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Three-DimensionalTreatment for

Scoliosis

By Christa Lehnert-Schroth

This classic, encyclopedicmanual of physiotherapeuticscoliosis exercise treatment hasbeen the standard Germanhandbook on the subject since1973. Now available in English.

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Contains descriptions andphotos of more than 100

scoliosis exercises from whichthe therapist can choose to

suit individual patients.

Discusses and showsexercises for scoliosis,

Scheuermann's kyphosis,flatback, hollow-back

syndrome (hyperlordosis),lumbar kyphosis,

spondylolisthesis, and relatedpathologies.

Most scolioses exhibit 3abnormal curves, but the

author discovered cases with2, 4, 5, and even 6

curves. Her book explains howto treat these anomalies. Four

curves have becomerelatively common, and mustbe treated differently than the

24-year-old woman (left) with extremely severe scoliosis and atrophied leftside.

After three courses of intensive Schroth treatment, each of 3 months duration(center).

After four in-patient courses (right).Treatment in this extraordinary case was significantly longer than usual.

SCOLIOTIC IMBALANCES AND ROTATIONS

For at least fifty years, clinical studies of scoliosis frequently have reportedparaspinal muscle imbalances of strength, diameter, length, fiber type, orelectromyographic activity. They support the Schroth thesis that scoliosisalways involves asymmetrical muscle groups in the back and elsewhere,which in normal bodies are more evenly symmetrical.

In a typical scoliotic configuration, depicted atright, back musculature pulls lower ribs so thatthe lumbar (abdominal) region rotates laterally,downwards, and backwards.

To maintain the torso's upright and forwardorientation, the thoracic (chest) region musttwist back in the opposite directions, and thecervical (neck) area responds with a thirdabnormal twist. Other imbalances are oftenpresent in the lower extremities. The resultingeccentric loads predispose the scoliosis to avicious cycle of progression with unpredictableoutcome.

In its effort to reverse the scoliotic spinalrotations, the Schroth method of scoliosisexercise therapy addresses all three planes --sagittal, frontal, and transverse. This meansthat correction needs to occur not only fromside to side and front to back, but alsolongitudinally: that is, the spine which hasshortened because of rotation must also belengthened. Hence the Schroth method'sdesignation as "three-dimensional" therapy.

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three-curve configuration.

Adult and post-operativepatients will benefit from the

Schroth method, as willchildren and adolescents.

The easiest cases to treat aremild ones in early stages, yeteven very severe cases (over

100 degrees) can achievesome success.

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CORRECTING SCOLIOTIC POSTURE

The Schroth method places great emphasis on conscious correction ofposture during routine daily living, not only during strenuous exerciseperiods. Each patient learns about her or his own body and what she/he hasto do in order to reverse and control abnormal posture so that improvedposture becomes a habit.

The photos above show a female patient with a very severe case (over100-degree curve). On the left she slumps, not thinking about her posture,and unconsciously allows the three torso sections to become exaggeratedand clearly recognizable. Her thoracic section is clearly twisted against thelumbar region, and her shoulder-cervical region compensates with a counter-rotation against the thoracic section. This reversion to faulty, scoliotic postureis akin to performing a wrong exercise. Left uncorrected, the posture couldallow the deformity to progress further.

In the photo on the right, she corrects her posture as far as possible. Sheuses the chair's back rest to widen her concave left side and fills it out furtherwith the Schroth rotational breathing technique. By correcting her posture,she not only improves her appearance, becoming somewhat straighter andtaller, but also increases her lung capacity and reduces the tendency forposture-related pain to develop.

SCHROTH TREATMENT GOALS

The scoliosis exercises are designed to reverse all of the abnormal curvatureswith a variety of means, based upon the therapist's analysis of a patient'smuscle imbalances. Christa Lehnert-Schroth writes in her book:

Scoliosis is characterised by a more or less pronounced changein the balance of forces, starting already in the feet, legs andhips, with inequality of muscles in terms of length and size. Thegreater the deviations from the midline, the longer the affectedmuscles become and the more volume is lost. They becomeflaccid and finally inactive. They lose their supportive function.Shape changes are only possible because the muscles permitthem to happen. They become longer or shorter depending on

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the direction in which the trunk is moved and rotated. In otherwords, deviations of the trunk to the side or backwards can onlydevelop if the corresponding supportive muscles give way andbecome elongated.

Therefore, treatment must improve posture so that the bodycan regain its original vertical axis. This can only happen bydeveloping and training the corresponding muscle groupsresponsible for upright posture. To restore muscular balance,those muscles that have grown longer must be shortened andthose that have become shorter must be lengthened. In orderfor these to be able to hold the spinal column and ribcage intheir normal vertical position again, they need to bestrengthened -- and on both sides. It is absolutely essential thatthe inactive, shortened muscles perform strength work in thelengthened state. [pp. 42-43]

The basis of correction is a properly aligned pelvis. A scoliotic pelvis is oftennot only shifted laterally but also tilted and rotated. Therefore the spine,which attaches to the pelvis via the sacrum, has a misaligned foundation. TheSchroth method first addresses the patient's pelvis position with fivecorrections.

The treatment can then focus on spinal elongation, and on derotation bymeans of individually designed scoliosis exercises.

One of the primary Schroth tools is strengthening exercises tailored to theindividual patient. Another, the unique rotational breathing technique,focuses on vertebral derotation using the ribs as levers, as well as onincreasing the patient's vital capacity. Click the page Exercises for Scoliosis tosee a few sample Schroth method scoliosis exercises designed for a specificpatient.

HISTORY OF THE SCHROTH METHODAND THE AUTHOR

In 1921 Katharina Schroth's success with her own scoliosis attractedattention, and she soon began to help others. By the late 1930s the methodshe had developed empirically was recognized as by far the bestconservative scoliosis treatment system in Germany.

As a girl, Christa Lehnert-Schroth began helping her mother Katharina withscoliosis patients. Eventually she was formally educated as a physicaltherapist and joined her mother's practice. In 1961 they moved their clinic toBad Sobernheim (Rhineland), where the author was director until 1995. TheAsklepios Katharina-Schroth Klinik now accommodates 200 inpatientsconcurrently and has a waiting list for its treatment courses.

Christa Lehnert-Schroth treated or supervised more than 10,000 scoliosispatients in her 50-year career. Though retired from active practice, sheretains an active interest in helping patients and therapists worldwide.

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