Schroth method

Katharina Schroth (1894–1985) was from Dresden, Germany, and had lived with scoliosis since her teenage years. She found a clue in the observation that directing her breath into the concave side of her chest, as if inflating one side of a balloon, changed the shape of her rib cage. She gradually developed her own way of correcting her breathing and posture in front of a mirror. She began teaching this method to others in 1921.

Her daughter, Christa Lehnert-Schroth, a physical therapist, later systematized the method and added a classification of scoliosis patterns. The approach continued to develop around the Schroth clinic in Bad Sobernheim, Germany. Today, physical therapists in many countries teach these exercises after completing training in the Schroth method.

Scoliosis is a three-dimensional deformity in which the spine not only curves sideways but also rotates at its individual segments. As a result, one side of the back protrudes backward (a rib hump), while the opposite side becomes flattened and sunken. The shoulders and pelvis also tend to sit at different heights.

The Schroth method views the trunk as a structure made up of stacked blocks: the pelvis, lower back, chest, and shoulders. In scoliosis, these blocks are considered to have shifted sideways and rotated out of alignment with one another. The exercises therefore involve identifying each corrective direction for shifting and rotating them back, then practicing bringing the blocks into proper alignment. Depending on the shape of the spinal curves, patterns are classified as having three or four major curves, and the exercises are designed differently for each pattern.

There are four key elements.

• Active self-correction: Rather than being pushed into position by someone's hands, you use your own muscles to lengthen your trunk and bring it into alignment.
• Rotational angular breathing: You direct your breath into the spaces between the ribs on the concave side to expand that side of the rib cage. This is the characteristic breathing technique of the Schroth method.
• Muscular stabilization: In the corrected posture, you exhale and engage your trunk muscles to hold that shape.
• Carrying it into daily life: You apply the alignment you have practiced to your everyday sitting, standing, and walking posture.

First, the therapist examines the shape of your back and your curve pattern, then determines your individual directions of correction. Exercises are performed in front of a full-length mirror so that you can see the height of your shoulders and pelvis and how much your trunk leans, and correct these yourself.

You may lie down with a small cushion or roll beneath the convex or concave side, or sit or stand while holding wall-mounted bars (wall bars) or a long pole to establish a corrective posture. Once in position, you use rotational angular breathing to direct your breath into the concave side, then engage your trunk as you exhale and hold the position for several breaths. Each movement is slow and requires deep concentration, so many people find the exercises demanding enough to make them sweat.

A common arrangement is to see a therapist about once a week to check the movements and practice independently at home every day. In Germany and elsewhere, there are also intensive programs in which participants spend several hours a day learning the method over several weeks.

• Adolescents whose scoliosis was detected during a school screening or an Adams forward bend test
• People who want to exercise while also wearing a brace
• Adults with scoliosis whose upper and lower backs tire easily and feel stiff or achy
• People concerned about uneven shoulder and pelvic heights or a trunk that leans to one side

• Bring a recent spinal X-ray. The therapist needs to know the location and angle of the curves to determine the appropriate directions of correction.
• Home practice is central. You will spend far more time practicing consistently on your own in front of a mirror than meeting with the therapist. Try to build a habit of practicing every day, even briefly.
• Continue wearing your brace and attending regular checkups. The Schroth method is an exercise approach used alongside the management plan set by your doctor.
• For adolescents, it helps if a parent or guardian learns alongside them. Having someone watch from the side to check that the movements are accurate makes practice much easier than doing it alone.

The Schroth method and physiotherapeutic scoliosis-specific exercises (PSSE) are not the same thing. PSSE is the umbrella term for exercises tailored to a person's scoliosis curves, and the Schroth method is the best-known approach within that category. The category also includes approaches that branched off from Schroth or developed separately, such as SEAS in Italy and BSPTS in Barcelona, Spain.

Bracing for scoliosis uses a custom-fitted brace to provide external support to keep curves from increasing. The Schroth method differs in that it is an exercise approach that uses your own muscles and breathing to establish alignment. In practice, the two are often used together, and the guidelines of the international society concerned with conservative scoliosis management (SOSORT) also address exercise as one component of conservative management.

Adolescent idiopathic scoliosis is the name of a condition, whereas the Schroth method is the name of an exercise approach used to manage that condition. Rotational angular breathing is just one component of the Schroth method, so following the breathing technique alone does not mean you are practicing the entire Schroth method.