We specialize in providing The Schroth Method which is a highly personalized therapy approach for scoliosis patients in the NYC Area.
This is part 2 of the article by Dr. Jon Diamond, PT, DPT. Click here to read part 1.
Almost all of our patients benefit in some way or another from this unique treatment approach.
In our last article, we provided a brief anatomy lesson to describe how scoliosis changes the spine and how it may affect each of the many patients who have it. We also talked about when treatment is usually needed for these patients, mentioned some of the treatment options that may be used, and explained why we consider the Schroth Method to be the most effective approach for bringing about lasting improvements. Here, we dive a bit deeper into the Schroth Method, highlighting what sets it apart from other interventions and why so many patients experience positive results.
Understanding why the 3-D nature of scoliosis is so important
If you recall from last time, when looked at from behind, an X-ray of a normal spine will look straight, while the same scan of a scoliosis patient will show a curve that looks like the letter “C” or “S.” While this is helpful for showing what scoliosis does to the spine, it fails to provide the entire picture.
These “C” or “S” curves of the spine give a rough idea of what scoliosis looks like, but they only represent a two-dimensional (2-D) understanding of the condition. In scoliosis, the spine certainly does bend to one side or the other—or both—but there is also some amount of rotation and extension of the spine in other directions as well. Therefore, it may be easier to visualize the spine of a patient with scoliosis more like a spiral or a coil than a curve, since it more accurately depicts the spine’s abnormal shape when seen in 3-D. This spiral shape is a consequence of multiple factors related to the way in which bones grow, which is why it tends to first appear when adolescents undergo growth spurts during puberty.
This clearly shows why scoliosis is a 3-D spinal deformity, which means it requires a 3-D treatment approach that considers these factors. Simply addressing the “S” or “C” curve alone and straightening the spine from one angle will not be sufficient because it would only be working in 2-D. Instead, a comprehensive approach is needed to align the 3-D geometry of the spine, and the Schroth Method works to achieve this by addressing the control of posture in every direction.
The ultimate goal of the Schroth Method is balance and harmony
In essence, the Schroth Method is a physical therapy-based set of exercises and techniques that are designed to elongate the trunk and correct any imbalances of the spine. Its ultimate goal is not necessarily to completely eradicate scoliosis, which may not be possible in every patient. Instead, the Schroth Method aims to achieve balance of the trunk, so that the head, torso, and legs rest in harmony with one another. This is primarily accomplished by developing the inner muscles of the ribcage in order to change the shape of the upper trunk and correct any spinal abnormalities that may be present.
The Schroth Method is also a highly personalized therapy that can be used on nearly any patient with scoliosis, and while it’s most commonly performed on children and adolescents, it can be effective for individuals of any age. Physical therapists trained in the Schroth Method—like our very own Jon Diamond, DPT—work closely and intensely with each patient, coaching and training them with various tools to help them visualize their corrections, so they can make the changes needed and continue to practice them at home as well.
The specific exercises prescribed will vary based on each patient’s age, medical history, and the severity of their scoliosis, but most Schroth Method exercise programs will follow two primary phases:
1) Positioning: the primary focus of this phase is to properly position the body to overcome the deformities of scoliosis
- Your physical therapist will show you how to align your posture from the bottom up, starting with the correct placement of your feet when standing
- Next up is the pelvis, where the therapist will show you how to set your hips and adjust the way in which you bear your bodyweight
- From there, you’ll work on aligning your ribcage over your pelvis, and then finally focus on positioning your head over your ribs
- This phase of treatment may also include equipment like a ladder wall for lengthening the spine, as well as straps or other props to assist in positioning your torso
2) Activation: the primary focus of this phase is to activate the corrections that were just acquired with positioning
- Your therapist will encourage and teach you how to actively elongate and expand your body by stretching it upwards and lengthening areas that need to be longer
- After making some progress with lengthening, you may also work on addressing the abnormal rotation of the spine, which shapes the ribs and leads to relatively flat areas behind and in front of it
- Breathing techniques are also very important at this phase, and there will be an emphasis on breathing into areas of the body that are more concave (shaped inward) to help them expand and de-rotate the spine; in exhaling, you will be activating muscles that help to stabilize the spine while also training other muscles that help control the convex areas (shaped outward)
To give you a better idea of exactly what a Schroth Method exercise program will look like, here are a few examples of the types of exercises that may be used:
- Rotational angular breathing technique: helps to push the ribs outward from the inside like an expanding air cushion, which achieves firmness and solidity for the sections above them
- Semi-hanging exercise: uses gravity to stretch out the spine and relieve pressure on vertebral joints; at the same time, the patient will apply the rotational breathing technique to flatten the prominent areas of their back and activate their muscles when exhaling to train their body to remember the corrected position
- Prone on stool exercise: this exercise is performed with the patient laying on their stomach facing towards the floor and requires equipment like tubes, stools, belts, straps, beanbags, and wedges; it has the potential to correct both thoracic and lumbar curves
- Thoracic spine correction exercises: addresses curvature of the thoracic spine (upper back) by correcting and aligning the ribcage, shoulders, and neck
- For more examples of Schroth Method exercises, click here
Looking for a Practitioner Experienced in the Schroth Method NYC?
After a scoliosis diagnosis is made, the doctor may classify it based on its severity. This is determined by the extent of the spinal curve and the angle of the rotation, as follows:
- Mild scoliosis: less than 20° of rotation
- Moderate scoliosis: between 20-50° of rotation
- Severe scoliosis: more than 50° of rotation
In children and adolescents, treatment will be decided according to the severity of their condition. If the scoliosis is mild, the Schroth Method alone may be sufficient to prevent further progression of the curve, because their spines are still relatively flexible. But patients with moderate scoliosis and an angle greater than 20° are more vulnerable to further progression of the curve, and in these cases, a Rigo-Cheneau brace may also be recommended in addition to the Schroth Method.
Wearing a brace won’t completely cure scoliosis or reverse the curve, but it’s considered another treatment that slows the progression of the curve. Most braces are made of plastic and are contoured to closely fit the body. This means that the brace is almost invisible under clothes and fits easily under the arms, ribs, back, and hips. The patient’s physician will give the brace prescription, but the more often it’s worn, the more effective it will be.
If a brace is prescribed, an NYC Schroth Method practitioner will be able to adapt the exercises used accordingly, so that they work with the 3-D shape of the brace to address the patient’s curvature. Combined, these interventions will give the child an even stronger chance of halting scoliosis from advancing and functioning better in the process.
The Schroth Method can also be used on adults with scoliosis, but the approach will be slightly different than what is used in younger patients. The adult spine is fully developed and therefore stiffer than it is in growing bodies, which means that the goals of treatment shift more towards controlling posture and how the patient moves in their daily activities.
Treating adults is also more complex because many of these individuals may have degenerative changes in their spine as well, which essentially means wear and tear spine that’s part of the normal aging process. If an adult has a degenerative condition like a herniated disc and scoliosis, then treatment will be modified in order to prevent the patient from experiencing additional pain. But even though the adult spine is more rigid, the Schroth Method is still often beneficial, as it helps patients build awareness of their posture, improves their breathing, and helps them understand how to position themselves in a way that promotes balance of the trunk.
Finally, for some patients with scoliosis that is too severe to be corrected by bracing and exercises, surgery may be recommended. As with other treatments, surgery is intended to reduce the severity of scoliosis and prevent it from getting worse. The most common surgical procedure used in these cases is called spinal fusion, which connects two or more vertebrae together so they can’t move independently. If a patient decides to undergo surgery, however, a major component of their recovery will be rehabilitation, and once again, the Schroth Method can help. In these cases, the treatments used may be slightly different than those prescribed for other patients, but the ultimate goal will remain the same: balance and harmony of the head, torso, and legs.
Our co-owner Jon Diamond is a certified practitioner of the Schroth Method in Midtown
There are only a limited number of physical therapists that are trained in the Schroth Method, but our very own co-owner Jon Diamond, DPT proudly offers this service. Jon is certified in teaching the Schroth Method and has a special interest in treating scoliosis in both nonoperative and postoperative patients. So if you or your child has been diagnosed with scoliosis or you’ve noticed symptoms that may suggest scoliosis is present, we strongly encourage you to contact Dynamic Sports Physical Therapy at 212-317-8303 to schedule an appointment as soon as possible. After completing a thorough evaluation, Jon will determine if scoliosis is present and then develop a personalized Schroth Method treatment program to begin immediately.
Contact us at (212) 317-8303 for more information about our scoliosis treatment in Midtown.