a 3-d treatment approach to treating scoliosis according to the principles of c.l. schroth michelle...
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A 3-D Treatment Approach to Treating Scoliosis According to the Principles of C.L. Schroth
Michelle Dwyer, DPTSchroth 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?
• 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 Germany 1921
Inpatient
Spain 1968 Outpatient
USA 2005 First certified therapists 2011 First US course
held Steven’s Point, WI
Correct scoliosis posture 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
• 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 StudyVisit 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 OptionsLocal Program
Basic Program 2x wk- 8wks
ProgressionMonthly,
Quarterly, Bi-AnnuallyUntil Risser 5
Immersion ProgramBasic Program for 5
consecutive days
ProgressionFirst yr every 3
monthsBi-Annually to
Risser 5
Assistants