curves that reach beyond 30 degrees Cobb are more likely to progress as adults⁵. This progression is probably related to mechanical forces (vicious cycle theory).

How can Physical Therapy help with scoliosis?

The basis for physical therapy intervention for scoliosis is the vicious cycle theory (see Question 2 above). Our specially trained staff will know how to assess individual curve patterns and teach individuals how to influence the vicious cycle by doing specific exercises designed to decrease the influences of gravity and uneven muscle pull. As a person begins to understand the corrected alignment, he or she will perform strengthening and breathing exercises in a specific corrected position. The exercises require frequent repetition throughout one's lifetime, in order to "reprogram" the body in the more symmetrical posture. The goal of treatment is to develop the ability to incorporate these corrections into daily activities at home, school and work.

Why hasn't this method been used in the US before?

There has been in the United States, a general, yet unsupported, concensus for the past century that exercises are not effective in the treatment of idiopathic scoliosis. Please refer to "Scoliosis and the Human Spine", by Martha Hawes, Ph.D. 2nd edition, 2003, available through the National Scoliosis Foundation (www.scoliosis.org/store/books.php).

Physical therapists are degreed, licensed medical professionals specializing in the evaluation and treatment of musculoskeletal problems. At this time, Physical therapist training, in general, usually includes several lectures on general types of scoliosis, non-specific exercises, pain control, general bracing, surgical techniques and rehabilitation after surgery.

It is time for Physical Therapist education to offer more specialization in training for conservative, pro-active intervention for scoliosis rehabilitation. We invite interested physical therapists to contact us about educational opportunities.

Who are the Schroth exercises recommended for?

The Schroth Method is recommended for people with idiopathic scoliosis who are willing to make the commitment to learn the exercises and change their movement patterns. The exercises can be started after a Cobb angle of 15 degrees is noted. Because of the level of commitment required, exercises usually start after age 10 years in girls and 12 years in boys. The Schroth Method can also be used for adults, but due to long standing movement patterns and soft tissue tightness in adults, the exercises generally progress more slowly. The exercises if taught and performed correctly should create no pain, but produce a sense of increased mobility and balance.

The exercises require frequent repetition throughout the patient's lifetime, in order to "reprogram" the body in an optimal symmetric posture.

How does the Schroth Method interface with the current standard of care for idiopathic adolescent scoliosis in the United States?

The Schroth Method can be used to support the current treatment approach in the USA. The exercises can begin after a 15 degree Cobb angle is noted after age 10 for girls, and age 12 for boys. Usually in this country, observation only is recommended for curves with Cobb angles of 10-25 degrees. Teaching the scoliosis patient about a more symmetrically, aligned posture equips the individual to make choices about how they move in his or her daily life.

A brace is usually recommended for adolescents if the curve progresses to more than a 25 degree Cobb angle. The exercises can be used to help keep the muscles of the torso strong and more balanced even while the individual wears a brace. Specific braces are recommended to support this optimal posture. The exercises are especially important as the spine matures, growth stops and the person is weaned from his or her brace. Continuing to perform the exercises as the individual comes out of the brace will train the person to maintain a more upright, balanced posture, decreasing the effects of the vicious cycle (see question 2).

In this country, many Doctors recommend surgery for people having curves with Cobb angles of greater than 45 degrees. The Schroth Method exercises can be used to maximize the neutral alignment of the spine if surgery is rejected by the patient or family for medical or other reasons. The Schroth Method advocates conservative management of scoliosis, but recognizes the fact that in some severe cases, surgery is the best option. These exercises can also be used before surgery to decrease the secondary soft tissue tightness and after recovery from surgery to facilitate more even muscle pull on the spinal correction.

How do I find a brace-maker (orthotist) who can make a Rigo System Cheneau Brace?

Rigo System Cheneau Brace requires specific training and practice with a master brace-maker. There are very few such orthotists in the United States. Please contact us for further information.

Does my insurance cover this type of Physical Therapy?

The physical therapy treatments associated with the Schroth Method are billed under standard physical therapy codes.

We recommend that you check on your insurance coverage for physical therapy services. Our trained staff will be able to help you with your insurance questions.

References:

1. Moen KY and Nachemson AL 1999 Spine 24: 2570-2575, Treatment of scoliosis: an historical perspective.
2. Deacon et al, 1984 J Bone and Jt Surgery-Br 66: 509-512. IS in three dimensions: a radiographic and morphometric analysis.
3. Matsumoto et al, 1997 Spinal Disorders 10:125-131. Flexibility in the scoliotic spine: three dimensional analysis.
4. Stokes et al, 1996 Spine 21: 1162-1167. Mechanical modulation of vertebral body growth. Implications for scoliosis progression.
5. Lonstein J.E., 1987 Spine: State of the Art Review, vol. 1, No. 2., p184-187. Editor Jesse H. Dickson. “ The Risk of Progression of Idiopathic Scoliosis in Skeletally Immature Patients”.
6. Weinstein S.L., 1987 Spine: State of the Art Review, vol. 1, No. 2, p. 203. Editor Jesse H. Dickson. “The Natural History of Scoliosis in a Skeletally Mature Patient”.