Physical Therapy and Schroth Method Exercises for Scoliosis
Scoliosis is a sideways curve of the spine, in the shape of a letter C or S. This is the most obvious sign of scoliosis, but other changes may be present, such as a rotation of the spine. The bones of the spine (vertebrae) may also become stretched in certain areas and compressed in others.
Physical therapy for scoliosis addresses all of these spine changes using a three-dimensional approach. The goal of this and other scoliosis treatments is to improve the look of the spine, keep the curve from worsening and prevent symptoms such as pain and breathing difficulties.
“If the curvature is causing you limitations—pain, decreased ability to complete daily tasks, etc.—a physical therapist will perform an examination to determine the type of curvature, as well as any other issues that may be contributing to your problem, such as decreased strength, range of motion, mobility, etc.,” said Michael Hildebrand, PT, DPT, COMT, owner of M3 Physio in northeast Louisiana.
The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) recommends scoliosis-specific exercises as the first step in the treatment of idiopathic scoliosis. “Idiopathic” means the cause is not known. This is the most common type of scoliosis that affects children and adolescents.
Children can also be born with spinal defects that cause scoliosis (congenital). Older adults can develop scoliosis due to age-related changes in the spine (acquired). Physical therapy may not be the best treatment for these other types of scoliosis.
Despite scoliosis being a challenging spinal condition, plenty of adults live with scoliosis (corrected or not). These people not only don't have difficulties, but some are even high performance athletes.
Scoliosis Exercises and Stretches
Several stretching and exercise programs have been developed for idiopathic scoliosis.
”Based on your evaluation, your physical therapist will develop a specific program to address your issues and improve your ability to perform your daily activities,” said Hildebrand.
SOSORT recommends that physical therapy programs for scoliosis include the following:
- Training patients how to self-correct the curve of the spine in three dimensions, both while doing scoliosis exercises and during daily activities
- Stabilizing the posture with scoliosis exercises and stretches designed to increase the strength and flexibility of the muscles around the spine
- Educating patients and families about scoliosis and the importance of exercises and mindfulness of posture
One group of programs uses specific scoliosis exercises to help people self-correct the curves and rotation of the spine. This approach includes the Schroth method and several other programs.
Another approach asks patients to first self-correct the scoliosis using specific techniques. Then they do a movement or exercise while trying to maintain the alignment of the spine. Patients work through a series of increasingly difficult exercises in this way.
A holistic approach to treating your scoliosis is important.
“Your treatment should include education about your condition and a self-management program,” said Hildebrand. “It could also include manual therapy, therapeutic exercise or activity and modalities as needed.”
The main focus, he said, should be on active exercises, with passive manual therapy or other modalities used sparingly as needed.
Schroth Method for Scoliosis
Schroth physical therapy for scoliosis uses customized exercises designed to reduce the scoliosis, and lengthen and stabilize the spine. This type of physical therapy includes:
- Exercises that restore the symmetry of the muscles that support the spine and improve the alignment of the posture
- Breathing exercises that help reduce the spinal curvature and rotation
- Teaching people to be aware of their posture
Props are used to help a person correct the curvature of their spine, such as poles, therapy balls and Schroth bars. The exercises are done while lying down, sitting or standing.
Because every person’s scoliosis is different, a physical therapist trained in the Schroth method customizes the exercises to a person’s unique spinal curvature. In general, the exercises and stretches for scoliosis include three components:
- Muscular symmetry. Scoliosis can affect the muscles that support the spine, with some muscles weaker and others overworked. Schroth exercises are designed to improve the symmetry of the muscles on both sides of the spine.
- Rotational angular breathing. The Schroth method includes breathing exercises to help increase flexibility in the spine and between the ribs.
- Postural awareness. People learn to be more aware of their posture, both while doing the exercises and during daily activities. This includes reducing positions or movements that make the scoliosis worse.
Schroth method exercises
Although Schroth exercises are customized for each person’s scoliosis, the four most common exercises are:
- “50 x Pezziball” exercise. A person sits on a stability ball in front of a mirror. They use a wall bar in front of them to help them actively self-correct the spine in three dimensions.
- Prone exercise. A person lies face down on a mat or stool. Other props may be used such as tubes, belts, straps, beanbags or wedges. They then apply techniques like traction and counter-traction in the shoulders, or activation of the iliopsoas muscle (hip flexor), in order to target specific curves in the spine.
- Sail exercise. A person stands on a half foam-roll and holds onto two vertical poles. They activate certain muscles and use directional breathing to target certain areas of the spine. This is an effective stretching exercise that helps lengthen the chest cavity.
- Muscle-cylinder exercise. A person lies on their side with the convex curve of the lower spine facing down. The body is supported with props such as a bag, stool or chair. The person uses traction and muscle activation to align the lower spine.
Each Schroth method session lasts from 45 minutes to an hour. A person may need to attend five to 20 sessions, depending upon the severity of their scoliosis.
Does Physical Therapy Help Scoliosis?
The Schroth method is one of the most studied physical therapy programs for scoliosis. One study found that people who completed the Schroth program with the help of a physical therapist had better results — improved spine curve and rotation — than those who just did the exercises at home.
Another study showed that people who completed a Schroth program had less pain and better self-image by the end of the program.
It is not just children and adolescents who benefit from these programs.
“Physical therapy treatment is appropriate for all people with scoliosis because it can be primary or tertiary care,” said Hildebrand. “Your physical therapist will work with the other members of your healthcare team to help you determine your best course of action.”
Research shows that adults who complete a program that includes both physical therapy for scoliosis and cognitive-behavioral therapy have reduced pain, improved quality of life and fewer negative thoughts.
Physical therapy can be an effective treatment for idiopathic scoliosis. While it is possible to do these exercises at home on your own, working with a physical therapist may provide better results because they are able to customize the exercises to fit a person’s scoliosis.
It’s important to find a physical therapist who has experience working with people with scoliosis.
“When choosing a physical therapist, you should choose one that performs a thorough examination and promotes an active approach to your rehabilitation,” said Hildebrand. “They should teach you what to do in order to improve your ability to self-care and [increase] your independence with daily activities.”